Legislature(2013 - 2014)CAPITOL 106
04/02/2013 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HJR14 | |
| HB54 | |
| Alaska Children's Services | |
| HB134 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | HJR 14 | TELECONFERENCED | |
| += | HB 54 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 134 | TELECONFERENCED | |
HB 134-MEDICAID PAYMENT FOR MEDISET PRESCRIPTION
4:37:55 PM
CHAIR HIGGINS announced that the final order of business would
be HOUSE BILL NO. 134, "An Act requiring Medicaid payment for
scheduled unit dose prescription drug packaging and dispensing
services for specified recipients." [In front of the committee
was Version 28-LS0303\Y, adopted as the working document on
March 28, 2013.]
REPRESENTATIVE KELLER moved to adopt the proposed committee
substitute (CS) for HB 134, labeled 28-LS0303\R, Mischel, 4/1/13
as the working document.
REPRESENTATIVE PRUITT objected for discussion.
4:38:24 PM
CHARLES GUINCHARD, Staff, Representative Mia Costello, Alaska
State Legislature, explained that the changes for Version R
included:
Section 1 AS 47.01.031(a). This section has been
amended by adding legislative intent language guiding
the department's eligibility regulations for this
program. This language was added to ensure that in
the event that Medicaid services were to expand, the
scope of individuals eligible for this program would
remain the same. This language appears as (1)-(5) in
paragraph (a), page 1, line 12.
MR. GUINCHARD referenced his earlier testimony for the bulleted
list of current regulations, and pointed out that similar
language had been requested for this change. He noted the
second change:
Section 1 AS 47.01.031(c). This section has been
amended by adding language to clarify that non-local
transportation of medication compliance packaging is
by mail or package delivery service.
MR. GUINCHARD explained that this addressed concerns for the
earlier limitation to USPS. He commented on the third change
for Version R:
Section 1 AS 47.01.031(e)(2). The definitions of
"units of use" has replaced the previous definition of
"medication compliance packaging".
MR. GUINCHARD said that the proposed bill had been updated
accordingly to reflect this new definition. He declared that
this concluded the changes for proposed Version R.
4:41:27 PM
REPRESENTATIVE KELLER said that he was "painfully aware of the
rising costs of health care." He declared that he would find it
difficult to vote for any expansion of Medicaid services.
JON SHERWOOD, Medicaid Special Projects, Office of the
Commissioner, Department of Health and Social Services, said
that dispensing fees and mediset fees were already being paid by
Medicaid. He stated that the proposed bill provided a statutory
requirement to continue with this payment, and that the
increased costs had been noted in the fiscal note. He said that
criteria in the proposed legislation defined qualified
providers, which were somewhat different than current
regulation. He declared that it was unclear whether this would
expand the number of qualified providers.
4:43:32 PM
The committee took a brief at-ease.
4:45:23 PM
REPRESENTATIVE KELLER asked if there was intent to hold the
bill.
CHAIR HIGGINS replied that he intended to hold it until Thursday
[April 4].
REPRESENTATIVE KELLER emphasized that he wanted a fiscal note
for the cost increases. He declared that it was necessary to be
cautious of increases because of the rising health care costs.
He asked if there would be a re-evaluated fiscal note.
MR. SHERWOOD said that the changes to Version R would not
significantly alter the fiscal note.
4:46:59 PM
REPRESENTATIVE KELLER asked if the proposed changes would make
it easier for smaller pharmacies to qualify as mediset
pharmacies.
MR. SHERWOOD replied that, currently the requirement was for a
percentage of volume to qualify, and that the current proposed
bill did not require that volume. He shared that he was not
aware if the other requirements were equally limiting.
4:48:10 PM
REPRESENTATIVE KELLER asked for assurance that the fee would
reflect in statute, so that businesses could respond.
MR. SHERWOOD, in response to Chair Higgins, explained that the
fiscal note for $414,000 was for the partial year in 2014, which
was then increased to $1,657,000 for the following fiscal years,
2015-2019. He pointed out that federal funding would pay half.
4:50:03 PM
CHAIR HIGGINS asked to clarify that Version R would not change
the cost estimate.
MR. SHERWOOD said that he would provide any necessary fiscal
note updates on Thursday, April 4.
4:50:44 PM
REPRESENTATIVE KELLER asked if the mediset program would
continue to be paid regardless of passage of the proposed bill,
and he asked to clarify the cost increase.
MR. SHERWOOD explained that the language of the proposed bill
would increase the frequency of the dispensing fee, or an
equivalent increase in the combined dispensing and mediset fee.
4:51:59 PM
REPRESENTATIVE TARR asked if it was possible to address the
proposed amendment.
4:52:42 PM
REPRESENTATIVE PRUITT removed his objection to Version R.
4:52:58 PM
REPRESENTATIVE TARR moved to adopt Amendment 1, labeled 28-
LS0303\Y.1, Mischel, 3/28/13, which read:
Page 2, following line 21:
Insert a new subsection to read:
"(e) The department may apply a volume discount
to a fee established under (b) of this section
(1) if a qualified pharmacy dispenses a
high volume, as defined by the department, of
prescriptions that require medication compliance
packaging for an individual patient; or
(2) based on the total number of
prescriptions requiring medication compliance
packaging annually dispensed by the pharmacy."
Reletter the following subsection accordingly.
REPRESENTATIVE KELLER objected for discussion.
REPRESENTATIVE TARR said that, as cost containment was a
priority for Medicaid programs, she had concerns with the fiscal
note. She reflected that, as the current dispensing fee was
billed per prescription, if a fee cap were placed on the
dispensing fee, then the pharmacist cost would still be covered,
and the fiscal note could be reduced. As discussion with the
sponsor and the department had indicated the difficulty with a
volume limitation or a fee cap, she withdrew proposed Amendment
1.
4:55:07 PM
REPRESENTATIVE TARR asked that Department of Health and Social
Services respond to the difficulty for a fee cap.
MR. SHERWOOD agreed that there had been discussion for a limit
to the fees for multiple prescriptions in the same mediset
package. He said that it was not practical as the prescriptions
were processed one at a time at the point of sale, pointing out
the difficulty for overseeing this. Commenting on proposed
Amendment 1, he opined that it would allow a discount for the
mediset fee for a pharmacy which dispensed a high volume of
medisets. He reported that DHSS had assumed there was this
latitude should the cost survey data support this fee structure.
He stated that it would not be problematic to state this
authority, as well.
4:57:38 PM
CHAIR HIGGINS asked if Representative Tarr still wanted to
withdraw proposed Amendment 1.
REPRESENTATIVE TARR replied that her decision would reflect the
will of the committee. She declared her desire for DHSS to
pursue every opportunity for cost containment, while still
providing medisets. She offered her belief that the pharmacies
would have covered all costs at some point in filling an
individual mediset, and that all prescriptions for that mediset
beyond that were being paid at a much higher profit.
4:59:03 PM
CHAIR HIGGINS asked to clarify whether proposed Amendment 1
would decrease the fiscal note.
MR. SHERWOOD offered his belief that it would not affect the
fiscal note. He declared that DHSS had assumed that the
latitude to lower the dispensing fee for higher volume
dispensing had already existed; therefore, this would not
decrease the fiscal note. He stated that DHSS did not object to
any language that clearly described the DHSS permission to
discount.
5:00:37 PM
REPRESENTATIVE KELLER asked if it was the doctor or the patient
who selected the pharmacy. He opined that a group contracting
with a pharmacy would bring a lower cost than an individual.
MR. SHERWOOD, in response, stated that this was determined by
the Medicaid services as "any willing provider." He detailed
that the qualifications for being a provider and a pharmacy
could result in enrollment as a pharmacy provider. He declared
that the recipient made the decision for pharmacy selection. He
stated that prices were set using national data for the drug
price, and that the department had sent a cost survey to the
participating Medicaid pharmacies to determine the best, most
reasonable way to approximate the dispensing fees. He said that
this data allowed distinctions to be made for volume.
5:03:34 PM
REPRESENTATIVE KELLER requested that Representative Tarr
withdraw the proposed amendment.
REPRESENTATIVE TARR withdrew proposed Amendment 1, stating that
she had primarily wanted to have the conversation. She declared
that, as it was a complex issue, she would keep reviewing
alternatives.
5:04:12 PM
MR. SHERWOOD clarified that the fiscal note reflected $657,000
for an anticipated expansion of mediset service into Fairbanks,
as determined by the bill sponsor. He declared that, although
it was unclear whether that expansion would happen, it would
serve as a proxy for that service.
5:05:38 PM
CHAIR HIGGINS said that HB 134 would be held over.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HJR14 Sponsor Statement.pdf |
HHSS 4/2/2013 3:00:00 PM |
HJR 14 |
| HJR 14 Proposed Amendment Ver U.1.pdf |
HHSS 4/2/2013 3:00:00 PM |
HJR 14 |
| HJR14.pdf |
HHSS 4/2/2013 3:00:00 PM |
HJR 14 |
| HJR14 Summary.pdf |
HHSS 4/2/2013 3:00:00 PM |
HJR 14 |
| HJR14 Resolution Sources.pdf |
HHSS 4/2/2013 3:00:00 PM |
HJR 14 |
| HJR14 Supporting Documents - ADN Article.pdf |
HHSS 4/2/2013 3:00:00 PM |
HJR 14 |
| HJR14 Supporting Documents - Alaska Dispatch Article.pdf |
HHSS 4/2/2013 3:00:00 PM |
HJR 14 |
| HJR Supporting Documents - NFIB.pdf |
HHSS 4/2/2013 3:00:00 PM |
HJR 14 |
| ACS Capsis.pdf |
HHSS 4/2/2013 3:00:00 PM |
ACS Presentation |
| ACS distance based delivery system.pdf |
HHSS 4/2/2013 3:00:00 PM |
ACS Presentation |
| Overview -20130402.pdf |
HHSS 4/2/2013 3:00:00 PM |
ACS Presentation |
| ANTHC ACS Letter 1.pdf |
HHSS 4/2/2013 3:00:00 PM |
ACS Presentation |
| HB054 Research - House HSS information from 4-2-13.pdf |
HHSS 4/2/2013 3:00:00 PM |
HB 54 |