Legislature(1997 - 1998)
05/07/1998 09:09 AM Senate FIN
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
HOUSE BILL 459
"An Act establishing new eligibility for medical
assistance for certain disabled persons and giving
their eligibility for services the highest priority
among optional services and groups under the medical
assistance program; amending the definition of
'personal care services in a recipient's home' as used
in the medical assistance program; moving midwife
services from being the first to being the seventh
service eliminated under the medical assistance
program when there is insufficient funding; adjusting
the priority of optional services and optional
eligible groups under the medical assistance program
in order to reflect the new priorities given to the
newly-eligible disabled persons and to midwife
services but without otherwise changing the relative
order of the other optional services and optional
groups; relating to catastrophic illness assistance;
establishing a medical assistance program for chronic
and acute medical conditions; and providing for an
effective date."
Co-chair Sharp provided history of the bill in committee,
including concerns about the midwife section. He noted that
the sponsor was indifferent to whether the section was in
the legislation or not.
Senator Phillips MOVED Amendment 1.
ROBERT BRIGGS, ATTORNEY, DISABILITY LAW CENTER OF ALASKA,
informed the committee that the center was neutral on the
position of whether the midwives section should be changed.
He opined that the midwifery provisions of the bill should
be deleted if the committee was inclined to not act on the
bill because of the mix of the two different subjects in
the bill.
Mr. Briggs maintained that the bill was very important to
the disability community and that the proposed amendment
would accomplish what was needed.
Senator Pearce OBJECTED to the amendment.
Senator Donley commented that the amendment would change
the title of the bill. There was a discussion about
procedure related to changing the title.
Senator Donley stated that there had been compelling
testimony the day before about the position of the Health,
Education, and Social Services Committee related to midwife
services; there could be a large potential savings for the
program, which would free up funds to provide the services
listed.
Co-chair Sharp queried whether the amount of Medicaid
appropriated by the state had failed to reach the whole
list.
NANCY WELLER, CHIEF MEDICAL ASSISTANT, DIVISION OF MEDICAL
ASSISTANCE, DEPARTMENT OF HEALTH AND SOCIAL SERVICES
(DHSS), responded that the first five services on the list
were not covered (midwives, clinical social workers,
psychologists, chiropractors, and advanced nurse
practitioners). She added that there were three types of
advanced nurse practitioners that were mandatory under
federal law and covered under the Medicaid program: nurse
midwives, pediatric nurse practitioners, and family
practice nurse practitioners.
Senator Phillips questioned coverage for chiropractors. Ms.
Weller responded that chiropractors were only funded for
children.
Co-chair Sharp asked whether a fiscal note had been
prepared by DHSS that at least projected the savings. He
noted the additional cost for disabled premiums. Ms. Weller
replied that when the amendment was proposed in the House
Finance Committee, DHSS reported that it did not have
experience with certified direct-entry midwives, though it
anticipated there could be some cost savings. There were
very few such midwives in Alaska. However, DHSS supported
the inclusion of direct-entry midwives in the Medicaid
program and had proposed a different way of including
direct-entry midwives in the program in the governor's
child health insurance program bill, but the change was
acceptable to the department.
Co-chair Sharp noted that he had kept hearing that there
would be savings using the midwives rather than doctors. He
asked whether the amounts could be estimated or projected
on a per-person basis. He wanted to see the numbers on a
fiscal note. Ms. Weller replied that it was possible there
could be savings; the department had not received
information from the midwives association of how many
clients it projected seeing. She stated the issue was more
about access to the types of services the clients wanted
for maternity and delivery care. She added that certified
direct-entry midwives could provide home deliveries.
Senator Parnell thought the department should be able to
get numbers related to the projected savings. He wanted
DHSS to estimate the possible savings.
Co-chair Sharp agreed and wanted to see something in
writing, at least an estimate in the narrative. He wanted a
fiscal note backing up a claim for savings.
Senator Parnell asked whether the department could provide
the information if the bill moved out of committee. Ms.
Weller replied that she would do her best.
Co-chair Sharp spoke to expected meetings and possible
delays. He requested that a fiscal note be supplied to the
committee with projected estimates of how many people would
be affected so that the committee could have something to
base a decision on. He was concerned that people who would
be moved down the list would be upset.
Senator Donley agreed that the department should provide
the information. He noted that birthing services would be
an alternative to doctor services; he did not think
expenses would increase, but only decrease.
Co-chair Sharp also wanted the total amount paid out to
adult dental services, which would be dropped off the list.
Senator Parnell thought that would miss the point because
people who were eligible could go to a doctor and get
reimbursed under the list already for pregnancy-related
services; they would go to a midwife instead and get the
service provided at less expense. He thought those were the
numbers needed from the department. He hoped the department
could also say that no other services would be lost as a
result of the savings.
Co-chair Sharp wanted to see the total cost paid out for
adult dental with a comparison with total anticipated
savings. He was concerned that people would be upset
because they did not qualify for adult dental expenses
because the list was changed; he wanted to be able to say
that DHSS had assured the committee in a fiscal note.
Ms. Weller pointed out that the projected number for adult
dental was $4 million per year, limited to emergency
treatment of pain and acute infection. She anticipated the
services would continue. She recalled intent language in
the budget the year prior to restore services 6 through 19;
the services were restored with program savings October 12,
1997.
Co-chair Sharp suggested moving midwives to position 6
instead of 15, if there was money available.
Senator Donley thought the suggestion might be reasonable;
however, the title specifically said 1 to 14; the other
suggestion would require a title amendment as well.
Co-chair Sharp assumed a simple title change could be
approved as long as the schedule was adjusted to qualify.
He did not think midwife services had gone up to $4 million
(the cost of the adult dental).
Co-chair Sharp SET ASIDE HB 459 until later in the meeting
(pending receipt of the new fiscal note by DHSS).
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