Legislature(2023 - 2024)ADAMS 519
04/01/2024 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Adjourn | |
| Start | |
| Amendments |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 268 | TELECONFERENCED | |
| += | HB 270 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
HOUSE FINANCE COMMITTEE
April 1, 2024
2:35 p.m.
2:35:45 PM
CALL TO ORDER
Co-Chair Johnson called the House Finance Committee meeting
to order at 2:35 p.m.
MEMBERS PRESENT
Representative Bryce Edgmon, Co-Chair
Representative Neal Foster, Co-Chair
Representative DeLena Johnson, Co-Chair
Representative Julie Coulombe
Representative Mike Cronk
Representative Alyse Galvin
Representative Sara Hannan
Representative Andy Josephson
Representative Dan Ortiz (via teleconference)
Representative Will Stapp
Representative Frank Tomaszewski
MEMBERS ABSENT
None
ALSO PRESENT
Alexei Painter, Director, Legislative Finance Division.
SUMMARY
HB 268 APPROP: OPERATING BUDGET; CAP; SUPP; AM
HB 268 was HEARD and HELD in committee for
further consideration.
HB 270 APPROP: MENTAL HEALTH BUDGET
HB 270 was HEARD and HELD in committee for
further consideration.
Co-Chair Johnson reviewed the meeting agenda. The committee
would consider amendments to the operating and mental
health budgets.
HOUSE BILL NO. 268
"An Act making appropriations for the operating and
loan program expenses of state government and for
certain programs; capitalizing funds; amending
appropriations; making capital appropriations; making
supplemental appropriations; making reappropriations;
making appropriations under art. IX, sec. 17(c),
Constitution of the State of Alaska, from the
constitutional budget reserve fund; and providing for
an effective date."
HOUSE BILL NO. 270
"An Act making appropriations for the operating and
capital expenses of the state's integrated
comprehensive mental health program; and providing for
an effective date."
^AMENDMENTS
2:35:57 PM
Co-Chair Johnson relayed that the committee had left off in
the prior meeting on Amendment N 37.
2:36:42 PM
Representative Josephson MOVED to ADOPT Amendment N 37
(copy on file):
Agency: Environmental Conservation
Appropriation: Administration
Allocation: Administrative Services
Transaction Details
Title: Add an Analyst/Programmer 4 Position for
Permitting Issues
Section: Section 1
Type: Inc
Line Items (Amounts are in thousands)
Personal Services: 139.1
Travel: 0.0
Services: 0.0
Commodities: 0.0
Capital Outlay: 0.0
Grants: 0.0
Miscellaneous: 0.0
139.1
Positions
Permanent Full-Time: 1
Permanent Part-Time: 0
Temporary: 0
Funding (Amounts are in thousands)
1004 Gen Fund 139.1
Explanation
DEC permit processing is time intensive and difficult
to navigate. This amendment would add a new
Analyst/Programmer 4 position solely to take on this
task.
Representative Stapp OBJECTED for discussion.
Representative Josephson explained that the amendment was
inspired by a conversation with a legislator who sat on the
Department of Environmental Conservation (DEC) finance
subcommittee. The legislator had told him that many DEC
permits were not processed quickly. His colleague described
a surprising system in which applicants used their My
Alaska account, but the DEC permit renewal processes did
not carry over information from existing approved permits.
Representative Josephson continued that the amendment would
add a new analyst position to help improve the process.
Some renewals required applicants to simply restate much of
the original application on a fillable PDF. When a permit
was approved by DEC, the department usually published the
permit itself but often not the application that led to
that permit, even though the applications were public
records accessible by request. Requiring public records
requests for the documents made it difficult for applicants
to model applications after successful examples, increasing
workloads for applicants and lowering the quality of
incoming permit applications. The amendment would also seek
to address a problem encountered in a member's professional
work. There was a complaint heard by many in the
construction industry that DEC permit applications and rule
processes were extremely difficult to navigate. He
explained that his colleague on the DEC subcommittee
concluded that the amendment would help fix the problem.
2:39:01 PM
Representative Tomaszewski remarked that he was not aware
of any conversation on the topic during the subcommittee
process. He was curious why the problem was being brought
up during the budget process and whether the new employee
would be stationed in a particular location.
Representative Ortiz commented that he was in support of
the amendment. He thought the amendment would help the
state be "even more open for business." He thought the
legislature would want to be in support of projects that
helped build the economy and a faster permitting process.
Representative Cronk asked if the issue was brought up in
the DEC subcommittee.
Representative Tomaszewski added that he did not recall
seeing the amendment during the subcommittee process and
was confused by it.
Representative Cronk MAINTAINED the OBJECTION.
Representative Josephson added that the new employee
requested by the amendment would be located in Anchorage.
2:41:32 PM
A roll call vote was taken on the motion.
IN FAVOR: Galvin, Josephson, Ortiz
OPPOSED: Coulombe, Cronk, Stapp, Tomaszewski, Hannan,
Edgmon, Foster, Johnson
The MOTION to adopt Amendment N 37 FAILED (3/8).
2:42:27 PM
Representative Josephson MOVED to ADOPT Amendment N 38
(copy on file):
Agency: Family and Community Services
Appropriation: Children's Services
Allocation: Children's Services Management
Transaction Details
Title: Reduce One-Time Increment for Legal Services to
Address Class Action Lawsuit
Section: Section 1
Type: Dec
Line Items (Amounts are in thousands)
Personal Services: 0.0
Travel: 0.0
Services: -500.0
Commodities: 0.0
Capital Outlay: 0.0
Grants: 0.0
Miscellaneous: 0.0
-500.0
Positions
Permanent Full-Time: 0
Permanent Part-Time: 0
Temporary: 0
Funding (Amounts are in thousands)
1004 Gen Fund -500.0
Explanation
The Department of Family and Community Services and
Office of Children's Services has been served with a
large class action lawsuit, A Better Childhood. The
lawsuit seeks compensation in the form of a consent
decree; consent decrees are extremely expensive with
average estimates over $15 million and continue over a
decade if the lawsuit prevails. This funding will
allow the department to retain legal counsel through a
reimbursable services agreement with the Department of
Law, procure expert witness testimony, and initiate a
public relations campaign.
This would decrement half the IncOTI appropriation.
Representative Stapp OBJECTED for discussion.
Representative Josephson explained the amendment. He
relayed that his colleague Representative Zack Fields had
discussed the lawsuit against the Office of Children's
Services (OCS) in the Department of Family and Community
Services (DFCS) subcommittee. There was a temporary one-
time increment of $1 million required to pay for legal
services to address the class action lawsuit. He explained
that the increment would allow the department to retain
additional legal counsel via a reimbursable services
agreement with the Department of Law (DOL) to pay for legal
services, procure expert witness testimony, and initiate a
public relations campaign. He found the public relations
campaign component interesting.
Representative Josephson shared that he asked his staff to
research the lawsuit. He noted that the Legislative Finance
Division (LFD) indicated that the lawsuit sought
compensation in the form of a consent decree. He could
infer that the litigants, an entity called A Better
Childhood (ABC) wanted the state to concede that OCS was
not performing well. The lawsuit alleged that OCS failed to
provide adequate case management and permanency planning
services and did not provide the required monetary and
licensure support to foster families and children. He
thought the allegations were partially true because the
state was offering OCS more money. He relayed that Mother
Jones magazine wrote about the topic and discussed the
symbiotic relationship between child welfare agencies.
There were too many children in custody and not enough
places to put them. There were large for-profit companies
with beds to fill.
Representative Josephson conceded that Mother Jones was a
progressive magazine, but nonetheless, the magazine talked
about North Star Behavioral Health's parent company,
Universal Health Services, which settled in another similar
case with the U.S. Department of Justice for $122 million
in 2020. He wondered why the state did not settle. There
were records of OCS billing for medically unnecessary
inpatient behavioral health services, failing to provide
adequate and appropriate services, and paying illegal
inducements to federal health care beneficiaries. The
investigation stated that Alaska had one of the highest
placements of foster kids in residential treatment
facilities. Children were being treated as psychiatric
problems. Suicidal ideation was used overwhelmingly as an
excuse but often it was a response to being
institutionalized. Administering drugs to ensure compliance
was a common practice. One OCS foster kid in the Mother
Jones profile was in North Star's care for five years.
2:47:31 PM
Representative Stapp made a point of order. He requested
that Representative Josephson speak to the amendment and
not about a lawsuit that was not relevant to the funding
request.
Representative Josephson remarked that he was not speaking
about a lawsuit but about an article that did not concern
the lawsuit. He noted that in New Jersey litigation, ABC
had forced change with diligent court-ordered monitoring
and now only 5 percent of foster kids were in group homes
or residential treatment centers. The point that was made
in subcommittee was that the lawsuit should settle
prudently. He understood that LFD likely read something
that suggested the state wanted to initiate a public
relations campaign. He did not want to do a public
relations campaign and he was asking for funding for DFCS
and to save the state half a million dollars in the current
year.
Representative Stapp expressed that he did not support the
amendment. The department was requesting $1 million for its
own legal defense on an ongoing lawsuit and he did not
think it was wise for the legislature to take a position on
the lawsuit. He noted that there were active litigations
and depositions that were occurring presently. He thought
that decrementing the funding would harm the department's
ability to defend itself against a lawsuit.
Representative Cronk MAINTAINED the OBJECTION.
2:50:25 PM
A roll call vote was taken on the motion.
IN FAVOR: Hannan, Josephson, Ortiz
OPPOSED: Coulombe, Cronk, Stapp, Tomaszewski, Galvin,
Edgmon, Foster, Johnson
The MOTION to adopt Amendment N 38 FAILED (3/8).
2:51:14 PM
AT EASE
2:52:23 PM
RECONVENED
Co-Chair Johnson announced that Amendment N 39 and
Amendment N 40 would be rolled to the bottom of the list in
order to allow Representative Ortiz to offer them in
person.
Representative Josephson requested that Amendment N 41 be
rolled to the bottom as well.
2:53:27 PM
Representative Josephson MOVED to ADOPT Amendment N 42
(copy on file):
Agency: Health
Appropriation: Medicaid Services
Allocation: Medicaid Services
Transaction Details
Title: Funding for Federally Qualified Health Centers'
Medicaid Payments
Section: Section 1
Type: Inc
Line Items (Amounts are in thousands)
Personal Services: 0.0
Travel: 0.0
Services: 0.0
Commodities: 0.0
Capital Outlay: 0.0
Grants: 1,500.0
Miscellaneous: 0.0
1,500.0
Positions
Permanent Full-Time: 0
Permanent Part-Time: 0
Temporary: 0
Funding (Amounts are in thousands)
1004 Gen Fund 1,500.0
Explanation
The Alaska Primary Care Association has requested a
$1.5 million appropriation for support to the
Department to accomplish the Federally Qualified
Health Center's Medicaid payment requests in order to:
1) Adjust PPS rates for inflation adjustment
unlawfully withheld (MEI).
2) Provide Alaska FQHCs accurate and legal Medicaid
payment for services delivered to patients who have
coverage from both Medicare and Medicaid (known as
dual eligibles).
3) Amend regulations and procedures to provide FQHCs
meaningful opportunities to apply for scope changes.
4) Revise and clarify new start policies for Alaska
FQHCs.
5) Revise and clarify FQHC Medicaid cost reporting
deadlines, processes, and requirements for APM rebase.
Representative Stapp OBJECTED for discussion.
Representative Josephson explained the amendment. He
relayed that the Alaska Primary Care Association (APCA) had
requested $1.5 million for support to the Department of
Health (DOH) to accomplish the Medicaid payment requests
from Federally Qualified Health Centers (FQHC). The funding
would help adjust Prospective Payment System (PPS) rates
with inflation. The amendment would help provide Alaska
FQHCs with accurate and legal Medicaid payments for
services delivered to patients with coverage from both
Medicare and Medicaid, known as dual eligibles.
Additionally, it would amend regulations and procedures to
provide FQHCs with meaningful opportunities to apply for
scope changes as well as revise and clarify new start
policies and FQHC Medicaid cost reporting deadlines,
processes, and requirements for Advanced Alternative
Payment Models (APMs) rebates. He reiterated that APCA was
seeking an appropriation of $1.5 million for support to the
department to accomplish the Medicaid payment requests that
he outlined. He thought that APCA had a strong case and the
repayment was necessary.
2:55:33 PM
Representative Stapp understood that the request was for
$1.5 million to the department's rate rebasement study. He
had asked the department if it needed the money and he was
told that it did not because it was already rebasing rates
for FQHCs. The state unlawfully withheld the rate
rebasement increase and there was certainly a dispute
between FQHCs. If FQHCs were entitled to the Medicare rate
or the Medicaid rate for reimbursements through the
publicly funded program, the FQHCs would argue that the
centers were entitled to the full Medicaid rate. He thought
that the $1.5 million request for the debasement study of
the rates was necessary because it was already being done.
The department did not need an additional $1.5 million.
Representative Cronk MAINTAINED the OBJECTION.
Representative Galvin commented that she had also heard
from APCA and she did not understand that it was asking for
funding for the rate rebasement study, but to be paid an
amount that better fit the services that the association
was providing. She relayed that APCA was currently
struggling to make ends meet because of the differences in
reimbursement rates. She understood that the association
presently needed payment.
Representative Josephson remarked that Representative
Galvin was correct and the amendment reflected her
comments. The adjusted PPS rates would adjust for inflation
and the funding would provide for much more than simply
another study.
2:59:12 PM
A roll call vote was taken on the motion.
IN FAVOR: Galvin, Hannan, Josephson, Ortiz
OPPOSED: Coulombe, Cronk, Stapp, Tomaszewski, Edgmon,
Foster, Johnson
The MOTION to adopt Amendment N 42 FAILED (4/7).
2:59:57 PM
Representative Josephson MOVED to ADOPT Amendment N 43
(copy on file):
Agency: Health
Appropriation: Public Health
Allocation: Epidemiology
Transaction Details
Title: Adopt Remaining Recommendations in the Alaska
Tuberculosis Elimination Plan (FY25-FY30)
Section: Section 1
Type: IncT
Line Items (Amounts are in thousands)
Personal Services: 0.0
Travel: 0.0
Services: 0.0
Commodities: 1,600.0
Capital Outlay: 0.0
Grants: 0.0
Miscellaneous: 0.0
1,600.0
Positions
Permanent Full-Time: 0
Permanent Part-Time: 0
Temporary: 0
Funding (Amounts are in thousands)
1003 GF/Match 1,600.0
Explanation
The Division of Public Health proposed increments for
the purpose to enacting recommendations from the
Alaska Tuberculosis Elimination Plan. Alaska's
indigenous populations are disproportionately affected
by this disease, and the Alaska TB Elimination Plan
outlines strategies to reduce the infection among
those populations by 25% of people by 2031.
In order to effectively screen, detect and treat TB
before it becomes infectious, the Division requires
this appropriation. The Governor decremented the TB
appropriation in his proposed budget, and $350,000 was
restored in the House Finance Department of Health
subcommittee, but this is inadequate to appropriately
implement this plan.
Representative Cronk OBJECTED for discussion.
Representative Josephson explained the amendment. He could
not understand why the governor was alarmed by the rate of
tuberculosis in the previous year and seemed no longer
concerned. He recalled that the governor was not alarmed by
syphilis rates in Alaska either, but thought that funding
was restored in a previous budget. The governor put a
smaller sum than had been appropriated in FY 24 into the FY
25 "bucket" with an emphasis on curbing syphilis in the
state. He relayed that tuberculosis was an issue when he
lived in Western Alaska. He was warned to stay away from
particular students due to their cough.
Representative Josephson explained that there was a
national article from February of 2024 that stated that
tuberculosis rates remained high in Alaska, Nevada, South
Carolina, and Washington state even after the pandemic. A
course of treatment for one tuberculosis case could cost
around $20,000 in the U.S.; however, a drug resistant case
could cost at least $182,000. The article went on to say
that Alaska had the highest tuberculosis rates. The number
of cases per 100,000 residents surged from 7.9 in 2021 to
13 in 2022. Advocates and medical professionals had been
pushing for more state funding for tuberculosis in Alaska.
Representative Josephson noted that Brian Lefferts, the
environmental health and engineering director of the Yukon-
Kuskokwim Health Corporation (YKHC), which represented 58
tribes, said the state contributed about $960,000 through a
tuberculosis and congenital syphilis prevention grant. Mr.
Lefferts stated that Alaska continued to have a huge
tuberculosis problem. Alaska's community testing efforts
focused on areas with the highest rates, including Alaska
Native communities in the southwestern and northern regions
of the state. In 2022, the state saw 95 cases, which was a
64 percent increase from the previous year. The article
quoted Ms. Kelleher, an Koyukon Athabaskan individual from
Nome, who spoke about the different manifestations of
tuberculosis. Ms. Kelleher said that there were other types
of tuberculosis that could affect the bones or kidneys. He
had not received a satisfactory explanation from the
administration on why there was such a reduced focus on
tuberculosis over the course of a year.
3:04:21 PM
Representative Stapp thought that the money for
tuberculosis was in a particular "track" in last year's
budget and it was not included in the current year's
budget. He indicated that money was added back into the
budget specifically for tuberculosis. He did not think the
funding should be increased at the current time. There was
already a multi-year funding mechanism that was used to
gauge how effective the state's resources could be against
tuberculosis and syphilis. If the efforts went well, he
would be happy to revisit the subject next year. He
believed in results-based budgeting and thought that the
appropriation was sufficient for the time being. He
appreciated Representative Josephson bringing up the issue
and noted that it was a challenge, especially in some of
the more rural communities of the state.
Representative Galvin understood that the funding increased
from $0 to $350,000, but it was much less than the $1.6
million request. Considering how quickly tuberculosis could
spread, she was concerned that the legislature might not be
able to compile a supplemental quickly enough to properly
address an outbreak. She was not sure that $350,000 would
be enough. She was in support of the amendment.
3:06:56 PM
Representative Ortiz asked Representative Stapp what
tuberculosis rates "going well" would mean. He recalled
that Representative Stapp would be supportive of revisiting
the subject if efforts were going well. He wondered why the
subject would need to be revisited if the rates were
decreasing. The budget was about making choices and
determining priorities. If tuberculosis rates were starting
to increase, particularly amongst indigenous populations,
it would seem that addressing the spread would be a
priority for the legislature. He agreed that the increase
from $350,000 to $1.6 million was substantial. He wanted to
offer a conceptual amendment to the amendment to bring the
total from $1.6 million to $1 million.
Representative Ortiz MOVED to ADOPT conceptual Amendment 1
to Amendment N 43.
Representative Stapp OBJECTED. He noted that the budget
included $500,000 in funding split between epidemiology,
public health labs, and nursing. The underlying Amendment N
43 was only referencing epidemiology. He thought that
tuberculosis was a relatively new recipient of resourcing
and it would be beneficial to be able to measure the
results of the funding. He did not support the conceptual
amendment because he wanted to be certain of the results of
the funding before allocating additional funding. The
funding was a temporary increment and was revisited every
year. He thought revisiting it was a useful accountability
metric.
Representative Stapp MAINTAINED the OBJECTION.
3:10:18 PM
A roll call vote was taken on the motion.
IN FAVOR: Galvin, Hannan, Josephson, Ortiz
OPPOSED: Coulombe, Cronk, Stapp, Tomaszewski, Edgmon,
Foster, Johnson
The MOTION to adopt conceptual Amendment 1 to Amendment N
43 FAILED (4/7).
3:11:17 PM
Co-Chair Johnson noted that the underlying Amendment N 43
was back before the committee.
Representative Josephson noted that Mr. Lefferts stated
that Alaska contributed about $960,000 towards prevention
through a tuberculosis and congenital syphilis prevention
grant. He assumed that the funding was only allocated to
YKHC. He relayed that Mr. Lefferts expressed that the state
continued to have an enormous tuberculosis problem and it
could be doing more to combat it.
Representative Cronk MAINTAINED the OBJECTION.
3:11:58 PM
A roll call vote was taken on the motion.
IN FAVOR: Galvin, Hannan, Josephson, Ortiz
OPPOSED: Coulombe, Cronk, Stapp, Tomaszewski, Edgmon,
Foster, Johnson
The MOTION to adopt Amendment N 43 FAILED (4/7).
3:12:47 PM
Representative Josephson relayed that he would not be
offering Amendment N 44 or Amendment N 45.
3:13:23 PM
Representative Josephson MOVED to ADOPT Amendment N 46
(copy on file):
Agency: Health
Appropriation: Medicaid Services
Allocation: Medicaid Services
Transaction Details
Title: Medicaid Rate Rebasing for Developmental
Disability and Personal Care Services
Section: Section 1
Type: Inc
Line Items (Amounts are in thousands)
Personal Services: 0.0
Travel: 0.0
Services: 0.0
Commodities: 0.0
Capital Outlay: 0.0
Grants: 15,000.0
Miscellaneous: 0.0
15,000.0
Positions
Permanent Full-Time: 0
Permanent Part-Time: 0
Temporary: 0
Funding (Amounts are in thousands)
1002 Fed Rcpts 7,500.0
1003 GF/Match 7,500.0
Explanation
Last year, the legislature approved a $15 million
increment for Direct Service Provider and Personal
Care Assistant rate increases. However, more funding
is needed to maintain healthy rate increase that
provide adequate funding in light of increased
inflation. This amendment would appropriate $7.5
million to match $7.5 million in federal dollars,
giving DPS and PCA rates a $15 million increase.
Representative Cronk OBJECTED for discussion.
Representative Josephson explained the amendment. He
reminded members that the committee had heard from over 20
different Alaskans who worked as caregivers who all pled
for assistance from the legislature. In the prior year, the
legislature approved a $15 million increment for Direct
Service Provider (DSP) and Personal Care Assistant (PCA)
rate increases. He argued that more funding was needed in
order to properly improve the rates. The amendment would
appropriate $7.5 million to match a $7.5 million investment
from the federal government. Overall, DSPs and PCAs would
receive $15 million. He shared that one of the largest
contingents of Alaskans who called in to ask for assistance
were seeking the content of Amendment 46. He reiterated
that Alaskans working in the field had expressed
overwhelming support for the amendment. The amendment would
also allow individuals receiving care to remain in their
homes rather than moving to a group home or facility, which
would provide a net savings to the state. He added that the
governor approved the concept in the prior year.
Representative Stapp remarked that he did not think the
amendment would accomplish the same thing that had been
discussed in the prior year. He did not remember the item
being removed in the FY 25 budget. He understood that the
home health care items remained in the budget.
3:16:52 PM
AT EASE
3:25:57 PM
RECONVENED
Co-Chair Johnson noted that the committee was still
discussing Amendment N 46.
Representative Ortiz stated that he was in full support of
the amendment. The strategy employed by the amendment was
called upstream spending and would ultimately save money
for the state. He thought that adopting the amendment would
show that the committee was responsive to public comment.
The committee had heard more public testimony about the
need for better pay for personal care assistants than any
other topic. He relayed that the committee had a
responsibility to respond to public comments and the need
was apparent. Studies showed that when individuals needing
care remained in their homes as long as possible, there
were better results and the state saved money.
Representative Cronk commented that the majority of the
public testimony callers were in support of senior care
services. While he supported the idea of the funding, he
could not support the funding until he knew where it was
going. He agreed that the providers should be receiving
more funding and that individuals needing care should stay
in their homes as long as possible. He thought it was
important to ensure that the money would be going to the
caretakers directly. He was in opposition to the amendment.
Representative Josephson agreed that it was a difficult
task to determine how to best provide compelling pay. He
relayed that many people who called in and provided
testimony said that they were unable to make ends meet on a
caretaker's salary. The testifiers were not only caretakers
for seniors, but for other individuals who needed a similar
level of care. For example, he recalled that Ms. Vanessa
Cunningham spoke about her son being housebound after being
in a tragic car crash many years ago and her son needed
constant care. The Alaska State Senate at one point in the
budget in 2023 afforded DSPs and PCAs $30 million, but the
funding was reduced to $15 million. He stressed that the
issue was seen as prudent in the prior year.
Representative Cronk MAINTAINED the OBJECTION.
3:30:58 PM
A roll call vote was taken on the motion.
IN FAVOR: Galvin, Hannan, Josephson, Ortiz
OPPOSED: Coulombe, Cronk, Stapp, Tomaszewski, Edgmon,
Foster, Johnson
The MOTION to adopt Amendment N 46 FAILED (4/7).
3:31:45 PM
Representative Josephson MOVED to ADOPT Amendment N 47
(copy on file):
Agency: Health
Appropriation: Behavioral Health
Allocation: BH Treatment and Recovery Grants
Transaction Details
Title: Behavioral Health Care Rate Review Increases
Section: Section 1
Type: IncOTI
Line Items (Amounts are in thousands)
Personal Services: 0.0
Travel: 0.0
Services: 0.0
Commodities: 0.0
Capital Outlay: 0.0
Grants: 12,900.0
Miscellaneous: 0.0
12,900.0
Positions
Permanent Full-Time: 0
Permanent Part-Time: 0
Temporary: 0
Funding (Amounts are in thousands)
1037 GF/MH 12,900.0
Explanation
Behavioral healthcare is a vital and equal part of the
healthcare system, and behavioral health treatment and
recovery grants are crucial to thousands of
underserved Alaskans to access essential treatment and
services like medication and in-home care services.
Alaskans with disabilities, family members, and other
caregivers need access to timely behavioral health
services.
The Department of Health initiated a rate review
intended to take effect in FY23 (July 2022). These
rates have yet to be enacted. Community behavioral
health providers are facing financial hardship due to
a delay in rate adjustment. According to preliminary
data from the Office of Rate Review for new potential
rates, the delayed implementation has resulted in
$12.9 million in missed revenue for behavioral health
providers over that time.
Consequently, providers have been operating with the
same rates since 2018, which predates the pandemic and
associated rise in service needs. This highlights the
critical need for swift action in enacting the updated
rates to ensure fair compensation for these essential
services. The $12.9 million to augment rates would
rectify the missing payments and allow providers to
maintain their capacity while waiting for the new rate
methodologies.
Representative Stapp OBJECTED for discussion.
Representative Josephson explained the amendment. He had
tried to champion behavioral health care, which he was
aware was partially covered by the 1115 waiver; however,
the 1115 waiver was inoperative due to startup costs. There
were residential alcohol treatment centers that did not
meet the four parameters required by the 1115 waiver. He
explained that the Key Coalition of Alaska was a coalition
of parents, family members, self-advocates, and friends. He
clarified that it was a members-only organization and one
of the organization's priorities was to invest in
behavioral health services. The coalition sought $13
million in funding to close the gap from a delayed rate
increase.
Representative Josephson argued that behavioral health care
was a vital and equal part of the health care system and
behavioral health treatment and recovery grants were
crucial. Thousands of underserved Alaskans used the grants
to access essential treatment and services like medication
and in-home care services. Alaskans with disabilities,
family members, and other caregivers needed access to
timely behavioral health services. He noted that DOH
initiated a rate review that was intended to take effect in
FY 23. Community behavioral health providers were facing
financial hardship due to delays in rate adjustment.
According to preliminary data from the Office of Rate
Review for new potential rates, the delayed implementation
had resulted in $12.9 million in missed revenue for
behavioral health providers. Consequently, providers had
been operating with the same rates since 2018, which
predated the COVID-19 pandemic and associated rise in
service needs. There was a critical need for swift action
in enacting the updated rates to ensure fair compensation.
The $12.9 million was designed to augment rates and rectify
the missing payments, allowing providers to maintain
capacity while waiting for the new rate methodologies.
3:35:08 PM
Representative Stapp stated that he was in opposition to
the amendment. The reason the 1115 behavioral health waiver
process began was to reduce the general funds in the grants
line to providers and offset it with federal funds through
a program called 1115 demonstration waiver. The renewal was
currently taking place and later on in the year, additional
services that were not currently covered under behavioral
health through Medicaid could be requested during the 1115
amend process. He was uncertain about there being five
years of lost rates. The 1115 waiver went through a review
process every five years. The legislature chose to give the
department the administrative authority to change rates
through Medicaid reimbursements. He would be open to a
broader conversation about revoking the department's
authority if it was so desired.
Representative Galvin remarked that she was not an expert
on the 1115 waiver, but people often came into her office
to share that they were only making $16 per hour to take
care of Alaskans with deep behavioral health issues. She
asked if Representative Josephson could provide
clarification on whether the dollars requested in the
amendment would go towards wages.
Representative Josephson relayed that he liked DOH, but he
had heard from too many credible sources that there was a
lack of compliance with the regulatory timeline for rate
review. He believed the comments from his sources. He
recalled that Representative Stapp asked why the
legislature gave the department the authority to review
rates, to which he would say that the legislature thought
that the department would complete the rate review on time.
While the amendment could translate into pay increases, he
thought it was less about the providers and more about the
services. The amendment was focused more on starting up
behavioral health programs and providing behavioral health
services.
Representative Stapp MAINTAINED the OBJECTION.
3:39:08 PM
A roll call vote was taken on the motion.
IN FAVOR: Galvin, Hannan, Josephson, Ortiz
OPPOSED: Coulombe, Cronk, Stapp, Tomaszewski, Edgmon,
Foster, Johnson
The MOTION to adopt Amendment N 47 FAILED (4/7).
3:39:55 PM
Representative Josephson relayed that he would not be
offering Amendment N 48.
Representative Josephson MOVED to ADOPT Amendment N 49
(copy on file):
Agency: Health
Appropriation: Medicaid Services
Allocation: Medicaid Services
Transaction Details
Title: Restore Funding Associated with Abortions
Section: Section 1
Type: Inc
Line Items (Amounts are in thousands)
Personal Services: 0.0
Travel: 0.0
Services: 0.0
Commodities: 0.0
Capital Outlay: 0.0
Grants: 90.7
Miscellaneous: 0.0
90.7
Positions
Permanent Full-Time: 0
Permanent Part-Time: 0
Temporary: 0
Funding (Amounts are in thousands)
1004 Gen Fund 90.7
Explanation
Following the subcommittee process, this amount toward
Medicaid was deducted from the allocation because it
is the amount representing expenditures on abortion-
related services during FY23. While the language is
technically constitutional, the decrement is not. The
Supreme Court has made it very clear that reproductive
services include abortion services in Alaska, so this
decrement will result in a cut to the entire
appropriation and not to any abortion services. This
is unfair to other Medicaid recipients receiving any
other service.
Representative Cronk OBJECTED for discussion.
Representative Josephson explained the amendment. He was
aware that the state's budgets routinely included language
indicating the state would not participate in Medicaid-
funded abortions. He was acutely aware that the governor
vetoed about $320,000 from the court system in 2019. He
wrote a lengthy op-ed about the veto and said it was
unconstitutional, which it was, and the court agreed. The
governor indicated that he did not like the court system's
rulings, which he found to be honest but improper of the
governor to say. The amendment would be "one step less
unconstitutional" in that the legislature was the
appropriator. Court cases from around the year 2000
reported that if the state provided OB/GYN care to women,
such as delivering healthy babies, pap smears, and
gynecological care, the state was required to provide the
whole panoply of care, which would include the $90,700
request in the amendment.
3:42:36 PM
Representative Galvin asked for clarification that the
funds that were being restored were the same funds that
were originally removed from the budget by the governor
because the governor felt that certain services should not
be covered. If her understanding was correct, she would be
supporting the amendment. She thought that any decision
about which Medicaid services a woman could receive should
be between a woman and the caregiver only.
Representative Josephson responded to Representative Galvin
that the $90,700 cut was in the committee substitute
proposed by the House Finance Committee and he was asking
for the funds to be restored.
Representative Cronk MAINTAINED the OBJECTION.
3:44:41 PM
A roll call vote was taken on the motion.
IN FAVOR: Galvin, Hannan, Josephson, Ortiz, Foster
OPPOSED: Coulombe, Cronk, Stapp, Tomaszewski, Edgmon,
Johnson
The MOTION to adopt Amendment N 49 FAILED (5/6).
3:45:30 PM
Representative Josephson MOVED to ADOPT Amendment N 50
(copy on file):
Agency: Health
Appropriation: Senior and Disabilities Svcs
Allocation: Senior Community Based Grants
Transaction Details
Title: Senior and Disabilities Grants Increase to
Match Population Increase
Section: Section 1
Type: Inc
Line Items (Amounts are in thousands)
Personal Services: 0.0
Travel: 0.0
Services: 0.0
Commodities: 0.0
Capital Outlay: 0.0
Grants: 998.3
Miscellaneous: 0.0
998.3
Positions
Permanent Full-Time: 0
Permanent Part-Time: 0
Temporary: 0
Funding (Amounts are in thousands)
1004 Gen Fund 998.3
Explanation
Last year, the population of seniors over the age of
75 in Alaska increased by 5% last year alone. AGEnet
has requested an increase equivalent to this fact (a
5% increase in community-based grants reflected in
this amendment). These services help seniors with
providing nutritious meals, daily safety checks,
transportation, exercise classes, and light-
housekeeping.
Representative Cronk OBJECTED for discussion.
Representative Josephson explained that the amendment
concerned senior and disabilities grants and a request from
the Alaska Geriatric Exchange Network (AGEnet). He met with
AGEnet and learned about its priorities. He understood that
many members of the committee were concerned that a COVID-
19 grant in the amount of $2.7 million in general funds for
senior community-based grants had lapsed. He was trying to
estimate how much money was available and unspent, and
whether the money could be supplemented to return funding
for seniors back to the $2.7 million total. He was not
certain where the committee left off on the issue and noted
that it was a separate topic, but the need was similar.
Representative Josephson stated that one in five Alaskans
were over 65. There was a "hollowing out" of 30 to 40
years, which was due to increased out migration. There was
a request in addition to the $2.7 million for a 5 percent
increase in senior community-based grants over the FY 24
funding level. From 2022 to 2023, the population of
Alaskans aged 75 and older increased by over 5 percent
according to Alaska Commission on Aging Statistics. The
older population was most at risk of going into an
institution without the support of senior community-based
grants. Community grants served older Alaskans all over the
state, including Anchorage, Bethel, Fairbanks, Kenai, Mat-
Su, and Nome, allowing seniors to live in the community of
their choice. The number of meals provided under the meal
grants to older Alaskans with disabilities around the state
increased 13 percent from 611,000 meals to 690,000 meals
from 2013 to 2023. The cost of food also increased 27
percent in the same time period. The amendment also came at
the request of AARP of Alaska and Senior Safety Net and
Health Security. He thought it was a righteous and
legitimate amendment.
3:49:58 PM
AT EASE
4:00:29 PM
RECONVENED
Co-Chair Johnson stated that the committee was still
discussing Amendment N 50. There had been some confusion
about what the amendment would be adding, and she requested
that the Legislative Finance Division (LFD) provide
additional context.
ALEXEI PAINTER, DIRECTOR, LEGISLATIVE FINANCE DIVISION,
explained that there was $21.7 million of funding within
the senior community-based grants within the CS, in
addition to $5.8 million of federal COVID-19 relief funding
that was carrying forward from prior years. The COVID money
needed to be spent and there was an appropriation in the CS
that extended the appropriations through FY 25; however,
all of the COVID money was required to be spent by January
28, 2025. He relayed that some portion of the $5.8 million
would be carried forward into the first half of FY 25. The
amendment would add to the existing $21.7 million funding.
Representative Galvin asked Mr. Painter whether there were
any additional funds to keep up with inflationary costs.
Mr. Painter responded that his understanding was that the
rates were expected to be comparable from 2024 to 2025 and
the COVID funding would be used to augment the rates. While
that COVID funding remained, the rates should be relatively
steady until FY 26, when there might be a shortfall when
the COVID funding ends. He did not think there was an
increase built into FY 25.
Representative Galvin understood that there was no increase
in one-time COVID funding. She asked if her understanding
was correct that there was a 5 percent increase in the
number of people being served.
Mr. Painter responded in the affirmative. There was an
increase in the number of seniors in the state, but he was
not certain that there was an increase in the number of
seniors receiving care. There was no change in the level of
funding.
Representative Coulombe asked if the amendment was an
increment in the base budget.
Mr. Painter responded in the affirmative.
Representative Galvin commented that she would support the
amendment and that it made sense to her. She thought it was
likely that there would be an increased number of seniors
seeking care with the increase in the senior population.
The cost of malnutrition for one day in the hospital for a
senior was more than $40,000, and one day in the hospital
for malnutrition was many times more than an entire year of
Meals on Wheels. The committee had heard testimony from
individuals who were delivering services to seniors that
working hours were decreasing due to a lack of resources.
Representative Cronk MAINTAINED the OBJECTION.
4:05:58 PM
A roll call vote was taken on the motion.
IN FAVOR: Galvin, Hannan, Josephson, Ortiz
OPPOSED: Coulombe, Cronk, Stapp, Tomaszewski, Edgmon,
Foster, Johnson
The MOTION to adopt Amendment N 50 FAILED (4/7).
4:06:43 PM
Representative Josephson MOVED to ADOPT Amendment N 51
(copy on file):
Agency: Health
Appropriation: Medicaid Services
Allocation: Medicaid Services
Transaction Details
Title: Restore General Fund Match for Medicaid Rate
Increases
Section: Section 1
Type: Inc
Line Items (Amounts are in thousands)
Personal Services: 0.0
Travel: 0.0
Services: 0.0
Commodities: 0.0
Capital Outlay: 0.0
Grants: 10,000.0
Miscellaneous: 0.0
10,000.0
Positions
Permanent Full-Time: 0
Permanent Part-Time: 0
Temporary: 0
Funding (Amounts are in thousands)
1003 GF/Match 10,000.0
Explanation
The House Finance Health Subcommittee decremented the
Governor's request for $21,000,000. A decrement of
$10,000,000 in GF reduces the state's ability to be
reimbursed $10,000,000 in Fed, effectively creating a
$20,000,000 cut to services. This original amount was
predicated on the department's estimates for
supporting the Medicaid program with rate increases
and inflation calculated. Services to be affected by
inadequate funding includes:
Resource-based Relative Value Scale (Physicians
Services Rates)
Senior and Disability Services 3.7% Provider Rate
Increase
Estimated Office of Rate Review Rates Increases (State
and Federal Required Provider-Specific Annual Rate
Increases)
Community Behavioral Health Rate Increase Final
1115 Rate Increase 2025 (Inflationary)
Representative Cronk OBJECTED for discussion.
Representative Josephson explained the amendment. He
relayed that he would be reading his notes from a meeting
he had with the Department of Corrections (DOC). The
department noted that enrollment and utilization of
Medicaid were hard to predict. There was attrition because
after the national emergency brought about by COVID ended,
there needed to be a period of re-enrollment. Essentially,
all applicants were screened to ensure that the applicants
were qualified; however, many others had re-enrolled since
the initial re-screening period. He questioned whether
individuals who were disenrolled were generating services
in other ways and whether some individuals were generating
services that were not directly related to the Medicaid
services. The governor and the administration sought $21
million for rate increases based on rebasing and inflation.
Representative Josephson explained that DOH used what was
called the Resource-Based Relative Value Scale for
physician payment purposes. The Medicaid rate had some
catching up to do with the Medicare rate, and the rates
that had been most recently rebased went into effect on
July 1, 2023. He thought it was inevitable that there would
be further rebasing of various rates in the summer of 2024.
The department and the governor thought it was unwise to
cut the $10 million in combination with re-enrollment. For
example, other rate reviews were pending and would be
completed later in 2024, which would drive costs further
and were reflected in the amendment. The federally
qualified health centers, for example, would need a $7
million increment after the rate review. He noted that the
committee had already voted in opposition to a different
federally qualified health center amendment [Amendment N
42], which he respected. He added that there was another
more costly issue related to the health centers that would
soon become relevant. The $10 million increment was needed
and he hoped the committee would vote to reinstate the
funds.
4:10:11 PM
Representative Stapp stated that he was opposed to the
amendment. The governor's budget requested $21 million in
Medicaid increases with $11 million of the increases
allocated to rate rebasements. He opted to reduce the
Medicaid services budget by $10 million to reject about
half of the request for the purpose of Medicaid utilization
and redetermination. During the pandemic, no one was
allowed to be disenrolled from the Medicaid program. During
the time, the federal government gave all states "Enhanced
FMAP" to compensate for the states' inability to disenroll
individuals from Medicaid who were not eligible. He thought
that Medicaid redeterminations were behind schedule and
noted that DOH had initiated 171,703 redeterminations to
date with 69,000 redeterminations remaining. The deadline
for the remainder of the redeterminations was January of
2025. Additionally, 40 percent of redeterminations were
"appended for additional information." He thought that
removing 100,000 people from the Medicaid program would
reduce the overall spend. He understood that DOH did not
plan to complete Medicaid redeterminations in 2024, which
he did not think was acceptable. He noted that the cost of
redeterminations was the same as the cost of about four
days of the total state annual spend on Medicaid. He
thought that completing the redeterminations and then
needing more money from the state was reasonable, but not
completing the redeterminations and asking for more money
was not acceptable.
Representative Josephson relayed that he understood that
there were redeterminations, but the redeterminations would
not result in the removal of 100,000 people from Medicaid.
Most people would likely still be qualified. There would
still be hundreds of thousands of people in public health
care. He did not think a decrement would be a good idea and
it would likely be a supplemental if the amendment was
rejected. He thought it would become newsworthy if
providers were not paid.
Representative Cronk MAINTAINED the OBJECTION.
4:14:19 PM
A roll call vote was taken on the motion.
IN FAVOR: Galvin, Hannan, Josephson, Ortiz, Edgmon
OPPOSED: Coulombe, Cronk, Stapp, Tomaszewski, Foster,
Johnson
The MOTION to adopt Amendment N 51 FAILED (5/6).
4:15:15 PM
Representative Josephson relayed that he would not be
offering Amendment N 52.
Representative Josephson MOVED to ADOPT Amendment N 53
(copy on file):
Agency: Health
Appropriation: Senior and Disabilities Svcs
Allocation: Senior/Disabilities Svcs Admin
Transaction Details
Title: Add Three Positions for Adult Protective
Services (FY25-FY29)
Section: Section 1
Type: IncT
Line Items (Amounts are in thousands)
Personal Services: 407.6
Travel: 0.0
Services: 0.0
Commodities: 0.0
Capital Outlay: 0.0
Grants: 0.0
Miscellaneous: 0.0
407.6
Positions
Permanent Full-Time: 0
Permanent Part-Time: 0
Temporary: 3
Funding (Amounts are in thousands)
1002 Fed Rcpts 203.8
1003 GF/Match 203.8
Explanation
In January 2024, the Alaska State Ombudsman released
an investigative report that revealed deficiencies in
the Department of Health's Adult Protective Services,
which resulted in the death of an elder under their
care. The Ombudsman's analysis substantiated the
allegations and included recommendations to support
APS to perform its duties sufficiently. Of the
recommendations, the Ombudsman recommends adding
funding for 3 permanent full-time positions to be
funded for 5 years. This amendment adds funding for
full-time temporary positions to match the
recommendation of temporary funding. A future
legislature may choose to reevaluate in FY30.
Each figure represents the cost of the salary,
benefits, services, and commodities combined:
Protective Services Manager 2 - $154,000/year, Range
22 The Ombudsman believes that the investigation
warranted more oversight from APS supervisors and
managers. This position could focus on APS
initiatives, like program evaluation, staff training,
and interpretation of policy and goals.
Quality Assurance Manager - $147,000/year, Range 19
This position would assume staff management roles and
create more opportunities for the APS Manager to work
with community stakeholders, and service recipients to
ensure values align with community's expectations.
Administrative Assistant 2 - $106,000/year, Range 14
The Ombudsman recommends that APS develop and
implement Multidisciplinary Teams (MDT), groups of
professional experts who are committed to supporting
the mission of the agency. This position would work to
develop regional MDTs and forming community and
stakeholder partnerships.
Representative Cronk OBJECTED for discussion.
Representative Josephson explained the amendment. In
January of 2024, the Alaska State Ombudsman released an
investigative report that revealed deficiencies at DOH's
Adult Protective Services (APS), which it concluded
resulted in the death of an elder under the care of APS.
The Ombudsman's analysis substantiated the allegations and
included recommendations for APS. The Ombudsman recommended
adding funding for three permanent full-time positions to
be funded for five years. The amendment added funding for
the full-time temporary positions to match the
recommendation of temporary funding. The future legislature
could choose to re-evaluate in FY 30. He thought that the
Ombudsman was one of the best sources of information for
the legislature.
Representative Cronk MAINTAINED the OBJECTION.
4:17:48 PM
A roll call vote was taken on the motion.
IN FAVOR: Galvin, Hannan, Josephson, Ortiz, Cronk
OPPOSED: Coulombe, Stapp, Tomaszewski, Foster, Johnson,
Edgmon
The MOTION to adopt Amendment N 53 FAILED (5/6).
4:19:03 PM
AT EASE
4:19:28 PM
RECONVENED
Representative Josephson asked that Amendment N 55 be
rolled behind Amendment N 54 because the two were
comparable. He noted that Representative Ortiz was
momentarily away from the committee room and he asked to
wait to present the amendments until he returned.
4:20:34 PM
Representative Josephson MOVED to ADOPT Amendment N 56
(copy on file):
Agency: Health
Appropriation: Senior and Disabilities Svcs
Allocation: Early Intervention Learning Prgm
Transaction Details
Title: Funding to Expand Outreach for the Alaska
Infant Learning Program
Section: Section 1
Type: Inc
Line Items (Amounts are in thousands)
Personal Services: 0.0
Travel: 0.0
Services: 750.0
Commodities: 0.0
Capital Outlay: 0.0
Grants: 0.0
Miscellaneous: 0.0
750.0
Positions
Permanent Full-Time: 0
Permanent Part-Time: 0
Temporary: 0
Funding (Amounts are in thousands)
1037 GF/MH 750.0
Explanation
This amendment proposal expands agency capacity for
outreach and expansion for the Alaska Infant Learning
Program. With this increment, DOH may expand outreach
to families with children at risk or who experience
developmental delays. Over the past 10 years ILP has
received flat funding, which has not been adequate to
keep up with inflation and the increased costs of
running ILP programs and services.
Early intervention has proven life-long benefits to
program recipients; however, program participation
rates remain low. Children from birth to 3 years are
in the most important developmental phase of their
lives. Support for early intervention efforts help to
bring Alaska up to the national average for outcomes
for young children with developmental disabilities.
Representative Cronk OBJECTED for discussion.
Representative Josephson explained that the amendment was
an increment for the Alaska Infant Learning Program. The
amendment proposal expanded agency capacity for outreach
and expansion. He explained that the responsible agency was
Senior and Disability Services' Early Intervention Learning
Program (ILP). With the increment, DOH could expand
outreach to families with children at risk or who
experience developmental delays. Over the past 10 years,
ILP had received flat funding, which had not been adequate
to keep up with inflation and increased costs of running
ILP programs and services. Early intervention had proven
lifelong benefits to program recipients, however program
participation rates remained low. Children from birth to
age three were in the most important developmental phase of
their lives. Support for early intervention efforts helped
to bring Alaska up to the national average for outcomes for
young children with developmental disabilities.
Representative Galvin commented that she was grateful to
hear from the Governor's Council on Disabilities and
Special Education because she was not aware that the
program had been flat funded for 10 years. She appreciated
that the work of the ILP programs was important and the
programs must be kept strong, particularly because the
programs were able to identify small children with
developmental delays early on and help prepare families and
the children for a better future.
4:22:33 PM
Representative Stapp remarked that at the beginning of the
budget process, there was a list of items that were not in
the budget due to the lack of a budget surplus. He
emphasized that the committee was now on its fifty-sixth
amendment. The vast majority of the amendments would add
money to the operating budget. He would not support the
amendment, but it was not because he did not think there
should be a discussion about expanding outreach for ILPs.
He found it slightly irritating that there were so many
amendments that added money to the budget without
subtracting money elsewhere.
Representative Hannan relayed that she was in favor of the
amendment and asked the committee to remember that the
longest return on investment was early investments. If a
child with developmental delays could be identified early
on, higher costs associated with a later-term
identification could be prevented. The cost to the state of
children with developmental delays compounded over time,
and the earlier the state intervened, the better the return
on investment and the better the services.
Representative Josephson noted that the budget had a $152
million surplus while the amendments to date cost roughly
$63 million. He thought the question for the committee was
whether it thought that the Senate would agree to claw back
about $140 billion in Constitutional Budget Reserve (CBR)
monies. There were many different ways the budget could
work.
Representative Cronk MAINTAINED the OBJECTION.
4:26:05 PM
A roll call vote was taken on the motion.
IN FAVOR: Galvin, Hannan, Josephson, Ortiz
OPPOSED: Coulombe, Cronk, Stapp, Tomaszewski, Edgmon,
Foster, Johnson
The MOTION to adopt Amendment N 56 FAILED (4/7).
4:27:08 PM
AT EASE
4:28:57 PM
RECONVENED
4:29:08 PM
Representative Josephson WITHDREW Amendment N 57.
4:29:51 PM
AT EASE
4:30:00 PM
RECONVENED
Representative Josephson asked that the committee discuss
Amendment N 59 before discussing Amendment N 58.
4:30:59 PM
HB 268 was HEARD and HELD in committee for further
consideration.
HB 270 was HEARD and HELD in committee for further
consideration.
Co-Chair Johnson reviewed the agenda for the following day.
ADJOURNMENT
4:31:20 PM
The meeting was adjourned at 4:31 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 268 Amendments with ACTIONS 040124.pdf |
HFIN 4/1/2024 1:30:00 PM |
HB 268 |