04/06/1994 08:25 AM Senate FIN

  SB 366:        An  Act  relating  to   medical  support  for                 
                 children; allowing a member of the  teachers'                 
                 retirement  system  or the  public employees'                 
                 retirement    system    to   assign    to   a                 
                 Medicaid-qualifying trust the  member's right                 
                 to  receive  a   monetary  benefit  from  the                 
                 system;   relating   to  the   effect   of  a                 
                 Medicaid-qualifying trust on  the eligibility                 
                 of a  person for  Medicaid;  relating to  the                 
                 recovery  of  certain Medicaid  payments from                 
                 estates  and  trusts;  requiring persons  who                 
                 receive  Medicaid services  to be  liable for                 
                 sharing in the cost of  those services to the                 
                 extent   allowed   under   federal  law   and                 
                 regulations; and providing  for an  effective                 
                                                                               
                                                                               
                 date.                                                         
                                                                               
                 David Skidmore, aide  to Senator Frank, spoke                 
                 to   the   bill.     Jon   Sherwood,  Medical                 
                 Assistance   Adminis-trator,    Division   of                 
                 Medical  Assistance,  Department of  Health &                 
                 Social Services, answered questions regarding                 
                 the  bill.    Amendments  1  and 2  had  been                 
                 ADOPTED in a previous meeting.  Amendments 5,                 
                 6, 7, and  a letter  of intent were  ADOPTED.                 
                 SB  366 was  REPORTED  OUT of  committee with                 
                 individual recommendations  and three  fiscal                 
                 notes  for  the  Department  Health &  Social                 
                 Services:   Claims   Processing   -   $130.0,                 
                 Medicaid  Facility  - $(550.0),  and Medicaid                 
                 Non-Facility - $(799.1).                                      
                                                                               
  SENATE BILL NO. 366:                                                         
                                                                               
       An  Act  relating  to  medical  support  for  children;                 
       allowing a member of the teachers' retirement system or                 
       the public employees' retirement system  to assign to a                 
       Medicaid-qualifying trust the member's right to receive                 
       a monetary  benefit from  the system;  relating to  the                 
       effect   of   a   Medicaid-qualifying  trust   on   the                 
       eligibility of a  person for Medicaid; relating  to the                 
       recovery of certain Medicaid payments from  estates and                 
       trusts; requiring persons who receive Medicaid services                 
       to be liable for sharing in  the cost of those services                 
       to   the  extent   allowed   under   federal  law   and                 
       regulations; and providing for an effective date.                       
                                                                               
  Co-chair  Frank  announced  that  SB   366  was  before  the                 
  committee.  He noted that amendments  1 and 2 had previously                 
  been ADOPTED in a prior meeting.  He invited David Skidmore,                 
  his aide, to speak to the bill and several new amendments.                   
                                                                               
                                                                               
  DAVID  SKIDMORE said that amendment  5 created a new section                 
  imposing  a co-payment  requirement  for inpatient  hospital                 
  services  of $50 a  day, up to  a maximum of  $200.  He said                 
  that was the  same co-payment policy under  Alaska's general                 
  relief medical program.                                                      
                                                                               
  Senator Sharp MOVED amendment 5.   No objection being heard,                 
  it was ADOPTED.                                                              
                                                                               
  Senator Rieger said he would like to propose amendment 6 but                 
  felt it  did not exactly  mirror the  letter of intent.   In                 
  answer  to  Co-chair  Frank,   Senator  Rieger  said  intent                 
  language read "to  the maximum extent allowed  under federal                 
  law."   Co-chair Frank supported  the amendment and  felt it                 
  was not inconsistent with the intent language.                               
                                                                               
  JON SHERWOOD, Medical Assistance Administrator, Division  of                 
  Medical Assistance, Department of Health & Social  Services,                 
  said  that  seeking  a  waiver  would be  permissible  under                 
  federal  law.   He  felt  the  department would  not  have a                 
  problem with either the letter of intent or amendment 6.  He                 
  said he would let  the committee know this afternoon  if the                 
  department had received any waivers.                                         
                                                                               
  Senator Rieger MOVED amendment 6.   Co-chair Frank suggested                 
  that  language   be  added   requiring  a   report  to   the                 
  legislature.   Senator  Rieger said  it  was his  intent  to                 
  reduce reports to the legislature.   Co-chair Frank withdrew                 
  his proposed language.   No  further objection being  heard,                 
  amendment 6 was ADOPTED.                                                     
                                                                               
  Senator Rieger said that there was a need on the part of the                 
  department to use discretion in regard  to waivers.  He felt                 
  the intent language would be important.                                      
                                                                               
  Senator Rieger MOVED  amendment 7.  He said  the utilization                 
  review  the department used needed  to be evaluated and this                 
  amendment  authorized that.   It  also gave  a case  manager                 
  authorization to approve optional services without following                 
  the  priority  listing  in  order  to  design  a  more  cost                 
  effective program.                                                           
                                                                               
  Mr. Sherwood said that presently  case management ideas were                 
  being considered and  evaluated.  Any case  management would                 
  require case managers.   Senator Rieger felt that  the state                 
  would be far ahead if it put  $1M of general funds into fund                 
  case management  and, in turn,  received $3M from  the feds.                 
  Mr.  Sherwood  agreed  there  was a  75  percent  match when                 
  professional case management was used.                                       
                                                                               
  End SFC-93 #59, Side 1                                                       
  Begin SFC-93 #59, Side 2                                                     
                                                                               
  Discussion was had  by Senators Sharp, Rieger,  and Co-chair                 
                                                                               
                                                                               
  Frank regarding pre-authorization, the  priority listing and                 
  optional  services.  Senator  Rieger informed  the committee                 
  that the legislature did not  determine which items were  on                 
  the priority  list, but was decided by  the department after                 
  budget funding.   In answer to Senator Sharp, Senator Rieger                 
  doubted there  was any  integrity to  the priority  list and                 
  money  could  be  saved  by  being  able to  choose  a  less                 
  expensive service that appeared lower on the priority list.                  
                                                                               
  Hearing no objection, amendment 7 was ADOPTED.                               
                                                                               
  Senator Sharp  MOVED the  letter of  intent adding  language                 
  that said  "a report shall  be made to include  a listing of                 
  waivers sought from the federal government and an indication                 
  of those granted."  No objection  being heard, the letter of                 
  intent as amended was ADOPTED.                                               
                                                                               
  Senator  Sharp MOVED for passage of CSSB 366(FIN) as amended                 
  from  committee   with  individual   recommendations.     No                 
  objection being heard, it was REPORTED OUT of committee with                 
  individual  recommendations,  a  zero  fiscal note  for  the                 
  Department of  Commerce &  Economic Development, and  fiscal                 
  notes for  the Department  of Health  &  Social Services  as                 
  follows:  Claims  Processing-$130.0,   Medicaid  Facilities-                 
  $(550.0),  and  Medicaid Non-facilities-$(799.1).   Co-chair                 
  Frank and Senator Rieger signed "do pass."   Senators Sharp,                 
  Jacko, Kelly and Kerttula signed "no recommendation."