04/02/2013 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HJR14 | |
| HB54 | |
| Alaska Children's Services | |
| HB134 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | HJR 14 | TELECONFERENCED | |
| += | HB 54 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 134 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 2, 2013
3:05 p.m.
MEMBERS PRESENT
Representative Pete Higgins, Chair
Representative Wes Keller, Vice Chair
Representative Benjamin Nageak
Representative Lance Pruitt
Representative Lora Reinbold
Representative Paul Seaton
Representative Geran Tarr
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE JOINT RESOLUTION NO. 14
Requesting the United States Congress and the Governor to take
actions necessary to delay implementation of the Patient
Protection and Affordable Care Act.
- MOVED CSHJR 14(HSS) OUT OF COMMITTEE
SPONSOR SUBSTITUE FOR HOUSE BILL NO. 54
"An Act relating to the identification, location, and
notification of specified family members and family friends of a
child who is in state custody."
- MOVED CSSSHB 54(HSS) OUT OF COMMITTEE
PRESENTATION: ALASKA CHILDREN'S SERVICES
- HEARD
HOUSE BILL NO. 134
"An Act requiring Medicaid payment for scheduled unit dose
prescription drug packaging and dispensing services for
specified recipients."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HJR 14
SHORT TITLE: DELAY IMPLEMENTING AFFORDABLE CARE ACT
SPONSOR(s): REPRESENTATIVE(s) STOLTZE
03/22/13 (H) READ THE FIRST TIME - REFERRALS
03/22/13 (H) HSS
04/02/13 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 54
SHORT TITLE: PLACEMENT OF A CHILD IN NEED OF AID
SPONSOR(s): REPRESENTATIVE(s) GARA, THOMPSON
01/16/13 (H) PREFILE RELEASED 1/11/13
01/16/13 (H) READ THE FIRST TIME - REFERRALS
01/16/13 (H) HSS, JUD
01/24/13 (H) SPONSOR SUBSTITUTE INTRODUCED
01/24/13 (H) READ THE FIRST TIME - REFERRALS
01/24/13 (H) HSS, JUD
02/07/13 (H) HSS AT 3:00 PM CAPITOL 106
02/07/13 (H) Scheduled But Not Heard
02/26/13 (H) HSS AT 3:00 PM CAPITOL 106
02/26/13 (H) Heard & Held
02/26/13 (H) MINUTE(HSS)
04/02/13 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 134
SHORT TITLE: MEDICAID PAYMENT FOR MEDISET PRESCRIPTION
SPONSOR(s): REPRESENTATIVE(s) COSTELLO
02/20/13 (H) READ THE FIRST TIME - REFERRALS
02/20/13 (H) HSS, FIN
03/19/13 (H) HSS AT 3:00 PM CAPITOL 106
03/19/13 (H) Heard & Held
03/19/13 (H) MINUTE(HSS)
03/28/13 (H) HSS AT 3:00 PM CAPITOL 106
03/28/13 (H) Heard & Held
03/28/13 (H) MINUTE(HSS)
04/02/13 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
REPRESENTATIVE BILL STOLTZE
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HJR 14, as the sponsor of the
bill.
MARK REGAN
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HJR 14.
KEN HELANDER, Associate Director for Advocacy
AARP
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HJR 14.
PEGGYANN MCCONNOCHIE, Owner
Cycle Alaska
Juneau, Alaska
POSITION STATEMENT: Testified in support of HJR 14.
TOBY SMITH, Staff
Representative Les Gara
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented SSHB 54 on behalf of the joint
prime sponsor of the bill, Representative Gara, and answered
questions.
AMANDA METIVIER, Statewide Coordinator
Facing Foster Care in Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of SSHB 54.
CHRISTY LAWTON, Director
Central Office
Office of Children's Services
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during the discussion of
SSHB 54.
DENIS McCARVILLE, President & CEO
Alaska Children's Services
Anchorage, Alaska
POSITION STATEMENT: Presented an overview about the Alaska
Children's Services.
MARY ANN PEASE, Vice President Finance and Administration
Alaska Children's Services
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the presentation
by the Alaska Children's Services.
CHARLES GUINCHARD, Staff
Representative Mia Costello
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 134 on behalf of
Representative Costello, sponsor of the bill.
JON SHERWOOD, Medicaid Special Projects
Office of the Commissioner
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified during discussion on HB 134.
ACTION NARRATIVE
3:05:13 PM
CHAIR PETE HIGGINS called the House Health and Social Services
Standing Committee meeting to order at 3:05 p.m.
Representatives Higgins, Keller, Tarr, Reinbold, and Nageak were
present at the call to order. Representatives Pruitt and Seaton
arrived as the meeting was in progress.
HJR 14-DELAY IMPLEMENTING AFFORDABLE CARE ACT
3:06:13 PM
CHAIR HIGGINS announced that the first order of business would
be HOUSE JOINT RESOLUTION NO. 14, Requesting the United States
Congress and the Governor to take actions necessary to delay
implementation of the Patient Protection and Affordable Care
Act.
REPRESENTATIVE BILL STOLTZE, Alaska State Legislature, stated
that he had drafted this resolution out of concern for the
implementation of the Patient Protection and Affordable Care
Act, and offered his belief that this act was not well vetted.
He suggested that the Supreme Court had identified the act as "a
massive tax increase." He said that the crux of this proposed
resolution was to seek delay for the implementation of the
Patient Protection and Affordable Care Act. He stated that his
goal was not to oppose it, but delay its implementation until
Congress had examined all the employer costs and impacts on the
private sector. He declared that he had contacted the National
Federation of Independent Business (NFIB), which he deemed to be
an advocacy group for "watching and protecting the interests of
the mom and pops in small businesses" which "make up the fabric
of our economy." He pointed out that the act did not take
effect until 2014. He questioned how many jobs would be lost
with the act. He offered his belief that this act was a tax
policy, declaring that "taxes affect behavior." He surmised
that the application of the act would affect employment and
business. He opined that this was one of the largest tax
increases in U.S. history.
3:11:41 PM
The committee took a brief at-ease.
3:12:19 PM
CHAIR HIGGINS brought the committee back to order, and opened
public testimony.
3:12:38 PM
MARK REGAN said that the State of Alaska, by not setting up a
health exchange and not actively regulating health insurance in
Alaska, had created a position whereby there was little the
state could do to stop the Patient Protection and Affordable
Care Act from going into effect. [indisc.] He suggested that
the business community was not as nervous about the
implementation of the act, as it had been earlier. He expressed
his hope that the committee would delay consideration of this
resolution until it had heard more balanced information.
3:14:21 PM
KEN HELANDER, Associate Director for Advocacy, AARP, said that
he was speaking on behalf of the 95,000 AARP members in Alaska,
and that AARP strongly objected to HJR 14 and a delay to
implementation of the Patient Protection and Affordable Care
Act. He stated that HJR 14 did little to advance any meaningful
purpose, pointing out that the act had been repeatedly upheld.
He suggested that the legislature should look for ways to
improve the opportunity for all Alaskans, instead of looking for
ways to stand in the way. He declared that the act presented
many opportunities for growth and economic stimulus in Alaska.
He referenced the Northern Economic study which concluded that
the Medicaid expansion would add an additional $15 in federal
funds for every state dollar, would generate 4,000 new jobs by
2017, and would generate a cumulative economic benefit between
2014 and 2019 of $2.3 billion. [indisc.] He pointed out that
Alaska had opted not to create its own health insurance
exchange, which would bring federal involvement for a federally
facilitated exchange. He emphasized that implementation of the
act in Alaska would allow all Alaskans access to affordable,
comprehensive health care coverage. He declared that AARP would
act collaboratively with policy makers to ensure that a
successful marketplace would be established, providing all
Alaskans with health care coverage.
3:17:54 PM
REPRESENTATIVE NAGEAK asked for the written comments to be sent
to the committee.
3:18:39 PM
PEGGYANN MCCONNOCHIE, Owner, Cycle Alaska, said that her
company, Cycle Alaska, employed "just under the amount necessary
for mandated health care." She said that her company wanted to
grow. She declared support for proposed HJR 14. She reviewed
that the annual [health care] premium for the average family
would increase by $2100, while the IRS estimated that a family
insurance plan in 2013 would be $20,000. She declared that her
insurance cost had just increased by 13 percent. She referenced
a report by the Congressional Budget Office (CBO) which
estimated that 7 million people would lose employer based
coverage, and she opined that this was due to employer penalties
for lack of employee insurance. She suggested that employers
would recommend for employees to purchase insurance through the
various health exchanges. She reported that other business
owners were not hiring, were dividing their companies into units
of fewer than 50 employees, or were reducing hours from full
time employment in order to avoid this requirement. Again
referencing the CBO, she declared there were 1 trillion new
taxes under the Patient Protection and Affordable Care Act. She
declared that she did not "need or want any more taxes." She
offered an anecdote about her pre-existing health condition, and
stated that she had always had health care. She opined that the
act would increase her health care costs, and would remove some
of her current choices. She urged support for HJR 14.
3:21:30 PM
CHAIR HIGGINS closed public testimony.
3:21:47 PM
The committee took a brief at-ease.
3:22:35 PM
CHAIR HIGGINS brought the committee back to order.
[CHAIR HIGGINS passed the gavel to Vice Chair Keller.]
CHAIR HIGGINS brought attention to proposed Amendment 1, labeled
28-LS0187\U.1, Bailey, 4/1/13, which read:
Page 1, line 1:
Delete "and the Governor"
Insert ", the Governor, and the state's
congressional delegation"
Page 5, following line 12:
Insert new material to read:
"FURTHER RESOLVED that the Alaska State
Legislature calls on the state's Congressional
delegation to introduce, sponsor, support, and vote to
pass legislation in both houses of the United States
Congress that will delay the implementation of the
Patient Protection and Affordable Care Act until a
full analysis of the economic effect of the Act on
Alaskans and Alaska can be clearly quantified; and be
it"
CHAIR HIGGINS explained that the proposed amendment added
another whereas which would also urge the Alaska congressional
delegation in Washington, D.C. to take action to delay
implementation of the act.
VICE CHAIR KELLER moved to adopt Amendment 1, labeled 28-
LS0187\U.1, Bailey, 4/1/13. [Text included above]
REPRESENTATIVE PRUITT objected for discussion.
REPRESENTATIVE STOLTZE expressed appreciation for the proposed
amendment which was consistent with his stated intent.
VICE CHAIR KELLER explained that proposed Amendment 1 would
delete "and the Governor" on page 1, line 1, and insert "the
Governor, and the state's congressional delegation". He noted
that, on page 5, line 12, a new "Further Resolved" would be
added, and he read:
further resolved that the Alaska State Legislature
calls on the state's Congressional delegation to
introduce, sponsor, support, and vote to pass
legislation in both houses of the United States
Congress that will delay the implementation of the
Patient Protection and Affordable Care Act until a
full analysis of the economic effect of the Act on
Alaskans and Alaska can be clearly quantified;
3:24:44 PM
REPRESENTATIVE PRUITT removed his objection.
VICE CHAIR KELLER objected.
REPRESENTATIVE NAGEAK asked if there would be further discussion
on the proposed resolution.
VICE CHAIR KELLER stated that there would be further discussion
and he removed his objection. There being no further objection,
Amendment 1 was approved.
3:25:13 PM
The committee took a brief at-ease.
[Vice Chair Keller returned the gavel to Chair Higgins]
CHAIR HIGGINS brought the committee back to order.
3:25:41 PM
REPRESENTATIVE NAGEAK questioned why there had not been any
testimony from the rest of the state regarding proposed HJR 14.
He pointed out that the committee had not heard anything from
municipalities or tribal governments. He remarked that comments
about a resolution of this magnitude should have been heard from
the rest of the state.
3:26:56 PM
REPRESENTATIVE KELLER declared that he supported the resolution.
He said the resolution had been properly posted to allow the
public to offer its comments. He offered his belief that the
estimated costs to the act would increase. He noted that there
were now more taxes, which created an unsustainable burden.
3:28:21 PM
REPRESENTATIVE STOLTZE offered his belief that AARP "cut a deal"
to market its insurance. He expressed his agreement with
earlier testimony that things had changed in the previous six
months, although, he opined, things had not "gotten rosier" as
the public and private sector were simply more acquiescent
toward the issues. He offered his belief that the stakes were
elevating even higher, referencing some recent newspaper
articles. He suggested that the public was "numbed." He
offered his belief that the NFIB testimony represented the
private sector and small businesses. He suggested to
Representative Nageak that he "be careful about having a lot of
trust in that long term; what the federal government gives, it
can yank away, and does routinely."
3:31:44 PM
REPRESENTATIVE KELLER commented that a tension from the Patient
Protection and Affordable Care Act (PPACA) was that it "cuts
huge amounts out of Medicare." He deemed that the provider had
to pay the difference as Medicare was reduced. He opined that
this would create a dependence on Medicaid, "a needs based
program." He expressed his concern for seniors, and he
suggested that a delay of the act would allow time for more
thought.
3:33:17 PM
REPRESENTATIVE STOLTZE concluded that he had focused his
objections, and that "government can't give us anything unless
they yank it away from someone else first."
3:33:58 PM
REPRESENTATIVE NAGEAK acknowledged that he was not personally
concerned as he had very good insurance, but he expressed his
unease for those who could not afford insurance.
3:35:03 PM
REPRESENTATIVE REINBOLD offered her belief that it was
"important to look out for the fabric of America that's holding
our economy together." She said "this is an unbelievable bill
and I think it's really important that we slow this process
down."
3:35:28 PM
REPRESENTATIVE TARR, reporting on the history of the Patient
Protection and Affordable Care Act, referenced the individual
mandate discussions during the early 1990s. She opined that the
individual mandate was the crux of this act and had been
supported by the Alaska congressional delegation, as well as
endorsed by the Heritage Foundation, which was a well-known pro-
business, conservative organization. She declared that this
history was important to remember. She remarked that the
catalyst for change resulted from the rising health care costs,
which were hurting businesses. She declared that "she wouldn't
want us to kick the can down the road and not address the
issue." She shared her interest in ensuring that "as many
Alaskans as possible have health insurance, have access to
affordable health insurance." She pointed out that the state
with the most insured citizens was Massachusetts, under its
health care program, known as "Romneycare." She directed
attention to a table titled, "Health Care Model Comparison."
[Included in members' packets] She declared that the
Massachusetts model was similar to the PPACA, although more
restrictive with regard to the employer mandate for required
insurance coverage.
3:37:39 PM
CHAIR HIGGINS stated that this discussion was not for a
comparison of Massachusetts care to PPACA, and that
Representative Tarr should "wrap this up."
REPRESENTATIVE TARR replied that her comments were valid for the
record, and that she did not appreciate her discussion time
being shortened as this was a very important issue. She opined:
"I don't think 35 minutes in committee over something that
affects thousands and thousands of Alaskans is too much time."
She pointed to the success of Massachusetts with insuring a high
number of individuals, and suggested a look at the components of
the Massachusetts plan, as they were important pieces of
information for developing a plan to attain this goal of
insuring more Alaskans.
3:38:39 PM
CHAIR HIGGINS stated that he had previously heard arguments
about the Massachusetts plan, which he deemed were "about
Massachusetts only and not about any other state, so it's
comparing apples to oranges, it's completely different, and
that's why the numbers are different."
3:39:16 PM
REPRESENTATIVE KELLER commented: "I really think we need to
really go slow on this." He indicated a statistic from a 2010
Institute of Social and Economic Research (ISER) study which
said that Alaskans spent $7.5 billion for health care, which was
projected to double. He said that this was approximately half
of the earnings of all Alaskans. He offered his belief that a
change was forthcoming, and that it would affect the lives of
the elderly and others in Alaska.
REPRESENTATIVE KELLER moved to report HJR 14, Version 28-
LS0187\U, [as amended], out of committee with individual
recommendations and the accompanying zero fiscal notes. There
being no objections, CSHJR 14(HSS) was moved from the House
Health and Social Services Standing Committee.
3:40:53 PM
The committee took an at ease from 3:40 p.m. to 3:46 p.m.
HB 54-PLACEMENT OF A CHILD IN NEED OF AID
3:46:16 PM
CHAIR HIGGINS announced that the next order of business would be
SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 54, "An Act relating to
the identification, location, and notification of specified
family members and family friends of a child who is in state
custody." [In front of the committee was Version 28-LS0202\R,
adopted as the working document on February 26, 2013.]
REPRESENTATIVE KELLER moved to adopt the proposed committee
substitute (CS) for HB 134, labeled 28-LS0303\R, Mischel,
4/1/13, as the working document.
REPRESENTATIVE PRUITT objected for discussion.
REPRESENTATIVE SEATON asked to clarify which bill was being
discussed.
REPRESENTATIVE KELLER clarified that he had meant to adopt
[SS]HB 54, Version R.
CHAIR HIGGINS rescinded the previous motion.
REPRESENTATIVE KELLER moved to adopt the proposed committee
substitute (CS) for [SS]HB 54, labeled 28-LS0202\R, Mischel,
2/7/13, as the working document.
3:47:15 PM
TOBY SMITH, Staff, Representative Les Gara, Alaska State
Legislature, explained that there were three sections in Version
R. He read from the House Bill 54 Sectional Analysis:
[Included in members' packets]
This section adds a new section to AS 47.10, requiring
that a supervisor in the Office of Children's Services
(OCS) certify in writing that a search for
noncustodial parents, adult family members, and
appropriate adult family friends of the child has been
conducted. OCS must notify these adults of the child's
removal within 30 days, unless there are extenuating
circumstances. This section codifies existing OCS
policy related to extended family searches, and adds
the requirement of supervisor certification.
This section adds a reference to the new section of
statute established in Section 1. It requires that due
diligence be conducted to locate extended family
members before the child is placed in a foster home.
This section allows the department to provide for
emergency placement of a child while conducting due
diligence.
MR. SMITH stated that the proposed bill would not cost the state
any money, and would address an accountability issue, to ensure
that "front line case workers are doing the work that they are
supposed to be doing, and that's in the best interests of foster
youth by requiring that a supervisor sign off when a case worker
has done a due diligence search."
3:49:11 PM
REPRESENTATIVE KELLER asked if the Department of Health and
Social Services (DHSS) had indicated a possibility that this
would remove an option for not contacting an individual
considered to be a danger to the child.
MR. SMITH deferred to DHSS.
3:50:02 PM
CHAIR HIGGINS opened public testimony.
REPRESENTATIVE PRUITT removed his objection.
3:51:05 PM
AMANDA METIVIER, Statewide Coordinator, Facing Foster Care in
Alaska, stated that the proposed bill ensured compliance with
regulations that were already an Office of Children's Service'
(OCS) policy. She noted that that there was not a cost to the
state, and it could potentially save money in the search for
foster homes, and for the cost of long term foster care.
3:52:59 PM
REPRESENTATIVE KELLER, noting that the proposed bill required
OCS to notify a list of people, asked if this would force OCS to
make contact with a non-custodial parent who they would prefer
not to contact.
3:53:48 PM
CHRISTY LAWTON, Director, Central Office, Office of Children's
Services, Department of Health and Social Services, said that
this proposed bill did not change the current requirements for
contact.
REPRESENTATIVE KELLER asked if a non-custodial parent included a
parent who had lost their parental rights through the courts.
MS. LAWTON opined that it would not.
REPRESENTATIVE KELLER asked to confirm this, as this
notification may not serve the best interest of the child.
3:54:54 PM
REPRESENTATIVE SEATON asked about earlier testimony that this
was required in federal law and was a policy of the DHSS. He
opined that the concerns presented by Representative Keller
would have already been addressed.
MS. LAWTON replied that the proposed bill included elements
already addressed in federal law, with some small additions that
were not yet included in policy or law.
REPRESENTATIVE SEATON asked if those additions were reasonable
and beneficial.
MS. LAWTON said that the additions were reasonable and could
provide some enhancements.
3:56:10 PM
CHAIR HIGGINS asked for the reasons that OCS wanted these
changes in statute.
MS. LAWTON replied that she preferred a change to the
regulations, instead of policy. She noted that there had been
concern for whether changes in regulation were the best forum,
as policy changes could have the same effect. She noted that
the majority of OCS policy, procedures, and day to day practice
were not covered in regulation. She offered her belief that
these proposed changes were a better fit in regulation; although
they would be allowable in procedure, the preferred avenue was
in regulations, per the Department of Law.
3:57:47 PM
CHAIR HIGGINS opined that there were too many layers of
bureaucracy, and he asked if this proposed bill would be a
hindrance.
MS. LAWTON replied that the proposed bill did not create
bureaucracy, but added components of good practice for
improvement. She said that, although the amount of work for the
staff would be less with a change in policy, the meaning and the
intent of the proposed bill was not bureaucratic.
CHAIR HIGGINS asked, if this became statute, would it invite
more litigation compared to current experience.
MS. LAWTON replied that she did not anticipate any increase in
litigation as the majority of the aspects of the proposed bill
were already in practice.
3:59:44 PM
REPRESENTATIVE KELLER asked to clarify that there was nothing in
the proposed bill that implied any preference for placement of a
child.
MS. LAWTON, in response, said that the proposed bill did outline
a preference standard, but that this was a standard which OCS
already used. She explained that the priority ranking was to
relatives, then family friends with a relationship to the child,
and then to the unrelated licensed foster care family. She
declared these to be the same preferences as were currently
followed.
4:01:15 PM
REPRESENTATIVE KELLER asked to ensure that his earlier request
for information be delivered to the House Judiciary Standing
Committee.
4:01:32 PM
CHAIR HIGGINS closed public testimony.
4:01:40 PM
REPRESENTATIVE KELLER moved to report CSSSHB 54, Version 28-
LS0202\R, Mischel, 2/7/13, out of committee with individual
recommendations and the accompanying zero fiscal notes. There
being no objection, CSSSHB 54(HSS) was moved from the House
Health and Social Services Standing Committee.
4:02:03 PM
The committee took an at-ease from 4:02 p.m. to 4:04 p.m.
^Alaska Children's Services
Presentation: Alaska Children's Services
4:04:27 PM
CHAIR HIGGINS announced that the next order of business would be
a presentation by the Alaska Children's Services.
DENIS McCARVILLE, President & CEO, Alaska Children's Services
(ACS), said that Alaska Children's Services was an organization
dedicated to the well-being of children. He declared that the
focus, since its inception in 1890 as the Jesse Lee Home, had
been to serve one family and one child at a time. He pointed
out that the children came from all parts of the state. He
reported that the children went through a lot of suffering just
to get to treatment. He acknowledged that the patterns had been
set for generations, and "will not be changed by a simple
program." He proposed that Alaska Children's Services take the
knowledge learned in Anchorage, and bring it to the villages.
He said that ACS had been successful in treating children from
the villages for many years. He noted that there was a loss of
culture, family, and community relationships when the children
came to Anchorage for treatment. He relayed that transportation
and technology advances now offered the ability to overcome many
problems. He said that Alaska Children's Services had trained
more than 300 people in Anchorage and more than 200 others in
outside areas.
4:07:41 PM
The committee took an at-ease from 4:08 p.m. to 4:13 p.m.
4:13:22 PM
CHAIR HIGGINS brought the committee back to order.
MR. McCARVILLE said that ACS was training and hiring individuals
who cared about people, and although they did not have
credentials, they were interested in serving and continuing on
for a professional degree. He proposed that ACS take its
training and clinical support to the villages to teach
individuals who care, as there was now the technology to do
this. He declared that a statewide behavioral health training
and delivery system would offer training and support to elders,
teachers, and other interested parties, to work collaboratively
in the villages with troubled youth and families. This
intervention could make an early difference when the problems
were just becoming evident. He offered his belief that the
needs of each family and each village would be different. He
suggested that the training would stay in the villages to help
the next people who needed help. He declared that the goal was
to blend the Anchorage training with the local cultures, using
in-person and distance based services in collaboration with
behavioral health aides. He stated that the staff would travel
to villages to build relationships and to provide services, and
then augment this with distance based initiatives. He listed
the trainings: mental health first aid; gatekeeper training;
brain based trauma informed training; source of strength; trauma
101; caring with love and logic; and, fetal alcohol spectrum
training. He noted other areas that could be adapted to village
needs, including: managing aggressive behavior; building
therapeutic relationships; competencies for direct care; basic
counseling and training; and, bullying intervention. He noted
that distance and in-person training were the foundation of the
services, but that there would also be 24 hour clinical support.
4:17:35 PM
MR. McCARVILLE reported that the staff, in Anchorage, could
provide telephonic and crisis intervention to any place with a
Wi-Fi connection. He recognized that services were limited in
some villages. He declared that it was time to begin to look at
where they could provide this service, and that technology could
be a solution.
4:19:17 PM
MR. McCARVILLE shared that ACS was making an $8.5 million
capital request to ramp up the program. He said that approval
would allow them to serve the children. He surmised that the
treatment of 66 children in the villages, preventing the need to
come to Anchorage for a residential treatment program, would pay
for this program. He asked that the House Health and Social
Services Standing Committee speak with the House Finance
Committee in support of this proposal.
4:20:13 PM
MARY ANN PEASE, Vice President Finance and Administration,
Alaska Children's Services, said that the board of Alaska
Children's Services was very focused on a business type
approach, in addition to its social and holistic mission. She
offered to deliver a business plan that would show an overall
reduction in the necessary funding for residential treatment.
She declared that the current cost was $350 each day for each
child, which did not include the $8 million spent for services
outside of Alaska. She proposed this innovative program as a
proactive, preventative measure for all the Alaska communities.
She directed attention to the letter in support from the Alaska
Native Tribal Health Consortium (ANTHC) [Included in members'
packets] and the support from Jeff Jessee, Chief Executive
Officer of the Alaska Mental Health Trust Authority.
4:22:46 PM
MR. McCARVILLE stated that the proposed program needed financial
help "to get this ramped up." He shared that the desire was to
bring this up to a scale to help multiple villages across
Alaska.
MS. PEASE reported that the majority of the current facility was
located near Robert Service High School in Anchorage. She
reported that the designer of the Alaska State Flag, Benny
Benson, had been a "member of the treatment program," so each
year, there was a ceremony honoring him, and the agency, on Flag
Day.
4:23:45 PM
REPRESENTATIVE KELLER asked to clarify, as this was a different
model, whether all the details for the program were known.
MR. McCARVILLE replied that ACS was working with ANTHC to
develop ways to operate in the villages. He declared that, as
it was most important for the program to be invited into the
villages, they were currently working toward those invitations.
He pointed out that each village program would vary to meet its
unique needs.
4:25:03 PM
REPRESENTATIVE KELLER asked if ACS would use electronics to
reach out beyond the residential treatment center.
MR. McCARVILLE explained that, as ACS already provided in-home
service in the Anchorage area, the program would use this to
train providers in the villages.
4:25:42 PM
REPRESENTATIVE KELLER asked what was the annual ACS budget, and
how many children were served.
MR. McCARVILLE replied that the annual budget was $14 million,
serving about 150 children on any given day. He detailed that
there were 55 children in the residential program, 65 were in
treatment foster homes, with the remainder living at home in the
communities.
4:26:34 PM
CHAIR HIGGINS, asking to clarify that this was an $8.5 million
capital proposal, requested a breakdown to the distribution of
the funding.
MR. McCARVILLE, in response, said that the money would be
invested into the building of a center for both in-person and
technology training. He stated that other agencies would be
invited to use the center in coordination with this program.
MS. PEASE added that the request included "a fairly hefty
technology component," as there was extensive technological
equipment necessary to serve the communities.
4:27:43 PM
CHAIR HIGGINS asked to clarify that the requested funding of
$8.5 million would build the 14,925 square foot building and
"fill it with all the equipment." He said that it was necessary
to work closely with all the stakeholders. He opined that there
were a lot of really good intentions, but that it was necessary
to consolidate the efforts with other organizations. He
encouraged ACS to develop "a game plan that will work, that
everyone's on board with."
MS. PEASE relayed that more than 50 percent of the children were
from areas outside of the Anchorage, Mat-Su, Kenai areas.
MR. McCARVILLE reported on a pilot program with a village that
had asked for help. He noted that the village had the
technology availability for the program. He shared that there
was a program being developed with Nome for tele-behavioral
health.
4:29:47 PM
CHAIR HIGGINS referenced an earlier presentation to the House
Health and Social Services Standing Committee regarding
development of a certification program for behavioral health
aides. He observed that, as ACS had a similar approach, the two
groups should work together.
MR. McCARVILLE replied that ACS was focusing on in-formal health
support, which would include parents, grandparents, aunts and
uncles, and other supporters who were raising the children. He
stated that ACS "would work hand in hand with a behavioral
health aide." He noted that this was similar to the ACS
collaborative approach with ANTHC and University of Alaska
Fairbanks. He reported that the ACS staff training was also
offered to the parents.
4:31:39 PM
CHAIR HIGGINS asked if ACS had estimated the annual maintenance
costs for this program, and if there would be funding necessary
in the future.
MR. McCARVILLE replied that the annual cost would include
maintenance staff, who already worked on the property, as well
as upkeep to the building. He said that clinical work for
prevention would be paid by Medicaid, and that there were other
prevention grants and existing funding, for which, he opined,
the program would be eligible.
CHAIR HIGGINS asked to clarify that Medicaid billing would pay
for the program.
MS. PEASE said that there would be a cost savings for prevention
and early intervention, instead of residential treatment, and
that this cost savings had been built into the model.
4:33:37 PM
REPRESENTATIVE NAGEAK, referencing the building maintenance
costs, suggested the use of new technology for lighting.
MS. PEASE expressed agreement, and reported that the building
design and diagrams had been donated, stating that it would be
energy efficient with high technology.
4:34:28 PM
CHAIR HIGGINS offered to try to help keep similar programs
alive.
4:34:54 PM
The committee took an at-ease from 4:34 to 4:37 p.m.
HB 134-MEDICAID PAYMENT FOR MEDISET PRESCRIPTION
4:37:55 PM
CHAIR HIGGINS announced that the final order of business would
be HOUSE BILL NO. 134, "An Act requiring Medicaid payment for
scheduled unit dose prescription drug packaging and dispensing
services for specified recipients." [In front of the committee
was Version 28-LS0303\Y, adopted as the working document on
March 28, 2013.]
REPRESENTATIVE KELLER moved to adopt the proposed committee
substitute (CS) for HB 134, labeled 28-LS0303\R, Mischel, 4/1/13
as the working document.
REPRESENTATIVE PRUITT objected for discussion.
4:38:24 PM
CHARLES GUINCHARD, Staff, Representative Mia Costello, Alaska
State Legislature, explained that the changes for Version R
included:
Section 1 AS 47.01.031(a). This section has been
amended by adding legislative intent language guiding
the department's eligibility regulations for this
program. This language was added to ensure that in
the event that Medicaid services were to expand, the
scope of individuals eligible for this program would
remain the same. This language appears as (1)-(5) in
paragraph (a), page 1, line 12.
MR. GUINCHARD referenced his earlier testimony for the bulleted
list of current regulations, and pointed out that similar
language had been requested for this change. He noted the
second change:
Section 1 AS 47.01.031(c). This section has been
amended by adding language to clarify that non-local
transportation of medication compliance packaging is
by mail or package delivery service.
MR. GUINCHARD explained that this addressed concerns for the
earlier limitation to USPS. He commented on the third change
for Version R:
Section 1 AS 47.01.031(e)(2). The definitions of
"units of use" has replaced the previous definition of
"medication compliance packaging".
MR. GUINCHARD said that the proposed bill had been updated
accordingly to reflect this new definition. He declared that
this concluded the changes for proposed Version R.
4:41:27 PM
REPRESENTATIVE KELLER said that he was "painfully aware of the
rising costs of health care." He declared that he would find it
difficult to vote for any expansion of Medicaid services.
JON SHERWOOD, Medicaid Special Projects, Office of the
Commissioner, Department of Health and Social Services, said
that dispensing fees and mediset fees were already being paid by
Medicaid. He stated that the proposed bill provided a statutory
requirement to continue with this payment, and that the
increased costs had been noted in the fiscal note. He said that
criteria in the proposed legislation defined qualified
providers, which were somewhat different than current
regulation. He declared that it was unclear whether this would
expand the number of qualified providers.
4:43:32 PM
The committee took a brief at-ease.
4:45:23 PM
REPRESENTATIVE KELLER asked if there was intent to hold the
bill.
CHAIR HIGGINS replied that he intended to hold it until Thursday
[April 4].
REPRESENTATIVE KELLER emphasized that he wanted a fiscal note
for the cost increases. He declared that it was necessary to be
cautious of increases because of the rising health care costs.
He asked if there would be a re-evaluated fiscal note.
MR. SHERWOOD said that the changes to Version R would not
significantly alter the fiscal note.
4:46:59 PM
REPRESENTATIVE KELLER asked if the proposed changes would make
it easier for smaller pharmacies to qualify as mediset
pharmacies.
MR. SHERWOOD replied that, currently the requirement was for a
percentage of volume to qualify, and that the current proposed
bill did not require that volume. He shared that he was not
aware if the other requirements were equally limiting.
4:48:10 PM
REPRESENTATIVE KELLER asked for assurance that the fee would
reflect in statute, so that businesses could respond.
MR. SHERWOOD, in response to Chair Higgins, explained that the
fiscal note for $414,000 was for the partial year in 2014, which
was then increased to $1,657,000 for the following fiscal years,
2015-2019. He pointed out that federal funding would pay half.
4:50:03 PM
CHAIR HIGGINS asked to clarify that Version R would not change
the cost estimate.
MR. SHERWOOD said that he would provide any necessary fiscal
note updates on Thursday, April 4.
4:50:44 PM
REPRESENTATIVE KELLER asked if the mediset program would
continue to be paid regardless of passage of the proposed bill,
and he asked to clarify the cost increase.
MR. SHERWOOD explained that the language of the proposed bill
would increase the frequency of the dispensing fee, or an
equivalent increase in the combined dispensing and mediset fee.
4:51:59 PM
REPRESENTATIVE TARR asked if it was possible to address the
proposed amendment.
4:52:42 PM
REPRESENTATIVE PRUITT removed his objection to Version R.
4:52:58 PM
REPRESENTATIVE TARR moved to adopt Amendment 1, labeled 28-
LS0303\Y.1, Mischel, 3/28/13, which read:
Page 2, following line 21:
Insert a new subsection to read:
"(e) The department may apply a volume discount
to a fee established under (b) of this section
(1) if a qualified pharmacy dispenses a
high volume, as defined by the department, of
prescriptions that require medication compliance
packaging for an individual patient; or
(2) based on the total number of
prescriptions requiring medication compliance
packaging annually dispensed by the pharmacy."
Reletter the following subsection accordingly.
REPRESENTATIVE KELLER objected for discussion.
REPRESENTATIVE TARR said that, as cost containment was a
priority for Medicaid programs, she had concerns with the fiscal
note. She reflected that, as the current dispensing fee was
billed per prescription, if a fee cap were placed on the
dispensing fee, then the pharmacist cost would still be covered,
and the fiscal note could be reduced. As discussion with the
sponsor and the department had indicated the difficulty with a
volume limitation or a fee cap, she withdrew proposed Amendment
1.
4:55:07 PM
REPRESENTATIVE TARR asked that Department of Health and Social
Services respond to the difficulty for a fee cap.
MR. SHERWOOD agreed that there had been discussion for a limit
to the fees for multiple prescriptions in the same mediset
package. He said that it was not practical as the prescriptions
were processed one at a time at the point of sale, pointing out
the difficulty for overseeing this. Commenting on proposed
Amendment 1, he opined that it would allow a discount for the
mediset fee for a pharmacy which dispensed a high volume of
medisets. He reported that DHSS had assumed there was this
latitude should the cost survey data support this fee structure.
He stated that it would not be problematic to state this
authority, as well.
4:57:38 PM
CHAIR HIGGINS asked if Representative Tarr still wanted to
withdraw proposed Amendment 1.
REPRESENTATIVE TARR replied that her decision would reflect the
will of the committee. She declared her desire for DHSS to
pursue every opportunity for cost containment, while still
providing medisets. She offered her belief that the pharmacies
would have covered all costs at some point in filling an
individual mediset, and that all prescriptions for that mediset
beyond that were being paid at a much higher profit.
4:59:03 PM
CHAIR HIGGINS asked to clarify whether proposed Amendment 1
would decrease the fiscal note.
MR. SHERWOOD offered his belief that it would not affect the
fiscal note. He declared that DHSS had assumed that the
latitude to lower the dispensing fee for higher volume
dispensing had already existed; therefore, this would not
decrease the fiscal note. He stated that DHSS did not object to
any language that clearly described the DHSS permission to
discount.
5:00:37 PM
REPRESENTATIVE KELLER asked if it was the doctor or the patient
who selected the pharmacy. He opined that a group contracting
with a pharmacy would bring a lower cost than an individual.
MR. SHERWOOD, in response, stated that this was determined by
the Medicaid services as "any willing provider." He detailed
that the qualifications for being a provider and a pharmacy
could result in enrollment as a pharmacy provider. He declared
that the recipient made the decision for pharmacy selection. He
stated that prices were set using national data for the drug
price, and that the department had sent a cost survey to the
participating Medicaid pharmacies to determine the best, most
reasonable way to approximate the dispensing fees. He said that
this data allowed distinctions to be made for volume.
5:03:34 PM
REPRESENTATIVE KELLER requested that Representative Tarr
withdraw the proposed amendment.
REPRESENTATIVE TARR withdrew proposed Amendment 1, stating that
she had primarily wanted to have the conversation. She declared
that, as it was a complex issue, she would keep reviewing
alternatives.
5:04:12 PM
MR. SHERWOOD clarified that the fiscal note reflected $657,000
for an anticipated expansion of mediset service into Fairbanks,
as determined by the bill sponsor. He declared that, although
it was unclear whether that expansion would happen, it would
serve as a proxy for that service.
5:05:38 PM
CHAIR HIGGINS said that HB 134 would be held over.
5:06:09 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:06 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HJR14 Sponsor Statement.pdf |
HHSS 4/2/2013 3:00:00 PM |
HJR 14 |
| HJR 14 Proposed Amendment Ver U.1.pdf |
HHSS 4/2/2013 3:00:00 PM |
HJR 14 |
| HJR14.pdf |
HHSS 4/2/2013 3:00:00 PM |
HJR 14 |
| HJR14 Summary.pdf |
HHSS 4/2/2013 3:00:00 PM |
HJR 14 |
| HJR14 Resolution Sources.pdf |
HHSS 4/2/2013 3:00:00 PM |
HJR 14 |
| HJR14 Supporting Documents - ADN Article.pdf |
HHSS 4/2/2013 3:00:00 PM |
HJR 14 |
| HJR14 Supporting Documents - Alaska Dispatch Article.pdf |
HHSS 4/2/2013 3:00:00 PM |
HJR 14 |
| HJR Supporting Documents - NFIB.pdf |
HHSS 4/2/2013 3:00:00 PM |
HJR 14 |
| ACS Capsis.pdf |
HHSS 4/2/2013 3:00:00 PM |
ACS Presentation |
| ACS distance based delivery system.pdf |
HHSS 4/2/2013 3:00:00 PM |
ACS Presentation |
| Overview -20130402.pdf |
HHSS 4/2/2013 3:00:00 PM |
ACS Presentation |
| ANTHC ACS Letter 1.pdf |
HHSS 4/2/2013 3:00:00 PM |
ACS Presentation |
| HB054 Research - House HSS information from 4-2-13.pdf |
HHSS 4/2/2013 3:00:00 PM |
HB 54 |