Legislature(2015 - 2016)CAPITOL 106
03/31/2015 06:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB148 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 148 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 31, 2015
6:03 p.m.
MEMBERS PRESENT
Representative Paul Seaton, Chair
Representative Liz Vazquez, Vice Chair
Representative Neal Foster
Representative Louise Stutes
Representative David Talerico
Representative Geran Tarr
Representative Adam Wool
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 148
"An Act relating to medical assistance reform measures; relating
to eligibility for medical assistance coverage; relating to
medical assistance cost containment measures by the Department
of Health and Social Services; and providing for an effective
date."
- MOVED CSHB 148(HSS) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 148
SHORT TITLE: MEDICAL ASSISTANCE COVERAGE; REFORM
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
03/18/15 (H) READ THE FIRST TIME - REFERRALS
03/18/15 (H) HSS, FIN
03/24/15 (H) HSS AT 3:00 PM CAPITOL 106
03/24/15 (H) Heard & Held
03/24/15 (H) MINUTE(HSS)
03/26/15 (H) HSS AT 3:00 PM CAPITOL 106
03/26/15 (H) Heard & Held
03/26/15 (H) MINUTE(HSS)
03/28/15 (H) HSS AT 3:00 PM CAPITOL 106
03/28/15 (H) Heard & Held
03/28/15 (H) MINUTE(HSS)
03/31/15 (H) HSS AT 3:00 PM CAPITOL 106
03/31/15 (H) HSS AT 6:00 PM CAPITOL 106
WITNESS REGISTER
JOSHUA BANKS, Staff
Representative Dave Talerico
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented Amendment 15 to HB 148, on behalf
of Representative Talerico.
JON SHERWOOD, Deputy Commissioner
Medicaid and Health Care Policy
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
148.
VALERIE DAVIDSON, Commissioner Designee
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Responded to questions during the hearing
on HB 148.
STACIE KRALY, Chief Assistant Attorney General
Human Services Section
Civil Division
Department of Law (DOL)
Juneau, Alaska
POSITION STATEMENT: Offered information during the hearing on
HB 148.
SHELLY VENDETTI-VUCKOVICH
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 148.
MARY TONSMIERE
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 148.
ILONA FARR, MD
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 148.
ACTION NARRATIVE
6:03:08 PM
CHAIR PAUL SEATON called the House Health and Social Services
Standing Committee meeting back to order at 6:03 p.m.
Representatives Stutes, Talerico, Wool, Tarr, Vazquez, and
Seaton were present at the call to order. Representative Foster
arrived as the meeting was in progress.
HB 148-MEDICAL ASSISTANCE COVERAGE; REFORM
6:03:14 PM
CHAIR SEATON announced that the only order of business would be
HOUSE BILL NO. 148, "An Act relating to medical assistance
reform measures; relating to eligibility for medical assistance
coverage; relating to medical assistance cost containment
measures by the Department of Health and Social Services; and
providing for an effective date."
6:03:30 PM
CHAIR SEATON announced that the committee would complete its
consideration of the remaining amendments in the committee
packet before continuing on to public testimony.
REPRESENTATIVE TALERICO moved to adopt Amendment 15, labeled
29GH1055\A.37, Glover, 3/30/15. [Amendment 15 is provided at
the end of the minutes on HB 148.]
CHAIR SEATON objected for discussion.
6:04:36 PM
JOSHUA BANKS, Staff, Representative Dave Talerico, Alaska State
Legislature, presented Amendment 15 on behalf of Representative
Talerico. He said the amendment would create a July 1, 2018,
sunset for each section of HB 148, by "creating new sections in
the bill to restore the original language in statute that the
bill changes." He said Amendment 15 would provide a way to
"test the waters of Medicaid expansion" and make sure the
federal government upholds its promise of 90 percent coverage.
He indicated that under Amendment 15, the State of Alaska could
withdraw for various reasons, for example if the federal
government dropped coverage below 90 percent or if an increased
number of applicants ended up costing the state more than it
anticipated.
6:06:32 PM
REPRESENTATIVE TALERICO said Amendment 15 was a concept for
consideration, and he said he would like to hear the Department
of Health and Social Services' opinion of it.
CHAIR SEATON noted that the committee had held an earlier
meeting that day.
CHAIR SEATON said there were an anticipated 20,000 to 30,000 new
enrollees, for which there would need to be additional services.
He expressed fear that even with federal funding at 95 percent,
it would be difficult to get private businesses to invest when
they know "a bill would terminate in three years."
6:08:41 PM
JON SHERWOOD, Deputy Commissioner, Medicaid and Health Care
Policy, Office of the Commissioner, Department of Health and
Social Services, stated that the department did not think a
sunset provision on Medicaid expansion was necessary. He said
some of the impacts of "this" were more in line with reform than
expansion. He indicated that the department views some issues,
such as clarification of income levels and deprivation
requirements, as "clean-up," and it did not see a need for a
2018 sunset, as proposed under Amendment 15.
6:10:14 PM
CHAIR SEATON noted that reports would be made after the 2018
sunset date, while some of the reforms would not have "kicked
in" or have good analysis before that date.
6:10:35 PM
REPRESENTATIVE TALERICO said Mr. Sherwood's response had
provided clarification.
REPRESENTATIVE TALERICO withdrew his motion to adopt Amendment
15.
6:12:12 PM
REPRESENTATIVE VAZQUEZ moved to adopt Amendment 16, labeled 29-
GH1055\A.40, Glover, 3/30/15, which read as follows [original
punctuation provided]:
Page 7, following line 15:
Insert a new bill section to read:
"* Sec. 9. AS 47.07.030 is amended by adding a new
subsection to read:
(g) The department shall annually prepare a
report, separately describing state costs for optional
and mandatory services provided under this section. On
or before March 1 of each year, the department shall
deliver the report to the senate secretary and the
clerk of the house of representatives and notify the
legislature that the report is available."
Renumber the following bill sections accordingly.
Page 9, line 12:
Delete "sec. 10"
Insert "sec. 11"
Page 9, line 17:
Delete "10"
Insert "11"
Page 9, line 23:
Delete "Sections 13 and 14"
Insert "Sections 14 and 15"
Page 9, line 24:
Delete "by sec. 16"
Insert "in sec. 17"
CHAIR SEATON objected for discussion.
6:12:31 PM
REPRESENTATIVE VAZQUEZ spoke to Amendment 16. She said there
were nine mandatory services and 27 optional services under the
Medicaid program. She opined that it would be helpful to have
the information required under Amendment 16 as the State of
Alaska faced upcoming fiscal challenges. She noted that the 27
optional services were not mandated by federal law, and other
states did not have all of them. She listed some examples of
optional services, including: optician, optometrist,
chiropractic, occupational therapy, vision, and transportation.
CHAIR SEATON questioned how the state would be served by an
annual report on "state costs for optional and mandatory
services". He said optional services were sometimes "a
replacement for mandatory services, which cost the state less."
He said, "It's not like optional means they're not needed or
they are insignificant to the Medicaid beneficiary." He asked
if the department had a position [on Amendment 16].
6:14:47 PM
MR. SHERWOOD answered no. He said, "This is information we
reproduce relatively routinely."
CHAIR SEATON asked if the department did each service separately
or if all mandatory services were "lumped as one." He said that
was the way he was reading Amendment 16. He clarified he wanted
to know how the department reported the services that were
provided under both the optional and mandatory categories.
MR. SHERWOOD responded that typically the department created a
list of all services and divided it into adult and child
services. He said essentially all child services were
mandatory. He said the department showed, service by service,
which was mandatory, which was optional, and how much was spent
on each. In response to a follow-up question, he said the
department typically did not post the report on its web site,
but did get requests for it and could produce the report
readily. He said he did not know the exact date by which the
department produced the report, but said it tried to complete it
at least three to four months after the close of the fiscal
year, so that the department would know it had "good, solid
numbers." Nevertheless, he said he did not think the department
would have difficulty producing a fiscal year report for one
year by March 1 of the following year.
6:17:13 PM
REPRESENTATIVE WOOL indicated that he viewed [Amendment 16] as
being in the category of report reform, and he was hesitant to
add another report "just for the sake of reports." He stated
his preference to "get good reports, at a good time that are
beneficial to everybody."
CHAIR SEATON asked Representative Vazquez whether the March 1
date in Amendment 16 was critical or whether the report could be
required to coincide with the department's annual report.
REPRESENTATIVE VAZQUEZ asked what the date was for the annual
report.
MR. SHERWOOD said he did not know the date on which the
department was required to report to the legislature, but said
he could check.
CHAIR SEATON ventured that "if it turns out on consideration
that it would work into a different date," he was sure the
committee would be [amenable] to "make that date change in the
amendment."
6:19:06 PM
CHAIR SEATON withdrew his objection to the motion to adopt
Amendment 16. He asked if there was any further objection.
REPRESENTATIVE VAZQUEZ stated that she would like [the report
required under Amendment 16] to be included in the department's
annual report.
6:19:37 PM
CHAIR SEATON moved to adopt Conceptual Amendment 1 to Amendment
16, to change the date from [on or before] March 1 of each year
and require the report to be included with the department's
annual report. He asked whether there was any objection to
Conceptual Amendment 1 to Amendment 16.
6:20:25 PM
REPRESENTATIVE WOOL asked for clarification that the proposed
Conceptual Amendment 1 to Amendment 16 would not require an
additional report, but incorporate the information required
under Amendment 16 within the department's annual report.
CHAIR SEATON responded that was correct. He offered his
understanding that "we" had made a change so that the reports
could be delivered to the legislature electronically. He
recalled that Mr. Sherwood had said the services were itemized,
and he posited that that would help in determining over time
which services may be increasing or decreasing.
REPRESENTATIVE WOOL offered his understanding that the
department was already providing what it would be required to
provide under Amendment 16; therefore, he opined that the
proposed amendment would be redundant.
CHAIR SEATON responded that according to the previous statement
by Mr. Sherwood, the department could "pull this" if it received
a request, but "it is not included as a category in the annual
report"; therefore, he concurred with Representative Vazquez
that [Amendment 16] would require additional information that
could be valuable to and easily accessed by all legislators,
rather than to just a specific legislator that made a request to
the department.
6:22:22 PM
REPRESENTATIVE SEATON announced that there being no objection,
Conceptual Amendment 1 to Amendment 16 was adopted.
CHAIR SEATON removed his objection to Amendment 16, as amended.
There being no further objection, Amendment 16, as amended, was
adopted.
6:23:07 PM
REPRESENTATIVE VAZQUEZ moved to adopt Amendment 17, labeled 29-
GH1055\A.42, Mischel/Glover, 3/30/15, which read as follows
[original punctuation provided]:
Page 8, lines 4 - 6:
Delete all material.
Renumber the following paragraphs accordingly.
CHAIR SEATON objected for discussion.
REPRESENTATIVE VAZQUEZ spoke to Amendment 17. She said it would
remove the [section] 1915(i) option. She stated that there was
not sufficient vetting of this option. She said if the reforms
were implementing, improvement was seen, and all issues related
to the audit report were addressed, then she could see the
possibility of the department coming back before the
legislature, with specific information regarding benefits and
costs, to consider the option.
6:25:18 PM
CHAIR SEATON spoke to his objection. He said current community
services that qualify were funded through general relief, which
was 100 percent state dollars, and "this is a switch, if we get
the waiver, to a 50-50 match of federal funds." He opined that
applying for a waiver that would reduce costs by 50 percent was
a good decision, in terms of the state's fiscal balance. He
said "the K waiver" increased the federal match from 50 to 56
percent. He observed that Amendment 17 seemed to say that
instead of taking a higher federal match, the State of Alaska
would pay more state dollars, which was going in the opposite
direction of "what we thought of as Medicaid reform."
6:26:34 PM
REPRESENTATIVE VAZQUEZ said Amendment 17 applied only to
1915(i). She asked Mr. Sherwood what the federal match was for
that option.
MR. SHERWOOD answered that in most cases the anticipated federal
match would be the federal default rate of 50 percent. However,
he noted that if an individual was eligible through the
Children's Health Insurance Program (CHIP), the rate would be 65
percent and if services were provided through a tribal facility
to an Indian Health Services (IHS) beneficiary, it would be 100
percent. He confirmed Chair Seaton's remark that "these
services are now being paid for through other state-funded
programs," including general relief, assisted living, senior and
disabilities grant programs, and behavioral health grant
programs.
6:28:07 PM
REPRESENTATIVE TARR stated her objection to Amendment 17. She
said, "This has been identified as one of the reform measures
that could really bring about significant savings for the state,
and I don't want the department to delay in getting that
application in and moving forward with that effort."
6:28:32 PM
REPRESENTATIVE VAZQUEZ asked what empirical evidence the
department had to show that the aforementioned option would save
the state money.
6:28:46 PM
VALERIE DAVIDSON, Commissioner Designee, Department of Health
and Social Services (DHSS), responded that the 1915(i) option
would allow the department to receive a federal match;
currently, because of the way the program was structured, it
received no federal money for these services. She said this
option had been available since 2010, but unfortunately the
department, through prior administration, had not taken the
opportunity to save the 50 percent in state general fund
dollars. She said the department thought that considering it
was now 2015, the state should take advantage of this
opportunity. In response to a follow-up question from
Representative Vazquez, she stated, "We have no prospective data
on a guaranteed way to be able to save the state general fund
savings of 50 percent, just as we have no guaranteed way of
demonstrating that we wouldn't be able to do that."
6:30:35 PM
CHAIR SEATON drew attention to reference material in the
committee packet, from the Corporation for Supportive Housing
(CSH), which contained a summary of improved 1915(i) Medicaid
home- and community-based state options from September 2010.
6:31:12 PM
REPRESENTATIVE VAZQUEZ asked under what circumstances people
were currently qualifying to receive behavioral health program
benefits from the general fund.
6:31:30 PM
MR. SHERWOOD answered that a number of grant programs provided
behavioral health services to individuals whose behavioral
health needs were not currently covered by Medicaid or who were
not currently eligible for Medicaid. He said the home and
community-based waiver program served individuals with
disabilities, when those individuals "meet an institutional
level of care for very similar services." He explained that
under law, Medicaid did not cover institutional care for
individuals between the ages of 21 and 64 with mental disease;
therefore, some of the services the department could provide to
people with other disabilities through its waiver program were
not available to the behavioral health institution.
6:32:58 PM
A roll call vote was taken. Representative Vazquez voted in
favor of Amendment 17. Representatives Stutes, Talerico, Wool,
Tarr, Foster, and Seaton voted against it. Therefore, Amendment
17 failed by a vote of 1-6.
6:33:55 PM
REPRESENTATIVE VAZQUEZ moved to adopt Amendment 18, labeled 29-
GH1055\A.43, Mischel/Glover, 3/30/15, which read as follows
[original punctuation provided]:
Page 8, lines 7 - 9:
Delete all material.
Renumber the following paragraphs accordingly.
CHAIR SEATON objected for discussion.
REPRESENTATIVE VAZQUEZ spoke to Amendment 18, which she said
focused on the [section] 1915(k) option. She said that there
appeared to be no evidence showing that the option would
actually save the state money. She continued as follows:
And should the department clean up ... the audit
findings and want to then expand additional services
because this option basically is like the 1915(c),
which are currently in existence, except that this
provides even more services, so ... what I would
expect is that it will actually cost the state more
money getting into this option.
REPRESENTATIVE VAZQUEZ indicated that it was unclear whether,
once [1915(k)] was provided, it could, under the Affordable Care
Act, be withdrawn. She said the same comment could be made for
the other options.
6:35:20 PM
CHAIR SEATON asked the department's position on Amendment 18.
6:35:29 PM
COMMISSIONER DAVIDSON answered that the department's position on
Amendment 18 was similar to that on Amendment 17, which was that
[1915(k)] was an opportunity for the state to enhance the
federal match from 50 percent to 56 percent. She said the
legislature had made the department aware that any opportunity
to save the state's general fund dollars by increasing the
federal match dollars was an opportunity that should not be
declined. She said these services were already being provided
today, but they would be refinanced for an enhanced federal
match. Regarding the ability to "opt out," she said the
department had not been made aware of any federal law that would
prohibit the state from doing so. She said the department had
been working with the Centers for Medicare & Medicaid Services
(CMS), who had made it clear that Alaska had the right to drop
its participation if the match dropped below the 90 percent
mark, for example.
6:37:18 PM
REPRESENTATIVE VAZQUEZ said she believed the letter to which she
said Ms. Davidson made reference did not specify which program;
therefore, she said she would not assume it referred to this
option.
6:37:46 PM
COMMISSIONER DAVIDSON said she did not mean to imply that the
letter stated the department was not allowed to change its mind
regarding 1915(k) or (i); it was specific to Medicaid expansion.
She offered her understanding that a copy of the letter
previously had been provided to the committee. She said
Congress could change a law; however, in order to make the
change, Congress would have to pass new legislation to limit
these kinds of options, and the legislation would have to have
the consent of the President. She said she thought this was
unlikely to happen, and she was not worried about it.
6:38:47 PM
CHAIR SEATON maintained his objection.
REPRESENTATIVE VAZQUEZ asked if Commissioner Davidson had a
legal opinion showing that the state could withdraw from the
aforementioned options.
COMMISSIONER DAVIDSON answered no.
6:39:20 PM
A roll call vote was taken. Representative Vazquez voted in
favor of Amendment 18. Representatives Foster, Stutes,
Talerico, Wool, Tarr, and Seaton voted against it. Therefore,
Amendment 18 failed by a vote of 1-6.
6:40:28 PM
The committee took a brief at-ease.
6:41:48 PM
CHAIR SEATON moved to adopt Amendment 19, labeled 29-
GH1055\A.60, Glover, 3/30/15, which read as follows [original
punctuation provided]:
Page 9, following line 3:
Insert a new bill section to read:
"* Sec. 13. The uncodified law of the State of
Alaska is amended by adding a new section to read:
MEDICAID WAIVERS; REPORT TO LEGISLATURE. On or
before February 1, 2019, the Department of Health and
Social Services shall complete a report informing the
legislature of the results of the applications for
waivers and options under AS 47.07.036(d)(1) - (3),
enacted by sec. 10 of this Act, and shall deliver the
report to the senate secretary and chief clerk of the
house of representatives and notify the legislature
that the report is available. The report must include
(1) information explaining whether the
department's applications for a section 1115 waiver
under 42 U.S.C. 1315(a), a section 1915(i) option
under 42 U.S.C. 1396n, and a section 1915(k) option
under 42 U.S.C. 1396n were approved by the United
States Department of Health and Human Services;
(2) a description of cost savings to the
state resulting from the programs implemented under
the waivers, including
(A) the extent to which the programs
implemented under the section 1115 waiver under 42
U.S.C. 1315(a) achieved the savings estimated by the
department;
(B) the extent to which the programs
implemented under the section 1915(i) and (k) options
under 42 U.S.C. 1396n achieved the savings estimated
by the department."
Renumber the following bill sections accordingly.
Page 9, line 23:
Delete "Sections 13 and 14"
Insert "Sections 14 and 15"
Page 9, line 24:
Delete "by sec. 16"
Insert "in sec. 17"
REPRESENTATIVE STUTES objected for discussion.
CHAIR SEATON spoke to Amendment 19, and he read from the
amendment language. He said the intent was to ensure the
legislature was informed of the progress, and he stated his
belief that the 2019 date was necessary, because it would take
until the 2018 fiscal year to fully analyze the effects of these
waivers.
6:43:45 PM
COMMISSIONER DAVIDSON, in response to Chair Seaton, said, "This
is something we were planning to report on anyway, so we would
have no objection to this reporting."
REPRESENTATIVE STUTES removed her objection to the motion to
adopt Amendment 19. There being no further objection, Amendment
19 was adopted.
6:44:23 PM
The committee took an at-ease from 6:44 p.m. to 6:47 p.m.
6:47:10 PM
REPRESENTATIVE VAZQUEZ moved to adopt Amendment 20, labeled 29-
GH1055\A.26, Strasbaugh/Glover, 3/28/15. [Amendment 20 is
provided at the end of the minutes on HB 148.]
CHAIR SEATON objected for discussion.
REPRESENTATIVE VAZQUEZ spoke to Amendment 20. She said it
concerned verification of eligibility for public assistance
programs administered by the department. It would require
verification of income, assets, and identity, as well as
resolution of discrepancy. Further, the proposed amendment
would require the department to follow up on fraud,
misrepresentation, and inadequate documentation in other state
agencies.
CHAIR SEATON noted that HB 148 addressed Medicaid and Medicaid
expansion, and public assistance programs, although administered
by the department, were really not the main topic of the
proposed legislation.
REPRESENTATIVE VAZQUEZ said the term "public assistance" would
be used in a broad sense and replace "medical assistance." She
said the thrust of Amendment 20 was within the realm of HB 148,
because the proposed legislation had been presented as a package
including reform and expansion, and [Amendment 20] would address
critical components of what a reform system should look like.
She reiterated those issues, which the proposed amendment would
target.
CHAIR SEATON clarified his prior comment by specifying that
[Amendment 20] would modify AS 47.05, and Medicaid and Medicaid
expansion was under AS 47.07.
CHAIR SEATON maintained his objection.
REPRESENTATIVE WOOL [called] for the question.
A roll call vote was taken. Representatives Vazquez and
Talerico voted in favor of Amendment 20. Representatives Tarr,
Foster, Stutes, Wool, and Seaton voted against it. Therefore,
Amendment 20 failed by a vote of 2-5.
6:50:49 PM
REPRESENTATIVE VAZQUEZ moved to adopt Amendment 21, labeled 29-
GH1055\A.57, Mischel/Glover, 3/30/15, which read as follows
[original punctuation provided]:
Page 7, following line 15:
Insert a new bill section to read:
"* Sec. 9. AS 47.07.020 is amended by adding a new
subsection to read:
(o) Notwithstanding the eligibility provisions
under (a) and (b) of this section, a provider may not
receive reimbursement for services provided to a
recipient of medical assistance under this section
unless the provider requires the recipient first to
enroll in the Medicare program under 42 U.S.C. 1395
and any other federally funded program providing
medical assistance to the extent that the person is
eligible to receive benefits and services under the
program. The department shall adopt regulations
establishing civil penalties for individuals who
knowingly seek medical assistance payments in
violation of this subsection. The department shall
prepare an annual report that describes the types and
amounts of penalties assessed under this subsection.
By January 1 of each year, the department shall
deliver the report to the senate secretary and the
chief clerk of the house of representatives and notify
the legislature that the report is available."
Renumber the following bill sections accordingly.
Page 9, line 12:
Delete "sec. 10"
Insert "sec. 11"
Page 9, line 17:
Delete "10"
Insert "11"
Page 9, line 23:
Delete "Sections 13 and 14"
Insert "Sections 14 and 15"
Page 9, line 24:
Delete "by sec. 16"
Insert "in sec. 17"
CHAIR SEATON objected for discussion.
REPRESENTATIVE VAZQUEZ spoke to Amendment 21. She said it would
require providers to pursue other federally funded programs
before billing Medicaid, which aligned with "the idea and
requirement that Medicaid is the payor of last resort."
Further, the proposed amendment would require the department to
regulate an imposed civil penalty and to provide a report to the
legislature regarding this effort.
CHAIR SEATON asked for the opinion of the department.
6:51:43 PM
COMMISSIONER DAVIDSON observed that Amendment 21 was "remarkably
familiar to" Amendment 12. She said as with Amendment 12, the
department already had "the authority to be able to do this."
She said Medicaid as payor of last resort is outlined in federal
law. Regarding the civil penalty, she said the department does
not think fines are necessary when it already had the ability to
terminate people from the program when they did not meet the
requirements.
REPRESENTATIVE VAZQUEZ asked, "Do you have a regulation in place
requiring this of providers?"
MR. SHERWOOD answered no. He said currently the state assumed
the responsibility for ensuring people "cooperate with any and
all third-party resources to the providers," and that was not a
burden the department would want to shift from the state.
REPRESENTATIVE WOOL [called] for the question.
6:53:27 PM
A roll call vote was taken. Representatives Vazquez and
Talerico voted in favor of Amendment 21. Representatives Wool,
Tarr, Foster, Stutes, and Seaton voted against it. Therefore,
Amendment 21 failed by a vote of 2-5.
6:54:02 PM
CHAIR SEATON moved to adopt Amendment 22, labeled 29-
GH1055\A.58, Glover, 3/30/15, which read as follows [original
punctuation provided]:
Page 8, following line 16:
Insert new subsections to read:
"(e) Notwithstanding (a) - (c) of this section
and in addition to the projects and services described
under (d) of this section, the department shall apply
for a section 1115 waiver under 42 U.S.C. 1315(a) to
establish one or more demonstration projects focused
on innovative payment models for one or more groups of
medical assistance recipients in one or more specific
geographic areas. The demonstration project or
projects may include
(1) managed care organizations as described
under 42 U.S.C. 1396u-2;
(2) community care organizations;
(3) patient-centered medical homes as
described under 42 U.S.C. 256a-1; or
(4) other innovative payment models that
ensure access to health care without reducing the
quality of care.
(f) The department shall design and implement at
least one demonstration project under (e) of this
section that is a coordinated care demonstration
project using a global payment fee structure. The
demonstration project must include a managed care
system that operates within a fixed budget to reduce
medical cost inflation, improves the quality of health
care for recipients, and results in a healthier
population. The department shall design the managed
care system to reduce the growth in medical assistance
expenditures with a goal of reducing the per capita
growth rate for medical assistance expenditures by at
least two percentage points. The managed care system
must implement alternative payment methodologies and
create a network of patient-centered primary care
homes, and will be measured based on quality and
performance outcomes. The department shall prepare a
report regarding the progress of this demonstration
project and shall, on or before February 1, 2019,
deliver the report to the senate secretary and the
chief clerk of the house of representatives and notify
the legislature that the report is available."
Reletter the following subsection accordingly.
REPRESENTATIVE STUTES objected for discussion.
CHAIR SEATON spoke to Amendment 22. He stated that innovative
payment models were a great opportunity for reform. He said,
"The department has placed this in their broader intent
language, but this language is more specific." He said there
was a hospital in Alaska already pursuing this global budget
option, but it needed coordination with the state. He said the
state could save money with this reform, and under Amendment 22,
there would be a report to the legislature at the earliest
possible date that it would be possible to show the progress
made.
6:56:17 PM
MS DAVIDSON, in response to Chair Seaton, stated that the
department had no objection to Amendment 22.
6:56:35 PM
REPRESENTATIVE VAZQUEZ questioned why there would be a four-year
wait for a report on the progress of the project. She observed
that under Amendment 22, the report would be due by February 1,
2019, and she said there would be no opportunity to monitor
progression.
CHAIR SEATON explained the reason for the February 1, 2019, date
was in order to allow for a full fiscal year. He said it would
probably take that much time to integrate the full payment model
into an entire community organization for a geographic region.
6:57:42 PM
COMMISSIONER DAVIDSON concurred with Chair Seaton's explanation.
6:57:52 PM
REPRESENTATIVE STUTES removed her objection to the motion to
adopt Amendment 22.
REPRESENTATIVE VAZQUEZ asked what other states may have
"implemented this particular waiver."
MR. SHERWOOD answered that [Amendment 22] described a project
similar to one currently in Oregon. He said there may be other
states, as well, but the project in Oregon was one with which he
is familiar. In response to a follow-up question from
Representative Vazquez, he said he did not remember the specific
timing of Oregon's project, but offered his understanding that
they phased it in throughout various regions in the state. He
said he thought Oregon had been successful in "at least reducing
the growth in cost," but said he did not have specific
information with him.
CHAIR SEATON pointed out that Amendment 22 was not brought forth
by the administration, but was one brought by the legislature to
ensure there was a reform model exercised in Alaska in a region
that would like to participate. He indicated there would be
some risk involved, because the model would put money aside for
all the participants, and the hospitals would be required to
maintain the health of the communities they served, but if the
participants needed additional services, it would cost them
extra, and they would not get additional reimbursement. He
said, "If we want to have demonstrations, if we want to have
reform, we're going to have to figure out how to do it." He
concluded that Amendment 22 was a legislative reform model.
REPRESENTATIVE VAZQUEZ said it troubled her that there was no
information related to Oregon's result, and, under Amendment 22,
Alaska would not have any reports for four years. She opined
that the state had a fiduciary duty, in light of its fiscal
crisis, to monitor how and when it entered into programs with
financial obligations. She added, "We're not even sure we can
withdraw from this project." She indicated that [adoption of
Amendment 22] would be fiscally irresponsible.
7:01:24 PM
REPRESENTATIVE WOOL stated his understanding that Amendment 22
would bring about a pilot project related to managed care, which
could be tested in a small geographical area. He stated his
belief that there was currently "some kind of managed care
thing" in all but ten states, and perhaps a demonstration
project in Alaska - one of the ten exception states - would
allow the state time to see if it would work. He said there
were many other reforms and projects going on that had many
report dates, and he did not see the state as doing this without
keen oversight. He stated his support of Amendment 22.
REPRESENTATIVE STUTES restated that she removed her objection.
7:02:43 PM
REPRESENTATIVE VAZQUEZ stated that conceptually Amendment 22
might be a good idea, but posited that waiting four years for a
report was ludicrous.
CHAIR SEATON announced that there being no further objection,
Amendment 22 was adopted.
7:03:11 PM
REPRESENTATIVE TALERICO moved to adopt Amendment 23, labeled 29-
GH1055\A.50, Glover, 3/30/15, which read as follows [original
punctuation provided]:
Page 1, line 1, following "Act":
Insert "relating to certificates of need;"
Page 2, following line 13:
Insert a new bill section to read:
"* Sec. 2. AS 18.07 is amended by adding a new
section to read:
Sec. 18.07.103. Exemption. Nothing in this
chapter applies to an existing or proposed health care
facility that is located or will be located in a
municipality with a population of more than 5,000
according to the most recent United States census
before initiation of the construction or alteration
of, or addition to, the health care facility."
Renumber the following bill sections accordingly.
Page 9, following line 8:
Insert a new bill section to read:
"* Sec. 15. The uncodified law of the State of
Alaska is amended by adding a new section to read:
APPLICABILITY. AS 18.07.103, enacted by sec. 2 of
this Act, applies to the construction or alteration
of, or addition to, a health care facility begun on or
after the effective date of sec. 2 of this Act. For a
health care facility that is located in a municipality
with a population of more than 5,000 according to the
most recent United States census and that has an
existing certificate of need issued by the department
under AS 18.07.031 or modified under AS 18.07.061
before the effective date of sec. 2 of this Act, the
department may not take any action to enforce or
modify the terms of the certificate."
Renumber the following bill sections accordingly.
Page 9, line 12:
Delete "sec. 10"
Insert "sec. 11"
Page 9, line 17:
Delete "10"
Insert "11"
Page 9, line 23:
Delete "Sections 13 and 14"
Insert "Sections 14 and 16"
Page 9, line 24:
Delete "by sec. 16"
Insert "in sec. 18"
CHAIR SEATON objected for discussion.
REPRESENTATIVE TALERICO explained that Amendment 23 was
generated by constituents from a neighboring district, who did
not have representation on the House Health and Social Services
Standing Committee. He said after speaking with Chair Seaton,
he realized that there was probably a more appropriate venue for
the issue that could be brought up in the future, outside of HB
148.
REPRESENTATIVE TALERICO withdrew his motion to adopt Amendment
23.
7:04:12 PM
REPRESENTATIVE TALERICO moved to adopt Amendment 24, labeled 29-
GH1055\A.51, Glover, 3/30/15, which read as follows [original
punctuation provided]:
Page 1, line 1, following "Act":
Insert "relating to certificates of need;"
Page 2, following line 13:
Insert a new bill section to read:
"* Sec. 2. AS 18.07.031(e) is amended to read:
(e) In (a) of this section, "expenditure"
includes the purchase of [PROPERTY OCCUPIED BY OR THE]
equipment required for the health care facility [AND
THE NET PRESENT VALUE OF A LEASE FOR SPACE OCCUPIED BY
OR THE EQUIPMENT REQUIRED FOR THE HEALTH CARE
FACILITY]; "expenditure" does not include costs
associated with routine maintenance and replacement of
equipment at an existing health care facility, the
purchase of property occupied by the facility, or the
net present value of a lease for space occupied by or
equipment required for the facility."
Renumber the following bill sections accordingly.
Page 9, following line 8:
Insert a new bill section to read:
"* Sec. 15. The uncodified law of the State of
Alaska is amended by adding a new section to read:
APPLICABILITY. Section 2 of this Act applies to
the construction or alteration of or an addition to a
health care facility initiated on or after the
effective date of sec. 2 of this Act and to
applications pending under AS 18.07.031."
Renumber the following bill sections accordingly.
Page 9, line 12:
Delete "sec. 10"
Insert "sec. 11"
Page 9, line 17:
Delete "10"
Insert "11"
Page 9, line 23:
Delete "Sections 13 and 14"
Insert "Sections 14 and 16"
Page 9, line 24:
Delete "by sec. 16"
Insert "in sec. 18"
CHAIR SEATON objected for discussion.
REPRESENTATIVE TALERICO stated that as with Amendment 23, there
would be a more appropriate way to address the issue in
Amendment 24 through future legislation. Nevertheless, he
stated that a lease was currently qualified as a capitalized
investment, but he thought a lease without an option to buy was
an expense under General Accounting Principles.
7:05:21 PM
REPRESENTATIVE TALERICO withdrew his motion to adopt Amendment
24.
CHAIR SEATON explained for the record that there had been a
number of amendments addressing large and complex certificate of
need issues, and Representative Talerico was choosing to take
them up in another piece of legislation in the future, because
to bring them up within HB 148 would muddy the waters.
7:06:46 PM
REPRESENTATIVE TALERICO moved to adopt Amendment 25, labeled 29-
GH1055\A.53, Shutts/Glover, 3/30/15, which read as follows
[original punctuation provided]:
Page 9, lines 9 - 17:
Delete all material.
Renumber the following bill sections accordingly.
Page 9, line 23:
Delete "Sections 13 and 14 of this Act take"
Insert "Section 13 of this Act takes"
Page 9, line 24:
Delete "by sec. 16"
Insert "in sec. 15"
7:06:57 PM
CHAIR SEATON objected for discussion.
REPRESENTATIVE TALERICO spoke to Amendment 25. He explained
that under Amendment 25, the department would have the ability
to create emergency regulations to implement the proposed
legislation. He stated concern that if the legislature was
going to create statutory provisions under HB 148, there may be
emergency regulations "that don't appear to have sideboards."
He said those currently in the department were trusted, but
there could be rapid changes within state government.
CHAIR SEATON noted that the language on page 9, lines 9-17, of
HB 148, which would be deleted under Amendment 25, addressed
emergency regulations. Section 14, he said, was uncodified law;
therefore, it was generally considered as short-term duration.
He said, "This is in uncodified law. I'm not sure quite why and
how that effects ... this."
7:09:41 PM
The committee took a brief at-ease.
7:10:24 PM
STACIE KRALY, Chief Assistant Attorney General - Statewide
Section Supervisor, Human Services Section, Civil Division
(Juneau), Department of Law (DOL), addressed points that had
been raised by Representative Talerico. First, she said
emergency regulatory authority was generally drafted as
uncodified law, which explained why it was done that way in HB
148. Second, she said the emergency regulation authority in HB
148 applied to only two sections: the intent language and a
section relating to reforms. It was designed specifically to
allow the department to have "a jumpstart" on getting some of
the reforms in progress. She said the regulatory process to
"get a project through" could take between 6-24 months;
therefore, an emergency regulation would give the option to
achieve a reform quickly. She suggested to Representative
Talerico that one way to address his concern about sideboards
would be to sunset the emergency regulation provision, which
would create a date in the future when reauthorization from the
legislature would be required, in the event that all the desired
savings had not been achieved. She said the intent was never to
do everything through emergency regulation, but rather to have
the opportunity to get done what needed to be done quickly.
7:12:24 PM
REPRESENTATIVE TALERICO said he thought it was the
responsibility of the legislature to "put the appropriate
information out there" and for the department to be able to
utilize it. He indicated he would like to know whether the
department felt it was "going out on a limb."
7:14:07 PM
MR. SHERWOOD offered his understanding that emergency
regulations took effect immediately and lasted 120 days. The
department noticed the regulations, took public comment, decided
whether it needed to make amendments to those regulations, then
adopted the regulation by the end of the 120-day period. He
said he thought a lot of the public protections that the
regulatory process was intended to provide were there in the
emergency regulation process, which, allowed immediate
implementation and possible instant savings, which, in turn
allowed the department from having to cut deeper. He echoed Ms.
Kraly's comment that the department never expected it would use
emergency regulations for every provision. He said
[Representative Talerico's] point was well taken that the
department would have to be judicious in its use [of emergency
regulations].
7:16:04 PM
REPRESENTATIVE SEATON asked what an appropriate date for such a
sunset might be.
MR. SHERWOOD suggested June 30, 2017.
COMMISSIONER DAVIDSON, in response to Chair Seaton, stated her
belief that two years would be long enough.
7:17:30 PM
REPRESENTATIVE TALERICO, in response to Chair Seaton, indicated
that he would be comfortable with a compromise of having a
sunset in two years.
7:17:56 PM
REPRESENTATIVE VAZQUEZ expressed her discomfort with this. She
said, "I'm very curious, because this will also apply to the tax
on providers, which is within Section 2, so that's going to be
on fast track." She said the tax would apply to all 19 provider
types, whether or not they accepted Medicaid. She referenced
Section 1 of HB 148, and offered her understanding that the
department already practiced "utilization control," and
questioned why the department would "need emergency regulations
for that."
7:19:11 PM
MR. SHERWOOD responded that although the department had cost-
sharing and utilization control provisions, in order to change
its provisions, it would need to change its regulations. He
clarified that HB 148 would not give the department taxing
authority; before it could ever levy a provider tax, the
department would have to request legislation that gave it that
authority.
REPRESENTATIVE VAZQUEZ offered her understanding that before
offering an option or waiver, the department would have to
obtain permission from CMS, which would take months; therefore,
she questioned [how the department would benefit from] emergency
regulations.
MR. SHERWOOD explained that a state plan amendment could become
effective as early as the first day of the quarter in which it
is submitted. He said the department often consulted with CMS
prior to submitting state plan amendments, so it would have a
good idea whether or not there would a significant issue
regarding the plan's approval.
7:21:10 PM
REPRESENTATIVE WOOL asked whether the department had emergency
regulation authority in the past.
MR. SHERWOOD answered that every department had the ability to
issue emergency regulations, if the regulations met statutory
criteria. He stated, "This language essentially provides a
legislative finding that these circumstances meet that criteria,
which would probably give us some degree of additional
protection were somebody challenge our ability to do emergency
regulations."
REPRESENTATIVE WOOL offered his understanding that the
department was tasked with initiating reforms and had used
emergency regulations to do so in the past for the sake of
efficiency. He asked, "This is pretty standard stuff, all in
all, correct?"
MR. SHERWOOD said he would not characterize giving the
department the specific authority to do emergency regulations as
standard. He added that it was not highly unusual, but it was
probably not common practice.
7:23:14 PM
REPRESENTATIVE TALERICO asked what the required number of days
was for posting notice [for public comment].
7:23:24 PM
MR. SHERWOOD answered 30 days was the minimum. He said an
emergency regulation would be effective immediately, and he
offered his understanding that public comment would be taken
immediately.
7:23:47 PM
CHAIR SEATON moved to adopt Conceptual Amendment 1 to Amendment
25, to add a sunset date of June 30, 2017, to Section 14.
REPRESENTATIVE STUTES objected. She indicated that she planned
to support Amendment 25, as it was; therefore, she would not
support Conceptual Amendment 1.
7:24:39 PM
A roll call vote was taken. Representatives Talerico, Wool,
Tarr, Foster, Vazquez, and Seaton voted in favor of Conceptual
Amendment 1 to Amendment 25. Representative Stutes voted
against it. Therefore, Conceptual Amendment 1 to Amendment 25
was adopted by a vote of 6-1.
7:25:15 PM
The committee took an at-ease from 7:25 p.m. to 7:27 p.m.
7:27:02 PM
There was discussion as to the effect of Conceptual Amendment 1
to Amendment 25 and the need for Conceptual Amendment 2 to
Amendment 25.
7:28:03 PM
The committee took a brief at-ease.
7:29:42 PM
REPRESENTATIVE TALERICO moved to adopt Conceptual Amendment 2 to
Amendment 25, which would delete the language embodied in
Amendment 25, as amended, such that Section 14 would remain in
HB 148.
REPRESENTATIVE STUTES objected.
7:30:22 PM
CHAIR SEATON explained that with the adoption of Conceptual
Amendment 2 to Amendment 25, Section 14 would remain in the bill
and due to the adoption of Conceptual Amendment 1 to Amendment
25, Section 14 would include a sunset date of June 30, 2017.
A roll call vote was taken. Representatives Talerico, Wool,
Tarr, Foster, and Seaton voted in favor of Conceptual Amendment
2 to Amendment 25, as amended. Representatives Stutes and
Vazquez voted against it. Therefore, Conceptual Amendment 2 to
Amendment 25, as amended, was adopted by a vote of 5-2.
CHAIR SEATON restated the effect of the adopted Amendment 25, as
amended.
7:32:30 PM
REPRESENTATIVE VAZQUEZ asked whether there was a legal opinion
that set forth the parameters around which the department could
utilize emergency regulations, which she characterized as
unusual and extraordinary.
7:33:07 PM
MS. KRALY responded that the standard for emergency regulations
was already established through [the Administrative Procedure
Act]. She said because of the current circumstances of the
state regarding its fiscal crisis and the need for Medicaid
reform, the legislature made the finding that the needs of the
agency were such that they track the language already set forth
in statute. She stated her belief, based on the information
that would be provided in the notices and process going forward
through emergency regulations, that the standards had been
established. She said she could not guarantee there would not
be a legal challenge to an emergency regulation that may be
adopted; however, she said she felt comfortable and confident
that the provisions were legally sufficient, based on the
current information showing the urgent need for Medicaid reform.
She stated that the health, safety, and welfare of individuals
would be at risk if the state did not achieve reform.
REPRESENTATIVE VAZQUEZ asked whether that would include
addressing audit findings, "especially the lack of criminal
background checks on providers."
MS. KRALY said she had not read the legislative audit findings;
therefore, she had no comment.
7:34:53 PM
CHAIR SEATON asked whether there was any objection to the
adoption of Amendment 25, as amended.
REPRESENTATIVE STUTES objected to the motion to adopt Amendment
25, as amended.
7:35:24 PM
A roll call vote was taken. Representatives Talerico, Wool,
Tarr, Foster, and Seaton voted in favor of Amendment 25, as
amended. Representatives Vazquez and Stutes voted against it.
Therefore, Amendment 25, as amended, was adopted by a vote of 5-
2.
7:35:59 PM
REPRESENTATIVE VAZQUEZ stated that she would not offer Amendment
26, labeled 29-GH1055\A.45, Glover, 3/30/15, [included in the
committee packet].
7:37:04 PM
CHAIR SEATON moved to adopt Amendment 27, labeled 29-
GH1055\A.63, Glover, 3/31/15, which read as follows [original
punctuation provided]:
Page 9, following line 3:
Insert a new bill section to read:
"* Sec. 13. The uncodified law of the State of
Alaska is amended by adding a new section to read:
DEMONSTRATION PROJECT: REDUCING PRE-TERM BIRTHS.
The Department of Health and Social Services shall
design and implement a demonstration project for the
purpose of reducing pre-term birth rates in the state
from the current rate of 10.3 percent. The
demonstration project shall provide for the voluntary
enrollment of approximately 500 recipients who are
eligible for medical assistance under
AS 47.07.020(b)(14). The Department of Health and
Social Services shall offer pregnancy counselling,
nutritional counselling, and, as necessary, vitamin D
supplementation to maintain levels of 40 ng/ml vitamin
D during pregnancy for participants in the
demonstration project. The demonstration project may
be modeled after the Protect Our Children NOW! project
implemented as a cooperative project of the South
Carolina Department of Health and Human Services and
private health organizations. The goal of the
demonstration project is to achieve a 50 percent
reduction in pre-term births in the state, consistent
with the results of the following published studies:
Wagner, C. L., et al., "A Randomized Trial of Vitamin
D Supplementation in Two Community Health Center
Networks in South Carolina," American Journal of
Obstetrics and Gynecology 208 (February 2013); Bodnar,
L. M., et al., "Maternal 25-Hydroxyvitamin D and
Preterm Birth in Twin Gestations," Obstetrics and
Gynecology 122 (July 2013)."
Renumber the following bill sections accordingly.
Page 9, line 23:
Delete "Sections 13 and 14"
Insert "Sections 14 and 15"
Page 9, line 24:
Delete "by sec. 16"
Insert "in sec. 17"
REPRESENTATIVE STUTES objected.
CHAIR SEATON initiated a summary of the language of Amendment
27.
7:37:42 PM
The committee took an at-ease from 7:37 p.m. to 7:39 p.m.
7:39:06 PM
CHAIR SEATON withdrew his motion to adopt Amendment 27.
7:39:29 PM
CHAIR SEATON moved to adopt Amendment 28, labeled 29-
GH1055\A.64, Glover, 3/31/15, which read as follows [original
punctuation provided]:
Page 9, following line 3:
Insert a new bill section to read:
"* Sec. 13. The uncodified law of the State of
Alaska is amended by adding a new section to read:
DEMONSTRATION PROJECT: REDUCING PRE-TERM BIRTHS.
Before January 1, 2018, the Department of Health and
Social Services shall investigate and design a
demonstration project for the purpose of reducing pre-
term birth rates in the state from the current rate of
10.3 percent. The demonstration project shall provide
for the voluntary enrollment of approximately 500
recipients who are eligible for medical assistance
under AS 47.07.020(b)(14). The Department of Health
and Social Services shall offer pregnancy counselling,
nutritional counselling, and, as necessary, vitamin D
supplementation to maintain levels of 40 ng/ml vitamin
D during pregnancy for participants in the
demonstration project. The demonstration project may
be modeled after the Protect Our Children NOW! project
implemented as a cooperative project of the South
Carolina Department of Health and Human Services and
private health organizations. The goal of the
demonstration project is to achieve a reduction in
pre-term births in the state, consistent with the
results of the following published studies: Wagner, C.
L., et al., "A Randomized Trial of Vitamin D
Supplementation in Two Community Health Center
Networks in South Carolina," American Journal of
Obstetrics and Gynecology 208 (February 2013); Bodnar,
L. M., et al., "Maternal 25-Hydroxyvitamin D and
Preterm Birth in Twin Gestations," Obstetrics and
Gynecology 122 (July 2013)."
Renumber the following bill sections accordingly.
Page 9, line 23:
Delete "Sections 13 and 14"
Insert "Sections 14 and 15"
Page 9, line 24:
Delete "by sec. 16"
Insert "in sec. 17"
REPRESENTATIVE STUTES objected for discussion.
CHAIR SEATON paraphrased Amendment 28.
7:42:14 PM
CHAIR SEATON moved to adopt Conceptual Amendment 1 to Amendment
28, following "investigate", to delete "and", and insert "the",
and following "design" insert "of". He explained that with the
change the language would read: "shall investigate the design
of a demonstration project". There being no objection,
Conceptual Amendment 1 to Amendment 28 was adopted.
7:43:44 PM
COMMISSIONER DAVIDSON, in response to Chair Seaton, said the
department had no objection to Amendment 28, [as amended].
7:43:54 PM
REPRESENTATIVE WOOL asked for clarification regarding the length
of the [demonstration project] proposed under Amendment 28, as
amended.
CHAIR SEATON indicated that if the demonstration project results
were similar to those of South Carolina, then Alaska's pre-term
birth rates could be reduced by half; however, he said a
reduction of just 25 percent would still be a huge cost savings
for Alaska's medical system. He said Amendment 28, as amended,
would give the department the authority to discover whether
there was a project that it could undertake. He opined that
this authority should be given to the department, because
preterm births should be addressed. He said the studies listed
within the proposed amendment were the only ones he had seen
that directly related to high success of reducing preterm
births, which was why he offered it. He said approximately
5,000 children were born under the state's Denali Kid Care
Program; therefore, it would be great to find success through a
demonstration project.
7:46:17 PM
REPRESENTATIVE TARR said she had worked in health research for a
long time and knew about the restrictions and requirements. She
said she thought there would be a great opportunity through the
demonstration projects to involve students throughout the
University of Alaska system.
REPRESENTATIVE STUTES removed her objection to the motion to
adopt Amendment 28 [as amended]. There being no further
objection, Amendment 28, as amended, was adopted.
7:47:43 PM
REPRESENTATIVE TALERICO, in response to Chair Seaton, stated
that due to the lack of support, he would not be offering
Amendment 29, labeled 29-GH1055\A.52, Strasbaugh, 3/31/15,
[Included in the committee packet].
7:48:17 PM
CHAIR SEATON, after ascertaining that there were no further
amendments to consider, returned to public testimony on HB 148.
7:49:04 PM
SHELLY VENDETTI-VUCKOVICH said HB 148 was a critical piece of
legislation for "all of those close to me." She said Alaskans
should be able to utilize a program funded by their federal
taxes. She relayed there were those who believed that Medicaid
should not be used as a safety net, but rather as a motivator to
beneficiaries to improve their circumstances; however, she
pointed out one group that would be helped by Medicaid expansion
was adults with a mental illness diagnosis, whose coverage ended
at the age of 21 years, and many of them would not receive
ongoing care. She said many in this group self-medicated
through alcohol and substance abuse, could not hold a job, and
would be in more difficult circumstances without access to
mental health medication. Many were in jail or homeless. She
stated that Alaskans were already paying the cost to incarcerate
many of the people in this group. For many, it was difficult to
continue with an education, get a better job, and improve their
circumstances when they did not have access to their mental
health medications just to function. Ms. Vendetti-Vuckovich
related her personal experience was that members of this group
did not want to go to jail and did want treatment, but were
discouraged by the paperwork, delays, and waitlists for
appointments, and just gave up. Medication and some treatment
was available to those in jail, but aftercare was short-lived.
Some in this group received services paid for by state general
funds, and expansion would augment state programs with matching
funds. She described the delays and problems related to
obtaining medical care through community clinics, even though
state grants paid for these services.
MS. VENDETTI-VUCKOVICH told the story of a family that suffered
terribly because psychiatric treatment was not available. She
opined that Medicaid reform should include suggestions from
those receiving assistance to identify inefficiencies, and she
offered to participate in finding remedies and cost-saving
procedures, because administration procedures needed to be
examined to ensure accuracy of reporting and tracking. She
expressed her belief that reform and expansion must happen
concurrently in a professional manner, without rancor, because
the issue was about people, their health, and their lives.
7:55:39 PM
MARY TONSMIERE informed the committee she had been a nurse for
47 years, 37 in Alaska. She said she established the first
Hospice in the state in 1980, and in 1994 established the first
school-based health center in Alaska. She said her experience
in providing services to the working poor and the underserved
had shown her that it is appreciated and important. She opined
it was appalling that the proposed legislation was being held
up. She further related her experience in listening to budget
hearings as one safety net after another was taken from citizens
of the state. She said the state had an opportunity to provide
health care that was vital to life, liberty, and the pursuit of
happiness, and she could not understand why this was not going
forward.
7:57:42 PM
ILONA FARR, MD, asked why Medicaid expansion would be done under
emergency regulations before public comment. She stated that a
6 percent tax would be devastating for sole practitioners and
people in small businesses, and she related that every
physician, dentist, pharmacist, and nurse she had talked to did
not know [about the tax]. Dr. Farr said HB 148 proposed to
authorize a provider tax up to the maximum extent allowed by
federal law, and she was unaware of any other tax the state had
put in place without consulting the people it was going to
impact. She expressed concern that no studies had been done as
to the impact such a tax would have, and she cautioned that such
a tax would drive out the very providers the state would need,
in order to provide care to these Medicaid patients. She
related that 38 percent of physicians nationwide had opted out
of Medicaid, 70 percent in California, and in 2014, Alaska went
from 4,500 providers to 3,500. More providers would be lost as
more tried to stay solvent, she maintained.
DR. FARR stated that under HB 148, people would be underpaid,
over-regulated, and over-audited, as well as taxed for serving
[Medicaid recipients]. She said no analysis had been included
about how state and federal taxes paid by Alaskans might
increase. She said currently $80 million was being paid so
these Medicaid patients could get their permanent fund dividend
(PFD), but she had not seen how much more the state was going to
pay for this expansion to allow them to keep their PFDs or
whether these patients would "have to interrupt their cancer
treatment for the month of ... October to be able to get their
cancer treatment." Additionally, for Medicaid patients at the
end of life, the state could come against their estates to try
to recoup some of the cost. Dr. Farr asked whether that would
happen with this expansion population if they died or got
cancer. She expressed her concern that there was no
verification of the assets of people, whether for the exchanges
or Medicaid. She said she was afraid HB 148 would cause the
collapse of the private sector of medicine, especially those in
small businesses, and the state would end up with a worse health
care system and people unable to get the care they deserved.
She urged that parts of the bill be reconsidered.
8:01:03 PM
CHAIR SEATON closed public testimony after ascertaining no one
further wished to tesify.
CHAIR SEATON said the Department of Health and Social Services
had the ability to design a proposal for a provider tax, but the
legislature would have to enact that tax, and the governor would
have to sign it, which would provide lots of opportunity for
discussion and public input.
CHAIR SEATON opened committee discussion on HB 148, as amended.
8:02:14 PM
REPRESENTATIVE VAZQUEZ said the proposed legislation went beyond
the Medicaid expansion often spoken about by the press. It
would cover the population, generally speaking, aged 19-64,
able-bodied, working age, no children, and at 138 percent income
of federal poverty level. She said presently, [the state's]
Medicaid covered the most vulnerable: the disabled, blind,
elderly, and low-income families with children. [The state]
also offered a very generous Medicaid package of mandatory
Medicaid services, plus 27 optional services that other states
did not necessarily provide. Representative Vazquez warned that
expanding Medicaid without looking at the numbers could
jeopardize the state's fiscal situation, especially in today's
situation. She opined that without sufficient vetting, the bill
was fiscally irresponsible, and she expressed shame that the
committee had not received expert data to consider. She
characterized the legislation as an octopus, and said it was
unknown whether these options would really save the state money,
because there were no empirical studies. She referred to the
aforementioned experimental waiver done by the State of Oregon,
and remarked that the committee had not seen the results,
because the department had not obtained them. She said at least
one study in Oregon showed that emergency room visits shot up by
41 percent after Medicaid expansion, yet the driving argument
being heard by the committee was that [HB 148] would lower
emergency room and other health costs.
8:04:41 PM
REPRESENTATIVE VAZQUEZ said the same Oregon study of 20,000
patients found that expanding Medicaid did almost nothing to
control high blood pressure, high blood sugar, and other
conditions. The study found an improvement in depression, but
she questioned whether that much needed to be spent to treat
depression. This was the tip of the iceberg, she opined,
because it was not known with confidence how many individuals
would be enrolled. The Lewin Group report, commissioned and
paid for by the Department of Health and Social Services,
predicts slightly over 40,000 enrollees, whereas a report from
Evergreen Economics put the number of enrollees at 26,000 -
about a 52 percent discrepancy. She remarked that the committee
had yet to hear any facts to show what the real enrollment
number would be. She said in seven states where expansion had
occurred under the Affordable Care Act, the average
underestimated enrollment was a whopping 88 percent; therefore,
she reiterated that the enrollment number was unknown, but could
be 26,000 to 40,000 or even double that.
8:07:03 PM
REPRESENTATIVE VAZQUEZ noted HB 148 proposed a provider tax.
She said she was troubled by the depth and the breadth of the
possibility of this tax. She said there were 19 provider types
upon which the state could impose taxes, whether or not they
accepted Medicaid, and that money would be used to offset
Medicaid costs. The department had enough containment efforts
that should be undertaken in this 25-page report, she argued,
and then the department should come back to [the committee] and
ask for what it wanted to do in order to expand the Medicaid
program. Citing from an audit report issued last week, she said
Recommendation 2014-07 stated there should be background checks
for criminal activity; that in fiscal year 2014, 15 of 30 tested
Medicaid provider certification files were missing complete
criminal history background checks, and each provider
certification file may include multiple employees requiring
background checks. She said the audit also stated that testing
of the 15 provider files disclosed that: for 4 providers, no
background clearances were located for 12 employees, and 5
employees were barred, meaning there was something in their past
criminal history that they were not allowed to participate as a
provider in the Medicaid program; for 2 additional providers, 3
employees were also barred; and for 2 providers, 6 employees
were in provisional status for a period of time ranging from 5-8
months.
8:09:42 PM
REPRESENTATIVE VAZQUEZ continued citing from the audit report,
saying it concluded that there was material weakness in internal
control, which could result in material misstatement to the
financial statements. Before the state proceeded to expand the
programs, she argued, the department should be tasked with
seriously addressing these deficiencies. She noted that seven
of the audit findings were a repeat of audit findings from the
previous year, so those previous findings had not been
corrected. She said studies in Oregon indicated that expanding
Medicaid may not lead to results the state may need. She
maintained that expanding Medicaid could result in unintended
consequences, such as squeezing out seniors in Medicare because
Medicaid provided better benefits and paid better than Medicare,
and she said Alaska's seniors already had a hard time finding
providers. She further warned that benefits received by
Alaska's existing disabled blind populations could potentially
be squeezed out, because - as the fiscal situation tightens -
cuts may need to be done and [the legislature] would be more
tempted to cut back on the population that was reimbursed by 50
percent versus the new expansion population that was reimbursed
at least 90 percent. Also, she said the federal government
could change the matching formula, which had been done in the
past; there was no guarantee what the federal government may
contribute after 2020. Representative Vazquez concluded that
the state might be committing itself to programs it could not
get out of and might be unable to afford in the future.
8:12:25 PM
REPRESENTATIVE TALERICO stated he had no intention of trying to
stop the bill from going to its next committee of referral, but
said he would be unable to recommend it to the next committee,
because several amendments were not included that he felt should
have been. He offered his appreciation for the spirit of
cooperation of the committee members and of the department.
8:13:26 PM
CHAIR SEATON expressed appreciation for the committee's hard
work on HB 148. He said there were a number of studies before
the committee, including ones from The Lewin Group and Evergreen
Economics; there was an investigation of what would happen. He
stated that approximately $6 million in savings was identified
with the 20,000 estimated participants and, should 41,000 people
sign up the identified savings was over $4 million. He added
that should 60,000 participants somehow appeared, it would still
be a savings of $2 million. He relayed that at the low end, the
fiscal impact to the State of Alaska was a positive economic
impact of $145 million that would be spread throughout the
state. A number of reforms were included in the initial bill,
and this committee added other reforms, targets, and timetables,
which would ensure that reform actually took place.
8:15:27 PM
REPRESENTATIVE TARR urged that any frustrations with how the
Medicaid program was previously administered not be directed at
current employees who are new. She expressed her trust that the
current employees would respond to the statements made in the
audit and look for opportunities to improve. She said there
would be opportunities for input on the provider tax. She
stated that currently, Alaska was the only state not doing a
provider tax; therefore, it would not come as a surprise to some
of the providers that that conversation might happen. She
stated disagreement that her actions in the future would be to
squeeze out other individuals from this important social safety
net program, including seniors. She also said she disagreed
that the state would be committing itself to programs it could
not get out of or could not afford, saying this had been
substantiated by a letter from "the secretary, that we do have a
process of getting out of this." Responding to the statement
that the state could not afford what was being done here, she
emphasized that the state could not afford to do nothing. She
said the responsibility was on legislators, and there had been
opportunity to obtain information from the department.
REPRESENTATIVE TARR indicated there was overwhelming public
support [for HB 148], and legislators worked for the people.
She added that of the individuals who weighed in on this matter,
90 percent were in support. She remarked upon the great
opportunity for very detailed discussions that had been afforded
the committee, and she noted that on several occasions, the
department had responded to lengthy questions the committee had
posed. She said she was sorry Representative Vazquez had missed
the committee meeting that covered all 16 fiscal notes, which
was the opportunity to delve into the financial information.
She stated that she was not ashamed of the work the committee
had done and would not characterize the committee's work in that
way.
8:18:42 PM
REPRESENTATIVE WOOL said committee members had heard the
arguments in support of Medicaid expansion, such that it would
be good for the state economy, would help bring in money to the
state, would help people, and would help create jobs in the
medical industry and spinoff jobs in other industries. He
stated that those arguments seemed compelling. He said that
while reports were conflicting, the data as a whole was all
positive. He drew attention to a Kaiser Family Foundation
article that looked at data up to March 2015 for states that had
adopted the expansion. He said 30 states had adopted the
expansion, so Alaska would not be experimenting in some
uncharted territory. He shared that someone he spoke with
talked about the empowerment of being insured, the security a
person receives from having insurance. He related his own
experience of having been self-employed and under-insured
because of the cost of insurance, but under the Affordable Care
Act was able to get a good family plan, which had provided him
an immeasurable ease of mind. He said [HB 148] would give
Alaskans peace of mind and let them know legislators were
looking out for their health, productivity, and ability to stay
in the state. He opined that expansion was a good thing and was
an overall net positive thing that had to be done.
8:21:55 PM
REPRESENTATIVE STUTES said she concurred with her colleagues and
appreciated Chair Seaton's efforts in the presentations provided
to the committee and his handling of this controversial subject.
8:22:34 PM
REPRESENTATIVE FOSTER recognized the work done, and said his
constituents and the constituents of other legislators were
happy with it.
8:22:57 PM
REPRESENTATIVE FOSTER moved to report HB 148, as amended, out of
committee with individual recommendations and the accompanying
fiscal notes.
REPRESENTATIVE VAZQUEZ objected, referring to her previous
statement and adding that other states were pursuing
alternatives to provide more access and more affordable health
care. The health care and fiscal consequences had not been
fully vetted, she maintained.
8:23:42 PM
A roll call vote was taken. Representatives Foster, Stutes,
Talerico, Wool, Tarr, and Seaton voted in favor of HB 148, as
amended. Representative Vazquez voted against it. Therefore,
CSHB 148(HSS) was reported out of the House Health and Social
Services Standing Committee by a vote of 6-1.
AMENDMENTS
The following amendments to HB 148 were either discussed or
adopted during the hearing. [Shorter amendments are provided
within the main text only.]
Amendment 15 [29GH1055\A.37, Glover, 3/30/15] (withdrawn):
Page 3, following line 6:
Insert a new bill section to read:
"* Sec. 4. AS 47.05.200(a), as amended by sec. 3 of
this Act, is amended to read:
(a) The department shall annually contract for
independent audits of a statewide sample of all
medical assistance providers in order to identify
overpayments and violations of criminal statutes. The
audits conducted under this section may not be
conducted by the department or employees of the
department. The number of audits under this section
[MAY NOT BE LESS THAN 50] each year, as a total for
the medical assistance programs under AS 47.07 and
AS 47.08, shall be 0.75 percent of all enrolled
providers under the programs, adjusted annually on
July 1, as determined by the department, except that
the number of audits under this section may not be
less than 75. The audits under this section must
include both on-site audits and desk audits and must
be of a variety of provider types. The department may
not award a contract under this subsection to an
organization that does not retain persons with a
significant level of expertise and recent professional
practice in the general areas of standard accounting
principles and financial auditing and in the specific
areas of medical records review, investigative
research, and Alaska health care criminal law. The
contractor, in consultation with the commissioner,
shall select the providers to be audited and decide
the ratio of desk audits and on-site audits to the
total number selected. [IN IDENTIFYING PROVIDERS WHO
ARE SUBJECT TO AN AUDIT UNDER THIS CHAPTER, THE
DEPARTMENT SHALL ATTEMPT TO MINIMIZE CONCURRENT STATE
OR FEDERAL AUDITS.]"
Renumber the following bill sections accordingly.
Page 3, following line 20:
Insert a new bill section to read:
"* Sec. 6. AS 47.05.200(b), as amended by sec. 5 of
this Act, is amended to read:
(b) Within 90 days after receiving each audit
report from an audit conducted under this section, the
department shall begin administrative procedures to
recoup overpayments identified in the audits and shall
allocate the reasonable and necessary financial and
human resources to ensure prompt recovery of
overpayments unless the attorney general has advised
the commissioner in writing that a criminal
investigation of an audited provider has been or is
about to be undertaken, in which case, the
commissioner shall hold the administrative procedure
in abeyance until a final charging decision by the
attorney general has been made. The commissioner shall
provide copies of all audit reports to the attorney
general so that the reports can be screened for the
purpose of bringing criminal charges. [THE DEPARTMENT
MAY ASSESS INTEREST PENALTIES ON ANY IDENTIFIED
OVERPAYMENT. INTEREST UNDER THIS SECTION SHALL BE
CALCULATED USING THE STATUTORY RATES FOR POST-JUDGMENT
INTEREST ACCRUING FROM THE DATE OF THE ISSUANCE OF THE
FINAL AUDIT.]"
Renumber the following bill sections accordingly.
Page 7, following line 1:
Insert a new bill section to read:
"* Sec. 9. AS 47.07.020(b), as amended by sec. 8 of
this Act, is amended to read:
(b) In addition to the persons specified in (a)
of this section, the following optional groups of
persons for whom the state may claim federal financial
participation are eligible for medical assistance:
(1) persons eligible for but not receiving
assistance under any plan of the state approved under
42 U.S.C. 1381 - 1383c (Title XVI, Social Security
Act, Supplemental Security Income) or a federal
program designated as the successor to the aid to
families with dependent children program;
(2) persons in a general hospital, skilled
nursing facility, or intermediate care facility, who,
if they left the facility, would be eligible for
assistance under one of the federal programs specified
in (1) of this subsection;
(3) persons under 21 years of age who are
under supervision of the department, for whom
maintenance is being paid in whole or in part from
public funds, and who are in foster homes or private
child-care institutions;
(4) aged, blind, or disabled persons, who,
because they do not meet income and resources
requirements, do not receive supplemental security
income under 42 U.S.C. 1381 - 1383c (Title XVI, Social
Security Act), and who do not receive a mandatory
state supplement, but who are eligible, or would be
eligible if they were not in a skilled nursing
facility or intermediate care facility to receive an
optional state supplementary payment;
(5) persons under 21 years of age who are in
an institution designated as an intermediate care
facility for persons with intellectual and
developmental disabilities and who are financially
eligible as determined by the standards of the federal
program designated as the successor to the aid to
families with dependent children program;
(6) persons in a medical or intermediate
care facility whose income while in the facility does
not exceed 300 percent of the supplemental security
income benefit rate under 42 U.S.C. 1381 - 1383c
(Title XVI, Social Security Act) but who would not be
eligible for an optional state supplementary payment
if they left the hospital or other facility;
(7) persons under 21 years of age who are
receiving active treatment in a psychiatric hospital
and who are financially eligible as determined by the
standards of the federal program designated as the
successor to the aid to families with dependent
children program;
(8) persons under 21 years of age and not
covered under (a) of this section, who would be
eligible for benefits under the federal program
designated as the successor to the aid to families
with dependent children program, except that they have
the care and support of both their natural and
adoptive parents [DO NOT MEET THE DEPRIVATION CRITERIA
UNDER 42 U.S.C. 1396u-1(b)(1)(A)(II)];
(9) pregnant women not covered under (a) of
this section and who meet the income and resource
requirements of the federal program designated as the
successor to the aid to families with dependent
children program;
(10) persons under 21 years of age not
covered under (a) of this section who the department
has determined cannot be placed for adoption without
medical assistance because of a special need for
medical or rehabilitative care and who the department
has determined are hard-to-place children eligible for
subsidy under AS 25.23.190 - 25.23.210;
(11) persons who can be considered under 42
U.S.C. 1396a(e)(3) (Title XIX, Social Security Act,
Medical Assistance) to be individuals with respect to
whom a supplemental security income is being paid
under 42 U.S.C. 1381 - 1383c (Title XVI, Social
Security Act) because they meet all of the following
criteria:
(A) they are 18 years of age or younger and
qualify as disabled individuals under 42 U.S.C.
1382c(a) (Title XVI, Social Security Act);
(B) the department has determined that
(i) they require a level of care provided in
a hospital, nursing facility, or intermediate care
facility for persons with intellectual and
developmental disabilities;
(ii) it is appropriate to provide their care
outside of an institution; and
(iii) the estimated amount that would be
spent for medical assistance for their individual care
outside an institution is not greater than the
estimated amount that would otherwise be expended
individually for medical assistance within an
appropriate institution;
(C) if they were in a medical institution,
they would be eligible for medical assistance under
other provisions of this chapter; and
(D) home and community-based services under
a waiver approved by the federal government are either
not available to them under this chapter or would be
inappropriate for them;
(12) disabled persons, as described in 42
U.S.C. 1396a(a)(10)(A)(ii)(XIII), who are in families
whose income, as determined under applicable federal
regulations or guidelines, is less than 250 percent of
the official poverty line applicable to a family of
that size according to the United States Department of
Health and Human Services, and who, but for earnings
in excess of the limit established under 42 U.S.C.
1396d(q)(2)(B), would be considered to be individuals
with respect to whom a supplemental security income is
being paid under 42 U.S.C. 1381 - 1383c; a person
eligible for assistance under this paragraph who is
not eligible under another provision of this section
shall pay a premium or other cost-sharing charges
according to a sliding fee scale that is based on
income as established by the department in
regulations;
(13) persons under 19 years of age who are
not covered under (a) of this section and whose
household income does not exceed 175 [203] percent of
the federal poverty line as defined by the United
States Department of Health and Human Services and
revised under 42 U.S.C. 9902(2);
(14) pregnant women who are not covered
under (a) of this section and whose household income
does not exceed 175 [200] percent of the federal
poverty line as defined by the United States
Department of Health and Human Services and revised
under 42 U.S.C. 9902(2);
(15) persons who have been diagnosed with
breast or cervical cancer and who are eligible for
coverage under 42 U.S.C. 1396a(a)(10)(A)(ii)(XVIII) [;
(16) PERSONS WHO ARE UNDER 65 YEARS OF AGE,
WHO ARE NOT PREGNANT, WHOSE HOUSEHOLD INCOME DOES NOT
EXCEED 138 PERCENT OF THE FEDERAL POVERTY LINE,
INCLUDING THE FIVE PERCENT INCOME DISREGARD, AS
DEFINED BY THE UNITED STATES DEPARTMENT OF HEALTH AND
HUMAN SERVICES AND REVISED UNDER 42 U.S.C. 9902(2),
AND WHO ARE ELIGIBLE UNDER 42 U.S.C.
1396A(a)(10)(A)(i)(VIII), IF THE FEDERAL MEDICAL
ASSISTANCE PERCENTAGE PAID TO THE STATE FOR THE
COVERAGE IS NOT LESS THAN 90 PERCENT]."
Renumber the following bill sections accordingly.
Page 7, following line 9:
Insert a new bill section to read:
"* Sec. 11. AS 47.07.020(g), as amended by sec. 10
of this Act, is amended to read:
(g) A person's [FOR THOSE PERSONS WHOSE MEDICAID
ELIGIBILITY IS NOT CALCULATED USING THE MODIFIED
ADJUSTED GROSS INCOME STANDARD SET OUT IN 42 U.S.C.
1396A(e)(14), THOSE PERSONS'] eligibility for medical
assistance under this chapter may not be denied or
delayed on the basis of a transfer of assets for less
than fair market value if the person establishes to
the satisfaction of the department that the denial or
delay would work an undue hardship on the person as
determined on the basis of criteria in applicable
federal regulations."
Renumber the following bill sections accordingly.
Page 7, following line 15:
Insert a new bill section to read:
"* Sec. 13. AS 47.07.020(m), as amended by sec. 12
of this Act, is amended to read:
(m) Except [FOR THOSE PERSONS WHOSE MEDICAID
ELIGIBILITY IS NOT CALCULATED USING THE MODIFIED
ADJUSTED GROSS INCOME STANDARD SET OUT IN 42 U.S.C.
1396A(e)(14), AND, EXCEPT] as provided in (g) of this
section, the department shall impose a penalty period
of ineligibility for the transfer of an asset for less
than fair market value by an applicant or an
applicant's spouse consistent with 42 U.S.C.
1396p(c)(1)."
Renumber the following bill sections accordingly.
Page 7, following line 28:
Insert a new bill section to read:
"* Sec. 15. AS 47.07.036(b), as amended by sec. 14
of this Act, is amended to read:
(b) The department, in implementing this section,
shall take all reasonable steps to implement cost
containment measures that do not eliminate program
eligibility or the scope of services required or
authorized under AS 47.07.020 and 47.07.030 before
implementing cost containment measures under (c) of
this section that directly affect program eligibility
or coverage of services. The cost containment measures
taken under this subsection may include new
utilization review procedures, changes in provider
payment rates, [AND] precertification requirements for
coverage of services, and agreements with federal
officials under which the federal government will
assume responsibility for coverage of some individuals
or some services for some individuals through federal
programs, including the Indian Health Service or
Medicare."
Renumber the following bill sections accordingly.
Page 8, following line 26:
Insert a new bill section to read:
"* Sec. 18. AS 47.07.900(4), as amended by sec. 17
of this Act, is amended to read:
(4) "clinic services" means services
provided by state-approved outpatient community mental
health clinics that receive grants under AS 47.30.520
- 47.30.620, state-operated community mental health
clinics, outpatient surgical care centers, and
physician clinics;"
Renumber the following bill sections accordingly.
Page 9, following line 3:
Insert new bill sections to read:
"* Sec. 20. AS 47.07.900(17), as amended by sec. 19
of this Act, is amended to read:
(17) "rehabilitative services" means
services for substance abusers and emotionally
disturbed or chronically mentally ill adults provided
by
(A) a drug or alcohol treatment center that
is funded with a grant under AS 47.30.475; or
(B) an outpatient community mental health
clinic that has a contract to provide community mental
health services under AS 47.30.520 - 47.30.620;
* Sec. 21. AS 43.23.075(d); AS 47.05.250;
AS 47.07.036(d), and 47.07.036(e) are repealed July 1,
2018."
Renumber the following bill sections accordingly.
Page 9, line 12:
Delete "sec. 10"
Insert "sec. 16"
Page 9, line 17:
Delete "10"
Insert "16"
Page 9, following line 17:
Insert a new bill section to read:
"* Sec. 24. Section 1 of this Act is repealed
July 1, 2018."
Renumber the following bill sections accordingly.
Page 9, line 23:
Delete "Sections 13 and 14"
Insert "Sections 21 - 23"
Page 9, line 24:
Delete all material and insert:
"* Sec. 27. Sections 1 - 3, 5, 7, 8, 10, 12, 14,
16, 17, and 19 of this Act take effect July 1, 2015.
* Sec. 28. Sections 4, 6, 9, 11, 13, 15, 18, and 20
of this Act take effect July 1, 2018."
Amendment 20 [29-GH1055\A.26, Strasbaugh/Glover, 3/28/15]
(failed 2-5):
Page 1, line 1, following "measures;":
Insert "relating to verification of eligibility
for public assistance programs administered by the
Department of Health and Social Services;"
Page 2, following line 16:
Insert a new bill section to read:
"* Sec. 3. AS 47.05 is amended by adding new
sections to article 1 to read:
Sec. 47.05.105. Computerized eligibility
verification system. (a) The department shall
establish a computerized income, asset, and identity
eligibility verification system for the purposes of
verifying eligibility, eliminating duplication of
public assistance payments, and deterring waste and
fraud in public assistance programs administered by
the department under AS 47.05.010.
(b) The department shall enter into a
competitively bid contract with a third-party vendor
for the purpose of developing a system under this
section for verifying an applicant's eligibility for
public assistance before the payment of benefits and
for periodically verifying eligibility between
eligibility redeterminations and during eligibility
redeterminations and reviews under AS 47.05.110 - 120.
The department may also contract with a third-party
vendor to provide information to facilitate reviews of
recipient eligibility conducted by the department.
(c) A contract awarded under this section must
(1) require the vendor to ensure that
annualized savings realized from implementation of the
verification system exceed the total yearly cost to
the state for implementing the verification system;
(2) provide a payment structure based on a
per applicant rate and provide a performance bonus for
achieving a rate of success in accurately identifying
waste and fraud that is higher than a predetermined
rate established by the department;
(3) require the vendor to include in its
system the databases identified in AS 47.05.110.
(d) The third-party vendor selected under this
section may not hold, bid on, or be awarded a contract
to provide enrollment services to an agency of the
state.
Sec. 47.05.110. Income and asset eligibility
verification. (a) Before awarding public assistance
and on a quarterly basis thereafter, to the extent
permitted by federal or state law, and if the
information is available to the department, the
department shall compare the financial information of
an applicant for and recipient of assistance with
information from the following sources:
(1) earned and unearned income information
maintained by the United States Internal Revenue
Service;
(2) employer weekly, monthly, or quarterly
reports of income and unemployment insurance payment
information maintained by the Department of Labor and
Workforce Development;
(3) earned income information maintained by
the United States Social Security Administration;
(4) a nationwide public records data source
of physical asset ownership such as real property,
automobiles, watercraft, aircraft, and luxury
vehicles, or any other vehicle owned by the applicant
for or recipient of public assistance;
(5) national and local financial
institutions;
(6) public housing and housing assistance
payment information maintained by the United States
Department of Housing and Urban Development;
(7) wage reporting and similar information
maintained by states contiguous to this state;
(8) beneficiary records, earnings, and
pension information maintained by the United States
Social Security Administration;
(9) employment information maintained by the
Department of Labor and Workforce Development;
(10) veterans' benefit information
maintained by the United States Department of Health
and Human Services, in coordination with the
department and the Department of Military and
Veterans' Affairs;
(11) child care services payment information
maintained by the department;
(12) income, employment, and child support
information maintained by the Department of Revenue
under AS 25.27;
(13) income, employment, and child support
information maintained by the United States Department
of Health and Human Services under 42 U.S.C. 652 -
669b;
(14) utility payment information maintained
by the department for the Alaska affordable heating
program under AS 47.25.621 - 47.25.626 or the federal
low-income home energy assistance program under 42
U.S.C. 8621 - 8629;
(15) emergency utility payment information
maintained by the state or a municipality;
(16) information maintained by the state
concerning a license, permit, or certificate issued by
a state agency if the cost of the license exceeds
$500;
(17) information maintained by the
Department of Administration concerning pension
payments made under AS 14.25, AS 26.05.222 -
26.05.229, AS 39.35, and former AS 39.37;
(18) a database of individuals receiving
public assistance or other benefits in another state;
(19) any other database or other source that
provides current and accurate information concerning
the income and assets of applicants for and recipients
of public assistance.
(b) Notwithstanding the requirements of this
section, an application for public assistance shall be
processed before a deadline set by federal or state
law or regulation.
Sec. 47.05.115. Identity verification process.
(a) Before awarding public assistance, the department
shall require an applicant for public assistance to
prove the applicant's identity by requiring the
applicant to answer a series of questions about the
applicant's personal and financial information that
the department can verify independently. The
department shall provide a means to verify the
financial history of an applicant without bank records
or a credit history.
(b) The department shall permit an applicant to
provide the answers to the questions posed under (a)
of this section electronically, in person, or by
telephone.
(c) Before awarding assistance, and on a
quarterly basis, the department shall, to the extent
permitted by federal or state law and if the
information is available to the department, match
identity information of an applicant for or recipient
of public assistance against, at a minimum, the
following public records:
(1) immigration status information
maintained by the United States Department of Homeland
Security, Citizenship and Immigration Services;
(2) death register information maintained by
the United States Social Security Administration;
(3) prisoner information maintained by the
United States Social Security Administration;
(4) national fleeing felon information
maintained by the Federal Bureau of Investigation;
(5) a nationwide public records data source
of incarcerated individuals;
(6) a nationwide best-address and driver's
license data source to verify that individuals are
residents of the state;
(7) a comprehensive public records database
that identifies potential identity fraud or identity
theft that can closely associate name, social security
number, date of birth, telephone number, and address
information;
(8) outstanding default or arrest warrant
information maintained by the Department of Public
Safety under AS 12.62; and
(9) any other database or other source that
provides current and accurate information concerning
the identification of individuals.
Sec. 47.05.120. Discrepancies and case review.
(a) If there is a discrepancy between the information
received from an applicant for or recipient of public
assistance and the results of the review conducted
under AS 47.05.110 and 47.05.115, the department shall
(1) take no further action if the
discrepancy does not affect the eligibility of the
applicant or recipient;
(2) undertake a further investigation under
(b) - (e) of this section if the discrepancy indicates
that an applicant or recipient is or has become
ineligible for assistance.
(b) The department shall provide written notice
to an applicant or recipient of a discrepancy under
(a)(2) of this section. The notice must describe the
discrepancy and set out the reasons the discrepancy
requires a redetermination of eligibility, the manner
in which the applicant or recipient may respond, and
the consequences of failing to respond.
(c) The applicant or recipient shall respond to a
notice under (b) of this section within 10 business
days. The applicant or recipient shall respond in
writing.
(d) After receiving the applicant's or
recipient's response, the department
(1) may request that the applicant or
recipient provide additional information;
(2) shall, if the applicant or recipient
disputes the accuracy of the information in a
database, disputes the effect of a discrepancy on
eligibility for assistance, or provides an explanation
for the discrepancy, reinvestigate the discrepancy and
its effect on the applicant's or recipient's
eligibility.
(e) In reviewing information under this section,
the department shall independently verify information
provided solely by the applicant or recipient.
(f) If the department finds that the report of a
discrepancy is inaccurate, that the discrepancy has
been satisfactorily explained, or that the discrepancy
does not affect the eligibility of the applicant or
recipient, the department shall approve or continue
eligibility for the relevant public assistance
program.
(g) If the department finds that the information
provided by the applicant or recipient is inaccurate,
and that the inaccurate information affects the
applicant's or recipient's eligibility, it shall
promptly redetermine eligibility. If the department
determines that an applicant or recipient is not
eligible for assistance, the department shall provide
written notice of the determination to the applicant
or recipient, along with notice of the applicant's or
recipient's right to a fair hearing under
AS 47.05.010.
(h) If the applicant or recipient does not
respond to the notice, the department shall deny or
discontinue assistance for failure to cooperate.
Eligibility for assistance may not be established or
reestablished until the discrepancy or change has been
resolved. The department shall provide written notice
of the denial or discontinuation to the applicant or
recipient, along with notice of the applicant's or
recipient's right to a fair hearing under
AS 47.05.010.
(i) The department shall adopt regulations to
implement this section.
Sec. 47.05.125. Referrals for fraud,
misrepresentation, or inadequate documentation. (a)
The department shall refer suspected cases of fraud,
including identity fraud, to the attorney general for
criminal prosecution, recovery of improper payments,
and collection of civil penalties.
(b) The department shall refer suspected cases of
fraud, misrepresentation, or inadequate documentation
to other state agencies and programs for review.
Sec. 47.05.130. Reporting. The department shall,
on a quarterly basis, deliver to the senate secretary
and the chief clerk of the house of representatives
and notify the legislature of the availability of a
report detailing the effectiveness and general
findings of the eligibility verification system,
including the number of cases reviewed, the number of
case closures, the number of referrals for criminal
prosecution, the recovery of improper payment, the
outcomes of cases referred to the attorney general,
and the savings that have resulted from the system.
Sec. 47.05.135. Provider payments. (a) To the
extent permitted by federal and state law, the
department shall make available to the public an
annual report of
(1) the names, office locations, and
national provider identifier under 42 U.S.C. 1396 -
1396p (Title XIX of the Social Security Act) of health
care providers receiving payments under a public
assistance program administered by the department; and
(2) for each health care provider, the
number and types of services provided under a public
assistance program, average submitted charges for each
type of service, average allowed amount, average
medical assistance payment, the common procedure
coding system compiled by the United States Department
of Health and Human Services for the services provided
by the physician, and whether the services were
performed in a facility or office setting.
(b) Notwithstanding (a) of this section, the
department may not release information under this
section if the information would disclose, directly or
indirectly, the identity and medical condition of a
patient of the health care provider, or could
reasonably be expected to constitute an unwarranted
invasion of the personal privacy of the patient.
Sec. 47.05.150. Definitions. In AS 47.05.105 -
47.05.150,
(1) "department" means the Department of
Health and Social Services;
(2) "health care provider" means a person or
facility approved by the department to provide health
care services to a recipient of public assistance
administered by the department;
(3) "identity information" includes the full
name, aliases, date of birth, address, social security
number, or other information identifying an applicant
for or recipient of an assistance program administered
by the department under AS 47.05.010."
Renumber the following bill sections accordingly.
Page 9, line 12, following the first occurrence of
"Act,":
Insert "AS 47.05.105 - 47.05.150, enacted by sec.
3 of this Act,"
Delete "sec. 10"
Insert "sec. 11"
Page 9, lines 16 - 17:
Delete "secs. 1 and 10"
Insert "secs. 1, 3, and 11"
Page 9, line 23:
Delete "Sections 13 and 14"
Insert "Sections 14 - 16"
Page 9, following line 23:
Insert new bill sections to read:
"* Sec. 18. AS 47.05.130, enacted by sec. 3 of this
Act, takes effect July 1, 2016.
* Sec. 19. Except as provided in sec. 18 of this
Act, sec. 3 of this Act takes effect January 1, 2016."
Page 9, line 24:
Delete "by sec. 16"
Insert "in secs. 17 - 19"
8:24:20 PM
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 8:24 p.m.