Legislature(2019 - 2020)Anch LIO Lg Conf Rm

01/09/2020 03:00 PM HEALTH & SOCIAL SERVICES

Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.

Download Mp3. <- Right click and save file as
Download Video part 1. <- Right click and save file as

Audio Topic
03:03:28 PM Start
03:03:57 PM Presentation(s): Medicaid Reform Update
05:20:56 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Update hearing on the reforms from Senate Bill TELECONFERENCED
74 (2016) & other Medicaid cost containment
initiatives by:
- Dept. of Health & Social Services
- Alaska Behavioral Health Assoc.
- Alaska Primary Care Assoc.
- Alaska State Hospital & Nursing Home Assoc.
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                        January 9, 2020                                                                                         
                           3:03 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Ivy Spohnholz, Co-Chair                                                                                          
Representative Matt Claman (via teleconference)                                                                                 
Representative Harriet Drummond                                                                                                 
Representative Geran Tarr                                                                                                       
Representative Sharon Jackson                                                                                                   
Representative Lance Pruitt                                                                                                     
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Tiffany Zulkosky, Co-Chair                                                                                       
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
PRESENTATION: MEDICAID REFORM UPDATE                                                                                            
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
ADAM CRUM, Commissioner                                                                                                         
Office of the Commissioner                                                                                                      
Department of Health and Social Services (DHSS)                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Presented a PowerPoint overview titled                                                                   
"Medicaid Reform Update."                                                                                                       
                                                                                                                                
RENEE GAYHART, Director                                                                                                         
Director's Office                                                                                                               
Division of Health Care Services                                                                                                
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Presented during the PowerPoint overview                                                                 
titled "Medicaid Reform Update."                                                                                                
                                                                                                                                
GENNIFER MOREAU-JOHNSON, Director                                                                                               
Division of Behavioral Health                                                                                                   
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION   STATEMENT:       Testified   during   the   PowerPoint                                                             
presentation on Medicaid Reform Update.                                                                                         
                                                                                                                                
HEATHER CARPENTER, Health Care Policy Advisor                                                                                   
Office of the Commissioner                                                                                                      
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Testified  during the  update on  Medicaid                                                             
Reform.                                                                                                                         
                                                                                                                                
NANCY MERRIMAN, Executive Director                                                                                              
Alaska Primary Care Association (APCA)                                                                                          
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:   Gave a  presentation entitled,  "Community                                                             
Health Centers  the Value Opportunity."                                                                                         
                                                                                                                                
APRIL KYLE, President                                                                                                           
Alaska Behavioral Health Association                                                                                            
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:   Presented,  "Update  on  SB 74  Behavioral                                                             
Health Reforms."                                                                                                                
                                                                                                                                
JARED KOSIN, President                                                                                                          
Alaska State Hospital and Nursing Home Association (ASHNHA)                                                                     
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:   Presented  a  PowerPoint overview  titled,                                                             
"MEDICAID: A Critical Component in Alaska's System of Care."                                                                    
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:03:28 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  IVY  SPOHNHOLZ  called  the  House  Health  and  Social                                                             
Services  Standing  Committee  meeting  to  order  at  3:03  p.m.                                                               
Representatives Spohnholz,  Drummond, Jackson, Pruitt,  Tarr, and                                                               
Claman (via teleconference) were present at the call to order.                                                                  
                                                                                                                                
^PRESENTATION(S): MEDICAID REFORM UPDATE                                                                                        
            PRESENTATION(S): MEDICAID REFORM UPDATE                                                                         
                                                                                                                                
3:03:57 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ announced  that  the only  order of  business                                                               
would  be  a presentation  updating  Medicaid  reform in  Alaska,                                                               
noting that this consisted of about $2.4 billion in the budget.                                                                 
                                                                                                                                
3:05:03 PM                                                                                                                    
                                                                                                                                
ADAM CRUM,  Commissioner, Office of the  Commissioner, Department                                                               
of Health and  Social Services (DHSS), directed  attention to the                                                               
PowerPoint titled "Medicaid Reform  Update," noting that Medicaid                                                               
Reform was  ongoing.  He  discussed slide 2,  "Topics," directing                                                               
attention to  Senate Bill 74, which  was passed in 2016,  and the                                                               
status  of the  2019 cost  containment  measures.   Moving on  to                                                               
slide 3,  "Senate Bill 74  (2016)" he  explained that this  was a                                                               
bi-partisan,  comprehensive,  holistic  approach  to  the  entire                                                               
health care system  in Alaska, allowing programs  to be developed                                                               
to change  health care,  make Medicaid  better, and  put together                                                               
many plans to give DHSS the  authority to move forward.  He noted                                                               
that  he  would  discuss Coordinated  Care  Projects,  Behavioral                                                               
Health System Reform, Electronic  Explanation of Benefits, Tribal                                                               
Reclaiming,  Pharmacy  Initiatives,  Fraud, Waste  &  Abuse,  and                                                               
Telehealth.     He  stated  that   slide  4,   "Coordinated  Care                                                               
Projects,"  meant  working  in  partnerships  with  patients  and                                                               
providers to  facilitate the appropriate delivery  of health care                                                               
and resulting in improved health and lower costs.                                                                               
                                                                                                                                
3:07:33 PM                                                                                                                    
                                                                                                                                
RENEE GAYHART,  Director, Director's  Office, Division  of Health                                                               
Care  Services,   Department  of  Health  and   Social  Services,                                                               
directed attention to the coordinated  care projects mentioned in                                                               
Senate  Bill 74.   She  added that  DHSS had  also been  asked to                                                               
enhance existing  efforts, which  included case management.   She                                                               
pointed  to  Medicaid recipients  who  used  services across  the                                                               
Medicaid  spectrum and  explained that  DHSS was  now working  to                                                               
assign these  recipients to  a single  primary care  and pharmacy                                                               
provider to allow for efficiencies in the management of care.                                                                   
                                                                                                                                
3:09:26 PM                                                                                                                    
                                                                                                                                
MS.   GAYHART   moved  on   to   the   Alaska  coordinated   care                                                               
demonstration projects, slides 4 and  5, and reported that Senate                                                               
Bill  74 created  a mechanism  for DHSS  to partner  and contract                                                               
with third  party outside entities,  which included  managed care                                                               
organizations  (MCOs) and  accountable care  organizations.   She                                                               
shared   slide   6,   "Alaska  Coordinated   Care   Demonstration                                                               
Projects,"  and  reported  that DHSS  had  negotiated  with  four                                                               
respondents to RFPs  (Request for Proposal) and gave  a notice of                                                               
intent  to award  with  United Health  Care  and with  Providence                                                               
Family and Medical Center for a medical home model.                                                                             
                                                                                                                                
3:12:03 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  CRUM directed  attention  to  "United Health  Care:                                                               
Managed  Care Organization,"  slide 5,  said that,  although DHSS                                                               
had been working on this  prior to the current administration, it                                                               
had been  evaluated within  the current  context of  planning and                                                               
was  now   determined  to  be   a  concern  for  its   impact  on                                                               
beneficiaries.   He  stated  that, as  other  options were  being                                                               
reviewed for the ability to  "mesh together into a global managed                                                               
care  system," it  was decided  not  to proceed  with the  United                                                               
Health Care contract.                                                                                                           
                                                                                                                                
CO-CHAIR SPOHNHOLZ asked if it  was possible to move forward with                                                               
a managed care project excluding the tribal health population.                                                                  
                                                                                                                                
COMMISSIONER CRUM replied that United  Health did not want to put                                                               
the decision  on hold until the  state made its decision  for how                                                               
to move forward  with the process in  a way to best  take care of                                                               
the tribal health partners.                                                                                                     
                                                                                                                                
CO-CHAIR SPOHNHOLZ  asked if there  could be an integration  of a                                                               
managed care demonstration project as  a sister company of United                                                               
Health Care was now managing the behavioral health.                                                                             
                                                                                                                                
COMMISSIONER  CRUM  said that  this  would  be evaluated  as  the                                                               
process moved forward.                                                                                                          
                                                                                                                                
CO-CHAIR SPOHNHOLZ  asked about the  timeline for the  next steps                                                               
on managed care.                                                                                                                
                                                                                                                                
COMMISSIONER CRUM replied  that DHSS was most  intrigued with the                                                               
local  and regional  aspect for  serving the  specific population                                                               
and was  reviewing a possible  pilot project in  conjunction with                                                               
the Medicaid  reform strategist and  the stakeholder  groups over                                                               
the upcoming months.                                                                                                            
                                                                                                                                
3:14:51 PM                                                                                                                    
                                                                                                                                
MS. GAYHART  moved on  to slide  7, "Alaska  Medicaid Coordinated                                                               
Care Initiative,"  AMCCI, and also  known as  the "superutilizer"                                                               
initiative.  She shared some of  its history, noting that in 2016                                                               
Alaska was  one of seven states  to receive a national  grant for                                                               
review  of this  in conjunction  with consulting  services.   She                                                               
reported that  there was  a focus on  the reduction  of emergency                                                               
room  visits  by helping  people  manage  chronic conditions  and                                                               
offering  case  management.    She  added  that  telephonic  case                                                               
management  was also  being reviewed,  even  though the  contract                                                               
with MedExpert [International]  had not been renewed.   She noted                                                               
that  Senate  Bill  74  also  suggested  that  the  Alaska  State                                                               
Hospital  and   Nursing  Home  Association  (ASHNHA)   work  with                                                               
superutilizers.                                                                                                                 
                                                                                                                                
3:17:47 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  asked whether  concern with delivery  was the                                                               
rationale for not renewing the MedExpert contract.                                                                              
                                                                                                                                
MS. GAYHART  replied that, as  DHSS was reviewing  enhancement of                                                               
the care management program for  additional cost containment, the                                                               
state had decided to pick up services from existing contracts.                                                                  
                                                                                                                                
3:18:52 PM                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM  explained that a  large aspect of  Senate Bill                                                               
74 was to "to address  the shortage of psychiatric inpatient beds                                                               
and residential  substance use  disorder treatment  programs, and                                                               
the  fragmented  system   of  community-based  behavioral  health                                                               
providers  and insufficient  treatment services,  particularly in                                                               
rural areas,"  slide 8,  "Behavioral Health  System Reform."   He                                                               
added that Senate Bill 105,  passed in 2018, allowed for licensed                                                               
marital  family therapists  to  independently  bill Medicaid  and                                                               
that Senate  Bill 169 allowed  any physician to operate  a mental                                                               
health physician  clinic and supervise  the provision of  care in                                                               
the clinic via  distance delivery.  He added that  Senate Bill 74                                                               
also removed the requirements  that Medicaid behavioral providers                                                               
be  grantees of  DHSS,  allowing  DHSS to  move  toward the  1115                                                               
waiver.                                                                                                                         
                                                                                                                                
3:20:07 PM                                                                                                                    
                                                                                                                                
GENNIFER   MOREAU-JOHNSON,  Director,   Division  of   Behavioral                                                               
Health,  Department  of  Health and  Social  Services,  discussed                                                               
slide  9, "1115  Behavioral Health  Waiver."   She explained  the                                                               
three components, which read, in part:                                                                                          
                                                                                                                                
     Substance Misuse Disorder Treatment Component                                                                              
     ? Approved in November 2018                                                                                                
     ? Became effective January 1, 2019                                                                                         
                                                                                                                                
MS. MOREAU-JOHNSON  added that currently there  were 38 providers                                                               
in  108  locations  certified to  provide  1115  Substance  Abuse                                                               
Services.   She reported  that the  revenue generated  from these                                                               
1115 waivers was helping the  agencies even more than the earlier                                                               
grants  as the  predominance were  Medicaid expansion  recipients                                                               
with a 90 - 10 match.  She  continued with slide 9, which read in                                                               
part:                                                                                                                           
                                                                                                                                
     Behavioral Health Component                                                                                                
     ? Approved September 2019                                                                                                  
     ? Will be implemented by June 30, 2020                                                                                     
                                                                                                                                
MS. MOREAU-JOHNSON  explained that  this was moving  more quickly                                                               
as it  was not necessary to  do the implementation plan  with the                                                               
federal government.  She finished slide 9, which read in part:                                                                  
                                                                                                                                
     Administrative Services Organization                                                                                       
     ? Contracted with Optum Health in November 2019                                                                            
     ? Goes live on February 1, 2020                                                                                            
                                                                                                                                
CO-CHAIR  SPOHNHOLZ asked  whether claims  would be  paid by  the                                                               
administrative services.                                                                                                        
                                                                                                                                
MS. MOREAU-JOHNSON  said that was  correct, that claims  would be                                                               
paid out  of two systems until  July 1 when Optum  would begin to                                                               
pay  all  the  claims,  do  the  utilization  review,  and  offer                                                               
technical support for providers.                                                                                                
                                                                                                                                
3:24:06 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR asked  whether,  as  the administrative  and                                                               
billing   services  were   currently  being   handled  by   state                                                               
employees, there would be any  attrition when these services were                                                               
transferred.                                                                                                                    
                                                                                                                                
MS.  MOREAU-JOHNSON  replied  that there  were  already  multiple                                                               
contracts with Optum performing  some of these existing contracts                                                               
and that state employees would not be replaced.                                                                                 
                                                                                                                                
3:25:27 PM                                                                                                                    
                                                                                                                                
MS.  GAYHART  discussed  slide  10,  "Electronic  Explanation  of                                                               
Medical Benefits (EOMBs)," which read:                                                                                          
                                                                                                                                
     Were made available October 2018  August 2019                                                                              
      ? Low participation rates and contract expenses that                                                                      
     exceeded overpayments identified and other benefits.                                                                       
          ? Division of Health Care Services plans to                                                                           
     reintroduce in early FY2021                                                                                                
                                                                                                                                
MS.  GAYHART explained  that, although  DHSS recognized  the EOMB                                                               
portion of Senate  Bill 74, it had been temporarily  put on hold.                                                               
She said  that the current  contract with MedExpert  was expiring                                                               
at  the same  time an  extension  was being  negotiated with  the                                                               
fiscal agent contract.  As  these EOMBs were being developed into                                                               
the contract with  Conduent, a one-time design and  build of this                                                               
EOMB  process would  cost about  $514,000, which  was matched  by                                                               
federal dollars  at 90  - 10; whereas,  the EOMBs  were currently                                                               
costing between  $1.3 - $1.5  million annually.  She  stated that                                                               
this would be  implemented by FY 21.  She  pointed out that, even                                                               
with these EOMBs, there were  additional extensive fraud controls                                                               
in place, emphasizing that DHSS took fraud very seriously.                                                                      
                                                                                                                                
CO-CHAIR SPOHNHOLZ asked if this  meant bringing the EOMB process                                                               
in-house.                                                                                                                       
                                                                                                                                
MS.  GAYHART replied  that this  would be  handled by  the fiscal                                                               
agent, Conduent.                                                                                                                
                                                                                                                                
3:29:39 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  CRUM  reminded the  committee  that  this would  be                                                               
built into the system at the 90 - 10 percent match.                                                                             
                                                                                                                                
CO-CHAIR  SPOHNHOLZ expressed  concern  about  Medicaid fraud  by                                                               
providers,  noting  that  it  was  constructive  to  educate  the                                                               
utilizers.                                                                                                                      
                                                                                                                                
3:30:53 PM                                                                                                                    
                                                                                                                                
COMMISSIONER   CRUM   paraphrased   slide  11,   "Tribal   Health                                                               
Reclaiming Efforts," which read:                                                                                                
                                                                                                                                
    Tribal   Medicaid   beneficiary    claims   have   been                                                                     
     reimbursed at 100% federal match for services provided                                                                     
     by or through a tribal health facility.                                                                                    
          ? Dependent on collaboration with Tribes and                                                                          
     providers:                                                                                                                 
     ? Care Coordination Agreements ? Referrals ? Exchange                                                                      
     of Records                                                                                                                 
                                                                                                                                
3:31:26 PM                                                                                                                    
                                                                                                                                
MS.  GAYHART  turned  attention   to  slide  12,  "Tribal  Health                                                               
Reclaiming Savings," and  said they were meeting  the targets set                                                               
forth in Senate Bill 74 by  the Centers for Medicare and Medicaid                                                               
Services,  through an  official state  health letter,  to qualify                                                               
for a 100  percent match.  She reported that  there were now more                                                               
than 1700 care coordination agreements  and that, even though the                                                               
percentage  of referral  verifications was  going up,  there were                                                               
still some  issues with health  information exchanges as  not all                                                               
the  providers had  the same  electronic  health record  systems.                                                               
She pointed  out that, as it  was not required to  designate your                                                               
race  in the  Medicaid system,  if  some Alaska  Natives did  not                                                               
designate, the reimbursement  was not 100 percent.   She declared                                                               
that the division was currently meeting its targets.                                                                            
                                                                                                                                
3:35:10 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ commended Ms.  Gayhart for saving $200 million                                                               
to date.                                                                                                                        
                                                                                                                                
3:36:00 PM                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM  paraphrased slide 13, "Fraud,  Waste & Abuse,"                                                               
which read:                                                                                                                     
                                                                                                                                
     Eligibility Verification system                                                                                            
     ? Both SB 74 and the Center for Medicare and Medicaid                                                                      
      Services have requirements for verification systems                                                                       
     for Medicaid recipients.                                                                                                   
         ? The U.S. Food and Nutrition Service also has                                                                         
       verification system requirements for its programs                                                                        
     (SNAP)                                                                                                                     
      ? DHSS is putting out a Request for Proposals for a                                                                       
     system that would meet both sets of requirements.                                                                          
                                                                                                                                
CO-CHAIR SPOHNHOLZ commented that  the 2019Medicaid Reform Report                                                               
had  noted a  $10.2  million savings,  the  result of  curtailing                                                               
fraud abuse by providers.                                                                                                       
                                                                                                                                
3:38:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  commented on the issues  with implementation                                                               
of coordination  between the two  state verification  systems and                                                               
asked if this new system  would replace both the existing systems                                                               
and allow for system wide efficiency.                                                                                           
                                                                                                                                
COMMISSIONER CRUM  offered his belief  that, over time,  this new                                                               
system  would integrate  both the  existing systems,  although it                                                               
would be  a delayed process.   He added that, in  addition to the                                                               
Eligibility  Verification System  (EVS),  an electronic  document                                                               
management (EDM)  system would be implemented  to allow documents                                                               
to be  scanned with a  program to  collect and organize  the data                                                               
and more easily track recipients.   He declared that this unified                                                               
process would save  staff time and better serve  the customers to                                                               
the Division of Public Assistance.                                                                                              
                                                                                                                                
3:39:55 PM                                                                                                                    
                                                                                                                                
HEATHER  CARPENTER, Health  Care  Policy Advisor,  Office of  the                                                               
Commissioner,  Department  of  Health  and  Social  Services,  in                                                               
response  to   Representative  Tarr,  stated  that   the  current                                                               
eligibility   system   was   different   from   the   Eligibility                                                               
Verification System.   This  new EVS system  would work  with the                                                               
current eligibility  system and final  eligibility determinations                                                               
had "to  be made by actual  state employees per CMS  rules."  She                                                               
explained that  this eligibility system  would look at all  of an                                                               
individual's assets, including those  in other states, and notice                                                               
whether  there were  multiple  identifications.   She  reiterated                                                               
that this would be linked with contractors.                                                                                     
                                                                                                                                
REPRESENTATIVE  TARR  expressed  her concern  for  the  purported                                                               
administrative inefficiencies of the current system.                                                                            
                                                                                                                                
COMMISSIONER CRUM expressed his agreement.                                                                                      
                                                                                                                                
3:42:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR noted  that there had been  a hesitation from                                                               
the  associations  regarding  the   electronic  time  sheets  for                                                               
personal  care  attendants  and  asked   if  there  had  been  an                                                               
administrative change to ensure this would happen.                                                                              
                                                                                                                                
COMMISSIONER  CRUM  replied  that  the   EVS  system  had  to  be                                                               
implemented to be in compliance  with the 21st Century Cares Act,                                                               
although DHSS had  needed to request a good faith  extension.  He                                                               
said that  DHSS would  work closely  with the  groups to  fix any                                                               
areas limited by technology.                                                                                                    
                                                                                                                                
3:44:33 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ suggested  that there could be  an update with                                                               
the public assistance process from the Division Director.                                                                       
                                                                                                                                
3:45:03 PM                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM introduced slide  14, "Telehealth," a breakdown                                                               
of the use and expenditures for the telehealth system.                                                                          
                                                                                                                                
MS. GAYHART continued with slide  14, explaining that Senate Bill                                                               
74  dictated   an  expansion  of  telehealth   to  primary  care,                                                               
behavioral health,  and urgent care,  which, in Alaska,  was used                                                               
as a  mode of service  delivery.   She declared that  the program                                                               
had  been successful  since  FY  16, and  pointing  to slide  15,                                                               
"Telehealth," she  listed the top  disease categories  as tracked                                                               
by the  diagnosis on each claim.   She reported that  most claims                                                               
were for  mental and behavioral health.   She noted that  many of                                                               
the  claims  indicated  youth  diseases,   which  allowed  for  a                                                               
transportation savings.  She pointed  out that Anchorage, Bethel,                                                               
Nome, and Fairbanks all had  high utilization in telehealth.  She                                                               
described  both the  interactive telehealth  method of  a patient                                                               
and a  provider on the screen,  and the store and  forward method                                                               
which  allowed x-rays  and  other lab  work to  be  put into  the                                                               
system for review.   She said it  was difficult to do  a "one for                                                               
one"  comparison  including  transportation costs,  as  sometimes                                                               
telehealth spurred a need for  transportation.  She reported that                                                               
the tribal health  organization, as they often  had the necessary                                                               
equipment, was the biggest provider and utilizer of the service.                                                                
                                                                                                                                
3:49:44 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  asked if there  could be an  approximation of                                                               
costs that would include travel costs in all the cases.                                                                         
                                                                                                                                
MS.  GAYHART  replied that  some  of  those analyses  required  a                                                               
support system  and not just a  "data pull by a  single analyst."                                                               
She declared  that this was "definitely  on the radar to  work on                                                               
this year,  we're just not there  yet."  In response  to Co-Chair                                                               
Spohnholz,  she explained  that a  decision support  system would                                                               
allow a  comparison of claims  by the system instead  of manually                                                               
by an individual.                                                                                                               
                                                                                                                                
CO-CHAIR   SPOHNHOLZ  asked   about   the   elimination  of   the                                                               
origination fee for Medicaid to out of state billings.                                                                          
                                                                                                                                
3:52:24 PM                                                                                                                    
                                                                                                                                
MS. MOREAU-JOHNSON, in response  to Co-Chair Spohnholz, said that                                                               
she would research that.                                                                                                        
                                                                                                                                
3:52:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CLAMAN  asked what  could  be  done to  encourage                                                               
providers, other  than tribal  health, to  increase their  use of                                                               
telehealth especially in the remote areas in Alaska.                                                                            
                                                                                                                                
MS. GAYHART declared  that the cost of the equipment,  as well as                                                               
connectivity, often excluded certain providers.                                                                                 
                                                                                                                                
REPRESENTATIVE CLAMAN  declared that it was  frustrating as there                                                               
seemed to be such easy access and lower costs to technology.                                                                    
                                                                                                                                
MS.  GAYHART added  that DHSS  struggled  with security  concerns                                                               
with  texting  and  cellphones.    She  referenced  a  telehealth                                                               
workgroup  during Senate  Bill 74,  noting  that the  regulations                                                               
demanded a strong security component.                                                                                           
                                                                                                                                
3:55:02 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  CRUM   reported  that  DHSS  was   having  internal                                                               
discussions for ways to proceed.                                                                                                
                                                                                                                                
CO-CHAIR SPOHNHOLZ added  that telehealth was one of  the ways to                                                               
increase access to health care and  to control costs.  She shared                                                               
the difficulty  of recruiting mental health  providers in Alaska,                                                               
especially in  small communities,  and expressed her  support for                                                               
the increase of telehealth as an appropriate level of care.                                                                     
                                                                                                                                
COMMISSIONER CRUM  stated, "we  put forward a  lot of  stuff this                                                               
last  session  in   order  to  meet  our   budgetary  goals"  and                                                               
paraphrased slide 16, "FY 2020  Cost Containment Measures," which                                                               
read:                                                                                                                           
                                                                                                                                
    DHSS    proposed    several    Medicaid-related    cost                                                                     
    containment   measures   during   the   FY2020   budget                                                                     
     preparation process.                                                                                                       
                                                                                                                                
    Expected   savings   from   several   of   these   were                                                                     
     incorporated by the Legislature into the final budget                                                                      
     submitted to the Governor.                                                                                                 
                                                                                                                                
     I will quickly review the status of each.                                                                                  
                                                                                                                                
COMMISSIONER CRUM moved on to  paraphrase slide 17, "FY 2020 Cost                                                               
Containment Measures," which read:                                                                                              
                                                                                                                                
     5% Provider Rate Reduction for Medicaid services                                                                           
                                                                                                                                
     Withholding Medicaid Rate Inflation Adjustments                                                                            
                                                                                                                                
     Hospital Diagnostic Related Groups (DRGs)                                                                                  
                                                                                                                                
     Long Term Care Rate Reduction                                                                                              
                                                                                                                                
     Cost-Based End Stage Renal Disease                                                                                         
                                                                                                                                
     Pharmacy Adjustments                                                                                                       
                                                                                                                                
COMMISSIONER  CRUM added  that,  as DRG  was  a very  complicated                                                               
process, DHSS  had hired a  contractor to do an  analysis working                                                               
directly  with  the stakeholder  groups  to  identify where  this                                                               
process could come in.  He pointed  out that Alaska was a fee for                                                               
service state, whereas  DRGs allowed for bundled  payments with a                                                               
movement toward a  value-based payment system.   Referring to the                                                               
long-term care rate reduction, he  stated that there was an issue                                                               
with the upper payment limit, so  it was necessary to implement a                                                               
three percent reduction.                                                                                                        
                                                                                                                                
3:58:36 PM                                                                                                                    
                                                                                                                                
MS. GAYHART  stated that the  cost-based end stage  renal disease                                                               
was on  track for the  expected savings as  DHSS had set  a lower                                                               
rate.    She  declared  that  there  were  several  efforts  with                                                               
pharmacy adjustments, including Senate  Bill 44 which allowed the                                                               
state to  update the  Medicaid preferred drug  list and  do prior                                                               
authorizations for the  medications list.  She  shared that there                                                               
was an expected savings for $6 million.                                                                                         
                                                                                                                                
3:59:39 PM                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM  mentioned that  some of the  cost containments                                                               
would not  allow a  sufficient level  of access  to care  for the                                                               
home and  community-based services,  so these waivers  "have been                                                               
held harmless" from both cost  containments and would continue to                                                               
receive the normal rates.                                                                                                       
                                                                                                                                
CO-CHAIR SPOHNHOLZ asked  about the process and  timeline for the                                                               
five percent provider rate reduction.                                                                                           
                                                                                                                                
COMMISSIONER  CRUM  explained  that the  agreements  with  Alaska                                                               
State Hospital and Nursing Home  Association (ASHNHA) would delay                                                               
implementation  of  the  five  percent  reduction  and  that  the                                                               
difference for  what had been removed  since July 1 had  now been                                                               
paid back.                                                                                                                      
                                                                                                                                
CO-CHAIR SPOHNHOLZ  asked if this included  hospitals and nursing                                                               
homes.                                                                                                                          
                                                                                                                                
COMMISSIONER  CRUM explained  that the  nursing homes  were under                                                               
the long-term  care and  would include  all providers  except for                                                               
the critical access and primary care.                                                                                           
                                                                                                                                
4:01:31 PM                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM moved on to  paraphrase slide 18, "FY 2020 Cost                                                               
Containment Measures," which read:                                                                                              
                                                                                                                                
       Limit Physical Therapy/Occupational Therapy/Speech                                                                       
     Therapy to 12 visits per year                                                                                              
                                                                                                                                
     Cost of Care Collection Improvements                                                                                       
                                                                                                                                
     Medicare Part B Premiums Recovery                                                                                          
                                                                                                                                
     Expand Care Management Program                                                                                             
                                                                                                                                
     Implement Nurse Hotline                                                                                                    
                                                                                                                                
COMMISSIONER  CRUM noted  that children's  physical, speech,  and                                                               
occupational  therapies were  exempt from  these service  limits,                                                               
and added  that should a  physician determine that  an individual                                                               
required more  service, the physician  could submit an  appeal to                                                               
DHSS.                                                                                                                           
                                                                                                                                
4:02:09 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ asked  for clarification  that the  limit for                                                               
the therapies was separate for each therapy.                                                                                    
                                                                                                                                
4:02:21 PM                                                                                                                    
                                                                                                                                
MS.  GAYHART  replied  that  this  would  soon  be  released  for                                                               
regulatory  comments.   She said  that the  limit for  the amount                                                               
allowed  for  an  option  should   the  provider  determine  that                                                               
additional  services were  necessary.   In  response to  Co-Chair                                                               
Spohnholz, she clarified that the limits were per category.                                                                     
                                                                                                                                
4:03:30 PM                                                                                                                    
                                                                                                                                
MS. GAYHART  said that individuals  in long-term  care situations                                                               
could qualify for Medicaid, although  they may have to contribute                                                               
to their cost  of care.  She  said that DHSS was  taking steps to                                                               
collect  these  obligations  from  both  the  recipient  and  the                                                               
representatives.    She  pointed  out that  this  was  a  federal                                                               
regulation, pointing  out that there  was the potential for  a $1                                                               
million savings.                                                                                                                
                                                                                                                                
4:04:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   JACKSON  asked,   regarding  the   five  percent                                                               
provider rate reduction, whether this  differed for a Medicaid or                                                               
private  provider,  and  if  so,   would  it  discourage  private                                                               
providers working with Medicaid patients.                                                                                       
                                                                                                                                
COMMISSIONER CRUM  explained that  rate reductions  were mandated                                                               
by the Centers for Medicare  and Medicaid Services to ensure that                                                               
there was not a loss of  providers.  He reported that, in Alaska,                                                               
Medicaid  paid  higher  than  Medicare.    He  stated  that  DHSS                                                               
recognized the  expense and difficulty  of providing  services in                                                               
Alaska.                                                                                                                         
                                                                                                                                
4:06:28 PM                                                                                                                    
                                                                                                                                
MS. GAYHART returned  attention to slide 18 and  stated that DHSS                                                               
paid the Medicare  Part B premium for  those eligible individuals                                                               
who could  not afford  the premium.   She discussed  expansion of                                                               
the  care management  program to  include  500 additional  people                                                               
this year, with  another 1,000 individuals during  the next year.                                                               
She explained  that this would  be conducted through  the quality                                                               
assurance unit.   She said the implementation of  a nurse hotline                                                               
had been delayed along with the delay of United Health Care.                                                                    
                                                                                                                                
4:09:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE DRUMMOND asked how  many superutilizers there were                                                               
in  Alaska and  what  kind of  progress had  been  made toward  a                                                               
reduction to that number.                                                                                                       
                                                                                                                                
MS. GAYHART explained  that the term superutilizer  was also used                                                               
for  high utilizers,  and in  her division,  the care  management                                                               
program was  looking to  expand its  management to  include 1,000                                                               
people in that program.  She  noted that many of these people may                                                               
not  be on  the  program long  term, dependent  on  the types  of                                                               
services needed.                                                                                                                
                                                                                                                                
REPRESENTATIVE  DRUMMOND asked  what  percentage  of those  1,000                                                               
individuals represented superutilizers.                                                                                         
                                                                                                                                
MS.  GAYHART  offered her  understanding  that,  in the  Medicaid                                                               
population  of  about  210,000   individuals,  about  1,000  were                                                               
considered   superutilizers  with   an   additional  100   people                                                               
considered to be high utilizers.                                                                                                
                                                                                                                                
4:12:50 PM                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM directed  attention to slide 19,  "FY 2020 Cost                                                               
Containment Measures," which read:                                                                                              
                                                                                                                                
     ? Electronic Visit Verification                                                                                            
     ? Timely filing allowance reduction                                                                                        
     ? Transportation Efficiencies                                                                                              
     ? Adult Preventive Dental                                                                                                  
                                                                                                                                
COMMISSIONER  CRUM explained  that  the  timely filing  allowance                                                               
would shorten  the time limit for  a provider to file  a Medicaid                                                               
claim from  12 months past  service to 6  months.  He  noted that                                                               
this would  require a change  to statute, although DHSS  now felt                                                               
that  this would  not  result in  any savings.    In response  to                                                               
Representative Claman,  he clarified  that this option  would not                                                               
be pursued.                                                                                                                     
                                                                                                                                
4:14:01 PM                                                                                                                    
                                                                                                                                
COMMISSIONER   CRUM   explained   that,  although   the   initial                                                               
transportation efficiencies were projected  to save $8.2 million,                                                               
the tribal  entities had  taken on  a large  part of  the savings                                                               
through management.   He stated that the  adult preventive dental                                                               
had originally been considered an  optional service, but with the                                                               
Patient  Protection  and  Affordable  Care Act,  it  was  now  an                                                               
essential health  benefit.   There had been  a decision  to fully                                                               
re-instate this program.   In response to  Co-Chair Spohnholz, he                                                               
offered  his belief  that  those providers  who  had been  denied                                                               
compensation since October, could now submit their claims.                                                                      
                                                                                                                                
CO-CHAIR  SPOHNHOLZ stated  that for  providers, especially  with                                                               
the small  profit margin  from Medicaid  patients, not  getting a                                                               
payment was "a  bit of a challenge so every  effort that could be                                                               
made to expedite that, I think, will make a lot of difference."                                                                 
                                                                                                                                
4:16:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JACKSON  asked whether the nurse  hotline had been                                                               
discontinued.   She  declared that  the  hotline saved  a lot  of                                                               
money  in times  of  concerns  or problems.    She expressed  her                                                               
desire that there was not abuse from dentists.                                                                                  
                                                                                                                                
COMMISSIONER  CRUM  replied that  DHSS  was  still exploring  the                                                               
nursing hotline  in a  cost appropriate manner.   He  shared that                                                               
many providers were  sharing ways to prevent  abuses and continue                                                               
to offer appropriate care.                                                                                                      
                                                                                                                                
COMMISSIONER CRUM reported that  the DHSS Medicaid consultant was                                                               
working to  "put forward something that  everybody understands is                                                               
do-able and good for Alaska moving  forward."  He added that DHSS                                                               
was actively engaging in partner  relationships, noting that DHSS                                                               
did not  deliver health care,  but helped to enable  the delivery                                                               
of health care.                                                                                                                 
                                                                                                                                
4:21:25 PM                                                                                                                    
                                                                                                                                
NANCY   MERRIMAN,  Executive   Director,   Alaska  Primary   Care                                                               
Association  (APCA),  explained  that  APCA  was  "the  statewide                                                               
training and  technical assistance provider for  community health                                                               
centers   across   the   state    and   also   their   membership                                                               
associations."   She  paraphrased  slide 2,  "We Believe:"  which                                                               
read:                                                                                                                           
                                                                                                                                
     We Believe:                                                                                                                
     ? Primary care is key to healthcare savings and value                                                                      
      ? Primary care seeks more opportunities to integrate                                                                      
     with other care providers                                                                                                  
     ? Primary care needs more flexible payment structures                                                                      
     ? Primary care should be comprehensive and integrated                                                                      
                                                                                                                                
     We also Believe:                                                                                                           
     ? SB 74 was a step in the right direction                                                                                  
                                                                                                                                
MS.    MERRIMAN    recapped    slide   3,    "Community    Health                                                               
Centers/Federally Qualified Health Centers," which read:                                                                        
                                                                                                                                
     27 CHC Organizations operating ~170 Clinics in Alaska                                                                      
     ? 113,000 Alaskans in more than 500,000 visits                                                                             
     ? Less than $100 Million Medicaid spend                                                                                    
     ? CHCs provide more high-value and less low-value care                                                                     
       ? Nationally, CHCs save Medicaid ~24% over care in                                                                       
     non-CHC settings                                                                                                           
                                                                                                                                
MS. MERRIMAN  discussed slide 4,  "SB 74 and Primary  Care Missed                                                               
Opportunities?", which read:                                                                                                    
                                                                                                                                
     SB 74 had 16 Major Medicaid Redesign Initiatives                                                                           
      Few had direct opportunities for primary care:                                                                            
     ? Coordinated Care Demonstration Projects                                                                                  
     ? Section 2703/1945 Health Homes                                                                                           
                                                                                                                                
     Challenges of the Time:                                                                                                    
     ? $3-4 Billion budget deficit                                                                                              
     ? No State Dollars were put toward significant system                                                                      
     reform                                                                                                                     
     ? A need for short-term savings                                                                                            
     These concerns continue to burden us today.                                                                                
                                                                                                                                
4:26:27 PM                                                                                                                    
                                                                                                                                
MS.  MERRIMAN said  they were  encouraged but  there was  still a                                                               
long way  to go and  it would  take meaningful investments.   She                                                               
turned  attention to  slide 6,  "Our  Investments and  priorities                                                               
align with SB 74 goals," which read:                                                                                            
                                                                                                                                
       CHC Data analytics and population health platform                                                                        
     ($1.5 Million)                                                                                                             
     o Health information                                                                                                       
     o Disease Prevention & Wellness (risk stratification,                                                                      
     referral tracking, visit planning)                                                                                         
     o Quality Measures                                                                                                         
                                                                                                                                
     ? Proposal: The Alaska Health Home Pilot                                                                                   
     o Coordinated Care Demonstration proposal                                                                                  
     o 1945 Waiver = Health Home                                                                                                
     o Redesigning the Payment Process                                                                                          
                                                                                                                                
     ? Patient-Centered Medical Home (PCMH)                                                                                     
     o 18 of 27 CHCs recognized                                                                                                 
     o Team-Based integrated care                                                                                               
                                                                                                                                
MS.  MERRIMAN stated  that care  coordination services  that were                                                               
required to be  provided, and were high value and  low cost, were                                                               
not reimbursed  by any  payer.   She pointed  out that  these low                                                               
cost  and   high  value  services   really  made   a  difference,                                                               
especially for  the highly complex, expensive  patients with many                                                               
health conditions.   She  noted that although  SB 74  provided an                                                               
opportunity to be  innovative with new tactics  to improve health                                                               
outcomes  and  save  on  costs, implementation  on  some  of  the                                                               
initiatives  had been  elusive.   She directed  attention to  the                                                               
1945 waiver, which would allow  Alaska to establish a health home                                                               
program and  had been  included in  legislation and  the Milliman                                                               
Report of October 2018.  She  added that the Centers for Medicare                                                               
and Medicaid  Services still offered financial  support to states                                                               
with development of  these health home programs,  noting that the                                                               
90 percent  FMAP (Federal Medical Assistance  Percentage) offered                                                               
for  those care  coordination  services was  still available  for                                                               
eight  quarters. She  noted  that the  initiative  had not  moved                                                               
forward,  even  though  it  was  an  opportunity  for  meaningful                                                               
coordinated care  demonstration with health center  expertise and                                                               
high  value  care  delivery.    She  declared  that  this  was  a                                                               
recognized,  proven  program to  pay  for  high value,  low  cost                                                               
services  for  highly  complex   patients,  lamenting  that  this                                                               
opportunity had been missed, but  she expressed the hope that the                                                               
program possibility  would be  examined again.   She  opined that                                                               
primary care needed to be recognized and supported.                                                                             
                                                                                                                                
MS. MERRIMAN  discussed slide  7, "CHCs continue  to be  the best                                                             
deal in healthcare," which read:                                                                                              
                                                                                                                                
     Future:                                                                                                                  
     ? We're Investing in the exploration of:                                                                                   
     o A Clinically Integrated Network and                                                                                      
     o Value-Based Pay                                                                                                          
     ? We're seeking:                                                                                                           
     o Reimbursement for Coordinated Care                                                                                       
     o An expanded list of reimbursable Provider Types that                                                                     
     would enhance integrated services                                                                                          
     ? We value:                                                                                                                
        o Transparency in Administrative and Legislative                                                                        
     Changes                                                                                                                    
     o Inclusion of stakeholder voices and perspectives                                                                         
                                                                                                                                
MS. MERRIMAN shared  an anecdote about a practice that,  due to a                                                               
lack  of  funds,  had  to decline  participation  in  a  valuable                                                               
project that would have delivered  robust information about their                                                               
patients and  their consumption habits.   She declared  that APCA                                                               
valued  transparency,  both  in  administrative  and  legislative                                                               
changes  to  the Medicaid  program  moving  forward, adding  that                                                               
stakeholder and  provider perspectives  would inform  the process                                                               
and help with  successful reforms.  She stated  that primary care                                                               
and preventive health saved Alaska  money, was good for patients,                                                               
and was good for Alaska.                                                                                                        
                                                                                                                                
4:33:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR asked  if the  suggestions for  the expanded                                                               
list  and  reimbursement  for  coordinated  care  were  allowable                                                               
within  the state  plan,  hence  could be  changed  at the  state                                                               
level,  or would  they  need  to be  changed  at  the state  plan                                                               
amendment level.                                                                                                                
                                                                                                                                
MS.  MERRIMAN  offered her  belief  that  expanding the  list  of                                                               
reimbursable  providers could  be  done at  the state  regulation                                                               
level.   She added that  coordinated care services  were tougher,                                                               
and she  opined that  those had  a "really  good chance  of being                                                               
covered within  the demonstration  project" and were  included in                                                               
the Providence  Primary Care Practice demonstration  project as a                                                               
per member  per month amount above  the cost of the  usual visit.                                                               
She  noted that  this flexible  payment allowed  the practice  to                                                               
deliver the  services that were  not reimbursable and  would have                                                               
been difficult to get reimbursed on a per item basis.                                                                           
                                                                                                                                
4:35:17 PM                                                                                                                    
                                                                                                                                
APRIL  KYLE,  President,  Alaska Behavioral  Health  Association,                                                               
contextualized what the behavioral  health system in Alaska looks                                                               
like  today.     She  informed  the  committee   that  there  are                                                               
committed, effective,  and competent behavioral  health providers                                                               
who   are  delivering   good  services   and  making   meaningful                                                               
improvements in  their communities.   The  problem, she  said, is                                                               
that  the  supply of  behavioral  health  providers and  services                                                               
doesn't reach the demand, which  leaves a lot of Alaskans without                                                               
the behavioral health  care that they need.   When Alaskans can't                                                               
access that  behavioral health care  because there  aren't enough                                                               
services there  becomes an increased demand  for law enforcement,                                                               
criminal justice,  and the Office  of Children's  Services (OCS).                                                               
The state  is in a  position where there's not  enough behavioral                                                               
health services and  a small group of providers who  want to meet                                                               
that  need,  which  leaves  a  gap in  the  system.    Next,  she                                                               
addressed   reform    and   the    1115   waiver,    calling   it                                                               
"transformational"  for behavioral  health in  Alaska.   The idea                                                               
behind  the 1115  waiver was  to  recognize the  gap between  the                                                               
supply and  demand and create  an environment where  new services                                                               
could  be built  in the  continuum.   She further  noted that  by                                                               
building out  those new services,  an argument was made  that the                                                               
state  would  save  money  in   other  parts  of  its  healthcare                                                               
delivery.  The 1115 waiver  specifically says that the state will                                                               
bring online  30 new  outpatient treatment  programs and  200 new                                                               
residential  treatment beds.    She said,  "think  about all  the                                                               
Alaskans today who need those  services right now but aren't able                                                               
to access them  because they don't exist in our  continuum."  The                                                               
1115  waiver ideology  is that  building up  those services  will                                                               
save money by providing less  expensive, earlier interventions in                                                               
real time, "because treatment works, and recovery is possible."                                                                 
                                                                                                                                
4:44:01 P M                                                                                                                   
                                                                                                                                
REPRESENTATIVE  TARR sought  clarification on  the percentage  of                                                               
providers that have joined the 1115 waiver environment thus far.                                                                
                                                                                                                                
MS. KYLE  explained that the  first step in becoming  an eligible                                                               
provider under  the 1115  waiver is to  apply and  seek approval.                                                               
According to the  Division of Behavioral Health  (DBH), she said,                                                               
there are five or six providers  that are being reimbursed in the                                                               
1115  [waiver] environment  and prepared  to meet  the regulatory                                                               
requirements.                                                                                                                   
                                                                                                                                
4:45:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CLAMAN  expressed  concern about  the  discussion                                                               
coming  from  the  executive branch  regarding  a  withdraw  from                                                               
Medicaid  expansion.   He asked  how that  would impact  the 1115                                                               
waiver.                                                                                                                         
                                                                                                                                
MS. KYLE stated that the  1115 [waiver] services are largely paid                                                               
through federal  (indisc.) services.   The ability to  launch new                                                               
behavioral  health services  depends  on the  environment of  the                                                               
(indisc.) continuing.   She reported  that if  Medicaid expansion                                                               
was in threat, the ability  to move forward for behavioral health                                                               
would be in jeopardy.                                                                                                           
                                                                                                                                
REPRESENTATIVE CLAMAN  asked Ms.  Kyle if  she knows  the current                                                               
position  of  this administration  on  whether  it will  continue                                                               
efforts to potentially roll back [Medicaid].                                                                                    
                                                                                                                                
MS. KYLE said she doesn't want to speak for the administration.                                                                 
                                                                                                                                
4:47:45 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  CRUM, in  response to  Representative Claman,  said                                                               
that at this point in time,  [the administration] has not had any                                                               
discussion about the removal of Medicaid expansion.                                                                             
                                                                                                                                
REPRESENTATIVE CLAMAN  opined that any  move to try to  roll back                                                               
the expansion  would be  devastating to  Alaska.   He said  he is                                                               
somewhat encouraged  that the administration  doesn't seem  to be                                                               
pursuing that at this point.                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ concurred.                                                                                                   
                                                                                                                                
4:48:46 PM                                                                                                                    
                                                                                                                                
MS. KYLE  resumed her presentation,  directing attention  back to                                                               
Medicaid reform  and the impact  on behavioral health  (slide 2).                                                               
She  said the  Administrative Services  Organization (ASO)  is in                                                               
contract and  scheduled to launch  the first part of  its service                                                               
February 1,  2020.  She  noted that  only a handful  of providers                                                               
will be submitting  claims on that day.  She  continued by saying                                                               
that  SB 74  aims  to  increase access  by  allowing any  willing                                                               
provider  to  participate  in   the  Medicaid  behavioral  health                                                               
continuum.   Part of  that, she said,  includes creating  an even                                                               
playing field  regarding the administrative  responsibilities and                                                               
the   obligations  of   behavioral  health   providers  who   had                                                               
previously been  delivering Medicaid services.   The ASO  is cast                                                               
with decreasing the administrative  burden on providers; however,                                                               
that work  hasn't started yet.   Finally, she related that  SB 74                                                               
called  for the  improved  integration of  behavioral health  and                                                               
primary care, which the 1115  waiver and behavioral health reform                                                               
has yet to address.                                                                                                             
                                                                                                                                
MS. KYLE turned  her attention to the next steps  (slide 3).  She                                                               
said  the  good  news  is   that  the  Alaska  Behavioral  Health                                                               
Association (ABHA) has a solid  business case that says they save                                                               
money  by  developing  more  behavioral  health  services.    She                                                               
reiterated  that  the 1115  waiver  creates  the environment  for                                                               
those  services to  be  developed.   However,  to be  successful,                                                               
reform  efforts  depend on  three  things.   First,  predictable,                                                               
sustainable  operational  funding  so providers  can  launch  new                                                               
services.  Second,  start-up capital to fund  the system changes,                                                               
which means  updates to billing  systems and medical  records for                                                               
better  care,  as well  as  required  quality data  reporting  to                                                               
transforming outreach  and clinical  delivery, she said.   Third,                                                               
transparent  open  conversations   and  involvement  in  planning                                                               
stages for providers.                                                                                                           
                                                                                                                                
4:54:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JACKSON  expressed her desire for  all Alaskans to                                                               
have the  opportunity to be above  the poverty level.   She said,                                                               
"I don't want us to, like,  neglect that idea in order to receive                                                               
government funds to provide them to keep them there."                                                                           
                                                                                                                                
4:55:48 PM                                                                                                                    
                                                                                                                                
MS.  KYLE  responded  by  addressing  addiction  services.    She                                                               
indicated  that   lives  are  changed  by   the  journey  through                                                               
treatment and  into recovery.   She indicated  that the  goals of                                                               
those  in  addiction  and  mental   health  treatment  are  about                                                               
education,  employment, housing,  and  reconnecting with  family.                                                               
She said behavioral  health is a stabilizing  factor, adding that                                                               
many success  stories are not  clinical outcome measures  as much                                                               
as they are functional outcome measures.                                                                                        
                                                                                                                                
4:57:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   TARR  sought   clarification  on   the  start-up                                                               
capital.   She questioned  whether the  state would  be providing                                                               
grants to individual providers.                                                                                                 
                                                                                                                                
4:58:45 PM                                                                                                                    
                                                                                                                                
MS. KYLE  replied in the  past, the legislature  has appropriated                                                               
dollars, which  were offered through competitive  grant processes                                                               
for  new  programs  to  launch.    That,  she  said,  has  proven                                                               
successful.   She  noted that  the behavioral  health network  of                                                               
providers  is operating  on thin  margins.   She  added that  she                                                               
doesn't want to speak for the  trust; however, there is a big gap                                                               
between supply and demand, and  everyone will need to think about                                                               
where the dollars will come from to launch the needed services.                                                                 
                                                                                                                                
5:00:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR, in  response to Ms. Kyle,  surmised that the                                                               
state  could  offer  a  competitive   grant  for  technology  and                                                               
infrastructure  upgrades necessary  to  participate  in the  1115                                                               
waiver program.                                                                                                                 
                                                                                                                                
MS.  KYLE  cautioned the  idea  that  the  dollars would  be  for                                                               
technical assistance.  She suggested  that, "if we can trust that                                                               
the payment will  be in the future what we  calculate now, and if                                                               
we can  have the launch  dollars then  we can really  bring those                                                               
services online."                                                                                                               
                                                                                                                                
5:01:22 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ emphasized  that behavioral  health providers                                                               
as well as  other health providers are businesses  like any other                                                               
organization.   They need  to know  what their  potential revenue                                                               
streams can be to provide a  service in order to build a business                                                               
model that  is sustainable.   If there isn't  predictability, she                                                               
said,  it creates  an  operating environment  where  risk is  not                                                               
enabled.   She reiterated  the importance  of a  stable operating                                                               
environment.                                                                                                                    
                                                                                                                                
5:02:14 PM                                                                                                                    
                                                                                                                                
JARED KOSIN,  President, Alaska State  Hospital and  Nursing Home                                                               
Association (ASHNHA), provided  a PowerPoint presentation titled,                                                               
"MEDICAID: A Critical Component in  Alaska's System of Care."  He                                                               
explained  that to  understand SB  74 and  the future  of reforms                                                               
it's  important to  know where  Medicaid stands  today.   He said                                                               
that Medicaid and health care  in general are highly connected in                                                               
Alaska,  which  means that  Alaska's  system  of care  has  major                                                               
vulnerabilities: capacity and effect  of reimbursement (slide 2).                                                               
He  described  health care  as  a  system  in  the concept  of  a                                                               
continuum (slide  3).  He  stated that Alaska's continuum  is not                                                               
efficient  for  "good reasons."    One  of those  being  capacity                                                               
challenges, or  not enough  beds for the  population.   He argued                                                               
that this,  in turn, drives up  health care costs.   He explained                                                               
how system  inefficiencies are driving and  trapping patient care                                                               
at  the highest  cost point  because the  lack of  long-term care                                                               
facilities  or assisted  living  homes to  discharge hospital  or                                                               
emergency  department   inpatients  (slides  4-5).     Mr.  Kosin                                                               
continued   by   describing  a   chart   on   slide  6   labeled,                                                               
"Hypothetical  Payor  Mix (admissions)."    He  said that  people                                                               
enrolled in government programs  like Medicaid and Medicare often                                                               
pay less than  the actual cost of patient  care and consequently,                                                               
private payers  are paying  more (slide  7).   He then  turned to                                                               
reform.   He reiterated that  Alaska's system is  fragile, adding                                                               
that it needs to be  stabilized before making decisions that will                                                               
affect it.   He discussed  making rational changes  through data-                                                               
driven decisions and payment reform,  as well as innovative ideas                                                               
on how to keep patients at a lower cost of care (slide 8).                                                                      
                                                                                                                                
5:18:41 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ commented  on an  issue related  to workforce                                                               
supply.   She  reported that  two separate  University of  Alaska                                                               
programs that provide behavioral  health care and physical health                                                               
care training  are on the  chopping block  as a result  of budget                                                               
cuts.    She  said  this  will  hinder  the  ability  to  have  a                                                               
sufficient workforce to  provide the health care  that this state                                                               
needs.   She said that  it is  important to remember  that health                                                               
care  operates in  a  larger  system and  thanked  Mr. Kosin  for                                                               
calling attention to that.                                                                                                      
                                                                                                                                
5:20:56 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 5:20 p.m.                                                                                                          

Document Name Date/Time Subjects
ABHA One Page Presentation Summary 01.09.2020.pdf HHSS 1/9/2020 3:00:00 PM
Medicaid Reform
Alaska Trust Beneficiary Scorecard for ABHA Presentation 01.09.2020.pdf HHSS 1/9/2020 3:00:00 PM
Medicaid Reform
ASHNHA Presentation 01.09.2020.pdf HHSS 1/9/2020 3:00:00 PM
Medicaid Reform
ABHA Presentation 01.09.2020.pdf HHSS 1/9/2020 3:00:00 PM
Medicaid Reform
APCA Presentation 01.09.2020.pdf HHSS 1/9/2020 3:00:00 PM
Medicaid Reform
DHSS Medicaid Reform Update Presentation 01.09.2020.pdf HHSS 1/9/2020 3:00:00 PM
Medicaid Reform
DHSS MH-Continuum-of-Care-0-to-21.pdf HHSS 1/9/2020 3:00:00 PM
Medicaid Reform
DHSS MH-Continuum-of-Care-18-and-older.pdf HHSS 1/9/2020 3:00:00 PM
Medicaid Reform
DHSS SUD-Continuum-of-Care-12-and-older.pdf HHSS 1/9/2020 3:00:00 PM
Medicaid Reform