Legislature(2015 - 2016)HOUSE FINANCE 519
04/10/2015 09:00 AM House FINANCE
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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 | |
| + | TELECONFERENCED |
HOUSE FINANCE COMMITTEE
April 10, 2015
9:04 a.m.
9:04:22 AM
CALL TO ORDER
Co-Chair Thompson called the House Finance Committee
meeting to order at 9:04 a.m.
MEMBERS PRESENT
Representative Mark Neuman, Co-Chair
Representative Steve Thompson, Co-Chair
Representative Dan Saddler, Vice-Chair
Representative Bryce Edgmon
Representative Les Gara
Representative Lynn Gattis
Representative David Guttenberg
Representative Scott Kawasaki
Representative Cathy Munoz
Representative Lance Pruitt
Representative Tammie Wilson
MEMBERS ABSENT
None
ALSO PRESENT
Becky Hultberg, President and Chief Executive Officer,
Alaska State Hospital and Nursing Association (ASHNHA); Jon
Sherwood, Deputy Commissioner, Medicaid and Health Care
Policy, Department of Health and Social Services; Jeff
Jessee, Chief Executive Officer, Alaska Mental Health Trust
Authority.
PRESENT VIA TELECONFERENCE
SUMMARY
HB 148 MEDICAL ASSISTANCE COVERAGE; REFORM
HB 148 was HEARD and HELD in committee for
further consideration.
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."
9:06:14 AM
BECKY HULTBERG, PRESIDENT AND CHIEF EXECUTIVE OFFICER,
ALASKA STATE HOSPITAL AND NURSING ASSOCIATION (ASHNHA),
supported HB 148 and Medicaid expansion. She voiced that
Alaskan hospitals provided over $100 million each year in
uncompensated care. She asserted that expansion would
reduce the amount of uncompensated care and provided
significant economic and fiscal benefits for the state. The
cost of healthcare for the state was unsustainable and was
"simply a math equation." She believed the problem was
solvable and that expansion "might be part of the
solution." She believed that the state's healthcare system
must be "transformed." She stated that healthcare was
different from any other industry in the state in service
delivery, payment, magnitude of the costs, and the personal
nature of the service. She thought that a different
approach to the issue was necessary. She shared concern
about policy debates that were based on sound bites,
deceptive Facebook ads, and speculation in an attempt to
"scare" the public. She stated that her purpose before the
committee was to answer member's questions and address the
idea of healthcare transformation.
Ms. Hultberg discussed the issue of the Medicaid Management
Information System (MMIS) [Xerox contract with Department
of Health and Social Services (DHSS)]. She stated her
concern and shared that the association had dealt with the
issue for over one and a half years. She related that the
association was "deeply engaged" with the state and Xerox
due to disruptions in payments. She indicated that
currently ASHNHA's clients were receiving timely payments
and the system's improvements were significant. She
reported that back payments were still problematic from the
time that the system was not functioning properly and would
be resolved over time. The association was confident that
the system could handle a "small number" of additional
recipients added to the system due to Medicaid expansion.
She stated that from a provider's view point ASHNHA was not
concerned with the status of the MMIS system in regards to
Medicaid expansion.
Co-Chair Neuman disagreed with her characterization that
"the policy debate was an attempt to scare people." Ms.
Hultberg clarified that she believed that Facebook ads and
soundbites were an attempt to scare people. She advocated
for honest policy debates regarding healthcare reform and
Medicaid expansion.
9:11:21 AM
Representative Gattis asked what amounted to a "small
number" of people in regards to Medicaid expansion. Ms.
Hultberg remembered that up to 20 thousand people out of
the potential 40 thousand eligible could enroll in the
program, which represented a small percentage of the total
number of Medicaid recipients. She added that the "volume"
would not overwhelm the system relative to what it
currently handles. Representative Gattis requested specific
numbers. Ms. Hultberg deferred to the department for the
answer.
JON SHERWOOD, DEPUTY COMMISSIONER, MEDICAID AND HEALTH CARE
POLICY, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, answered
that approximately 160 thousand beneficiaries were expected
to enroll in Medicaid next year. He expounded that the
20,000 new enrollees from expansion would represent a one-
eighth increase in the Medicaid population or roughly 12.5
percent. The expansion population was not anticipated to be
high utilizers similar to other populations already covered
such as, people with disabilities therefore, the new claims
volume was expected to be less than 12.5 percent.
Representative Gara agreed that the ads that Ms. Hultberg
referred to were deceptive.
Vice-Chair Saddler cited Facebook ads by DHSS encouraging
citizens to contact their legislator in support of Medicaid
expansion. He strongly agreed that policy discussions
should not be based on Facebook soundbites. He requested
discussions focused on utilization rates and reductions in
uncompensated care in addition to what other states
experiences were.
Ms. Hultberg "sincerely regretted mentioning Facebook…" and
would discuss the policy merits.
9:16:04 AM
Representative Pruitt referred back to the idea of small
numbers regarding expansion. He wondered what happened in
relation to the estimated number of new recipients versus
the actual number of new enrollees, in other states that
expanded Medicaid. He asked how a larger number than
anticipated of new recipients would impact the system. Ms.
Hultberg concurred that some states experienced a higher
number of new enrollees than projected. She stated that
ASHNHA had confidence in the department's projections but
realized they could be inaccurate. The association
expressed confidence that the MMIS system could handle
additional volume over the 20,000 estimated new
beneficiaries based on how the system was currently
handling claims.
Co-Chair Neuman stated that the committee would hear from
experts on the MMIS system from DHSS at a later date.
Representative Wilson wondered how expanding Medicaid was
going to save the state money since the state paid much
higher rates for medical procedures. She deduced that
Medicaid recipients were being served and that the issue
was about who was paying for the services. Ms. Hultberg
responded that the short answer was that "structural
change" in healthcare delivery and how and what was paid
for was needed to lower healthcare costs. The healthcare
system needed to pay for "value" instead of "volume." She
felt that the necessary changes would be "significant and
disruptive." She opined that making disruptive change in an
established system "required both capital and confidence"
and would be a huge challenge. She declared that "change
was going to happen" due to the economics of the healthcare
cost curve on federal and state levels. She pointed out
that how the state responded to the change was the issue.
If the state was not the "architect" of the change the
state would be "victims" of any changes.
Representative Wilson declared that Ms. Hultberg's answer
"made no sense." She thought that Ms. Hultberg was
advocating for more government involvement in managing
healthcare and thought that was a private matter. She
believed that Medicaid expansion instituted over a short
time frame was "irresponsible." She stated that 30 percent
of the state's population would be eligible for Medicaid
and many new recipients would not have jobs. She did not
believe expansion could happen without "a lot of government
control."
9:22:56 AM
Ms. Hultberg answered that she could better answer the
question if she could get through more of her presentation.
She revealed that government currently paid approximately
50 or more percent of healthcare costs and was already a
huge payer, which made the industry different than other
business. She remarked that government and healthcare were
linked in ways other industries were not. Representative
Wilson felt like she was hearing a lot of rhetoric and had
not heard statistics or facts. She wanted to hear about
other states that did not choose expansion but utilized
some other system of healthcare before hasty decisions were
made on Medicaid expansion in Alaska.
Representative Edgmon thought that the committee had
previously engaged in thorough discussions regarding
expansion with representatives from medium sized hospitals
from Kenai and Ketchikan (04/09/2015 08:37AM). He deduced
that Medicaid expansion provided the "front-end capital" to
initiate innovation. He cited the following from the
previous meetings testimony, "Healthcare in Alaska is
fragmented and lacked coordination…" He summarized that the
only way to implement a payment restructuring system with
accountability and information sharing was with the front-
end capital that Medicaid expansion could provide. He
believed that projections were not possible to predict
exactly. He requested that the committee hear testimony
from the large providers in Anchorage and the Matanuska-
Susitna Borough who would be the primary beneficiaries of
expansion. He felt that the healthcare industry was a
business and Medicaid expansion was creating a new business
model.
Co-Chair Neuman agreed to provide the requested testimony.
9:26:02 AM
Representative Guttenberg requested that Ms. Hultberg
highlight the areas where ASHNHA thought savings could be
achieved through expansion.
Co-Chair Neuman requested examples and comparatives and
more information regarding a provider tax.
Vice-Chair Saddler referred to Representative Edgmon's
comments and disagreed with his conclusions. He felt that
the medium sized hospitals spoke about "what might be"
through Medicaid expansion and "cherry picked" elements
from a demonstration project they were involved in and not
as part of a "systematic revamping expansion of Medicaid."
Co-Chair Neuman asked the committee to stay focused on the
presentation at hand.
Ms. Hultberg moved the discussion to payment reform. She
referenced the previous day's testimony regarding reform
and summarized that tangible examples of feasible reform
were currently taking place. She recounted that the
Ketchikan hospital's current demonstration project resulted
in better quality outcomes at lower costs. The project was
funded by a $3 million CMS (Centers for Medicaid Services)
innovation grant but was not sustainable because of the way
hospitals were reimbursed; they were incentivized to treat
people in the hospital. She detailed that the project could
continue through payment reform that financially rewarded
hospitals for "keeping people out of the hospital" and
improved margins that expansion would provide. The second
reform project was a community care organization project
modeled after a currently operating reform project in
Oregon. She explained that the model paid a provider a
"global payment" which was a fixed dollar amount payment
based upon a number of people in a pool. If the costs of
providing healthcare was larger than the payment the
provider absorbed the loss. The provider gained financially
if they provided better quality outcomes at a lower cost.
She delineated that the benefit of a global payment was
that every provider's financial incentives were "aligned."
The goal was better care at a low cost versus more care at
a higher cost. The Kenai (Central Peninsula) hospital would
develop the model if they can make it financially viable.
She voiced that Ketchikan's demonstration project required
more capital. The Central Peninsula hospital did not have a
grant source and were relying on the reduction in
uncompensated care achieved through Medicaid expansion to
implement its demonstration project. She thought that
without Medicaid expansion the hospitals would still seek
new models of delivering care, but the models would not be
as comprehensive and innovative without the expansion
capital to implement them.
Representative Guttenberg understood the concept of global
payment systems. He wondered what safeguards were in place
in instances when a hospital was turning people away from
the ER for treatment in a different facility. He asked
whether the system was integrated and would ensure follow
up care.
9:32:31 AM
Ms. Hultberg stated that integrated "IT" (Information
Technology) systems were part of the model. She revealed
that the model included multiple providers, along with
hospitals uniting to form the healthcare system. The
providers were paid based on quality benchmarks as well and
had no incentive to deny care. They are incentivized to
ensure that the care was delivered at the best location at
the best value. She furthered that "by combining the
financial incentives and the quality matrix" one could
guarantee high standards of care at lower costs.
Representative Guttenberg provided an example of a hospital
discharging a sick patient due to cost factors. He asked
whether the model would allow the patient to be treated at
multiple facilities without penalizing one provider for not
providing quality care on their end. Ms. Hultberg relayed
that the patient would retain a primary care provider and
had a choice of clinics within the system but that all
providers were "on the same page" regarding the patients
needs. She understood that at some point someone would
stray outside the model's health system and would most
likely be back in the Medicaid fee for service model. She
stated that she needed more information regarding how that
particular "dynamic" was handled in Oregon.
Representative Gattis remained fixed on the business model.
She wanted to address the business model of private
insurers. She thought that the private insurance companies
would be interested in participating in the cost cutting
models and weren't part of the conversation. Ms. Hultberg
suggested that many of the models also had insurance
partners. The exemplified coordinated care model in Oregon
had insurance partners as part of the model due to the
level of risk.
Co-Chair Neuman agreed with Representative Gattis and
wondered whether the coordinated care model allowed the
state to submit RFP's (request for proposals) from private
insurance companies to manage a coordinated care system.
Ms. Hultberg suggested that the managed care demonstration
projects proposed in the legislation provided for wide
ranging managed care opportunities besides the coordinated
care model.
9:39:32 AM
Representative Gara stated that there were many questions
about how Medicaid "produced savings." He noted that much
of the testimony addressed multiple instances where
Medicaid would cover costs that were currently being paid
for by the state's general fund. He identified the
additional Medicaid coverage in lieu of general funds as
cost savings to the state. He reiterated that it cost more
to treat people in an ER than in a clinic and was one area
of potential savings. He reminded the committee that
Medicaid coverage would decrease Alaska Regional Hospital's
costs for uncompensated care which allowed the hospital to
provide a primary care type clinic under Medicaid
expansion. He asked whether the scenario could be
widespread under Medicaid expansion to other hospitals in
the state. Ms. Hultberg responded that he identified two
types of savings. One saved general fund expenses by
offsetting general funds through federal Medicaid expansion
funding. The other savings were within the healthcare
system through Medicaid expansion and payment reform. She
hoped that other hospitals would choose the Alaska Regional
model but could not speak for them. She emphasized that in
general, the "highest likelihood for healthcare
transformation" was through Medicaid expansion and payment
reform.
Vice-Chair Saddler agreed with Representative Edgmon that
hospitals were businesses and that the federal government
was "squeezing" hospitals into reducing uncompensated care
costs with a "stick" and that the carrot was Medicaid
expansion which provided additional funding. He asked her
to describe the efforts the association had done before the
possibility of Medicaid expansion to accomplish payment
reform or provide managed care.
Ms. Hultberg answered that Medicare was primarily driving
payment reform throughout the country as well as private
payers in some states. Several large corporate private
payers like Walmart and Boeing were driving larger change
through alterations in their plans. She pointed out that
the association's members were businesses and payment
reform required risk to potentially lower revenue.
Currently, forces aligned to "allow the conversation to
occur." Some of the changes were being driven by the
"future" realization of even higher costs without cost
containment and some change was driven by the carrot and
stick of Medicaid expansion. She shared that providers were
aware that change had to occur and that changing the
business model was disruptive and could potentially lead to
loss in revenue. She believed that providers were currently
"at the table" because it was the "right thing to do" and
Medicaid expansion offered the carrot to do it. The
financial incentives to lower costs had to accompany the
need for change or hospitals and providers would act
"rationally" as businesses facing losing profit and
continue the current system "given the payment structure"
even though it was not the "right thing to do."
Co-Chair Neuman understood Ms. Hultberg's opinion on the
matter.
Vice-Chair Saddler restated his question. Ms. Hultberg
replied that the association had not had the conversation
of payment reform before because the financial incentives
did not exist.
Co-Chair Neuman wanted to hear more about provider taxes
and the differences between large hospitals and small
office providers.
9:46:09 AM
Ms. Hultberg moved to the topic of provider taxes. She
reported that a white paper produced by Alaska State
Hospital and Nursing Home Association (ASHNHA) titled,
"Provider Taxes - A comprehensive Overview" (copy on file)
was included in the members backup packets. She explained
that provider taxes were taxes imposed on providers by
states. If a state wanted to use the proceeds of the tax as
part of the Medicaid match then the state must adhere to
certain federal requirements. The federal requirements
delineated that the tax must be broad based and apply to
all providers. The tax must be uniform to all providers
within a class of providers and cannot hold the providers
harmless; in this case guarantee that the state was
compensated for the entire amount the state paid in taxes.
The requirements also included specific limits on how much
a provider could be taxed. She noted that the provider tax
was applied in 49 states. She voiced that often the tax
worked for both the provider and the state; specifically
when the Medicaid rate for services was below the Medicaid
upper payment limit the tax can leverage additional federal
reimbursement up to the upper payment limit. She summarized
that the provider tax levied a tax on the provider and the
state received the revenue. The federal government matched
the revenue and the "pot of new money" was divided between
the providers and the state. Providers received the funds
in the form of increased rates or supplemental payments and
the state gained tax revenue to help support the Medicaid
program. She declared that it was not known whether the
provider tax system would work in Alaska. The association's
consultant would study the issue. The tax was typically
levied on hospitals and nursing homes. However, under
federal law, 19 classes of providers could be taxed which
included physicians and ambulatory surgery centers. She
expounded that one of the decisions in considering a
provider tax would be assessing what type of providers the
state wanted to tax. The broad based tax could be applied
differently within a class by taxing similar types of
facilities within one class differently. For instance
within the hospital class large hospital could be taxed
differently than small hospitals. She summarized that
within the broad based requirement, classes of providers
could be carved up based on specific criteria and taxed
differently.
Representative Pruitt referred to Ms. Hultberg's comment
that 50 percent of healthcare was paid for by government.
He assumed that the majority of the 50 percent was derived
from Medicare and Medicaid. He thought that if providers
saw the benefit from expansion through increased enrollees,
he wondered how long it would be before providers come
forward to ask the state for "more" based on increasing the
market for providers through expansion. He was concerned
about rising costs for the state as Medicaid expansion
grew. Ms. Hultberg clarified that her 50 percent comment
only applied to hospitals and no other provider classes.
She responded that "government was the worst payer for
hospitals." She emphasized that her statements merely
reflected the reality that at some hospitals the government
paid for 50 percent of the bill. She revealed that
commercial payers were better payers. The association's
intent was not to "crowd out" the private payers. The
current business model of the legal mandate to provide free
care in the form of uncompensated care was not optimal. She
believed that the opportunity to reduce the uncompensated
care costs at the same time as implementing changes to the
entire system was compelling.
9:52:56 AM
Vice-Chair Saddler asked for clarification regarding taxing
one classification of providers at different rates under
the provider tax. Ms. Hultberg restated that the tax must
be broad based within a provider group. She offered the
example of physicians as a provider group and stated that
"all similarly situated providers" must be treated equally
within the broad based tax. However, classes of providers
within a group were allowed to be taxed differently. She
exemplified hospitals as an example. She elaborated that
hospitals classified as "Perspective Payment System" (PPS)
were large hospitals and "critical access hospitals" were
small hospitals. Based on the two types of hospital
providers, the tax could be differentiated within that same
class of hospital providers.
9:54:58 AM
JEFF JESSEE, CHIEF EXECUTIVE OFFICER, ALASKA MENTAL HEALTH
TRUST AUTHORITY, declared that the Alaska Mental Health
Trust Authority (AMHTA) was interested in both Medicaid
expansion and reform. The trustees believed that the
current system was "unsustainable" and that drastic
solutions were necessary. He thought that "reform was not
an option or a destination" but was a process over time. He
felt that restructuring healthcare payment and delivery
systems would be necessary. He reported that over the last
6 years the trust successfully reformed the children's
mental health system. He detailed that over $40 million of
state funding was reprogrammed to create a community based
system of care within the state versus sending children and
funding outside of the state. Currently, 92 children, down
from a high of 438 remained out-of-state. The trust
provided over $16 million to assist in the reform effort.
He reported that the trust was excited about expansion
because of the potential capital opportunities offered via
Medicaid expansion. In addition, the trust was charged with
reformation in certain areas of Department of Corrections
(DOC) and the Criminal Justice System.
Mr. Jessee stated that the prisons were currently at 101
percent of capacity and reform efforts could not wait. He
shared that the trust beneficiaries were either not being
served or were served inappropriately at very high costs.
Beneficiaries could not receive substance abuse treatment
when necessary and ended up in jail or psych emergency
rooms. He explored potential savings in DOC, particularly
focused on 24 hour hospitalizations. He referred to the
white paper and a distribution chart titled, "Alaska Inmate
Hospitalization Costs FY 12-15" (copy on file) distributed
by AMHTA and declared that the savings under Medicaid
expansion in regards to 24 hour inmate hospitalizations
were real.
10:00:41 AM
Mr. Jessee identified a critical point related to 24 hour
hospitalizations; whether the inmates would have access to
Medicaid when they were released from the hospital. He
stressed the importance of providing support for sobriety
and recovery when released from prison; 65 percent of
inmates were AMHTA beneficiaries and over 80 percent of
inmates had substance abuse problems. He elucidated that
Medicaid eligibility was a critical piece of funding for
criminal justice reformation due to the importance of
providing services in order to keep recidivism down. The
trust viewed Medicaid expansion as a way to accelerate
providing services to beneficiaries at lower costs to the
state. He thought that the work could be done, but it would
be much more difficult without Medicaid expansion. He
believed that without addressing substance abuse issues
criminal justice reform and recidivism would be nearly
impossible.
Representative Wilson referred to the 24-hour hospital stay
and asked for verification that Medicaid expansion would
apply "to the new group and not for the current group."
Mr. Jessee answered that Medicaid expansion applied to
anyone currently in prison that was eligible for Medicaid.
Representative Wilson asked how many inmates currently
stayed in the hospital longer than 24 hours. Mr. Jessee
pointed to the inmate count on the chart titled "Alaska
Inmate Hospitalization Costs FY 12-15" (copy on file).
Vice-Chair Saddler noted that one of Mr. Jessee's
"underpinning" of support for Medicaid expansion was
substance abuse treatment in order to reduce recidivism. He
asked how many times an individual needed treatment and
what obligation did the state have to keep sending an
individual to expensive treatment services in order to
reduce recidivism. Mr. Jessee answered that in his case it
took one time in a treatment program to achieve sobriety
and for others it varied. He delineated that the experience
was not different than other diseases like diabetes where
success of treatment and follow up also varied. He thought
that follow-up played a major part in minimizing relapses.
He emphasized that relapses were a common occurrence in
addiction.
10:06:48 AM
Representative Pruitt asked for an interpretation of the
graphs distributed by the trust. Mr. Jessee explained that
in viewing the graphs moving from left to right the lines
represented the numbers of individuals and what the costs
were per person. He exemplified the 50 mark and
extrapolated that 50 inmates hospitalizations for over 24
hours costs $10 thousand per person and increased to $50
thousand for the next 50 inmates and continued until the
line spiked upward. He concluded that a relatively small
number of inmates hospitalizations were very expensive.
Representative Pruitt could not see the correlation with
the graphs and the points that Mr. Jessee was making. Mr.
Jessee deduced that the cost of inmates going into the
hospital remained relatively stable from year to year and
therefore the costs and savings were predictable.
Co-Chair Neuman related that up to 95 percent of the costs
in Medicaid could be associated to 5 percent of the
Medicaid recipients which were trust beneficiaries. He
stated that managed care was broad ranging. He wanted Mr.
Jessee to better define managed care in relation to
beneficiaries and discuss the different services that could
be provided.
10:11:55 AM
Representative Gattis asked why private industry could not
provide services under managed care and why private
insurers were not offering managed care services
particularly if it realized savings for private insurers.
Mr. Jessee stated that private insurers were moving towards
managed care services through health fairs and
informational emails. He disliked the term managed care
because for many it meant a set fee for service system of
managing payment. He stated that the most important goal
was to assist beneficiaries to become smarter utilizers of
services because many were high users of mental health care
as well as health care in general.
Representative Wilson asked why the trust had not offered a
private insurance policy specifically for beneficiaries and
used trust funding as an insurance policy. She wondered why
the trust had not explored an insurance model. Mr. Jessee
stated that the Trust had already invested in medical home
pilot programs in partnership with the Department of Health
and Social Services (DHSS) and was looking into that
option. He furthered that the Trust was not in a financial
position to become an insurance company and was proposing
placing the beneficiaries into an insurance plan called
"Medicaid expansion." Representative Wilson felt that he
missed her point. She asked why the trust did not invest
the millions of dollars that the trust had already spent in
programs and provided beneficiaries insurance policies
instead of investing in programs. Mr. Jessee replied that
it would be too expensive for the Trust and "beyond its
means" to provide insurance coverage for thousands of
individuals. However, the Trust could provide some capital
for system reformation.
10:17:15 AM
Vice-Chair Saddler stated that his son was a trust
beneficiary and received a Medicaid waiver. He understood
that the decision by the trust to cover the administrative
costs of Medicaid expansion "diluted" the expenditure by
including non-beneficiaries. He wondered whether the trust
was concerned over the dilution of trust funds and who in
the trust decided to pay for the administrative costs of
expansion. He asked for clarification regarding the
decision making process. Mr. Jessee reported that the
trustees made the decision and would review it in May,
2015. The trustees were always concerned when an investment
was made that benefited people outside of the beneficiary
pool. He elaborated that if the reform was "systemic" and
would benefit beneficiaries "over the long haul" the
trustees would consider paying administrative costs a good
investment even if it helped non-beneficiaries.
10:19:15 AM
Representative Edgmon wondered whether information was
available that discussed what "the building blocks of the
argument really are." He listed reform, costs, benefits,
and structural changes; administrative and statutory as
necessary for expansion. He wondered whether a white paper
that distilled expansion issues into one or two pages was
available.
Co-Chair Neuman remarked DHSS was taking notes on his
request and would hopefully provide the information to
Representative Edgmon.
HB 148 was HEARD and HELD in committee for further
consideration.
ADJOURNMENT
10:21:11 AM
The meeting was adjourned at 10:21 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 148 Inmate Hospital Costs.pdf |
HFIN 4/10/2015 9:00:00 AM |
HB 148 |