Legislature(2017 - 2018)CAPITOL 106

04/18/2017 03:00 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HB 215 DHSS: PUBLIC HEALTH FEES TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= HB 176 GROUND EMER. MEDICAL TRANSPORT PAYMENTS TELECONFERENCED
Moved CSHB 176(HSS) Out of Committee
-- Public Testimony --
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         April 18, 2017                                                                                         
                           3:04 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Ivy Spohnholz, Chair                                                                                             
Representative Bryce Edgmon, Vice Chair                                                                                         
Representative Sam Kito                                                                                                         
Representative Geran Tarr                                                                                                       
Representative David Eastman                                                                                                    
Representative Jennifer Johnston                                                                                                
Representative Colleen Sullivan-Leonard                                                                                         
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Matt Claman (alternate)                                                                                          
Representative Dan Saddler (alternate)                                                                                          
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 215                                                                                                              
"An Act relating to program receipts; and relating to fees for                                                                  
services provided by the Department of Health and Social                                                                        
Services."                                                                                                                      
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 176                                                                                                              
"An Act relating to medical assistance reimbursement for ground                                                                 
emergency medical transportation services; and providing for an                                                                 
effective date."                                                                                                                
                                                                                                                                
     - MOVED CSHB 176(HSS) OUT OF COMMITTEE                                                                                     
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 215                                                                                                                  
SHORT TITLE: DHSS: PUBLIC HEALTH FEES                                                                                           
SPONSOR(s): FINANCE                                                                                                             
                                                                                                                                
04/07/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
04/07/17       (H)       HSS, FIN                                                                                               
04/18/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 176                                                                                                                  
SHORT TITLE: GROUND EMER. MEDICAL TRANSPORT PAYMENTS                                                                            
SPONSOR(s): FANSLER                                                                                                             
                                                                                                                                
03/14/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/14/17       (H)       HSS, FIN                                                                                               
04/13/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/13/17       (H)       Heard & Held                                                                                           
04/13/17       (H)       MINUTE(HSS)                                                                                            
04/18/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
TOM SPITZFADEN, Staff                                                                                                           
Representative Paul Seaton                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 215 on behalf of the bill                                                                   
sponsor, the House Finance Committee.                                                                                           
                                                                                                                                
JILL LEWIS, Deputy Director - Juneau                                                                                            
Central Office                                                                                                                  
Division of Public Health                                                                                                       
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified and answered questions during the                                                              
presentation of HB 215.                                                                                                         
                                                                                                                                
REPRESENTATIVE ZACH FANSLER                                                                                                     
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified and answered questions on HB 176,                                                              
as the sponsor of the bill.                                                                                                     
                                                                                                                                
RICHARD ETHERIDGE, Chief                                                                                                        
Capital City Fire and Rescue                                                                                                    
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during discussion of HB                                                               
176.                                                                                                                            
                                                                                                                                
TOM WESTCOTT, President                                                                                                         
Alaska Professional Firefighters                                                                                                
Eagle River, Alaska                                                                                                             
POSITION STATEMENT:  Testified in support of HB 176.                                                                          
                                                                                                                                
MARGARET BRODIE, Director                                                                                                       
Director's Office                                                                                                               
Division of Health Care Services                                                                                                
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Answered questions during  discussion of HB                                                             
176.                                                                                                                            
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:04:36 PM                                                                                                                    
                                                                                                                                
CHAIR IVY SPOHNHOLZ  called the House Health  and Social Services                                                             
Standing   Committee    meeting   to    order   at    3:04   p.m.                                                               
Representatives Spohnholz, Tarr,  Sullivan-Leonard, Johnston, and                                                               
Eastman were present at the  call to order.  Representatives Kito                                                               
and Edgmon arrived as the meeting was in progress.                                                                              
                                                                                                                                
                HB 215-DHSS: PUBLIC HEALTH FEES                                                                             
                                                                                                                                
3:05:21 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that the  first order of business would                                                               
be HOUSE BILL NO. 215, "An  Act relating to program receipts; and                                                               
relating  to fees  for  services provided  by  the Department  of                                                               
Health and Social Services."                                                                                                    
                                                                                                                                
3:06:03 PM                                                                                                                    
                                                                                                                                
TOM SPITZFADEN,  Staff, Representative Paul Seaton,  Alaska State                                                               
Legislature, paraphrased from the  Sponsor Statement [Included in                                                               
members' packets], which read:                                                                                                  
                                                                                                                                
     This  bill would  amend AS  44.29.022(a)  to grant  the                                                                    
     Alaska  Department of  Health and  Social Services  the                                                                    
     authority    to   collect    fees   to    support   the                                                                    
     administration  of  public  health programs.  The  bill                                                                    
     would  also  add public  health  fees  to the  list  of                                                                    
     designated   general  fund   program  receipts   in  AS                                                                    
     37.05.146(c),  making  clear  that the  fees  collected                                                                    
     would be used to support public health operations.                                                                         
                                                                                                                                
     Currently, the division is not  able to charge fees for                                                                    
     all  the  potential  public health  services  it  could                                                                    
     because the list of "public  health related duties" for                                                                    
     which  fees  are allowed  is  limited  to maternal  and                                                                    
     child  health,  preventive   medical  services,  public                                                                    
     health  nursing,   nutrition,  health   education,  and                                                                    
     laboratories.                                                                                                              
                                                                                                                                
     This bill will  give the Division of  Public Health the                                                                    
     opportunity  to  collect  reasonable  fees  to  support                                                                    
     essential  public health  services consistent  with its                                                                    
     duties  and authority  under state  law; services  that                                                                    
     protect Alaskans  from preventable illness,  injury and                                                                    
     death.   Examples  of   public   health  services   and                                                                    
     functions  provided by  the  Department that  currently                                                                    
     lack   fee  authority   include  data   extraction  and                                                                    
     analysis,  training,  expert consultation,  inspections                                                                    
     and     certifications,     enforcement     activities,                                                                    
     administrative functions, and professional services.                                                                       
                                                                                                                                
     HB 215 is  necessary to allow the  Department of Health                                                                    
     and  Social  Services'  Division of  Public  Health  to                                                                    
     increase and diversify  revenue opportunities, ensuring                                                                    
     the  means  to  support public  health  operations  and                                                                    
     thereby  reducing   reliance  on  general   funds.  The                                                                    
     Division  of Public  Health budget  includes nearly  $7                                                                    
     million in  revenue from  fees, primarily  for clinical                                                                    
     laboratory  and  public  health  nursing  services  and                                                                    
     certified  copies of  vital records.  The widening  gap                                                                    
     between  public health  costs and  state general  funds                                                                    
     jeopardizes  our ability  to  protect  and promote  the                                                                    
     health of  Alaskans. It is  necessary in  public health                                                                    
     that those  who can  pay, should contribute  to support                                                                    
     these essential services.                                                                                                  
                                                                                                                                
3:09:21 PM                                                                                                                    
                                                                                                                                
MR. SPITZFADEN paraphrased from the Sectional Analysis [included                                                                
in members' packets], which read as follows [original                                                                           
punctuation provided]:                                                                                                          
                                                                                                                                
     Section  1  (page  1,  line 4)     Adds  public  health                                                                  
     program fees under AS 18.05.010  to the definition list                                                                    
     of designated  general fund  program receipts  and non-                                                                    
     general fund program receipts  AS 37.05.146(c) that are                                                                    
     accounted for separately  and appropriations from these                                                                    
     program  receipts are  not made  from the  unrestricted                                                                    
     general fund.                                                                                                              
                                                                                                                                
     Section 2 (page 1, line  7)   Amends AS 44.29.022(a) to                                                                  
     allow the  Commissioner of the  Department of  Health &                                                                    
     Social  Services  to  create  a schedule  of  fees  for                                                                    
     services   for   public   health  programs   under   AS                                                                    
     18.05.010.                                                                                                                 
                                                                                                                                
3:10:16 PM                                                                                                                    
                                                                                                                                
JILL LEWIS,  Deputy Director -  Juneau, Central  Office, Division                                                               
of Public Health, Department of  Health and Social Services, said                                                               
that  the Division  of  Public Health  focused  on programs  that                                                               
addressed the health status of  every Alaskan and community.  The                                                               
Public Health Services  controlled infectious diseases, prevented                                                               
chronic  diseases  and  injuries, protected  maternal  and  child                                                               
health, and promoted healthy life  styles.  She stated that there                                                               
was a  widely held  belief that  the division  should do  more to                                                               
maximize collections  for billable services where  possible.  She                                                               
reported that  public health had traditionally  relied on federal                                                               
grants  and  state  general  funds   rather  than  fees;  whereas                                                               
national public health agencies had  now been forced to reexamine                                                               
fees  as  a  funding  stream   in  order  to  continue  providing                                                               
essential services,  and Alaska  was no  different.   She pointed                                                               
out that  the division was  not able to  charge fees for  all the                                                               
services  offered.   She said  that there  was an  opportunity to                                                               
collect  fees for  immunization,  as well  as  health and  safety                                                               
issues; for  birth and marriage certificates  and data extraction                                                               
and analysis;  for lab tests, training  and expert consultations.                                                               
She pointed out that the  proposed bill would enable the division                                                               
to  be  more  self-sufficient  and  collect  reasonable  fees  to                                                               
support these public health services.   She offered some examples                                                               
of these fees, which included:   inspection of devices such as x-                                                               
ray, CT  scan, and  MRI; reasonable  fees for  custom statistical                                                               
and epidemiological analysis  on the public health  data sets, as                                                               
the  division resources  were consumed  in simply  collecting the                                                               
data.   She reported that  other states  charged an annual  or an                                                               
hourly  fee  for analytical  work.    She  pointed out  that  the                                                               
division turned  away these requests for  analytical work because                                                               
there  were  no longer  the  staff.    She  noted that  only  the                                                               
radiologic  health would  be a  required fee,  whereas the  other                                                               
fees  would be  optional,  as communities  could  decide if  they                                                               
wanted the  service or preferred  to use  a private vendor.   She                                                               
explained that for  each new fee, the division  would establish a                                                               
separate  regulation to  allow the  public  and the  stakeholders                                                               
ample  opportunity for  input.   She pointed  out that  the rates                                                               
were limited  to the actual  cost for providing the  service, and                                                               
fees were only  charged when the cost benefit  was economical, in                                                               
the public interest and did  not undermine the mission to protect                                                               
and promote the public health of  Alaskans.  She added that there                                                               
would  be a  system of  waivers or  a sliding  scale of  fees, to                                                               
ensure that the  fees were applied equitably.   She declared that                                                               
the collected  receipts would be  applied back to  the generating                                                               
program,  instead of  the  general  fund.   She  stated that  the                                                               
"widening  gap between  our  public health  costs  and our  state                                                               
general  fund jeopardizes  our ability  to  provide the  services                                                               
that  protect  Alaskans  from preventable  illness,  injury,  and                                                               
death."  She  emphasized that the proposed bill  was necessary to                                                               
allow the  Division of Public  Health to be  more self-sufficient                                                               
and reduce the reliance on general funds.                                                                                       
                                                                                                                                
3:17:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOHNSTON asked  if there  was a  benefit for  the                                                               
department to contract out the  services until it was established                                                               
what fee services were necessary.                                                                                               
                                                                                                                                
MS.  LEWIS acknowledged  that there  was uncertainty  "around the                                                               
amounts  that we  put in  the fiscal  note and  what we  think we                                                               
might be  able to collect  right off the  bat."  She  stated that                                                               
there would be  opportunities during the upcoming  fiscal year to                                                               
review this through the regulation  packages and assess the need.                                                               
She  pointed out  that the  fiscal note  began in  FY 2019.   She                                                               
suggested that  the position might  need to be spread  among many                                                               
people, and that  it would take some time to  realize the overall                                                               
potential.                                                                                                                      
                                                                                                                                
3:20:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD asked if  the division had spoken                                                               
with outside groups regarding assistance.                                                                                       
                                                                                                                                
MS.  LEWIS expressed  agreement  that they  did  work with  their                                                               
partners, although relying on the  kindness of these partners was                                                               
not a  good long-term strategy  for the division.   She explained                                                               
that establishing a fee would bring the cost up front.                                                                          
                                                                                                                                
3:22:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   SULLIVAN-LEONARD  asked   how  to   determine  a                                                               
reasonable fee,  what mechanism  would be  used to  determine the                                                               
fee, and who would be charged.                                                                                                  
                                                                                                                                
MS. LEWIS said that this fee  would vary for each service and, as                                                               
they would  be limited to the  cost, they first needed  to figure                                                               
the  cost.   She suggested  that  review of  data, training,  and                                                               
consultation would most  likely be an hourly or annual  fee.  She                                                               
reiterated that all  these fees would be cost based,  and if they                                                               
were not  economical, the division  would not continue  to pursue                                                               
these.                                                                                                                          
                                                                                                                                
3:24:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD offered an  example of a chest x-                                                               
ray.                                                                                                                            
                                                                                                                                
MS.  LEWIS  explained  that  the  division  did  not  have  x-ray                                                               
machines,  although  they inspected  them.    She said  that  the                                                               
division  was  already  charging  fees  to  organizations.    She                                                               
suggested  that  there was  an  opportunity  to do  analysis  for                                                               
community  organizations and  non-profits,  and  less likely  for                                                               
individuals.                                                                                                                    
                                                                                                                                
3:26:11 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ   commended  the  department  for   its  review,                                                               
especially given the  new fiscal reality. She shared  that as she                                                               
had done  community health needs  assessments and  data analysis,                                                               
the  ability to  purchase  this data  analysis  "could be  really                                                               
valuable, there's been  a lot of times, I  think, when non-profit                                                               
organizations  have wanted  that  kind of  information and  being                                                               
able  to  ...  essentially buy  additional  information  analysis                                                               
could be  really useful."   She suggested that the  proposed bill                                                               
be  set  up for  more  transparency  for other  organizations  to                                                               
better understand  how this could  work.  She shared  her concern                                                               
that the  proposed bill had  brought to her attention  that there                                                               
were  not inspections  to much  of the  radiologic equipment,  as                                                               
currently  only  x-rays were  billable.    She explained  that  a                                                               
Department   of  Law   determination   stated   that  the   other                                                               
inspections  could  not  be  charged  for as  there  was  not  an                                                               
explicit authority.                                                                                                             
                                                                                                                                
MS.  LEWIS expressed  agreement, pointing  out that  although the                                                               
department  had  the broad  authority  to  inspect, certify,  and                                                               
register radiologic  devices for  humans, they  did not  have the                                                               
authority  to charge  a  fee.   As  there  was  no other  revenue                                                               
source, and  there was only  one health physicist for  the state,                                                               
it would  be necessary to  make a second  hire.  She  stated that                                                               
the proposed  fees would be  based on  the cost of  personnel and                                                               
the expected travel, with a small additional cost for supplies.                                                                 
                                                                                                                                
CHAIR SPOHNHOLZ  asked if  there was  a sense  for the  amount of                                                               
equipment that should be inspected.                                                                                             
                                                                                                                                
MS. LEWIS  replied that  there were  hundreds, if  not thousands,                                                               
mostly found in the larger clinics and hospitals.                                                                               
                                                                                                                                
CHAIR  SPOHNHOLZ  asked  whether this  inspection  would  require                                                               
special expertise.                                                                                                              
                                                                                                                                
MS. LEWIS  explained that this was  not the same person  as would                                                               
conduct the  clinical service, and it  required special equipment                                                               
to calibrate the machines and ensure they were operating safely.                                                                
                                                                                                                                
3:31:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  asked about  the steps taken  to identify                                                               
the availability for private inspectors.                                                                                        
                                                                                                                                
MS.  LEWIS  replied  that  there   were  no  independent  private                                                               
inspectors  in  Alaska, although  there  were  inspectors out  of                                                               
state.    She  reported  that Department  of  Health  and  Social                                                               
Services did not have the funding for this.                                                                                     
                                                                                                                                
3:32:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR asked  if the  department was  limited to  a                                                               
charge for services and was not allowed for any extra revenue.                                                                  
                                                                                                                                
MS. LEWIS replied that they were  only allowed to charge fees for                                                               
cost.                                                                                                                           
                                                                                                                                
3:32:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  directed attention  to page 2,  [line 2],                                                               
of the proposed  bill, musing that "it sounds  rather vague," and                                                               
asked if  this should be  interpreted to  mean that a  refusal to                                                               
pay was  not economically  feasible to collect,  or was  this per                                                               
case.                                                                                                                           
                                                                                                                                
MS. LEWIS clarified that the  department would perform an overall                                                               
review to determine whether this  was an economical fee to pursue                                                               
for the  service.  She stated  that the waivers would  be granted                                                               
on  an individual  basis.    She reported  that  the process  for                                                               
application to  a waiver,  including criteria  and qualification,                                                               
was already in regulations to be applied equally to everyone.                                                                   
                                                                                                                                
3:34:47 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that HB 215 would be held over.                                                                       
                                                                                                                                
         HB 176-GROUND EMER. MEDICAL TRANSPORT PAYMENTS                                                                     
                                                                                                                                
3:34:57 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that the  final order of business would                                                               
be HOUSE  BILL NO.  176, "An Act  relating to  medical assistance                                                               
reimbursement   for  ground   emergency  medical   transportation                                                               
services; and providing for an effective date."                                                                                 
                                                                                                                                
REPRESENTATIVE ZACH  FANSLER, Alaska State  Legislature, recapped                                                               
HB 176, and  paraphrased from the Sponsor  Statement [included in                                                               
members' packets],  which read  as follows  [original punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
     Emergency   Medical   Transportation  Services   (EMTS)                                                                    
     relates  to the  emergency transportation  of patients.                                                                    
     For  what  is  traditionally  considered  an  ambulance                                                                    
     ride,  EMTS   reflects  Alaska's   unique  geographical                                                                    
     challenges to  include air,  water, and  other approved                                                                    
     medical  transport services.  As  it currently  stands,                                                                    
     Alaska's  emergency  medical  service  providers  incur                                                                    
     additional uncompensated costs  when providing services                                                                    
     to  Medicaid   beneficiaries,  by  as  much   as  sixty                                                                    
     percent.                                                                                                                   
                                                                                                                                
     Reimbursement    for     ground    emergency    medical                                                                    
     transportation  services  occurs   when  the  providers                                                                    
     submit  a billing  to the  department (specifically  to                                                                    
     the  Medicaid  fiscal   agent  Conduent)  for  eligible                                                                    
     services  provided;   the  department   reimburses  the                                                                    
     provider  using  the established  Medicaid  methodology                                                                    
     and   rate;   the  department   submits   documentation                                                                    
     supporting  the   payment  of  the   federal  financial                                                                    
     participation  (FFP)   to  Centers  for   Medicare  and                                                                    
     Medicaid Services  (CMS); and once it  is approved, the                                                                    
     department receives reimbursement for  the FFP from CMS                                                                    
     that  amounts  to  the appropriate  federal  assistance                                                                    
     percentage (FMAP).                                                                                                         
                                                                                                                                
     By enacting  this legislation  along with  an amendment                                                                    
     to the  state Medicaid  plan, public EMS  providers are                                                                    
     eligible  to   access  enhanced  federal   funding  for                                                                    
     emergency medical transportation  of Medicaid patients.                                                                    
     The use  of transfers is clearly  authorized in federal                                                                    
     statute  and is  both  legal and  useful. Further,  CMS                                                                    
     provides  reimbursement  for the  administrative  costs                                                                    
     associated  with  administrating  EMTS by  as  much  as                                                                    
     twenty percent.                                                                                                            
                                                                                                                                
     Anchorage,  Juneau,  Kenai,   and  Ketchikan,  combined                                                                    
     serve approximately forty-eight  percent of the state's                                                                    
     population.  In  2015  (for Kenai)  and  2016  for  the                                                                    
     others, these departments  provided 7,035 transports to                                                                    
     Medicaid  patients,   without  EMTS,   the  departments                                                                    
     received just  $2.1 million in reimbursements;  a total                                                                    
     collective under-compensation of  roughly $3.9 million.                                                                    
     Were they  EMTS eligible,  they could have  collected a                                                                    
     total of $6 million.                                                                                                       
                                                                                                                                
     HB 176  would allow EMS  providers around the  state to                                                                    
     collect  underfunded  costs  from the  effective  date,                                                                    
     providing a  financial boon to those  organizations and                                                                    
     communities.  Even smaller  communities such  as Bethel                                                                    
     can see  over a  quarter of a  million dollars  in EMTS                                                                    
     reimbursements per year.                                                                                                   
                                                                                                                                
     As you can see from  the attached bill packet, there is                                                                    
     widespread support  for HB 176 throughout  the state to                                                                    
     help   our  local   communities  receive   payments  to                                                                    
     actively cover the services they provide.                                                                                  
                                                                                                                                
3:37:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   SULLIVAN-LEONARD    asked   why    the   various                                                               
municipalities  would  not  do this  independently,  without  any                                                               
state oversight.                                                                                                                
                                                                                                                                
REPRESENTATIVE FANSLER  explained that  there needed to  be state                                                               
acceptance to receive this expanded  reimbursement and was not an                                                               
individual decision made by a  municipality.  He pointed out that                                                               
there was no obligation for a municipality to participate.                                                                      
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  asked  if they  would  have  to                                                               
follow the state mandate.                                                                                                       
                                                                                                                                
REPRESENTATIVE FANSLER replied that this was his understanding.                                                                 
                                                                                                                                
CHAIR SPOHNHOLZ  suggested that "authorization" could  be another                                                               
way of framing this.                                                                                                            
                                                                                                                                
3:38:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  directed attention to page  2, line [13],                                                               
of the  proposed bill, and  read:  "is  owned or operated  by the                                                               
state,  a political  subdivision  of the  state,  or a  federally                                                               
recognized tribe  or tribal  organization;"   He asked  about the                                                               
reason for this language, whether  it was dictated by the federal                                                               
government.                                                                                                                     
                                                                                                                                
REPRESENTATIVE FANSLER  said that this language  was required and                                                               
was dictated by the program,  that community programs which could                                                               
receive  this  expanded  Medicaid  reimbursement  could  only  be                                                               
governmental.                                                                                                                   
                                                                                                                                
3:40:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHNSTON asked about  the changes to the committee                                                               
substitute.                                                                                                                     
                                                                                                                                
REPRESENTATIVE FANSLER  explained that  as the original  bill had                                                               
been   written  for   ground  emergency   medical  transportation                                                               
services,  and was  hence  limited, it  had  been recommended  to                                                               
expand  the proposed  bill and  address emergency  transportation                                                               
services.                                                                                                                       
                                                                                                                                
REPRESENTATIVE JOHNSTON  expressed her  concern for  the increase                                                               
in usage of emergency rooms  and ambulances.  She questioned how,                                                               
policy wise,  to put  "sidebars" on  this.   She stated  that the                                                               
original  policy was  to move  individuals away  from the  use of                                                               
emergency services and the emergency  rooms and that the proposed                                                               
bill was not moving in that direction.                                                                                          
                                                                                                                                
3:43:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FANSLER  acknowledged that  he was  very cognizant                                                               
of  these  concerns  for  an enticement  that  people  would  use                                                               
emergency services,  which had  higher costs.   He  declared that                                                               
the  focus of  the  proposed  bill was  for  transportation.   He                                                               
shared that he "would love to  figure out a policy that starts to                                                               
say  let's  have  people  using   their  primary  care  situation                                                               
better."   He  suggested that  there  was a  need for  additional                                                               
service  providers  and  better  education for  defining  a  true                                                               
emergency.   He stated that it  was his belief that  the proposed                                                               
bill did not entice the use  of these services or would "drive up                                                               
the use of emergency rooms."                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHNSTON asked  if he was interested  to putting a                                                               
sunset clause  in the bill,  or an amendment  for accountability,                                                               
which could include  a reporting mechanism.  She  stated that she                                                               
had concerns for the proposed bill.                                                                                             
                                                                                                                                
3:46:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FANSLER replied that he  had no interest in either                                                               
an amendment  or a sunset  provision, at  this time.   He offered                                                               
his belief that public testimony  indicated that the use of these                                                               
services  was increasing  statewide.   He suggested  a cause  and                                                               
effect type  of experiment  prior to  deciding that  the proposed                                                               
bill had  created an increase  in the use of  emergency services.                                                               
He  opined that  the  legislature  was "inclined  to  be our  own                                                               
sunset provision or our own sidebars on these kinds of thing."                                                                  
                                                                                                                                
CHAIR  SPOHNHOLZ  reminded  the  committee  that  emergency  room                                                               
physicians were  working on  a database  of causes  for emergency                                                               
room utilization,  and she suggested  that this may offer  a more                                                               
direct solution to the aforementioned problem.                                                                                  
                                                                                                                                
3:48:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD asked if  CPT codes were used for                                                               
transportation or were the transportation billings separate.                                                                    
                                                                                                                                
REPRESENTATIVE FANSLER said that he  did not know how the medical                                                               
billing was  handled, although he  offered his belief that  a CPT                                                               
code was used.   He clarified that each  municipality handled its                                                               
own transportation for the Medicaid  reimbursement and he offered                                                               
an example for the City of Bethel.                                                                                              
                                                                                                                                
REPRESENTATIVE    SULLIVAN-LEONARD    asked    if    the    basic                                                               
transportation fee  was separate from  any other charges  and how                                                               
was it billed and matched to the patient.                                                                                       
                                                                                                                                
REPRESENTATIVE FANSLER said that he did not know.                                                                               
                                                                                                                                
3:53:24 PM                                                                                                                    
                                                                                                                                
RICHARD  ETHERIDGE,   Chief,  Capital   City  Fire   and  Rescue,                                                               
explained  that most  fire departments  and EMS  departments used                                                               
third party billers.  He said  that the department would fill out                                                               
an EMS report with detailed  descriptions for everything done, as                                                               
there were  different rates for  each type of  transportation and                                                               
care, and  then the  billing company would  sort out  the billing                                                               
codes  to go  to either  the insurance  companies or  Medicare or                                                               
Medicaid.                                                                                                                       
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  asked   if  Medicaid  made  its                                                               
decision based on whether the patient  was injured, or if it only                                                               
paid for transportation.                                                                                                        
                                                                                                                                
MR. ETHERIDGE expressed  his agreement.  He  addressed an earlier                                                               
question  from  Representative  Eastman  regarding  the  outlying                                                               
departments around Anchorage.  He  stated that if an organization                                                               
was  affiliated  with  a  municipality  and  had  a  relationship                                                               
whereby they could bill through  them, that organization would be                                                               
included in this program.                                                                                                       
                                                                                                                                
3:55:13 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened public testimony.                                                                                        
                                                                                                                                
3:55:24 PM                                                                                                                    
                                                                                                                                
TOM  WESTCOTT,   President,  Alaska   Professional  Firefighters,                                                               
stated  support  for  proposed  HB   176.    He  said  that  fire                                                               
departments  and EMS  providers around  the state  determined the                                                               
cost of ambulance  transports and charged accordingly.   He noted                                                               
that Medicaid  only reimbursed a  percentage of the  actual cost,                                                               
which lead to local tax payers  needing to make up the difference                                                               
to maintain adequate  EMS services.  He stated  that the proposed                                                               
bill would  allow departments the opportunity  to demonstrate the                                                               
actual  costs of  transports and  be reimbursed  accordingly when                                                               
transporting  Medicaid  patients.     He  pointed  out  that  the                                                               
increase in revenue could then be  spent as seen fit by the local                                                               
government.   He reminded the committee  that as the cuts  at the                                                               
state   level   had   resulted  in   cost   shifting   in   local                                                               
municipalities,  the  proposed  bill  would help  the  cities  to                                                               
better deal with the increased costs.   He pointed out that there                                                               
was about a 12-month lag for implementation of the program.                                                                     
                                                                                                                                
3:57:48 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHNSTON asked about  any statistics for the usage                                                               
of transport for Medicare or Medicaid.                                                                                          
                                                                                                                                
3:58:12 PM                                                                                                                    
                                                                                                                                
MARGARET BRODIE, Director, Director's  Office, Division of Health                                                               
Care  Services, Department  of Health  and Social  Services, said                                                               
that  although they  did keep  statistics, she  did not  know the                                                               
exact  costs to  the  municipalities  because the  transportation                                                               
rates were capped.                                                                                                              
                                                                                                                                
REPRESENTATIVE   JOHNSTON  asked   if  the   statistics  included                                                               
anything regarding the need for transport.                                                                                      
                                                                                                                                
MS.   BRODIE  said   that  the   statistics  only   included  the                                                               
transportation  although projects  had reviewed  the claims  data                                                               
for emergency rooms  in alignment with the  transportation to see                                                               
how much was for real emergency transport.                                                                                      
                                                                                                                                
REPRESENTATIVE JOHNSTON asked if this was an ongoing project.                                                                   
                                                                                                                                
MS.  BRODIE, in  response  to  Representative Johnston,  reported                                                               
that this had  been done as "a pilot type  project to ensure that                                                               
the use of emergency services aren't being abused."                                                                             
                                                                                                                                
4:00:04 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ closed public testimony on HB 176.                                                                              
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
4:01:59 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ brought the committee back to order.                                                                            
                                                                                                                                
4:02:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EDGMON  moved to  report  CSHB  176, Version  30-                                                               
LS0705\J,  Glover,  4/7/17,  out  of  committee  with  individual                                                               
recommendations and  the accompanying fiscal notes.   There being                                                               
no objection, CSHB  176(HSS) was moved from the  House Health and                                                               
Social Services Standing Committee.                                                                                             
                                                                                                                                
4:02:48 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
4:04:49 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 4:05 p.m.                                                                                                          

Document Name Date/Time Subjects
HB0215 ver D 4.7.17.pdf HHSS 4/18/2017 3:00:00 PM
HHSS 4/25/2017 3:00:00 PM
HHSS 5/9/2017 3:00:00 PM
HB 215
HB215 Fiscal Note DHSS--PHAS 4.17.17.pdf HHSS 4/18/2017 3:00:00 PM
HHSS 4/25/2017 3:00:00 PM
HHSS 5/9/2017 3:00:00 PM
HB 215
HB215 Sectional Analysis ver D 4.7.2017.pdf HHSS 4/18/2017 3:00:00 PM
HHSS 4/25/2017 3:00:00 PM
HHSS 5/9/2017 3:00:00 PM
HB 215
HB215 Sponsor Statement ver D 4.7.2017.pdf HHSS 4/18/2017 3:00:00 PM
HHSS 4/25/2017 3:00:00 PM
HHSS 5/9/2017 3:00:00 PM
HB 215
HB 176 Sponsor Statement 4.12.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - City of Bethel resolution 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - FNSB memo 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - FNSB resolution 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - Letter AK Fire Chiefs Assoc 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - letter AK Prof Firefighters Assoc 4.11.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - memo Bethel FD 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Supporting Document - North Pole resolution 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Additional Document AK FD budget reimb process 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 ver A.PDF HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Additional Document DHSS review 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Draft Proposed CS ver J 4.5.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Fiscal Note DHSS--HCMS 4.10.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB 176 Fiscal Note DHSS--MAA 4.10.17.pdf HHSS 4/13/2017 3:00:00 PM
HHSS 4/18/2017 3:00:00 PM
HB 176
HB215 Supporting Document - Division of Public Health Fee Summary 4.7.17.pdf HHSS 4/18/2017 3:00:00 PM
HHSS 4/25/2017 3:00:00 PM
HHSS 5/9/2017 3:00:00 PM
HB 215
HB215 Supporting Document - Division of Public Health Funding Sources 4.7.17.pdf HHSS 4/18/2017 3:00:00 PM
HHSS 4/25/2017 3:00:00 PM
HHSS 5/9/2017 3:00:00 PM
HB 215