Legislature(2023 - 2024)DAVIS 106

02/02/2023 03:00 PM House HEALTH & SOCIAL SERVICES

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Audio Topic
03:03:52 PM Start
03:05:03 PM Presentation(s): Department of Health
05:01:58 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Presentation: Department of Health by TELECONFERENCED
Commissioner-Designee Heidi Hedberg
**Streamed live on AKL.tv**
                      ALASKA STATE LEGISLATURE                                                                                
        HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                   
                          February 2, 2023                                                                                      
                             3:03 p.m.                                                                                          
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Mike Prax, Chair                                                                                                 
Representative CJ McCormick                                                                                                     
Representative Justin Ruffridge                                                                                                 
Representative Dan Saddler                                                                                                      
Representative Jesse Sumner                                                                                                     
Representative   Zack Fields                                                                                                    
Representative Genevieve Mina                                                                                                   
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
PRESENTATION(S): DEPARTMENT OF HEALTH                                                                                           
                                                                                                                                
      - HEARD                                                                                                                   
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
HEIDI HEDBERG, Commissioner Designee                                                                                            
Department of Health                                                                                                            
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Co-offered a PowerPoint presentation on the                                                              
Department of Health.                                                                                                           
                                                                                                                                
ANNE ZINK, MD, Chief Medical Officer                                                                                            
Division of Public Health                                                                                                       
Department of Health                                                                                                            
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Co-offered a PowerPoint presentation on the                                                              
Department of Health.                                                                                                           
                                                                                                                                
EMILY RICCI, Deputy Commissioner                                                                                                
Department of Health                                                                                                            
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:    Co-offered  a PowerPoint  presentation   on the                                                       
Department of Health.                                                                                                           
                                                                                                                                
JOSEPHINE "JOSIE" STERN, Assistant Commissioner                                                                                 
Finance Management Services                                                                                                     
Department of Health                                                                                                            
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:    Co-offered  a PowerPoint  presentation   on the                                                       
Department of Health.                                                                                                           
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:03:52 PM                                                                                                                    
                                                                                                                                
CHAIR  MIKE   PRAX  called  the  House   Health  and  Social   Services                                                       
Standing     Committee    meeting     to    order    at    3:03    p.m.                                                         
Representatives   Fields,   Sumner,  Saddler,   McCormick,   Ruffridge,                                                         
Mina, and Prax were present at the call to order.                                                                               
                                                                                                                                
^PRESENTATION(s): DEPARTMENT OF HEALTH                                                                                          
               PRESENTATION(s): DEPARTMENT OF HEALTH                                                                        
                                                                                                                              
3:05:03 PM                                                                                                                    
                                                                                                                                
CHAIR  PRAX  announced  that  the only  order  of business  would  be  a                                                        
presentation on the Department of Health.                                                                                       
                                                                                                                                
3:06:02 PM                                                                                                                    
                                                                                                                                
HEIDI   HEDBERG,   Commissioner   Designee,   Department    of  Health,                                                         
stated  that  the presentation   would  serve  to  provide  information                                                         
regarding   the  Department   of  Health,   with  some   focus  on  the                                                         
backlog  of  the  Division  of  Public  Assistance.     She  introduced                                                         
herself  and  fellow presenters   and relayed  her  experience  working                                                         
for  the Division   of Public  Health  (DPH)  for  13  years,  the last                                                         
four  years  as  the  director  of  the  division.    She  invited  Dr.                                                         
Anne Zink to begin the PowerPoint.                                                                                              
                                                                                                                                
3:07:52 PM                                                                                                                    
                                                                                                                                
ANNE  ZINK, MD,  Chief  Medical  Officer,  Division  of Public  Health,                                                         
Department   of  Health,   offered   a  brief  overview   of  her  work                                                         
history  and  how her  work  as a  medical  professional  led  to focus                                                         
on  policy,   then  began  the  PowerPoint   presentation   [hard  copy                                                         
included  in  the committee  packet],  addressing   slides 2-4,  "State                                                         
of  Health."    She  spoke  about  the  puzzle   pieces  necessary  for                                                         
good  health and  well-being  [shown  on  slide 2]:   neighborhood  and                                                         
environment;   education;  long-term  service   & supports;  access   to                                                        
health    care;    economic    stability;    and    physical    health;                                                         
transportation   and  housing;  adverse  childhood   experiences;  cost                                                         
of  care;  and   social  connectedness.     She  stated   that  healthy                                                         
people  make  healthy  economies;   80 percent   of what  makes  people                                                         
healthy  lies  outside  of  the  healthcare  system.    She noted  that                                                         
there are varied lenses when considering healthcare.                                                                            
                                                                                                                                
DR.  ZINK  spoke   about  the  leading   causes  of  death,   comparing                                                         
Alaska  with  the  U.S.  as  a whole,  and  life  expectancy   at birth                                                         
versus  health  care  expenditures   per  capita  [slide   3].   Alaska                                                         
has  more  deaths  per capita  compared   to the  rest  of the  country                                                         
in  accidents,  suicide,  and  liver disease.    She  noted one  way  to                                                        
consider  how  the  state  is  doing  is by  considering   the  cost  of                                                        
healthcare.     Alaska  is  ranked  twenty-ninth   in  the  country   in                                                        
terms  of life  expectancy  but ranks  the  second  highest in  cost  of                                                        
healthcare per capita.                                                                                                          
                                                                                                                                
3:12:57 PM                                                                                                                    
                                                                                                                                
DR.  ZINK  discussed  Alaska's   health  improvement  plan  [slide  4],                                                         
which read as follows:                                                                                                          
                                                                                                                                
      Healthy Weight and Nutrition                                                                                              
      Environmental Health                                                                                                      
      Healthcare Access                                                                                                         
      Alcohol, Tobacco, and Substance Misuse                                                                                    
      Mental Health & Suicide                                                                                                   
      Injury and Violence                                                                                                       
      Infectious Disease                                                                                                        
      Cancer & Chronic Disease                                                                                                  
      Social and Protective Factors                                                                                             
                                                                                                                                
   checkbld Thirty health objectives with specific targets to                                                                   
           reach by 2030 provide a common framework with                                                                        
      strategies and actions to achieve each target                                                                             
   checkbld Partnering with Alaska Native Tribal Health Consortium                                                              
      (ANTHC)                                                                                                                   
   checkbld Serves as roadmap for stakeholders to work together on                                                              
      upstream health improvements                                                                                              
   checkbld Annual progress report on each target                                                                               
                                                                                                                                
DR.  ZINK  talked  about  report  cards  showing   data  from 2010  and                                                         
2020,  as  well  as annual   interim  report  cards.    She turned  the                                                         
presentation back over to Commissioner Designee Hedberg.                                                                        
                                                                                                                                
3:14:32 PM                                                                                                                    
                                                                                                                                
COMMISSIONER   DESIGNEE   HEDBERG  directed   attention   to  slide   5,                                                        
"Healthy Families Initiative," which read as follows:                                                                           
                                                                                                                                
          Strong families are the foundation of a healthy                                                                       
      society and a vibrant economy.                                                                                            
                                                                                                                                
          • 4-year statewide investments in the health and                                                                      
      wellbeing of Alaskan families                                                                                             
                                                                                                                                
       • Governor Dunleavy proposed $9.9M (UGF) in his FY2024                                                                   
          operating budget for Healthy Families activities                                                                      
      within DOH:                                                                                                               
                                                                                                                                
        checkbld Postpartum Medicaid extension                                                                                  
        checkbld Office of Health Savings                                                                                       
        checkbld TB and congenital syphilis mitigation                                                                          
        checkbld Fresh Start Campaign                                                                                           
                                                                                                                                
COMMISSIONER  DESIGNEE   HEDBERG  noted the  three  color-coded  topics                                                         
on    slide   5:       Healthy    Beginnings     [yellow],    including                                                         
prioritization    of   child   and   maternal   health,   emphasis    on                                                        
prevention   measures,   and  improvement   of  child  care  and  after                                                         
school  programs;  Health  Care  Access  [red],  including  mental  and                                                         
physical  health  care,  working   with partners   to create   a robust                                                         
healthcare  workforce,   seeking  better health  outcomes,   and "aging                                                         
in  place";  and Healthy  Communities   [blue],  building  on  existing                                                         
efforts  to  create  healthful   workplaces  and  affordable   housing,                                                         
and  reducing   the   burden  of   infectious   and  chronic   diseases                                                         
through  the "Fresh  Start"  campaign.    She said  this initiative   is                                                        
supported with federal funds.                                                                                                   
                                                                                                                                
3:16:40 PM                                                                                                                    
                                                                                                                                
DR.  ZINK  picked   up  the  presentation   on  slide   6,  "Office   of                                                        
Health Savings," which read as follows:                                                                                         
                                                                                                                                
          • Reducing health care costs while improving the                                                                      
      health of Alaskans                                                                                                        
                                                                                                                                
      • Positioned within DOH Commissioner's Office                                                                             
                                                                                                                                
        checkbld Initial savings focused on Medicaid program                                                                    
        checkbld Innovative payment models                                                                                      
        checkbld Pharmacy costs and improved access to critical                                                                 
           medications                                                                                                          
                                                                                                                                
DR.  ZINK pointed  to a  graph on  the right  of slide  6,  which shows                                                         
health   care  expenditures    per  capita   in   "Alaska   vs.  United                                                         
States"   from  1991  to  2020,   and  in  about   2000  there  was   an                                                        
increase in the amount Alaska spends.                                                                                           
                                                                                                                                
3:18:47 PM                                                                                                                    
                                                                                                                                
COMMISSIONER    DESIGNEE   HEDBERG    resumed   on   slide   7,   which                                                         
addresses  the  reorganization   of the  former  Department   of Health                                                         
and  Social   Services  (DHSS),   [on  July  1,  2022,   via  Executive                                                         
Order  121],   into  two  departments:     the  Department   of  Health                                                         
(DOH)   and  the   Department   of  Family   and   Community   Services                                                         
(DFCS),  and  which  lists  the  offices   within  each  department   as                                                        
follows:                                                                                                                        
                                                                                                                                
[DOH]                                                                                                                           
   checkbld Commissioner's Office                                                                                               
   checkbld Finance & Management Services                                                                                       
   checkbld Health Care Services                                                                                                
   checkbld Behavioral Health                                                                                                   
   checkbld Senior & Disabilities Services                                                                                      
   checkbld Public Assistance                                                                                                   
   checkbld Public Health                                                                                                       
                                                                                                                                
[DFCS]                                                                                                                          
   checkbld Commissioner's Office                                                                                               
   checkbld Finance & Management Services                                                                                       
   checkbld Alaska Psychiatric Institute                                                                                        
   checkbld Juvenile Justice                                                                                                    
   checkbld Alaska Pioneer Homes                                                                                                
   checkbld Office of Children's Services                                                                                       
                                                                                                                                
COMMISSIONER    DESIGNEE    HEDBERG   offered    an   update   on   the                                                         
department split, as shown on slide 8, which read:                                                                              
                                                                                                                                
      • Shared IT Resources                                                                                                     
      Developing a roadmap to separating resources                                                                              
                                                                                                                                
      • Information Technology Debt                                                                                             
       Seeking contractors and modernizing systems to improve                                                                   
      efficiency and quality of service                                                                                         
                                                                                                                                
      • Improving the Continuum of Care                                                                                         
       Establishing a coordinated system across DOH and DFCS                                                                    
      to ensure person-centered care                                                                                            
                                                                                                                                
      • Complex Care                                                                                                            
         Identifying solutions to address systemic gaps in                                                                      
      access to care for patients with complex needs                                                                            
                                                                                                                                
COMMISSIONER   DESIGNEE   HEDBERG  discussed   slide  9,  "Finance  and                                                         
Management Services," which read:                                                                                               
                                                                                                                                
        FMS provides financial, administrative, facilities,                                                                     
      and technology services to the department                                                                                 
                                                                                                                                
      • Budget                                                                                                                  
      • Revenue & Finance                                                                                                       
      • Information Technology Services                                                                                         
        checkbld HIPAA Compliant                                                                                                
      • Human Resources                                                                                                         
      • Grants and Contracts                                                                                                    
        checkbld $173+ million distributed in grants                                                                            
        checkbld 500+ operating grantees                                                                                        
      • Program Integrity                                                                                                       
      • Medicaid, Allocations, and Audit Services                                                                               
                                                                                                                                
COMMISSIONER   DESIGNEE  HEDBERG   described  Finance   and  Management                                                         
Services  as  the  "backbone"   of DOH.    She  then  introduced  Emily                                                         
Ricci  to  provide   an  overview   of  the  Division   of  Senior  and                                                         
Disabilities   Services,   the  Division  of  Behavioral   Health,  and                                                         
the Division of Health Care Services.                                                                                           
                                                                                                                                
3:23:03 PM                                                                                                                    
                                                                                                                                
EMILY  RICCI,  Deputy  Commissioner,   Department  of  Health,  offered                                                         
a  brief work  history.    She  then covered   slide 10,  "Division   of                                                        
Senior and Disabilities Services," which read as follows:                                                                       
                                                                                                                                
      SDS   promotes   health,    well-being   and    safety   for                                                              
      individuals  with  disabilities,   seniors  and  vulnerable                                                               
      adults  by facilitating   access  to  quality  services  and                                                              
      supports  that foster  independence,   personal  choice  and                                                              
      dignity.                                                                                                                  
                                                                                                                                
      Programs                                                                                                                  
        checkbld Home and Community Based Services (HCBS)                                                                       
        checkbld Adult Protective Services (APS)                                                                                
        checkbld Infant Learning program                                                                                        
        checkbld General Relief program                                                                                         
                                                                                                                                
      Highlights from FY22                                                                                                      
        checkbld 10% Medicaid rate increase for HCBS providers                                                                  
        checkbld $8 million in American Rescue Plan Act funds for                                                               
           HCBS providers                                                                                                       
        checkbld Full funding allocated to improvements to HCBS                                                                 
           for seniors and people with disabilities                                                                             
        checkbld Stakeholder engagement                                                                                         
                                                                                                                                
DEPUTY  COMMISSIONER   RICCI   moved  on  to  slide  11,  "Division   of                                                        
Health  Care  Services."   She  called  this  division  "the  heartbeat                                                         
of  the Medicaid   Program."   She  discussed   the slide,  which  read                                                         
as follows:                                                                                                                     
                                                                                                                                
      HCS's  mission  is  to provide  to  all  eligible  Alaskans                                                               
      access  and oversight   to the  full  range  of appropriate                                                               
      Medicaid   services.   We   also  protect    Alaska's   most                                                              
      vulnerable  populations   through   our  certification   and                                                              
      licensing sections.                                                                                                       
                                                                                                                                
      Programs                                                                                                                  
        checkbld Administering Medicaid services  $45-50 million                                                                
           weekly check write                                                                                                   
        checkbld Background Check Unit (BCU)                                                                                    
        checkbld Licensing (Residential & Facilities)                                                                           
        checkbld Transportation                                                                                                 
        checkbld Tribal reclaiming                                                                                              
                                                                                                                                
      Highlights from FY22                                                                                                      
                                                                                                                                
        checkbld Fiscal agent transition                                                                                        
        checkbld $155 million in claims recovery                                                                                
        checkbld $45 million in pharmacy savings                                                                                
        checkbld $74 million in tribal reclaiming                                                                               
        checkbld 22K+ determinations issued on background check                                                                 
           applications                                                                                                         
                                                                                                                                
DEPUTY  COMMISSIONER   RICCI  talked  about  staffing   challenges  and                                                         
efforts  to  shorten   "turnaround"   time  in relation   to  services.                                                         
She  highlighted  fiscal  agent  services  in  relation  to  processing                                                         
claims and a contract in the works.                                                                                             
                                                                                                                                
3:29:37 PM                                                                                                                    
                                                                                                                                
DEPUTY COMMISSIONER RICCI discussed slide 12, "Division of                                                                      
Behavioral Health," which read:                                                                                                 
                                                                                                                                
       DBH has a commitment to improving the quality of life                                                                    
         of Alaskans through the right service to the right                                                                     
      person at the right time.                                                                                                 
                                                                                                                                
      Programs                                                                                                                  
        checkbld Behavioral health Medicaid Services (State Plan &                                                              
           1115 Waiver)                                                                                                         
        checkbld Tobacco enforcement                                                                                            
        checkbld Alcohol Safety Action Program                                                                                  
        checkbld Treatment and Recovery Team                                                                                    
        checkbld Suicide prevention                                                                                             
                                                                                                                                
      Highlights from FY22                                                                                                      
        checkbld 988 Implementation  and    the    Zero    Suicide                                                              
           Initiative                                                                                                           
        checkbld 180 grant awards                                                                                               
        checkbld Expanded services                                                                                              
        checkbld $190 Million claims paid through 1115 Waiver                                                                   
                                                                                                                                
DEPUTY  COMMISSIONER   RICCI summarized   the work  being  done  in the                                                         
division.                                                                                                                       
                                                                                                                                
3:32:08 PM                                                                                                                    
                                                                                                                                
DR.  ZINK  took  up  slide  13, "Division   of  Public  Health,"  which                                                         
states   that   the  division    "is  committed   to   protecting   and                                                         
promoting  the  health  of Alaskans."    She  discussed  the  functions                                                         
of  the eight  programs  within  the  division,  listed  on the  slide:                                                         
Chronic   Disease   Prevention   &  Health  Promotion;   Epidemiology;                                                          
Health   Analytics    and   Vital   Records;    State   Public   Health                                                         
laboratories;   Public  Health   Nursing;  Rural   & Community   Health                                                         
Systems;    State    Medical   Examiner's     Office,   and    Women's,                                                         
Children's   &  Family  Health.     The  rest   of  slide  13  read   as                                                        
follows:                                                                                                                        
                                                                                                                                
      Highlights                                                                                                                
        checkbld Healthy Alaskans 2030                                                                                          
        checkbld Eliminated age restrictions for services at                                                                    
           Public Health Centers                                                                                                
        checkbld Expanded work on addressing the opioid epidemic                                                                
           including distribution of ~20K naloxone kits                                                                         
        checkbld Fresh Start Campaign                                                                                           
                                                                                                                                
3:38:13 PM                                                                                                                    
                                                                                                                                
COMMISSIONER   DESIGNEE   HEDBERG   picked   up  the  presentation    at                                                        
slide  14,  "Division   of  Public   Assistance,"   and  discussed  the                                                         
issue of backlog.  Slide 14 read as follows:                                                                                    
                                                                                                                                
          DPA promotes self sufficiency and provides basic                                                                      
      living expenses to Alaskans in need.                                                                                      
                                                                                                                                
      Programs                                                                                                                  
        checkbld 18 Public Assistance programs                                                                                  
        checkbld Child Care Assistance & Licensing                                                                              
                                                                                                                                
      Highlights                                                                                                                
        checkbld Provided public assistance to ~300K Alaskans per                                                               
           month                                                                                                                
        checkbld $95.5 million in COVID-19 relief for childcare                                                                 
                                                                                                                                
COMMISSIONER   DESIGNEE  HEDBERG   listed  the  18  programs.    Within                                                         
Food  and  Public   Assistance   are  the  following   eight  programs:                                                         
the   Supplemental    Nutrition   Assistance    Program   (SNAP);   the                                                         
Supplemental   Nutrition   Assistance   Education  Program   (SNAP-ED);                                                         
the  Women,  Infant  and Children   (WIC)  Program;  the Breastfeeding                                                          
and  Peer  Counseling  Program;   the  Commodities   Supplemental  Food                                                         
Program;   the  WIC  Farmer  Market   Nutrition  Program;   the  Senior                                                         
Farmer   Market  Nutrition   Program;   and  the  Pandemic   Electronic                                                         
Benefit  Transfer  (Pandemic   EBT).   Within  Medical  Assistance  are                                                         
the   following    programs:      Medicaid,    which   resides   within                                                         
Healthcare   Services;  and  Chronic   and  Acute  Medical   Assistance                                                         
(CAMI).      The   next   group   is   Assistance    to   Seniors   and                                                         
Disabilities,   which   contains  the   Adult  Senior   Assistance  and                                                         
Benefits  Program.    Then  there  is  Heating  and  Water  Assistance,                                                         
under   which   are   the   following    three   programs:      Heating                                                         
Assistance;   Water  Assistance;   and the  Alaska   Affordable  Health                                                         
Program.     The   next  group   is   Assistance   for  Families   with                                                         
Dependent  Children,   including:    the Alaska  Temporary   Assistance                                                         
Program  (ATAP);  and  the  Childcare  Assistance  Program.    Finally,                                                         
there is the General Relief Assistance Program.                                                                                 
                                                                                                                                
3:41:49 PM                                                                                                                    
                                                                                                                                
COMMISSIONER    DESIGNEE   HEDBERG   addressed    the   issue   of  the                                                         
backlog, which begins on slide 15, which read as follows:                                                                       
                                                                                                                                
      1. IT systems  40-year legacy system                                                                                      
   checkbld Eligibility Information System (EIS) was never fully                                                                
      migrated to ARIES                                                                                                         
   checkbld Fiscal crisis delayed efforts to modernize systems                                                                  
                                                                                                                                
      2. Pandemic  Manual Processing of benefits                                                                                
   checkbld DPA was unable to automate the SNAP Emergency                                                                       
       Allotments (EA), resulted in manually issued benefits                                                                    
      processed by staff for over 2+ year                                                                                       
   checkbld The Pandemic Electronic Benefit Transfer (P-EBT)                                                                    
      benefits issued by DPA on behalf DEED                                                                                     
   checkbld When the state public health emergency ended and Food                                                               
    and   Nutrition    Service    (FNS)    clarified     policy,                                                                
      recertifications restarted for SNAP                                                                                       
                                                                                                                                
      3. Cyber Attack in May 2021                                                                                               
   checkbld Pivoted existing IT staff to protection of personal                                                                 
        health information, forensic analysis, and recovery                                                                     
      efforts                                                                                                                   
   checkbld The majority of DPA systems were taken down requiring                                                               
      substantial manual processing                                                                                             
   checkbld Planned system changes that would have brought online                                                               
      forms and other improvements were further delayed                                                                         
                                                                                                                                
COMMISSIONER   DESIGNEE  HEDBERG  explained  that  the  image  on slide                                                         
16  is  a COBOL  stream   showing  what  the  eligibility   information                                                         
systems   looks  like.     She   then  moved   to  slide   17,  "Public                                                         
Assistance Backlog: IT Systems," which read as follows:                                                                         
                                                                                                                                
   checkbld Most eligibility staff will need to access up to 9 systems:                                                         
      Eligibility  Information  System  (EIS),  Alaska's  Resource  for                                                         
      Integrated  Eligibility   Services   (ARIES),  Energy   Community                                                         
      Online  System   (ECOS),   ILINX  Document   Management   System,                                                         
      current?   Workload   Management    Tool,   WinStar,   SAM   (DOL                                                         
      interface),  Instant  Eligibility   Verification  System  (IEVS),                                                         
      Genesys Virtual Call Center                                                                                               
                                                                                                                                
   checkbld The Department needs more programmers capable of coding in                                                          
      the  Public   Assistance   mainframe   which   requires   various                                                         
      outdated  programing   languages  such  as  COBOL,  Natural,  and                                                         
      ADABAS.                                                                                                                   
                                                                                                                                
   checkbld DOH has one IT programmer who can code in COBOL, one of the                                                         
      languages  required   to  update  EIS  where  SNAP  applications                                                          
      are worked.                                                                                                               
                                                                                                                                
3:47:36 PM                                                                                                                    
                                                                                                                                
MS. RICCI presented slide 18, regarding SNAP and Medicaid                                                                       
backlog, which read as follows:                                                                                                 
                                                                                                                                
        checkbld Team focused on oldest SNAP recertifications  and                                                              
           applications first .                                                                                                 
        checkbld All September recertification    benefits    were                                                              
           issued for SNAP.                                                                                                     
        checkbld Certain  Medicaid        applications         and                                                              
           recertifications    are  impacted   by   the  backlog.                                                               
           These  include  new  applications   submitted   without                                                              
           a SNAP  application  and  those  stored  in the  legacy                                                              
           system.                                                                                                              
        checkbld Open enrollment period    for    the   Federally                                                               
           Facilitated    Marketplace    from   October   2022                                                                  
           January   2023  also   created   a  recent  influx   of                                                              
           applications.                                                                                                        
        checkbld Estimate difficult to determine due  to  lack  of                                                              
           definition   in  system.  Duplicate   applications   or                                                              
           those    transferred    in   error   all   appear    as                                                              
           outstanding.                                                                                                         
                                                                                                                                
3:50:37 PM                                                                                                                    
                                                                                                                                
COMMISSIONER DESIGNEE HEDBERG picked back up on slides 19 and                                                                   
20, regarding the backlog of the Virtual Call Center, and which                                                                 
read as follows:                                                                                                                
                                                                                                                                
                                                                                                                                
      VCC went live April 2021                                                                                                  
                                                                                                                                
        checkbld VCC allows DPA to   serve   the   entire    state                                                              
           equitably,  including   communities  that  do not  have                                                              
           in-person lobbies available.                                                                                         
                                                                                                                                
        checkbld VCC allows a client to wait anywhere to  talk  to                                                              
           an  eligibility  technician   instead  of  only  having                                                              
           the  option   to  wait  in   person  in  a  lobby   and                                                              
           perhaps not be seen that day.                                                                                        
                                                                                                                                
        checkbld Incoming phone calls are recorded,  which   allow                                                              
           for  training  and ability  to  review  calls if  calls                                                              
           come  in  from Governor's   Constituent   Relations  or                                                              
           Legislative offices.                                                                                                 
                                                                                                                                
        checkbld Lobbies have historically been over crowed  (sic)                                                              
           and    at   times    hostile,    creating    difficult                                                               
           situations   for  vulnerable   Alaskans   and  our  DPA                                                              
           staff members.                                                                                                       
                                                                                                                                
      High call volume  1,000 to 1,500 calls a day.                                                                             
                                                                                                                                
        checkbld The VCC is temporarily dedicated to gathering                                                                  
           information    from   each   client.   They   are   not                                                              
           processing    applications   in   real   time   as   of                                                              
           10/25/2022.  This  allows  more  callers  to talk  to a                                                              
           live person each day.                                                                                                
                                                                                                                                
        checkbld Each Wednesday, the division reassigns staff from                                                              
           the VCC to process applications. VCC is still                                                                        
           available for emergency access on those days.                                                                        
                                                                                                                                
        checkbld The VCC automatic menu options vary depending on                                                               
           the amount of staff available to answer the                                                                          
           phone, which can be frustrating to callers.                                                                          
                                                                                                                                
        checkbld We welcome input and suggestions on further                                                                    
           improvements we can make.                                                                                            
                                                                                                                                
3:59:26 PM                                                                                                                    
                                                                                                                                
COMMISSIONER DESIGNEE HEDBERG covered the key points of                                                                         
addressing the backlog, as shown on slide 19, which read as                                                                     
follows:                                                                                                                        
                                                                                                                                
        checkbld Pursuing contractors to program EIS                                                                            
                                                                                                                                
        checkbld Pursuing contracting to support the VCC                                                                        
                                                                                                                                
        checkbld Crisis Communication                                                                                           
                                                                                                                                
        checkbld Security evaluations and security guards for DPA                                                               
           lobbies                                                                                                              
                                                                                                                                
        checkbld Recruiting and  onboarding     both    permanent                                                               
           eligibility technicians and long term non-                                                                           
           permanent positions                                                                                                  
                                                                                                                                
4:00:46 PM                                                                                                                    
                                                                                                                                
COMMISSIONER DESIGNEE HEDBERG moved on to slide 22, "Suggestions                                                                
from Partners," which read as follows:                                                                                          
                                                                                                                                
   1. Lengthen certification periods                                                                                            
   2. Waive unnecessary interviews                                                                                              
   3. Streamline the review of housing, utilities, and                                                                          
      dependent care costs                                                                                                      
   4. Implement broad-based categorical eligibility                                                                             
   5. Extend one month of SNAP benefits for all who are                                                                         
      delayed because of agency fault                                                                                           
   6. Establish    a    cost    effectiveness    threshold     and                                                              
      compromise overpayment claims                                                                                             
   7. Recruit and train more fee agents                                                                                         
   8. Improve website capacity.                                                                                                 
                                                                                                                                
COMMISSIONER   DESIGNEE   HEDBERG  noted   the  current  certification                                                          
period  for SNAP  is six  months,  and the  plan is  to extend  that  to                                                        
12  months.     The  department   agrees   with  suggestions   two  and                                                         
three,  and  will  review   suggestion  four.    Regarding   suggestion                                                         
five,  she said  the  department  does  not have  the  mechanism  to  be                                                        
able  to add  a  month  automatically.    The  department  will  review                                                         
its  options  under  the federal  program  rules  in  consideration   of                                                        
suggestion   six.   It  agrees  with  suggestion   seven  but has  some                                                         
restrictions.    Finally,  the division  has  improved  aspects  of its                                                         
website capacity, with security in mind.                                                                                        
                                                                                                                                
4:05:55 PM                                                                                                                    
                                                                                                                                
MS.   RICCI   addressed    slide    23,   "Unwinding    of   Continuous                                                         
Enrollment for Medicaid," which read as follows:                                                                                
                                                                                                                                
        checkbld Beginning March 2020, states were required to                                                                  
           maintain     eligibility     status    for    Medicaid                                                               
           beneficiaries                                                                                                        
                                                                                                                                
        checkbld Starting April 1, Alaska will begin Medicaid                                                                   
           eligibility redeterminations                                                                                         
                                                                                                                                
        checkbld Alaska has 12 months to complete redeterminations                                                              
           for all active Medicaid cases                                                                                        
                                                                                                                                
        checkbld Redetermination Plans are submitted to CMS by                                                                  
           February 15th                                                                                                        
                                                                                                                                
        checkbld DOH will work with stakeholders to maximize                                                                    
           public communication starting in February                                                                            
                                                                                                                                
MS.  RICCI   said  an  omnibus   bill  passed   Congress   and  clearly                                                         
outlined   a   timeline   for   ending   continuous    enrollment   for                                                         
Medicaid,  which  is March  31.   She spoke  about  having  the systems                                                         
in  place  to  manage  the  redetermination   effort.    She  mentioned                                                         
two  system  names:   Alaska's  Resource   for Integrated   Eligibility                                                         
Services   (ARIES)  and  the  Electronic   Information   System  (EIS).                                                         
The  latter   is  problematic   for  the   division  currently.     She                                                         
noted,  however,  that  the  majority   of Medicaid   applications  are                                                         
stored  in ARIES,  which  is  newer  and has  support  available.   She                                                         
talked  about  efforts to  inform  Alaskans  as to  what to  expect and                                                         
to  ensure  that people  are  covered.    She  pointed  out that  while                                                         
the  redeterminations  will  begin  April  1, resulting  disenrollment                                                          
from  the Medicaid  program    will begin  to  occur May  31    60 days                                                         
later.                                                                                                                          
                                                                                                                                
4:14:12 PM                                                                                                                    
                                                                                                                                
JOSEPHINE    "JOSIE"    STERN,    Assistant    Commissioner,    Finance                                                         
Management   Services,   Department    of  Health,   offered   a  brief                                                         
account  of  her  work  experience,   then  presented   the  "Operating                                                         
Budget,"   shown  on   slide  24.    She   explained   that  the  slide                                                         
reflects   a  comparison   of   the  FY  22   actuals   to  the  FY   22                                                        
management   plan,  and the  proposed  FY  24  governor's  budget  that                                                         
was  released  on  12/15/22.    She  said  slide  24 does  not  include                                                         
departmental    support    services,    Human    Services,    Community                                                         
Matching  Grants,  and  Community  Initiative  Matching  Grants,  which                                                         
are  generally  presented  as a  consolidated  item,  the reason  being                                                         
that  the  change  associated   with  the  bifurcation  of  the  former                                                         
two  departments  occurred   in departmental   support  services;  this                                                         
item  was pulled  out  of the  slide  because  it did  not provide  "an                                                         
accurate  apples  to  apples  comparison  across  fiscal  years."   She                                                         
stated  that  with the  inclusion  of departmental   support  services,                                                         
the   total    operating    budget    in   "FY   2024    governor"    is                                                        
approximately   $3.14  billion."    She noted  there  are  1,453  full-                                                         
time  positions  within  DOH, and  the majority  of  the FY  24 budget,                                                         
"as  well   as  the  Department   of  Health,"   resides   in  Medicaid                                                         
Services;  the  total  funds  in Medicaid   Services  is approximately                                                          
$2.5 billion.                                                                                                                   
                                                                                                                                
COMMISSIONER   DESIGNEE   HEDBERG  stated   that  that   concluded  the                                                         
presentation.                                                                                                                   
                                                                                                                                
4:16:29 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX invited questions from the committee.                                                                                
                                                                                                                                
4:17:09 PM                                                                                                                    
                                                                                                                                
MS.  RICCI,   in  response   to   a  request   for  clarity   regarding                                                         
Medicaid  enrollment  and  eligibility,  emphasized   that the  goal  is                                                        
to  avoid unintentionally   disenrolling   anyone  from  Medicaid.    In                                                        
response   to  a  follow-up  question,   she  said   she  thinks  every                                                         
state   is  attempting    to  do   as  many   automatic   renewals    as                                                        
possible.    She  then  confirmed  that  the  division   is looking   at                                                        
whether  it  can  use  SNAP  eligibility   when  considering   Medicaid                                                         
eligibility.                                                                                                                    
                                                                                                                                
4:21:25 PM                                                                                                                    
                                                                                                                                
MS.  RICCI,  in  response  to  a  question  from  Representative   Mina                                                         
regarding   resources    available   for   enrollment   following   the                                                         
predetermination   process,  said  the  department  wants  to  leverage                                                         
every  opportunity,   and  she  advised   people  to  make  sure  their                                                         
information   is updated.    She added  that  eligibility   technicians                                                         
would   be  available   to  assist.     In  response   to  a  follow-up                                                         
question,   she  said  there  is  currently   not  a way  in  which   to                                                        
offer   this  to  be   done  online.     She   said  the   division   is                                                        
establishing a web page regarding redetermination.                                                                              
                                                                                                                                
4:25:26 PM                                                                                                                    
                                                                                                                                
MS.  RICCI, in  response  to Representative   Ruffridge,  said  current                                                         
discussion   about  a communication   plan  is  considering  what  type                                                         
of  advertising    can  be  done   and  what   kind  of   support  from                                                         
stakeholders   can  be   leveraged.     She  mentioned   that  CMS  has                                                         
provided a toolkit for states to use as needed.                                                                                 
                                                                                                                                
4:28:39 PM                                                                                                                    
                                                                                                                                
DR.  ZINK,  in response   to a  question  from  Representative   Sumner                                                         
regarding  rates  of  death [from  slide  3],  said  DOH puts  together                                                         
an  annual  death   report,  which   classifies  different   causes   of                                                        
death.   She  talked  about  the  complexity  of  causes  of  death and                                                         
explained   that  these  reports  list  the  primary  cause  of  death.                                                         
She  offered  to  supply   the  committee  with   more  information   on                                                        
this subject.                                                                                                                   
                                                                                                                                
4:31:17 PM                                                                                                                    
                                                                                                                                
DR.  ZINK,  in response   to Chair  Prax,  regarding   life  expectancy                                                         
and  healthcare  costs,  said back  in about  2018,  rural  communities                                                         
were  driving  the  more expensive   per capita  costs  of  healthcare.                                                         
She  said there  are a  lot of  ways that  states  pay for  healthcare,                                                         
and  she indicated  a  trend  in focusing  more  on  prevention.   That                                                         
is  particularly   challenging  in  Alaska  based  on  its  size.   She                                                         
talked about working with tribal leaders.                                                                                       
                                                                                                                                
4:34:14 PM                                                                                                                    
                                                                                                                                
MS.  RICCI,  in response  to  a question   from Representative   Fields                                                         
regarding   slide   10,   gave   information   regarding   the   Infant                                                         
Learning  Program.    She  said  she  could  follow-up   regarding  the                                                         
number of individuals who participate in the program.                                                                           
                                                                                                                                
4:36:06 PM                                                                                                                    
                                                                                                                                
DR.  ZINK,  in  response   to  a question   from  Representative   Mina                                                         
regarding   slide   13,  spoke   about  chronic   disease   and  opioid                                                         
addiction.    Beside  the distribution   of  Naloxone,  the  department                                                         
works  with  communities  and  with  the Department   of Public  Safety                                                         
(DPS)    regarding   opioid    remediation.       She    talked   about                                                         
counterfeit   pills  mixed  with  fentanyl  and  how  deadly  that  is.                                                         
She  said  the department   wants  youth  to know  about  that  danger,                                                         
and  is working   with industry   to distribute   Naloxone  kits.   She                                                         
offered to provide more information.                                                                                            
                                                                                                                                
4:39:46 PM                                                                                                                    
                                                                                                                                
DR.  ZINK,  in response  to  Representative   Ruffridge,  talked  about                                                         
the  Prescription  Drug  Monitoring   Program  (PDMT)  and  determining                                                         
its  strengths   and   weaknesses.     She   talked  about   an  opioid                                                         
dashboard   that  provides  statistics,   and  understanding   data   in                                                        
order  to take  action.   She  said  she thinks  use  of the  data will                                                         
be  beneficial   in  transforming   health   systems,   and  she  spoke                                                         
about  the  lack of  internet  technology   (IT) infrastructure   being                                                         
a huge challenge in Alaska.                                                                                                     
                                                                                                                                
4:42:45 PM                                                                                                                    
                                                                                                                                
DR.  ZINK,   in  response   to  questions   from  Representative   Mina                                                         
regarding  slide   6 and  the  Office  of  Health  Care  Savings,  said                                                         
the  department  needs  personnel  to  help with  this  area  of health                                                         
care  savings.    She  said  there  has  been  focus  on  pharmacy  and                                                         
Medicaid  in  terms  of seeking   savings,  and there  is  more  to do,                                                         
including  reaching  out  to other  divisions.   She  said  the current                                                         
budgetary   "ask"   is   "quite   small"   and   spreads   across   all                                                         
divisions.    Another  consideration   is the  use of  federal  grants.                                                         
She  mentioned   a  change  to  emergency   billing.    She  noted  the                                                         
database  is  within  the Division  of  Insurance.    In response  to  a                                                        
follow-up   question,    she   offered   to   find  the   request   for                                                         
proposals  (RFP)  from  the Health  Payment  and  Utilization  Database                                                         
(HPUD).                                                                                                                         
                                                                                                                                
4:46:33 PM                                                                                                                    
                                                                                                                                
DR.  ZINK,  in  response  to  a question   from  Chair  Prax  regarding                                                         
postpartum   care  and   the  cost  of  programs,   said   Medicaid   is                                                        
required  to cover  it  for the  first 60  days; however,   many states                                                         
have  moved to  cover  for 360  days.   She  said that  early  data out                                                         
of California   and Texas  have  shown that  [moving  to the  lengthier                                                         
coverage  time]  has resulted  in  a decrease  in  maternal  deaths,  as                                                        
well  as  an increase   in life  expectancy   for  the  mother  in that                                                         
first  year.   She  said  it can  be  difficult  to do  a  cost-benefit                                                         
analysis,  but  there  are  estimates   available  from  national  data                                                         
suggesting significant savings.                                                                                                 
                                                                                                                                
4:48:47 PM                                                                                                                    
                                                                                                                                
COMMISSIONER   DESIGNEE   HEDBERG,   in  response   to  Representative                                                          
Saddler  regarding   the  length   of  time  it  will  take  to  update                                                         
programming,   described   different   "arcs   of  effort"   necessary.                                                         
First,  she   said,  is  the  move  from   6  to  12  months  for  SNAP                                                         
certification.     Additional   reprogramming   needs  to  happen,  and                                                         
she offered to bring back that information at a later date.                                                                     
                                                                                                                                
4:50:33 PM                                                                                                                    
                                                                                                                                
COMMISSIONER   DESIGNEE  HEDBERG,   in  response  to  a  question  from                                                         
Representative   Ruffridge   regarding   slide  17   and  error  rates,                                                         
confirmed    there   are  errors,    but   she   does   not  know   the                                                         
percentage.                                                                                                                     
                                                                                                                                
4:52:02 PM                                                                                                                    
                                                                                                                                
DR.   ZINK,   in  response    to   a  question   from   Representative                                                          
Ruffridge  regarding   slides  5 and  6, talked  about  prevention  and                                                         
a four-year  plan  utilizing  existing  and  future  plans to  create  a                                                        
healthy  Alaska.   She  noted there  is a  web site  available  on this                                                         
topic.    Regarding   the   phrase,  "payment   for  prevention,"   she                                                         
spoke about incentives to both providers and patients.                                                                          
                                                                                                                                
4:55:40 PM                                                                                                                    
                                                                                                                                
MS.  RICCI,  in response  to  a second  question   from Representative                                                          
Ruffridge   regarding  pharmacies,   talked   about  saving  through   a                                                        
pharmacy  program,  including   rebates  for use  of  certain  types  of                                                        
medications  and  being  more aggressive   with outlining   medications                                                         
that  are  more economical   while  offering  the  same  benefit.   She                                                         
talked  about   the  Office  of  Health   Savings  considerations   and                                                         
"leveraging  the  volume  that Alaska  has  in its  different  types  of                                                        
state   programs   to   purchase   or   negotiate   lower   rates   for                                                         
prescriptions    and  then   make  that   available   to   the  general                                                         
public."                                                                                                                        
                                                                                                                                
4:57:58 PM                                                                                                                    
                                                                                                                                
COMMISSIONER   DESIGNEE  HEDBERG,   in  response  to  a  question  from                                                         
Representative    Mina,   said   the   skill  set   to   work   in  the                                                         
aforementioned   virtual  call  center  is  minimal  because   it would                                                         
require  answering   the  phone  and  collecting  certain   information                                                         
and  documents;  it  is  "clerical  at  best."    That  information   is                                                        
shared   with  eligibility    technicians.     In   terms   of  minimum                                                         
qualifications   for  technicians,   she   said  she  would  follow   up                                                        
with information at a later date.                                                                                               
                                                                                                                                
4:59:37 PM                                                                                                                    
                                                                                                                                
COMMISSIONER   DESIGNEE  HEDBERG,   in  response  to  a  question  from                                                         
Representative   Ruffridge,   said  currently   the  department   has  a                                                        
total  of 458  PCNs  in the  division,  and  she would  follow-up  at  a                                                        
later  date   to  let  the  committee   know  how  many  of  those  are                                                         
eligibility technicians.                                                                                                        
                                                                                                                                
5:00:16 PM                                                                                                                    
                                                                                                                                
CHAIR  PRAX  asked how  to  best communicate   with  the department   so                                                        
that   each  committee   member   can  "get   up  to  speed"   on  this                                                         
information.                                                                                                                    
                                                                                                                                
COMMISSIONER   DESIGNEE   HEDBERG   recommended   contacting   Courtney                                                         
Enright, Legislative Liaison for the Department of Health.                                                                      
                                                                                                                                
5:01:58 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There  being  no further  business   before  the committee,   the House                                                         
Health   and   Social   Services   Standing   Committee   meeting   was                                                         
adjourned at [5:02] p.m.                                                                                                        
                                                                                                                                

Document Name Date/Time Subjects
DOH Department Overview - DRP 01.23.2023.pdf HHSS 2/2/2023 3:00:00 PM
Dept. of Health Overview
Dept of Health Org Chart.pdf HHSS 2/2/2023 3:00:00 PM
Dept. of Health Org. Chart