02/08/2005 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB82 | |
| HB105 | |
| HB106 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 82 | TELECONFERENCED | |
| *+ | HB 105 | TELECONFERENCED | |
| *+ | HB 106 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
February 8, 2005
3:12 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Paul Seaton, Vice Chair
Representative Tom Anderson
Representative Lesil McGuire
Representative Berta Gardner
MEMBERS ABSENT
Representative Vic Kohring
Representative Sharon Cissna
COMMITTEE CALENDAR
HOUSE BILL NO. 82
"An Act extending the termination date of the Statewide Suicide
Prevention Council; and providing for an effective date."
- MOVED HB 82 OUT OF COMMITTEE
CS FOR HOUSE BILL NO. 105(HES)
"An Act relating to coverage for adult dental services under
Medicaid; and providing for an effective date."
- HEARD AND HELD
HOUSE BILL NO. 106
"An Act establishing the senior care program and relating to
that program; creating a fund for the provision of the senior
care program; repealing ch. 3, SLA 2004; and providing for an
effective date."
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 82
SHORT TITLE: EXTEND SUICIDE PREVENTION COUNCIL
SPONSOR(S): REPRESENTATIVE(S) DAHLSTROM
01/19/05 (H) READ THE FIRST TIME - REFERRALS
01/19/05 (H) HES, FIN
02/08/05 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 105
SHORT TITLE: MEDICAID FOR ADULT DENTAL SERVICES
SPONSOR(S): RULES BY REQUEST OF THE GOVERNOR
01/24/05 (H) READ THE FIRST TIME - REFERRALS
01/24/05 (H) HES, FIN
02/08/05 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 106
SHORT TITLE: SENIOR CARE PROGRAM
SPONSOR(S): RULES BY REQUEST OF THE GOVERNOR
01/24/05 (H) READ THE FIRST TIME - REFERRALS
01/24/05 (H) HES, FIN
02/08/05 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
REPRESENTATIVE NANCY DAHLSTROM
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of HB 82.
KATHRYN CRAFT, Departmental Coordinator
Prevention and Early Intervention Section
Department of Health and Social Services
Fairbanks, Alaska
POSITION STATEMENT: Spoke in support of HB 82.
BILL HOGAN, Director
Division of Behavioral Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Provide comments on HB 82.
JOEL GILBERTSON, Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented HB 105 on behalf of the
administration; presented HB 106 on behalf of the
administration.
JON SHERWOOD, Medical Assistant Administrator
Division of Finance & Management Services
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Responded to questions during discussion of
HB 105; responded to questions during discussion of HB 106.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:12:15 PM.
Representatives Wilson, Seaton, McGuire, and Gardner were
present at the call to order. Representative Anderson arrived
as the meeting was in progress.
HB 82 - EXTEND SUICIDE PREVENTION COUNCIL
3:13:47 PM
CHAIR WILSON announced that the first order of business would be
HOUSE BILL NO. 82, "An Act extending the termination date of the
Statewide Suicide Prevention Council; and providing for an
effective date."
REPRESENTATIVE NANCY DAHLSTROM, Alaska State Legislature,
Sponsor, relayed HB 82 extends the suicide council until 2009.
The council consists of 15 members who represent rural and urban
Alaska. The Joint Committee on Legislative Budget and Audit has
recommended its extension in order for the council to continue
addressing three issues: finding ways to reduce the suicide
rate, broadening public awareness, and enhancing suicide
prevention services throughout the state.
3:15:07 PM
KATHRYN CRAFT, Departmental Coordinator, Prevention and Early
Intervention Section, Department of Health and Social Services
(DHSS), explained that the goals of the Suicide Prevention
Council are: to broaden public awareness of suicide and the
risk factors related to suicide, to enhance the suicide
prevention programs by aligning work with the Division of
Behavioral Health, to develop healthy communities through
collaborative community - or faith - based approaches, and to
strengthen existing, and build new, partnerships between public
and private entities that will advance suicide prevention
efforts. The council is pleased with the audit recommendation
to extend its sunset to June 2009, because it will allow the
council to continue the work it started, she noted.
MS. CRAFT relayed that the council is working on a "follow back"
study, also called psychological autopsies. The study entails
gathering a year's worth of data on individuals who have
committed suicide. After an appropriate duration for the
mourning of the deceased, the council asks family members for
voluntary interviews to gather information. Some of the
information gathered is aggregate on suicide rates, age groups,
primary methods of suicide, gender, documentation of substance
use, ethnicity, urban versus rural, and regional data on suicide
attempts. In September 2004, the council released the statewide
suicide prevention plan. The council has started media and
public awareness campaigns, and is currently involved in a
clergy and clinician initiative, which allows professionals to
combine efforts through working together to prevent suicide in
local areas. The fiscal year (FY) 2005 annual report is due
March 1, 2004; she noted that would be "forthcoming in just a
couple of weeks."
3:18:18 PM
CHAIR WILSON noted that the prevention plan has been given to
the committee. She stated that "Alaska, per capita, is number
one in the nation with suicides ... and we really need to work
on this; ... we should continue this program."
3:18:51 PM
REPRESENTATIVE GARDNER related her belief that Alaska is second
to Nevada in suicides.
3:19:08 PM
MS. CRAFT relayed that Alaska ranges either between one and six,
regarding per capita suicide rates. She noted that next year,
Alaska will be rated number one in suicides, but that has yet to
be released.
3:19:35 PM
REPRESENTATIVE SEATON commented on an Anchorage Daily News
article that details a recent audit on the suicide council.
According to the article only 20 percent of the $200,000
allocated to the council went to suicide prevention efforts.
The article cites that the Department of Health and Social
Services spent about $32,000 on furniture for unrelated
programs, he noted. He asked why the money never went to the
suicide prevention program.
3:20:16 PM
REPRESENTATIVE DAHLSTROM related that the audit will be
addressed through the House Finance Committee.
3:20:40 PM
REPRESENTATIVE SEATON opined that the committee needs to be
aware of funding issues. He asked how the expenditures will be
instituted from the department's standpoint.
3:21:27 PM
BILL HOGAN, Director, Division of Behavioral Health, DHSS,
notified the committee that within the last year a number of
changes have occurred for the DHSS. Simultaneously, the Suicide
Prevention Council lost its coordinator. An employee from the
Division of Behavioral Health temporarily replaced the then
vacated position, and was responsible for determining the FY
budget; however, due to the reorganization, the task proved
difficult, he noted. He said that the monies that did not go
directly to the council were used to support the DHSS's
integrated information technology efforts, which also supported
some of the efforts and activities of the council, he added. He
told the committee that the division will actively work with the
council to ensure support of council's activities.
3:24:00 PM
MR. HOGAN, in response to Chair Wilson, stated that all the
dollars allotted to the Suicide Prevention Council will go
towards the council's activities.
3:24:26 PM
REPRESENTATIVE McGUIRE moved to report HB 82 out of committee
with individual recommendations and the accompanying fiscal
notes.
3:25:14 PM
REPRESENTATIVE SEATON objected for the purpose of discussing the
zero fiscal note.
3:25:31 PM
REPRESENTATIVE DAHLSTROM explained that there is a zero fiscal
note because the amount is budgeted from the governor's health
and social services budget.
3:25:53 PM
REPRESENTATIVE SEATON withdrew the objection.
CHAIR WILSON asked if there were any further objections. There
being none, HB 82 was reported from the House Health, Education
and Social Services Standing Committee.
HB 105 - MEDICAID FOR ADULT DENTAL SERVICES
[Contains discussion of HB 106.]
3:26:31 PM
CHAIR WILSON announced that the next order of business would be
HOUSE BILL NO. 105, "An Act relating to coverage for adult
dental services under Medicaid; and providing for an effective
date."
REPRESENTATIVE SEATON moved to adopt the proposed committee
substitute (CS) for HB 105, Version 24-GH1081\G, Mischel,
2/7/05, as the working document. There being no objection,
Version G was before the committee.
3:27:37 PM
JOEL GILBERTSON, Commissioner, Department of Health and Social
Services (DHSS), explained that HB 105 and HB 106 are a combined
effort to establish better senior care. The administration and
the twenty-third legislature established the SeniorCare program.
He said that together SeniorCare and the state have addressed
the issue of high prescription costs by forming the multi-state
prescription drug purchasing plan and establishing a senior
information office. He reported that Alaska has a vibrant,
growing senior population and that senior services need to grow
alongside that population. He said that HB 105 is a proposal
from Governor Murkowski, to strengthen oral health and dental
services offered to low income seniors.
COMMISSIONER GILBERTSON relayed that the administration has
worked very constructively with the Alaska Mental Health Trust
Authority on a collaborative project to focus on dental
services. The current Medicaid coverage for adults, adults is
defined as those over the age of 21, is restricted only to
emergency dental services. Thus, seniors and adults covered by
Medicaid have no access to oral health care outside of an
emergency setting; emergency services include the requirement to
remove immediate pain and acute infection. He said that the
administration and the Alaska Mental Health Trust Authority
perceive this as a "tremendous health care problem facing our
state." Oral health care is an important piece of health care
for individuals and the state needs to invest in preventative
measures, he noted. He said that HB 105 allows state Medicaid
coverage for preventative and restorative care. In order to
provide immediate service, and to keep the proposed program
stable as the state addresses the pent-up demand needs, the
benefits are capped at $1,150 per person annually. The cap
ensures that each year, over a period of two years, a senior
could purchase one-half of a complete set of teeth. The
services available at the $1,150 threshold would cover either:
one exam, 4 bitewing radiographs, basic cleaning, 8 restorations
and/or extractions; or one exam and an upper or lower full
denture. The fiscal note estimates 41,000 adults will be
eligible for the expanded Medicaid dental benefits.
COMMISSIONER GILBERTSON relayed that the federal contribution
through fiscal year (FY) 2011 will cover approximately 66
percent of the costs for those individuals eligible for 100
percent of federal reimbursement. The state general fund (GF)
will constitute 25 percent and the Alaska Mental Health Trust
Authority about 9 percent of the matching funds. It is
anticipated that the program will be operational the last
quarter of FY 06, so costs that year are calculated at
approximately 25 percent of the FY 07 costs and adjusted higher
to allow for pent up demand, he said. He noted, that over time
the Alaska Mental Health Trust Authority commitment to funding
the GF portion of the "Medicaid match" will diminish.
3:37:20 PM
CHAIR WILSON said that when she visits the dentist, she receives
more than four x-rays, and the proposed program only covers four
bitewings x-rays. She asked if the participating dentists would
be informed about the allowable number of x-rays.
3:38:28 PM
JON SHERWOOD, Medical Assistant Administrator, Division of
Finance & Management Services, Department of Health and Social
Services (DHSS), relayed that under the HIPAA [Health Insurance
Portability and Accountability Act] rules there is a requirement
to ascertain how much of a benefit foreign authorizations have
allowed, and essentially obtain the prior authorization and the
approval to pay for the service. He relayed that non-electronic
methods are also available to check on prior authorization
status.
3:39:36 PM
COMMISSIONER GILBERTSON added that the vast majority of
providers require prior authorizations and that most of the
transactions are electronic. However, the providers that do not
use electronic interaction with the state use telephonic
communication.
3:40:28 PM
COMMISSIONER GILBERTSON, in response to Representative Seaton,
relayed that the FY 06 fiscal note reflects the operating cost
for one quarter. The pent up demand will take three years to
alleviate, after which there will be a more traditional
inflation factor for the program. The GF portion will increase
at a higher rate because concurrently with the program growth
there will be diminishing support from the Mental Health Trust,
he said.
3:41:51 PM
MR. SHERWOOD, in response to Representative Seaton, related
that:
The assumption in this fiscal note would be [that]
approximately 66 percent of the cost would be
federally funded. And that's a combination of the
regular match rate and the match rate we would receive
from ... [the] 100 percent federal match rate for
services provided through tribal facilities, which
would be a significant portion.
3:42:33 PM
COMMISSIONER GILBERTSON related that the calculations for the
fiscal note assumed the 50-50 match rate.
3:43:25 PM
MR. SHERWOOD, in response to Representative McGuire, relayed
that the subsection B of version G "refers to the ... base
treatment, the treatment people are already eligible for; ... it
says that the limits we impose, under the previous paragraph,
don't apply to that emergency treatment of dental care, so we
wouldn't somehow come in and inadvertently limit and restrict
the care we are already offering for these individuals."
3:44:30 PM
REPRESENTATIVE McGUIRE reiterated that the only difference
between the original HB 105 and Version G is the definition of
minimum treatment. She asked what the administration's
reasoning was for the definition change.
3:44:56 PM
MR. SHERWOOD said he did not know.
3:45:31 PM
COMMISSIONER GILBERTSON, in response to Representative Seaton,
related that the "access issue around dental services is a
legitimate one" and that while many dentists take Medicaid
patients, many do not. The Dental Association of Alaska has
stated its reasons for refusing Medicaid, such as reimbursement
issues, clients not showing for appointments, and the reluctance
of clients to sign the provider agreement required for Medicaid
providers. He said that the DHSS is addressing the
association's issues with the Department of Law (DOL), in order
to provide advisory guidance. He related his belief that the
department has gone out of its way to make Medicaid a "good
product," He stated that the state needs more providers and
more dentists willing to take Medicaid, and offered his belief
that the governor's proposal is the right thing to do and it
tells seniors, "we care."
3:52:25 PM
CHAIR WILSON said that one of the reasons many of the dentists
complained about Medicaid patients was due to cancelled
appointments, and the department should address that issue.
3:52:50 PM
COMMISSIONER GILBERTSON noted that he would not speak as to the
motivations of dentists to treat Medicaid patients, but there
are a variety of reasons. He noted that the U.S. Senator Ted
Stevens is very concerned about this problem and he has been
"approping money" to support the dental health care system by
developing dental health aides.
3:53:50 PM
REPRESENTATIVE McGUIRE said that she would be interested in
analyzing the provider agreement because it could be impacted
legislatively. She related her belief that the federal
government should consider tax write-offs for the providers who
treat Medicaid patients, thus creating more incentive for those
providers.
3:55:34 PM
COMMISSIONER GILBERTSON related that he would explore that
option, but warned that tax credit issues and their interaction
with other aspects of reimbursement policies are complex.
During the twenty-third legislative session, Senate Bill 41 was
signed into law and mandated that the department must contract a
third party to conduct audits under all Medicaid services. He
noted that while the provider agreement may be a topic to
discuss, the real issue is what is the agency doing to support
providers and what are the providers doing to make sure they are
increasing access to health care. He concluded that
reimbursement issues should be responsive to providers; the
supply and demand of health care should be assessed and
addressed.
3:57:21 PM
REPRESENTATIVE GARDNER said that Alaskan rural health care has
practitioners that provide cleaning, exams, and basic fillings.
She asked if the rural health care providers would be eligible
to participate in the Medicaid program.
3:57:40 PM
COMMISSIONER GILBERTSON said "yes," adding that the rural health
care is a federal initiative through Indian Health Services
(IHS) and the Alaska Native corporations, and the proposal plan
is to use more extender services. The Alaska Native Tribal
Health Consortium (ANTHC), alongside the Native corporations, is
in the process of utilizing more mid-level professionals, who
are the crux of the health care system in rural Alaska, he
noted.
4:00:37 PM
COMMISSIONER GILBERTSON, in response to Representative Seaton,
said that the DHSS is currently providing the service for
children, but there is no coverage for adults. The proposal
would give adults the increased coverage that the children
already receive, he noted.
4:01:45 PM
MR. SHERWOOD, in response to Representative Seaton, related his
belief that the DHSS fiscal note did not "factor in an unusual
amount for transportation."
4:02:43 PM
COMMISSIONER GILBERTSON added that the fiscal note should not
have to factor in additional transportation costs, since
Medicaid is the largest transportation purchaser in Alaska and
any reimbursement of transportation services is done through the
Medicaid program, so it is a larger leverage of federal dollars.
4:03:15 PM
REPRESENTATIVE SEATON related the dentists who accept Medicaid
patients would continue to service the ones they have, but will
not take any new Medicaid patients. Under these circumstances,
would any patient under the proposed program have to be
transported out of the area? He asked the DHSS to report back
to the committee with a response.
[HB 105, Version G, was held over.]
HB 106 - SENIOR CARE PROGRAM
4:05:51 PM
CHAIR WILSON announced that the final order of business would be
HOUSE BILL NO. 106, "An Act establishing the senior care program
and relating to that program; creating a fund for the provision
of the senior care program; repealing ch. 3, SLA 2004; and
providing for an effective date."
REPRESENTATIVE ANDERSON moved to adopt the proposed CS for HB
106, Version GH1090\G, Mischel, 2/8/05, as the working document.
There being no objection version G was before the committee.
4:06:08 PM
JOEL GILBERTSON, Commissioner, Department of Health and Social
Services (DHSS), stated that HB 106 would enhance the SeniorCare
program established by the administration. Seniors in Alaska
have high prescription drug costs. In 2003, congress passed the
Medicare Prescription Drug, Improvement and Modernization Act,
which established the Medicare prescription drug benefit for
seniors. For clarification purposes Commissioner Gilbertson
explained that Medicare is a collection of programs and
benefits, and when discussing the prescription drug coverage,
Part D is what is referenced. In 2003, Part D was established
by congress. In 1965, the origins of the Medicare program, part
A and B, were passed. Part A, goes towards insurance coverage
for seniors, mainly for in-patient care facility services. Part
B, is what most seniors use, and the coverage is for outpatient
services. Part C - which was originally called Medicare Plus
Choice and was [essentially a form of] Medicaid managed care -
has been renamed Medicare Advantage. Part D, is the new
benefit, which adds coverage for prescription drugs.
Preferential treatment is given to low-income seniors because
the federal government covers the premium and the deductible
costs. He said that HB 106 will allow the state to transition,
extend, and enhance the prescription drug and cash assistance
services provided to seniors.
COMMISSIONER GILBERTSON related that the seniors below 135
percent of poverty level - for a single individual receiving a
yearly income under $16,000 and for a couple $21,000 - will
continue receiving cash assistance of $120 per month, amounting
to $1,440 per year. In addition to the income qualifications
there is a liquid asset level, he noted. The Medicare benefit
will be extended to those who qualify and their premiums and
deductibles will be covered, the value of which is about $670
per person. Those who qualify will receive the full
prescription drug coverage under Medicare Part D. The State
expects to serve about 7,000 seniors. However, HB 106 plans to
expand coverage for seniors above the 135 percent of poverty
level and up to those at 300 percent of poverty level; which is
applicable to an individual receiving a yearly income of $35,000
and a couple receiving $47,000, with a higher liquid asset level
for an individual of $50,000 and for a couple of $100,000. He
related that the governor's proposal ensures that there will not
be a senior in the state who is unable to enroll in Medicare
Part D simply because they cannot afford the premium deductible.
The governor's proposal plans to pay the premium, monthly
premium, deductible cost for those seniors, and the proposal
will serve 10,000 seniors, he noted.
COMMISSIONER GILBERTSON related that the cost of the program for
FY 06 could initially be low, because there is still a balance
in the SeniorCare trust fund and the program will not go into
effect until 2006. However, after FY 06 the program will have a
higher cost, and the administration will fund the differences in
revenue on a "rolling" basis.
4:17:33 PM
COMMISSIONER GILBERTSON presented a chart entitled Strengthening
and Improving Drug Coverage for Alaska Seniors. The chart
compared the "old" SeniorCare prescription drug benefits to the
"new" benefits. He pointed out that under the old SeniorCare
benefits, seniors up to 135 percent and 150 percent of the
poverty level had $1,000 of drug subsidies; for example, the out
of pocket expense for an individual with a high drug cost of
$2,500 would be $1,500. The out of pocket expense under [HB
106] for the same high drug cost would be $457, he noted. This
reduced out of pocket expense is due to the SeniorCare drug
benefit, which covers the premium and deductibles, and the
Medicare drug benefit, which covers the Medicare cost of drugs.
4:21:05 PM
JON SHERWOOD, Medical Assistant Administrator, Division of
Finance & Management Services, Department of Health and Social
Services (DHSS), in response to Representative Gardner, said
that asset limitations are not defined in HB 106, but are
established by regulation, which defines assets as liquid assets
that could be readily converted to cash within 20 days and could
include bank accounts and retirement accounts.
4:21:57 PM
REPRESENTATIVE GARDNER asked if seniors could own a paid-off
home worth $500,000 and still receive the proposed benefits.
4:22:19 PM
COMMISSIONER GILBERTSON said that would be correct.
4:22:25 PM
REPRESENTATIVE GARDNER said:
I find it a little troubling, when they can have ...
300 percent ... of the federally defined poverty level
and yet our Denali Kid Care, for children, who would
have no other assets whatsoever, have to have under
175 percent of poverty level. So it seems ... we are
being far more generous with seniors than we are with
children.
4:22:47 PM
COMMISSIONER GILBERTSON related that there is no "acid test" on
Denali Kid Care.
4:22:58 PM
COMMISSIONER GILBERTSON, in response to Representative Seaton,
clarified that Denali Kid Care bases eligibility on income
rather than assets.
4:23:13 PM
COMMISSIONER GILBERTSON, in response to Representative Seaton,
pointed to the side of the aforementioned chart, pertaining to
those at 135 percent of poverty level and the other side
pertaining to those at 300 percent of poverty level. The gap
between the first and second side are the individuals that will
have access to the prescription drug benefits, and those below
the 135 percent of poverty will have the cash assistance.
4:24:46 PM
COMMISSIONER GILBERTSON, in response to Representative Seaton,
related that the charts were used for broad audiences so the
numbers are rounded. The fiscal note details the exact
projections, he relayed. He said that the state plans to serve
about 17,000 seniors, which is [over] 40 percent of the 40,000
seniors in Alaska.
4:25:34 PM
MR. SHERWOOD, in response to Chair Wilson, explained that the
rationale for excluding people from public facilities and other
institutions is to prevent the duplication of existing programs.
For instance, he said, the state already provides health care
for inmates of correctional facilities, and pioneer and veterans
homes have a payment assistance program, which covers health
costs.
4:27:06 PM
COMMISSIONER GILBERTSON relayed that the bill was drafted to
extend but not duplicate a benefit already offered by the state,
and the state covers prescription drug costs for individuals in
facilities.
4:27:31 PM
COMMISSIONER GILBERTSON, in response to Representative Seaton,
related that the administration did not intend to replace
longevity payments with SeniorCare benefits. The program will
provide service to a host of individuals who are not even
eligible for the longevity bonus program, he noted.
4:28:56 PM
MR. SHERWOOD, in response to Representative Seaton, said when
drafting HB 106 the administration did not include the
beneficiary client hearings for public assistance programs. The
process under AS 7 AAC 49 sets forth hearing rights, processes,
and procedures for assistance clients.
4:30:18 PM
COMMISSIONER GILBERTSON added that during the initial effort
there was a conscious decision not to include public assistance
determinations.
4:30:35 PM
COMMISSIONER GILBERTSON, in response to Representative Wilson,
noted that the DHSS never operated the longevity bonus program.
4:31:07 PM
REPRESENTATIVE SEATON raised the issue of appeal hearings.
4:31:55 PM
COMMISSIONER GILBERTSON stated that the administration is very
supportive of streamlining hearings in the "closed" process.
The determinations around public assistance benefits are handled
in an integrated, uniform, centralized way through the U.S.
Department of Public Health and Social Services, he noted.
[HB 106, Version G, was held over.]
ADJOURNMENT
4:32:28 PM
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 4:32 p.m.
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