Legislature(2019 - 2020)ADAMS 519
03/05/2020 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB127 | |
| HB182 | |
| HB30 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | HB 127 | TELECONFERENCED | |
| += | HB 182 | TELECONFERENCED | |
| += | HB 30 | TELECONFERENCED | |
HOUSE FINANCE COMMITTEE
March 5, 2020
1:36 p.m.
1:36:07 PM
CALL TO ORDER
Co-Chair Johnston called the House Finance Committee
meeting to order at 1:36 p.m.
MEMBERS PRESENT
Representative Neal Foster, Co-Chair
Representative Jennifer Johnston, Co-Chair
Representative Dan Ortiz, Vice-Chair
Representative Andy Josephson
Representative Bart LeBon
Representative Kelly Merrick
Representative Colleen Sullivan-Leonard
Representative Cathy Tilton
Representative Adam Wool
MEMBERS ABSENT
Representative Ben Carpenter
Representative Gary Knopp
ALSO PRESENT
Representative Ivy Spohnholz, Sponsor; Melissa Hill,
Administrative Operations Manager, Division of Health Care
Services, Department of Health and Social Services,
Anchorage; Representative Geran Tarr, Sponsor; Carmen
Lowery, Executive Director, Alaska Network on Domestic
Violence and Sexual Assault; Elise Sorum-Birk, Staff,
Representative Andy Josephson; Scott Jordan, Director,
Division of Risk Management, Department of Administration.
PRESENT VIA TELECONFERENCE
Dominic Wenzell, Dentist and Board Member, Alaska Board of
Dental Examiners, Anchorage; Katrina Virgin, President,
Alaska Dental Hygienists Association, Kodiak; Renee
Gayhart, Division Director, Healthcare Services, Department
of Health and Social Services; Grey Mitchell, Director,
Division of Workers' Compensation, Department of Labor and
Workforce Development.
SUMMARY
HB 30 WORKERS' COMP: DEATH; PERM PARTIAL IMPAIR
HB 30 was HEARD and HELD in committee for further
consideration.
HB 127 DENTAL HYGIENIST ADVANCED PRAC PERMIT
HB 127 was HEARD and HELD in committee for
further consideration.
HB 182 SEXUAL ASSAULT EXAMINATION KITS: TESTING
HB 182 was HEARD and HELD in committee for
further consideration.
Co-Chair Johnston reviewed the agenda for the day. She
reported that the committee would be hearing HB 127,
HB 182, and HB 30.
HOUSE BILL NO. 127
"An Act relating to the practice of dental hygiene;
establishing an advanced practice permit; prohibiting
unfair discrimination under group health insurance
against a dental hygienist who holds an advanced
practice permit; relating to medical assistance for
dental hygiene services; and providing for an
effective date."
1:36:59 PM
Co-Chair Johnston invited the bill sponsor to the table.
REPRESENTATIVE IVY SPOHNHOLZ, SPONSOR, reported that the
bill created an advanced practice permit which would allow
dental hygienists to provide care for underserved
populations at senior centers, healthcare facilities, day
cares and schools. Dental hygienists would be allowed to
provide care to Alaskans who were eligible for Public
Assistance, home bound, or lived in an underserved
community. The permit would be available for dental
hygienists who had a minimum of 4000 hours of clinical
experience and who were approved by the Alaska Board of
Dental Examiners. Alaska would not be the first state to
make such changes. Dental hygienists practiced under
advanced practice permits or similar permits in six other
states. She reported that 40 other states were considered
"direct access" states meaning that dental hygienists could
initiate treatment based on their assessment of a patient's
need without the authorization or the presence of a
dentist.
1:38:31 PM
Co-Chair Johnston OPENED Public Testimony.
1:38:45 PM
DOMINIC WENZELL, DENTIST AND BOARD MEMBER, ALASKA BOARD OF
DENTAL EXAMINERS, ANCHORAGE (via teleconference), reported
that the board agreed the bill addressed the concerns it
initially had with the original Senate version. Members of
the board supported HB 127 in its current form.
1:39:55 PM
KATRINA VIRGIN, PRESIDENT, ALASKA DENTAL HYGIENISTS
ASSOCIATION, KODIAK (via teleconference), supported the
advanced practice permit. The association had seen a great
demand across the state that needed to be filled. The
dental hygienists would like to be able to practice to the
extent of their licensure and abilities.
1:40:38 PM
Co-Chair Johnston CLOSED Public Testimony on the bill. She
indicated individuals from the Department of Health and
Social Services (DHSS) were available online to address
questions regarding the fiscal note.
Representative Tilton referenced the fiscal note with an
OMB component number of 3234 and cited the cost related to
the implementation into the Alaska Health Enterprise System
of $250,000. She asked for an explanation of the cost.
MELISSA HILL, ADMINISTRATIVE OPERATIONS MANAGER, DIVISION
OF HEALTH CARE SERVICES, DEPARTMENT OF HEALTH AND SOCIAL
SERVICES, ANCHORAGE, reported that a portion of the costs
were related to hours needed to work on the adjudication
and payment process. The division needed to add the billing
provider, as it was new to the system. The cost was
approximately $187,000. Once the billing provider was added
to the system, a provider change would be necessary and
would take about 600 hours to complete and cost
approximately $63,000.
Co-Chair Johnston asked about the fiscal note for HB 127 in
comparison to the fiscal notes for SB 105 related to the
Marital and Family Therapist (LMFT) licenses and SB 134 for
licensed professional counselors. The fiscal notes for both
Senate bills were $50,000 compared to $63,000 for HB 127.
She queried the difference. Ms. Hill responded that the
current legislation created a brand-new provider type. The
previous programs could be billed under a health group. If
the division was only doing a provider type change it took
about 600 hours to do the work which cost about $50,000
previously. However, the contractor's cost per hour
increased.
1:44:17 PM
RENEE GAYHART, DIVISION DIRECTOR, HEALTHCARE SERVICES,
DEPARTMENT OF HEALTH AND SOCIAL SERVICES (via
teleconference), reported that there was a price increase
on the modification hours with the contractor which was the
difference between the cost in the previous year of $50,000
with the LMFTs and the cost of $63,000 for licensed
professional counselors. The claims related to both would
be adjudicated through the newly established ASO with
Optum, their behavioral health claims. The only cost to and
through the Healthcare Services fiscal agent was the
enrollment component. The division would not be doing the
adjudication, so the price was not included. However, the
division would be doing the claims adjudication for the
dental hygienists under their new provider type.
Representative Wool asked if 600 hours of programming was
the standard every time a provider type was added into the
system. Ms. Hill responded affirmatively.
Representative Wool asked if it was an industry standard,
or whether the software was particularly cumbersome. Ms.
Gayhart replied that the division had the system in place
with Conduent, the division' fiscal agent since 2013. New
provider types were rarely added to the system. Often, they
were added as rendering providers affiliated to a provider.
She confirmed that the cost was an industry standard for
implementing a new provider type or I.D. She confirmed that
$63,000 was standard for adding the enrollment component.
The work included completing all of the related hard coding
for the system to accept a new provider type.
Representative Wool asked about the additional amount of
$180,000. Ms. Gayhart responded that the amount was related
to claims adjudication. She explained further that the
dental hygienists were currently paid under a dental
provider's number. They had a subset of codes they could
provide for cleaning and other services. Claims
adjudication ensured that as claims came through the
system, they edited to ensure that the particular provider
type was able to bill for the codes and were paid
correctly. Claims adjudication built logic into the system
to pay claims appropriately and to deny claims that should
not be paid.
Representative Wool asked if behavioral health was easier
to enter into the system because it had fewer codes. He
asked if he was accurate. Ms. Gayhart indicated that was
because the particular claims would be run through the
administrative service organization or Optum. They were not
paid through the MMIAS which was Conduent, the fiscal agent
that the dental hygienists would be under. She continued to
explain that the LMFTs and the licensed professional
counselors were being paid through a different system.
1:49:34 PM
Vice-Chair Ortiz was aware the bill was for the purpose of
better-serving underserved folks. He wondered about driving
down other costs. Representative Spohnholz reported it was
difficult to predict cost savings that would result from
the bill. However, with folks getting more preventative
care, they would likely need less surgeries and removals
and have fewer cavities which would, in turn, lead to a
savings for the state in the future. There was a value in
preventative dental care verses only urgent and treatment
related dental. Looking at preventative dental as a whole
saved the state money. She hypothesized that by increasing
access to preventative dental care, the state would save
money down the road.
Vice-Chair Ortiz asked his question because of the
communities on the list that he was aware already had
dentists providing care including the Ketchikan Indian
Community Tribal Health Clinic. Representative Spohnholz
indicated that the practitioner would be paid less and cost
the state less.
Representative Wool noted Representative Spohnholz
asserting that the state would save money in the long run.
He asked, in an underserved area without basic dental
hygiene care, if hygienists would find several problems in
patients that would require a dentist's intervention. He
spoke of his personal experience discovering larger
problems during routine dental services. He wondered if the
sponsor had anticipated or accounted for such scenarios.
Representative Spohnholz suspected there might be an
initial short-term upswing in care from a dentist. However,
in the end it would likely cost the state less.
Co-Chair Foster commented that he supported the bill. He
relayed that the local hospital in Nome, Norton Sound
Health Corporation, served 15 villages in the region and
supported the bill.
Co-Chair Johnston indicated amendments were due on March 9,
2020 by 5:00 p.m.
HB 127 was HEARD and HELD in committee for further
consideration.
HOUSE BILL NO. 182
An Act relating to testing of sexual assault
examination kits; and providing for an effective date.
1:55:41 PM
Co-Chair Johnston invited the bill sponsor to provide a
summary of the bill.
REPRESENTATIVE GERAN TARR, SPONSOR, relayed that currently
state law required rape kits to be processed within 1 year.
The bill would change the time to 6 months.
1:56:34 PM
Co-Chair Johnston OPENED Public Testimony.
1:56:52 PM
CARMEN LOWERY, EXECUTIVE DIRECTOR, ALASKA NETWORK ON
DOMESTIC VIOLENCE AND SEXUAL ASSAULT, reviewed that the
network was a membership-based organization of 21 programs
across the state that provided community services for
victims of domestic violence. The network also engaged in
prevention work and advocacy work to create conditions
where sexual assault and domestic violence did not occur
and to ensure that victims and survivors were treated with
the utmost respect when their rights were violated. The
network had been working with Representative Tarr on
different iterations of the sexual assault kit initiative.
She was very pleased to say that the network was very
supportive of the committee substitute (CS) of HB 127. She
suggested that although 6 months did not sound like a
significant amount of time, a shorter period of getting
information back to survivors was a good thing. She
furthered that for a victim who reported a sexual assault
or a sexual violence crime, they lived in a state of
anxiety, stress, and anger while waiting for their results.
The bill would reduce the time they did not know what was
going on and providing some relief to a victim or survivor.
She thought it sent a strong message that the state cared.
Co-Chair Johnston indicated the amendments for the bill
were due by Monday, March 9, 2020 at 5:00 p.m.
1:59:36 PM
AT EASE
1:59:48 PM
RECONVENED
Co-Chair Johnston CLOSED Public Testimony.
HB 182 was HEARD and HELD in committee for further
consideration.
HOUSE BILL NO. 30
"An Act relating to the exclusiveness of liability of
an employer in the case of death; relating to the
payment of workers' compensation benefits in the case
of permanent partial impairment; relating to notice of
workers' compensation death benefits; relating to the
payment of workers' compensation death benefits
payable to a child of an employee where there is no
surviving spouse; relating to the payment of workers'
compensation death benefits for an employee without a
surviving spouse or child; and providing for an
effective date."
2:00:24 PM
Co-Chair Johnston invited the bill sponsor to the table.
REPRESENTATIVE ANDY JOSEPHSON, SPONSOR, asked if the chair
wanted a reintroduction to the bill. Co-Chair Johnston
responded in the affirmative.
Representative Josephson explained that when a person was
partially injured at work, a doctor declared whether or not
they had a degree of disability. Sometimes a disability was
obvious to the eye and, sometimes further study was
necessary. For example, a back injury might require
additional assessment. The state had a permanent-partial
impairment (PPI) rating and a whole-body multiplier. The
bill changed the whole-body multiplier which had not been
adjusted in 20 years. Alaska ranked between 40th and 50th
place amongst the 50 states in terms of impairment ratings.
The legislation would result in Alaska moving up to 26th
place in ranking in the United States. The bill deleted a
category of death benefit for the single childless worker
and replaced it with a requirement that a new worker in
Alaska received notice of their Worker's Compensation
benefits. The bill was designed to put people who were
single and childless on notice that they might want to
purchase life insurance, as there was no remedy for their
family if they were to pass away.
Representative Josephson indicated the bill made one other
provision change for a child whose parent died at work.
Currently, the child would have 4 years of medical coverage
through Worker's Compensation beginning at age 19 as long
as they were enrolled at a vocational school or college.
The bill removed the provision of having to be enrolled in
school. He provided a couple of examples. He suggested that
by removing the school stipulation, the provision was more
equitable because it captured all different kinds of people
between the ages of 19 and 23.
2:04:55 PM
Representative Wool asked if the purpose of the initial
provision was to help a person up to 23 years of age,
essentially a dependent, while they were attending school
and not earning money. He wondered if there was a
distinction between a person in school and a person in the
workforce relating to their status as a dependent.
Representative Josephson indicated that the language in
AS 23.33.95 was odd and, he was not suggesting making a
change to it. However, the way the statute was written, it
seemed to infer that a dependent could be 40 years old. If
their 65-year-old father died in the workplace because of a
work-related accident, they could be eligible for the
benefit. However, the language suggested the survivor had
to be enrolled in school at the moment of their parent's
death. Instead of making a change to the language, the bill
was stipulating that the benefit would be available from
ages 19-23.
Representative Wool asked for clarification about a
40-year-old dependent who lived with their parents, and
could not live on their own. Representative Josephson
reminded members they were referring to current law. He
opined that it did not require that a person live with
their parent. However, he agreed that there was a category
of dependents who were either cognitively or physically
disabled and could receive their weekly allowance for a
significant amount of time. It would remain the same under
the legislation.
Vice-Chair Ortiz recalled the bill sponsor reporting that
the passage of the bill would place Alaska in the middle of
the ranking of the rest of the United States for
compensation for death.
Representative Josephson responded that he was not talking
about compensation for death, which was a different matter.
The bill was talking about compensation for a permanent
injury. He reported that the Department of Labor and
Workforce Development (DOL) two years prior reported that
for the loss of an arm from the shoulder down Alaska was
32nd in payment rankings. He furthered that Alaska ranked
33rd in compensation for the loss of a hip, 35th for the
loss of an eye, 33rd for the loss of an ear. He believed
Alaska's rankings were worse because there were about 10 or
11 states that had a different way of calculating loss. He
referred to an information sheet which he held up from DOL
that showed the loss of 1 eye at work Alaska was not on
the page. The page had to be flipped to find Alaska. If a
person lost an eye at work in Maryland, the Worker's
Compensation Plan would pay just over $250,000. If a person
were to lose their eye at work in Alaska, they would
receive $44,000 or less than 20 percent of what they would
receive in Maryland.
ELISE SORUM-BIRK, STAFF, REPRESENTATIVE ANDY JOSEPHSON,
noted the number used in the bill was based on inflation.
Co-Chair Johnston invited Mr. Mitchell to discuss the
fiscal notes.
2:10:14 PM
GREY MITCHELL, DIRECTOR, DIVISION OF WORKERS' COMPENSATION,
DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT (via
teleconference), relayed that the department had 2 fiscal
notes. The first dealt with the Worker's Compensation
component. The fiscal note illustrated a revenue increase
associated with increasing the permanent-partial impairment
benefits. The revenue increase was estimated to be $110,000
per year. The fiscal note showed an increase of $55,000 for
FY 21 and an increase of $110,000 per year from FY 22
through FY 26. The amount was based on a 44 percent
increase in PPI benefits. He elaborated that the reason the
revenue increased to the division was because there were 2
taxes. The first tax was collected by the Division of
Insurance on all premiums issued. The increase of 44
percent was expected to increase premiums in a like amount.
The other revenue source was a service fee placed on self-
insured employers such as the State of Alaska and other
large employers that had the resources to self-insure. The
insurers were required to pay 2 percent of all the
indemnity benefits they paid out over the year.
Mr. Mitchell reviewed the second fiscal note which dealt
with the Second Injury Fund. He explained that in Alaska
there was a fund that paid benefits for workers who had
pre-existing conditions and who had claims that met certain
conditions. In order to pay the claims, there was an
assessment against of all of the indemnity benefits that
were paid out over a year by all employers. He expounded
that the assessment was based on the amount of revenue in
the account at a given time over the year. The claims that
were charged against the account determined a reserve rate.
He reported in the previous year the reserve rate was set
at 5 percent. He suggested that for every dollar of
indemnity benefit payment, an employer was required to
submit 5 percent to the Second Injury Fund. The increase
was based on an estimate of an increase of $4.2 million in
indemnity payments. He continued that the amount was based
on indemnity payments that were made in 2018 multiplied by
44 percent. The estimated amount of the increase was
$105,000 in FY 21 and $210,000 each year for FY 22 through
FY 26.
2:14:52 PM
Representative Wool referred to language on the second page
of the fiscal note which stated:
"Studies indicate that significant benefit increases
are typically accompanied by changes in claimant
behavior. Changes in claimant behavior might result in
an increased number of PPI claims."
Representative Wool asked if more people would claim they
lost their eye because they would receive additional money.
He did not see how extra claims would result. He suggested
the loss of a limb would be difficult to fake.
Mr. Mitchell responded that Representative Wool's statement
was true. The National Council of Compensation Insurance
(NCCI) had done an extensive evaluation based on the
previous year's version of HB 30. The language was in the
previous year's analysis. He suggested that changing the
benefits to such a large amount, 44 percent, in a single
year might influence claimant behavior. It was a
consideration. He agreed that no one would fake the loss of
an eye or a similar injury. He reported that because the
language was included in the NCCI analysis, the division
included it in the fiscal note explanation.
Representative Wool just wanted to point it out.
Mr. Mitchell clarified that Mr. Jordan had a separate
fiscal note from the Department of Administration to
review. The fiscal note showed the effect the bill would
have on an employer. The note showed the cost to the state
related to increasing the PPI benefit amount.
2:17:11 PM
SCOTT JORDAN, DIRECTOR, DIVISION OF RISK MANAGEMENT,
DEPARTMENT OF ADMINISTRATION, reported that the
department's fiscal note reflected the 44 percent increase
on what the state paid out for the PPI rating. The fiscal
note reflected a 10-year average of what it paid out which
was $979,286 per year. The amount fluctuated from year-to-
year. He continued that the 44 percent increase would
increase the amount by $434,313 and the fee that Director
Mitchell had mentioned was also included for $26,059. The
fiscal note for FY 21 was half of the amount because the
effective date would be half of the year or $230,200. In
the out years from FY 22 through FY 26 the amount would be
$460,400 per year.
Representative Josephson wanted to see a fiscal note
because the point of the bill was to provide more benefit.
He noted that in the Worker's Compensation Annual Report
from 2018 showed total compensation payments statewide had
decreased from $292 million in 2015 to $225 million in
2018. He was unclear the reason for the change. The
decrease was about $70 million in indemnity and medical
benefit payments.
Co-Chair Johnston reported the amendments were due by
March 9, 2020 at 5:00 PM. She relayed the agenda for the
following day.
HB 30 was HEARD and HELD in committee for further
consideration.
ADJOURNMENT
2:20:33 PM
The meeting was adjourned at 2:20 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 127 Dental Health Provider Shortage Areas 3.3.2020.pdf |
HFIN 3/5/2020 1:30:00 PM |
HB 127 |
| HB127 Letters of Support 05.01.19.pdf |
HFIN 3/5/2020 1:30:00 PM |
HB 127 |
| HB 127 Response to Qusestions HFIN 3.3.2020.pdf |
HFIN 3/5/2020 1:30:00 PM |
HB 127 |
| HB 182 ANDVSA Letter of Support.pdf |
HFIN 3/5/2020 1:30:00 PM |
HB 182 |
| HB 182 RAINN 2.27.20.pdf |
HFIN 3/5/2020 1:30:00 PM |
HB 182 |