Legislature(1993 - 1994)
03/19/1993 03:00 PM House HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
March 19, 1993
3:00 p.m.
MEMBERS PRESENT
Rep. Cynthia Toohey, Co-Chair
Rep. Gary Davis, Vice Chair
Rep. Al Vezey
Rep. Pete Kott
Rep. Harley Olberg
Rep. Tom Brice
MEMBERS ABSENT
Rep. Con Bunde, Co-Chair
Rep. Bettye Davis
Rep. Irene Nicholia
COMMITTEE CALENDAR
*HB 171: "An Act providing coverage for hospice care under
the Medicaid program; reordering the priorities
given to optional services under the Medicaid
program; and providing for an effective date."
PASSED WITH INDIVIDUAL RECOMMENDATIONS
*HB 178: "An Act adding children under the age of 21 who
are eligible for adoption assistance because of
special needs to the optional Medicaid coverage
list and revising the order of priority in which
groups eligible for optional Medicaid coverage are
eliminated; and providing for an effective date."
PASSED WITH INDIVIDUAL RECOMMENDATIONS
(* First public hearing.)
WITNESS REGISTER
DORIS LUM, Manager
Valley Health Services Department
Valley Hospital
P.O. Box 1687
Palmer, Alaska 99645
Phone: (907) 376-1625
Position Statement:
JUDY MATHIS
Aide to Rep. Ron Larson
Alaska State Legislature
State Capitol, Room 502
Juneau, Alaska 99801-1182
Phone: (907) 465-3878
Position Statement: Representing sponsor of HB 171
DAVE WILLIAMS
H&SS Planner
Division of Medical Assistance
Department of Health and Social Services
P.O. Box 110660
Juneau, Alaska 99811-0660
Phone: (907) 465-3123
Position Statement: Available to answer questions on
HB 171 and HB 178
RITCHIE SONNER, Executive Director
Hospice and Home Care of Juneau
3256 Hospital Drive
Juneau, Alaska 99801
Phone: (907) 463-3113
Position Statement: Testified in favor of HB 171
PREVIOUS ACTION
BILL: HB 171
SHORT TITLE: MEDICAID COVERAGE FOR HOSPICE CARE
BILL VERSION:
SPONSOR(S): REPRESENTATIVE(S) LARSON
TITLE: "An Act providing coverage for hospice care under the
Medicaid program; reordering the priorities given to
optional services under the Medicaid program; and providing
for an effective date."
JRN-DATE JRN-PG ACTION
02/22/93 413 (H) READ THE FIRST TIME/REFERRAL(S)
02/22/93 413 (H) HES, FINANCE
03/18/93 (H) HES AT 03:00 PM CAPITOL 106
03/19/93 (H) HES AT 03:00 PM CAPITOL 106
BILL: HB 178
SHORT TITLE: MEDICAID FOR CERTAIN CHILDREN
BILL VERSION:
SPONSOR(S): LABOR & COMMERCE
TITLE: "An Act adding children under the age of 21 who are
eligible for adoption assistance because of special needs to
the optional Medicaid coverage list and revising the order
of priority in which groups eligible for optional Medicaid
coverage are eliminated; and providing for an effective
date."
JRN-DATE JRN-PG ACTION
02/24/93 434 (H) READ THE FIRST TIME/REFERRAL(S)
02/24/93 435 (H) HES, FINANCE
03/18/93 (H) HES AT 03:00 PM CAPITOL 106
03/19/93 (H) HES AT 03:00 PM CAPITOL 106
ACTION NARRATIVE
TAPE 93-40, SIDE A
Number 000
CHAIR TOOHEY called the meeting to order at 3:18 p.m., noted
members present, and announced the calendar. She called
HB 171 to the table.
HB 171 - MEDICAID COVERAGE FOR HOSPICE CARE
DORIS LUM, MANAGER OF VALLEY HEALTH SERVICES AT VALLEY
HOSPITAL IN PALMER, testified via teleconference from Palmer
in support of HB 171. She said she hoped to provide hospice
service at less cost to residents of the Mat-Su Valley.
While Alaska has no certified hospice as yet, she hopes to
provide hospice care in a fiscally responsible way and to
provide mechanisms to do so across the state. The patient
base for hospice care is too small to support a hospice
unless the facility could be qualified to receive payment
through Medicaid. She said the bill would improve the level
of service for hospice patients and would be a good deal for
the state government.
Number 068
JUDY MATHIS, AIDE TO REP. RON LARSON, PRIME SPONSOR OF
HB 171, made herself available in Juneau to answer questions
on HB 171.
REP. BRICE asked Rep. Larson's feelings on changing the
bill's effective date.
Number 085
DAVE WILLIAMS, H&SS PLANNER, DIVISION OF MEDICAL ASSISTANCE
IN THE DEPARTMENT OF HEALTH AND SOCIAL SERVICES, testified
in Juneau that the department had asked for the bill's
effective date to be delayed from July 1, 1993, to January
1, 1994, because the department did not believe it could
hire people or perform the work quickly enough to begin the
program by July 1, 1993. He said the bill would require
much work on its management information (computer) system to
handle four waivers and other changes.
REP. BRICE asked Ms. Mathis if she believed Rep. Larson
would believe the delay was reasonable.
MS. MATHIS indicated that she did.
REP. BRICE offered to make a motion for an amendment
changing HB 171's effective date to January 1, 1994.
Number 109
CHAIR TOOHEY asked a clarifying question on the effective
date of the bill and how it related to the change in
Medicaid billing services the bill would allow.
REP. BRICE said he had asked why the Department of Health
and Social Services had asked for the change in effective
date for HB 171, and said Mr. Williams had answered his
question. He said the change would be appropriate, barring
opposition from the sponsor.
Number 128
CHAIR TOOHEY asked what difference the change would make.
MR. WILLIAMS stated the department could not make the
changes to its management information system necessary to
meet the bill's conditions by July 1, 1993. He added,
though, that no provider was ready to take advantage of the
bill's provisions right away, and a six-month delay in the
bill's effective date would not harm anyone.
Number 140
CHAIR TOOHEY asked if there was any reason the department
could not implement the bill's provisions, starting slowly
if necessary, by July 1, 1993.
REP. BRICE offered his opinion that the sooner the changes
got on-line, the better. But he also acknowledged that the
department had other priorities relating to other Medicaid
waivers that might come before HB 171, which might explain
the request for a delay.
Number 161
CHAIR TOOHEY called a brief at-ease at 3:26 p.m., and called
the meting back to order at 3:28 p.m.
REP. VEZEY noted that the bill's effective date was July 1,
but the bill does not mandate that the program be in place
by July 1. He also questioned the reasonableness of the
bill's $10,000 fiscal note from the Department of Health and
Social Services, saying the program must surely cost more
than $10,000.
Number 176
REP. OLBERG said he understood the fiscal note as reflecting
the cost of doing the computer work necessary to put the
program in place, not of operating the program.
MR. WILLIAMS said the fiscal note reflected the cost of
changes in the information system to allow the department
payment system to process payments to hospices. He said the
bill would likely not cost the state any more money. He
said the bill would not extend Medicaid coverage to anyone
who did not already have it. He said the cost of hospice
care for a terminally ill Medicaid patient would be the same
as or less than the cost of caring for such a patient in a
nursing home or through a home care provider.
Number 200
REP. VEZEY stated that without a fiscal note he could not
tell how many new people were expected to sign up for health
care services under Medicaid. He asked whether Medicaid
paid much money for hospital services.
MR. WILLIAMS replied that Medicaid paid a great deal for
hospital services, especially for terminally ill patients.
He said Medicare certification was difficult to obtain.
Number 225
REP. VEZEY interrupted, commenting that the program in
question was not Medicare, but Medicaid.
MR. WILLIAMS clarified that Medicare was a federal insurance
program, and that Medicaid often relies on Medicare
certification requirements. A hospice would normally have
to be certified by the Medicare program in order to receive
payment for its services through the Medicaid insurance
program, he said.
REP. VEZEY commented he believed that Medicaid covered
things that Medicare did not.
MR. WILLIAMS said that was often true. But in the case of
hospice service, Congress first passed certification for
hospice care for Medicare, and later allowed hospices that
were certified under Medicare to collect from the Medicaid
program. He added that he did not anticipate more people
availing themselves of hospice care. Those who are
terminally ill and likely to die within six months will be
receiving service through home care providers or hospices.
Hospices are places where the terminally ill go to die, not
places where they are encouraged to get well, which means a
special kind of service.
Number 248
REP. VEZEY said the prospect of care for the terminally ill
was an unpleasant thought and one that few people dwell on,
but it is nonetheless important to consider.
Number 252
RITCHIE SONNER, EXECUTIVE DIRECTOR OF HOSPICE AND HOME CARE
OF JUNEAU, testified in Juneau in support of HB 171. She
said Juneau has no Medicare-certified hospices, but Medicare
has waived the certification requirement in Juneau, allowing
her organization to provide hospice services. She said some
Juneau residents receive hospice services through other
funding sources, but Hospice and Home Care would like to
channel those funds to different directions if those clients
could qualify for Medicaid. She echoed Mr. Williams'
statement that it would not cost the state any more to
allocate hospice services under Medicaid, as people already
receive other state funded services. She said hospices
allow people to die in dignity and comfort, surrounded by
family and friends and not in sterile, often frightening
institutions.
Number 281
CHAIR TOOHEY called for more public testimony and, hearing
none, closed public testimony and asked the will of the
committee.
REP. BRICE moved passage of HB 171 from the committee with
individual recommendations.
CHAIR TOOHEY asked for objections, and, hearing none,
indicated that HB 171 was passed with individual
recommendations.
CHAIR TOOHEY then brought HB 178 to the table.
HB 178 - MEDICAID COVERAGE FOR CERTAIN CHILDREN
DAVE WILLIAMS, FROM THE DIVISION OF MEDICAL ASSISTANCE IN
THE DEPARTMENT OF HEALTH AND SOCIAL SERVICES, read a
statement saying that HB 178 would continue, after adoption,
the Medicaid coverage already provided to children in foster
homes under state custody whose mental or medical problems
carried large potential financial liabilities which made
them difficult to place in adoptive homes. Several years
ago the state began to contract with adoptive parents to pay
some of the costs associated with these children in an
effort to place the children in adoption, he said. The
federal government later made Medicaid coverage available to
such children in such states that chose to accept it. He
said HB 178 would allow the state to leave the medical cost
of adopting such children to the Medicaid program, leaving
the state to provide, through contracts, money for the
nonmedical expenses associated with the adoption of such
children.
MR. WILLIAMS pointed out that the fiscal notes for the bill
reflect the transfer of $35,000 in FY94 from the Department
of Family and Youth Services to the general fund, which is
offset by another $35,000 allocation to the Division of
Medical Assistance, half of which will come from Medicaid
and half of which will come from the general fund. The
Division of Medical Assistance would pay the costs for
medical care for the children in future years, he said.
Number 339
REP. VEZEY expressed skepticism that the program would not
somehow cost the state more money.
MR. WILLIAMS explained again that the state was already
subsidizing all the medical costs for some hard-to-adopt
children under the subsidized adoption program. Before that
program, such children remained in state custody with the
state paying all their living costs, not just medical costs.
Under HB 178, the state could get half those medical bills
paid for by the federal government by taking advantage of
the federal government's offer to provide Medicaid coverage
for the children. He said the bill would save the state
$17,700 in the first year, and the savings would increase as
more children take advantage of the program.
Number 365
There followed a free-flowing discussion in which Rep.
Vezey, Rep. Brice, and Rep. Toohey asked several questions
about the fiscal notes for the bill, how the different
accounts listed in the fiscal notes would be affected, and
how the bill would save the state money. Mr. Williams
answered those questions with substantially the same
information as he presented earlier.
Number 432
REP. OLBERG said HB 178 would free up $17,700 for use
elsewhere in the department, and he speculated that the
money might be used by the commissioner for travel expenses.
Number 467
REP. BRICE moved for passage of HB 178 from the committee
with individual recommendations.
CHAIR TOOHEY asked for objections, and, hearing none,
declared HB 178 passed with individual recommendations.
There being no further business before the committee, CHAIR
TOOHEY ADJOURNED the meeting at approximately 3:45 p.m.
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