Legislature(2015 - 2016)CAPITOL 106
03/31/2015 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB148 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 148 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 31, 2015
3:03 p.m.
MEMBERS PRESENT
Representative Paul Seaton, Chair
Representative Liz Vazquez, Vice Chair
Representative Neal Foster
Representative Louise Stutes
Representative David Talerico
Representative Geran Tarr
Representative Adam Wool
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 148
"An Act relating to medical assistance reform measures; relating
to eligibility for medical assistance coverage; relating to
medical assistance cost containment measures by the Department
of Health and Social Services; and providing for an effective
date."
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 148
SHORT TITLE: MEDICAL ASSISTANCE COVERAGE; REFORM
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
03/18/15 (H) READ THE FIRST TIME - REFERRALS
03/18/15 (H) HSS, FIN
03/24/15 (H) HSS AT 3:00 PM CAPITOL 106
03/24/15 (H) Heard & Held
03/24/15 (H) MINUTE(HSS)
03/26/15 (H) HSS AT 3:00 PM CAPITOL 106
03/26/15 (H) Heard & Held
03/26/15 (H) MINUTE(HSS)
03/28/15 (H) HSS AT 3:00 PM CAPITOL 106
03/28/15 (H) Heard & Held
03/28/15 (H) MINUTE(HSS)
03/31/15 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
JON SHERWOOD, Deputy Commissioner
Medicaid and Health Care Policy
Office of the Commissioner
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during the discussion of
HB 148.
VALERIE DAVIDSON, Commissioner Designee
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions during the discussion of
HB 148.
MARGARET BRODIE, Director
Director's Office
Division of Health Care Services
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
148.
STACIE KRALY, Chief Assistant Attorney General
Statewide Section Supervisor
Human Services Section
Civil Division (Juneau)
Department of Law
Juneau, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
148.
ACTION NARRATIVE
3:03:01 PM
CHAIR PAUL SEATON called the House Health and Social Services
Standing Committee meeting to order at 3:03 p.m.
Representatives Seaton, Vazquez, Tarr, Stutes, Talerico, and
Wool were present at the call to order. Representative Foster
arrived as the meeting was in progress.
HB 148-MEDICAL ASSISTANCE COVERAGE; REFORM
3:03:30 PM
CHAIR SEATON announced that the only order of business would be
HOUSE BILL NO. 148, "An Act relating to medical assistance
reform measures; relating to eligibility for medical assistance
coverage; relating to medical assistance cost containment
measures by the Department of Health and Social Services; and
providing for an effective date."
3:06:40 PM
CHAIR SEATON moved to adopt Amendment 1, labeled 29-GH1055\A.2,
Glover, 3/24/15, which read:
Page 7, following line 15:
Insert a new bill section to read:
"* Sec. 9. AS 47.07.030(d) is amended to read:
(d) The department shall [MAY] establish [AS
OPTIONAL SERVICES] a primary care case management
system or a managed care organization contract in
which certain eligible individuals, including super-
utilizers as identified by the department, are
required to enroll and seek approval from a case
manager or the managed care organization before
receiving certain services. The department shall
establish enrollment criteria and determine
eligibility for services consistent with federal and
state law."
Renumber the following bill sections accordingly.
Page 9, following line 3:
Insert a new bill section to read:
* Sec. 14. The uncodified law of the State of
Alaska is amended by adding a new section to read:
MEDICAID MANAGED CARE FOR SUPER-UTILIZERS. On or
before January 1, 2017, the Department of Health and
Social Services shall
(1) establish a primary care case
management system or a managed care organization
contract under AS 47.07.030(d), as amended by sec. 9
of this Act, for super-utilizers, as identified by the
department; and
(2) deliver a report on the system or
contract to the senate secretary and the chief clerk
of the house of representatives and notify the
legislature that the report is available."
Renumber the following bill sections accordingly.
Page 9, line 12:
Delete "sec. 10"
Insert "sec. 11"
Page 9, line 17:
Delete "10"
Insert "11"
Page 9, line 23:
Delete "Sections 13 and 14"
Insert "Sections 15 and 16"
Page 9, line 24:
Delete "by sec. 16"
Insert "in sec. 18"
CHAIR SEATON explained that this amended Section 9 of the
proposed bill, the establishment of a primary care case
management system or managed care organization for certain
individuals, changing "may" to "shall" and adding the phase
"including super-utilizers as identified by the department." He
reported that the proposed amendment also added a new section,
Section 14, to the proposed bill. He stated that the genesis of
this amendment was to address super-utilizers, as they had been
identified as a source of a large potential savings.
REPRESENTATIVE TARR objected, and asked for clarification of the
intention, as she had understood that this proposed amendment
had been withdrawn during the previous meeting.
CHAIR SEATON explained that he had only taken it off the table
during the previous meeting, and that this proposed amendment
would require that Department of Health and Social Services do
what was in statute.
REPRESENTATIVE TARR expressed her concern whether there was
capacity to meet the proposed amendment, noting that almost 25
percent of the super-utilizers were her constituents. She
acknowledged that there had been a program implemented to
address this problem, which had saved several million dollars.
She reported that Medicaid Expansion would provide an additional
opportunity to address this, although she expressed her concern
for the availability of capacity to meet this directive. She
asked how the proposed amendment differed from the existing
reform measures.
3:08:35 PM
JON SHERWOOD, Deputy Commissioner, Medicaid and Health Care
Policy, Office of the Commissioner, Department of Health and
Social Services, in response, said that the department believed
that it had the capacity to expand for more use by super-
utilizers under the current case management system.
CHAIR SEATON reiterated that the amendment allowed the committee
to identify reforms which it required to be in the proposed
bill, and for the legislature to receive a report that the
reforms were being addressed.
3:09:39 PM
REPRESENTATIVE TARR asked how this was different than the
current program addressing the super-utilizer problem.
VALERIE DAVIDSON, Commissioner Designee, Office of the
Commissioner, Department of Health and Social Services (DHSS),
replied that there were about 2000 Medicaid beneficiaries
currently enrolled in the super-utilizer contract. She said
that, as the program was voluntary, this provision of the
proposed amendment would require the department to set up the
system, reiterating that it would become compulsory instead of
optional, and would reinforce the ongoing efforts by the
department. She pointed out that it allowed flexibility for
this to be accomplished either through the existing contract or
another mechanism.
REPRESENTATIVE TARR pointed out that, as the required report was
one of three that came due on January 1, this would allow for
the possibility of consolidation or coordination of report
requirements.
CHAIR SEATON said that the committee would be in contact with
the department to work toward a practical solution, although he
expressed concern that the reform reports may be lost in a
larger report.
3:11:31 PM
REPRESENTATIVE VAZQUEZ asked which database or software was used
to identify super-utilizers.
MR. SHERWOOD said that the information was obtained from the
claims payment system, the Medicaid Management Information
Systems (MMIS), although he was not sure which specific software
was used.
REPRESENTATIVE VAZQUEZ asked whether MMIS was the predecessor of
the Alaska Health Enterprise System.
MR. SHERWOOD replied that he had used MMIS as a generic term for
the claims processing and related software system. He expressed
agreement that the current system was called Enterprise,
although he was unsure for when the data had been extracted.
REPRESENTATIVE VAZQUEZ asked whether accuracy in the Enterprise
was important.
MR. SHERWOOD replied that DHSS did strive for an accurate claims
payment system.
CHAIR SEATON asked if these questions were directed to the
proposed amendment.
REPRESENTATIVE VAZQUEZ explained that, as it was necessary to
identify super-utilizers through the Enterprise claims payment
system, she was going to ask questions pertaining to the
effectiveness of the claims payment system. She directed
attention to the statewide single audit for Fiscal Year 2014.
MR. SHERWOOD replied that he was familiar with the audit.
REPRESENTATIVE VAZQUEZ pointed to a recommendation that the DHSS
commissioner should take action to implement effective controls
to ensure Medicaid claims were processed accurately and timely.
She said that there were many defects identified, and this
"resulted in a material weakness in internal controls over the
Medicaid and CHIP programs." She asked how DHSS planned to
identify more super utilizers, if the claims payment system was
not functioning properly.
3:15:00 PM
MARGARET BRODIE, Director, Director's Office, Division of Health
Care Services, Department of Health and Social Services,
explained that the super utilizer information was taken from the
decision support system, not the claims payment processing
system.
REPRESENTATIVE VAZQUEZ asked for an explanation to the decision
support system, questioning whether it was a surveillance
utilization and review system.
MS. BRODIE replied that it was similar, although a different
tool.
CHAIR SEATON asked to return to the proposed amendment for
establishment of a case management system, and not be concerned
with the exact technology used to identify super-utilizers.
3:16:03 PM
REPRESENTATIVE TARR removed her objection. There being no
further, Amendment 1, labeled 29-GH1055\A.2, Glover, 3/24/15,
was adopted.
3:16:35 PM
CHAIR SEATON moved to adopt Amendment 3, labeled 29-GH1055\A.1,
Glover, 3/24/15, which read:
Page 9, line 24:
Delete "July"
Insert "August"
CHAIR SEATON explained that this changed the effective date from
July 1 to August 1, in order to avoid overlap and potential
coding issues created by the rollout of the new state fiscal
system which would begin on July 1. There being no objection,
Amendment 3, labeled 29-GH1055\A.1, Glover, 3/24/15, was
adopted.
3:17:33 PM
REPRESENTATIVE VAZQUEZ moved to adopt Amendment 4, labeled 29-
GH1055\A.9, Glover, 3/24/15, which read:
Page 6, line 17:
Delete "203 [175]"
Insert "175"
Page 6, line 21:
Delete "200 [175]"
Insert "175"
CHAIR SEATON objected for discussion.
REPRESENTATIVE VAZQUEZ explained that the proposed amendment
would decrease the percentage relative to the federal poverty
level back to its original level of 175 percent.
3:19:02 PM
REPRESENTATIVE TARR offered her understanding that the current
calculations were set at 175 percent of the federal poverty
level, but were then adjusted, which brought the percentages to
the proposed levels of 203 percent and 200 percent. She
declared that it would be necessary to continue to make these
modified adjusted gross income (MAGI) adjustments. She offered
her understanding that placing the figures in the statute
offered more transparency to the actual amount of income, and
did not make it necessary to make the adjustments.
3:20:01 PM
MR. SHERWOOD confirmed the explanation by Representative Tarr
that this reflected the required conversion of income levels to
the MAGI standards.
CHAIR SEATON asked for clarification that the MAGI of 203
percent and 200 percent was a federal requirement, and that
maintenance of the 175 percent would not be adhered to as it was
in violation of federal law.
MR. SHERWOOD said that the amendment would not have any effect,
as it was necessary to include the MAGI conversion when
calculating income eligibility.
3:21:28 PM
REPRESENTATIVE VAZQUEZ asked for clarification that the present
standard for 175 percent of federal poverty level was not
federally allowed.
MR. SHERWOOD explained that it was a requirement to convert the
pre-MAGI standard, which included the use of income disregards,
to a post-MAGI standard which was the equivalent amount without
the use of income disregards.
REPRESENTATIVE VAZQUEZ reiterated her question whether 175
percent of the federal poverty level was not allowed by federal
statute.
MR. SHERWOOD explained that federal law dictated the ways to
apply the standard, as there was a maintenance of effort
requirement for covering children. He declared that DHSS could
not reduce the standard for children and make a MAGI standard at
175 percent of federal poverty level. He offered his belief
that the pregnant woman standard could be amended. He stated
that removal of the proposed language change would have the
effect of allowing the pre-MAGI standard in statute to remain in
statute, and federal law required that these standards be
converted.
3:23:26 PM
REPRESENTATIVE VAZQUEZ pointed out that the first part of
proposed Amendment 4 pertained to Denali Kid Care, with a
present standard of 175 percent of the federal poverty level;
whereas the second part of the proposed amendment pertained to
pregnant ladies, which was also at 175 percent of the federal
poverty level. She asked if this was not in compliance with
federal law.
3:24:09 PM
COMMISSIONER DAVIDSON asserted that testimony in every previous
hearing for proposed HB 148 had explained that this change of
the proposed bill endeavored to be open and transparent to the
public for the new percentages [to federal poverty levels] after
they were converted to the newly required MAGI standards.
CHAIR SEATON stated that the 175 percent with disregards for
certain amounts equaled 203 percent [of federal poverty levels]
in one section, and it equaled 200 percent [of federal poverty
levels] in the other section.
COMMISSIONER DAVIDSON offered her agreement.
CHAIR SEATON maintained his objection so that the statutes did
not reflect a figure no longer allowed by Medicaid.
3:25:17 PM
REPRESENTATIVE VAZQUEZ asked if the present statute was not in
compliance with federal law.
CHAIR SEATON emphasized that 175 percent with disregards was
equal to 203 percent, pointing out that, as the proposed
amendment did not address the disregards, it did not address the
complete law. He reiterated that the complete law was for 175
percent with disregards, which equaled 203 percent of the MAGI
standards. He said that the 175 percent with disregards was no
longer acceptable to Medicaid and Medicare Services.
REPRESENTATIVE VAZQUEZ said she had not seen any federal
regulations that Alaska statute was not in compliance. She
acknowledged the MAGI formula, but that an argument was being
made that the current Alaska statute was not in compliance with
federal law. She said that this was a separate issue than
taking into consideration the MAGI formula. She demanded an
answer to the legal issue by someone who had a juris doctor and
knew something about federal statutes that affected our
programs.
CHAIR SEATON declared that there was a proposed amendment in
front of the committee, that there had been discussion and it
was understood that there were differences in opinion, and he
was now calling for a vote.
A roll call vote was taken. Representatives Vazquez and
Talerico voted in favor of Amendment 4. Representatives Stutes,
Wool, Tarr, Foster, and Seaton voted against it. Therefore,
Amendment 4, labeled 29-GH1055\A.9, Glover, 3/24/15, failed by a
vote of 2 yeas - 5 nays.
3:28:42 PM
CHAIR SEATON moved to adopt Amendment 5, labeled 29-GH1055\A.14,
Nauman/Glover, 3/25/15, which read:
Page 2, line 13, following "program":
Insert "; and the Department of Health and Social
Services shall contract with an independent third
party to advise the department during the development
of the tax proposal under this paragraph."
REPRESENTATIVE TALERICO objected for discussion.
CHAIR SEATON explained that the proposed amendment added to the
governor's intent language on page 2 [of the proposed bill] for
a provider tax with a requirement that Department of Health and
Social Services contract with an independent third party to
advise in the development of the tax. He reported that a
provider tax was a good mechanism for support toward the state
deficit in health care, as every state with the exception of
Alaska had some sort of provider tax. He allowed that, as these
taxes were complicated and complex, a third party contractor
would offer advice.
REPRESENTATIVE TALERICO withdrew his objection. There being no
further objection, Amendment 5, labeled 29-GH1055\A.14,
Nauman/Glover, 3/25/15, was adopted.
3:30:34 PM
REPRESENTATIVE TALERICO withdrew proposed Amendment 6, labeled
29-GH1055\A.17, Mischel/Glover, 3/25/15.
3:31:02 PM
CHAIR SEATON moved to adopt Amendment 7, labeled 29-GH1055\A.19,
Nauman/Glover, 3/25/15, which read:
Page 9, following line 3:
Insert a new bill section to read:
"* Sec. 13. The uncodified law of the State of
Alaska is amended by adding a new section to read:
COST-SHARING; REPORT TO LEGISLATURE. The
Department of Health and Social Services shall prepare
a report summarizing cost-sharing measures implemented
before March 1, 2015, by the Department of Health and
Social Services under AS 47.07.042 and describing the
effect of those measures on the state budget. On or
before March 1, 2016, the Department of Health and
Social Services shall deliver a copy of the report to
the senate secretary and chief clerk of the house of
representatives and notify the legislature that the
report is available."
Renumber the following bill sections accordingly.
Page 9, line 23:
Delete "Sections 13 and 14"
Insert "Sections 14 and 15"
Page 9, line 24:
Delete "sec. 16"
Insert "sec. 17"
REPRESENTATIVE TALERICO objected for discussion.
CHAIR SEATON explained that this added to the uncodified law
requirements that the Department of Health and Social Services
prepare a report describing the current cost measures
implemented under AS 47.07.042 prior to March [1, 2015] with a
report due [describing the effects of those measures] on March
1, 2016. He offered conceptual Amendment 1 to proposed
Amendment 7, changing March 1, 2015 on line 7 of the proposed
amendment to October 1, 2015, as it would then correspond to the
due date for federal changes.
REPRESENTATIVE TARR asked for clarification that the report was
due on March 1, 2016.
CHAIR SEATON expressed his agreement, and reiterated that the
conceptual amendment would change the date on line 7 of proposed
Amendment 7 from March 1, 2015 to October 1, 2015 so it could
include the implemented changes required by the Centers for
Medicare and Medicaid Services (CMS) related to this as these
needed to be completed prior to October.
CHAIR SEATON asked if there was further objection to conceptual
Amendment 1 to proposed Amendment 7. In response to
Representative Wool, he explained that the report would be due
on March 1, 2016, which would summarize information through
October 1, 2015. He explained that there were cost savings
measures which had been already been implemented, and that there
could possibly be more before the federal deadline of October 1,
2015. He stated that this would require a report from DHSS to
the legislature on the effects of these cost savings measures by
March 1, 2016.
3:34:42 PM
REPRESENTATIVE WOOL expressed his concern that October would not
allow enough time, and that he wanted to ensure that report
reform was not necessary.
CHAIR SEATON directed attention back to the proposed conceptual
Amendment 1 which proposed a change to the date for the cost
sharing measures to be implemented as it would then correspond
to the federal deadline for changes prior to October 1, 2015.
He added that the report to the legislature for the DHSS
implemented cost sharing measures would then be due by March 1,
2016.
3:36:11 PM
REPRESENTATIVE VAZQUEZ asked how cost sharing was defined.
CHAIR SEATON read from the cost sharing mechanism handout titled
"Medicare Cost Sharing" [Included in members' packets], noting
that the department was currently soliciting federal technical
assistance for implementing the new federal rules which were
income based formulaic and aggregate caps. He explained that
the amendment would request that a report be submitted to the
legislature from DHSS to list what had been implemented.
REPRESENTATIVE VAZQUEZ asked if this was a working document from
DHSS, a proposed regulation, or a conceptual document. She
stated that the source had not been indicated on the document.
3:38:28 PM
CHAIR SEATON, in response, said that the document was a synopsis
of existing cost sharing measures, that it came from the statute
in regulations, 7AAC.105.610(b), which were required to be done.
He pointed out that the impending required cost sharing charges
were at the bottom. He reiterated that proposed Amendment 7
required a report on the cost sharing measures to the Alaska
State Legislature.
3:39:10 PM
REPRESENTATIVE VAZQUEZ asked for the department to confirm these
regulations.
MR. SHERWOOD stated that this document was prepared by DHSS and
provided to the House Health and Social Services Standing
Committee, and that it summarized the current regulations and
described the impending changes in federal statute and
regulations.
REPRESENTATIVE VAZQUEZ asked if this was required by the Patient
Protection and Affordable Care Act as of January 1, 2014.
MR. SHERWOOD said that the Patient Protection and Affordable
Care Act did require changes to cost sharing, and that it was
accompanied by changes to federal regulations around cost
sharing.
3:40:19 PM
REPRESENTATIVE VAZQUEZ expressed concern that March 1, 2015 was
rather late in the legislative session, and she suggested that
this be moved to an earlier date.
CHAIR SEATON asked if she was objecting to conceptual Amendment
1, which changed the report date from March 1, 2015 until
October 1, 2015. He pointed out that October was the date for
federal guidelines to be implemented and that DHSS had requested
technical assistance for those changes. Without the date change
there would only be a report for what had been done prior to
March 1, 2015, which would not include any additional cost
sharing measures implemented prior to the required federal
timeline.
REPRESENTATIVE VAZQUEZ said that she wanted to know what was
being done in the future, next January or February [2016].
CHAIR SEATON declared that this the intention of conceptual
Amendment 1. He reiterated that the date change for the report
would allow inclusion of all the cost sharing elements which
were changed and implemented.
3:42:25 PM
There being no objection, conceptual Amendment 1 to proposed
Amendment 7 was adopted.
3:43:07 PM
REPRESENTATIVE TALERICO removed his objection to proposed
Amendment 7, and then reinserted his objection for further
discussion.
REPRESENTATIVE TARR asked whether the dates could be better
aligned to fiscal year reports in order to better assess the
success of the programs.
CHAIR SEATON clarified that the proposed amendment was
summarizing the cost sharing measures and not necessarily the
exact money saved by these measures.
3:44:55 PM
REPRESENTATIVE TALERICO removed his objection. There being no
further objection, Amendment 7, as amended, labeled 29-
GH1055\A.19, Nauman/Glover, 3/25/15, was adopted.
3:45:11 PM
CHAIR SEATON moved to adopt Amendment 8, labeled 29-GH1055\A.20,
Glover, 3/25/15, which read: [Amendment 8 is provided at the
end of these minutes]
REPRESENTATIVE TALERICO objected for discussion.
CHAIR SEATON explained that proposed Amendment 8 required that
DHSS would establish prevention of disease as a primary model of
health care, which had been unanimously requested by the
legislature in 2011 in Legislative Resolve 16. He declared that
the proposed amendment added the duty to DHSS to establish
guidelines for medical assistance providers to develop health
care delivery models that encourage adequate nutrition and
disease prevention.
3:46:07 PM
REPRESENTATIVE TALERICO asked for any comments by DHSS.
MR. SHERWOOD declared that DHSS had no objection to proposed
Amendment 8.
REPRESENTATIVE TALERICO removed his objection. There being no
further objection, Amendment 8, labeled 29-GH1055\A.20, Glover,
3/25/15, was adopted.
3:46:49 PM
REPRESENTATIVE VAZQUEZ moved to adopt Amendment 9, labeled 29-
GH1055\A.24, Glover, 3/26/15, which read:
Page 7, following line 1:
Insert a new bill section to read:
"* Sec. 7. AS 47.07.020(d) is amended to read:
(d) Notwithstanding (a) of this section,
additional [ADDITIONAL] groups, including groups added
on or after March 23, 2010, to the list of persons for
whom the Social Security Act requires Medicaid
coverage under 42 U.S.C. 1396 - 1396p (Title XIX,
Social Security Act), may not be added unless approved
by the legislature."
Renumber the following bill sections accordingly.
Page 9, line 12:
Delete "sec. 10"
Insert "sec. 11"
Page 9, line 17:
Delete "10"
Insert "11"
Page 9, line 23:
Delete "Sections 13 and 14"
Insert "Sections 14 and 15"
Page 9, line 24:
Delete "by sec. 16"
Insert "in sec. 17"
CHAIR SEATON objected for discussion.
REPRESENTATIVE VAZQUEZ explained that proposed Amendment 9
required that the legislature approve any expansion of
eligibility categories and that it was appropriate for the
legislature to properly consider all issues and consequences
intended and unintended before additional eligibility categories
or groups were added on to the Medicaid program, given the
fiscal situation in Alaska. She referenced a Legislative Audit
Division report which indicated that there were many issues
confronting the Department of Health and Social Services. She
offered her belief that the addition of populations to a program
that was not functioning well was not in the best interests of
the State of Alaska.
COMMISSIONER DAVIDSON, in response to Chair Seaton, said that it
was unusual for a requirement asking permission from the
legislature to comply with federal law. She declared that this
provision was for a mandatory covered service and that DHSS had
a concern that non-compliance with a mandatory provision and
federal law would put the entire Medicaid program at risk.
CHAIR SEATON asked for examples for mandatory Medicaid
expansions.
MR. SHERWOOD replied that the most recent addition was the
Medicaid expansion population but that the Supreme Court ruled
that states could not be sanctioned for non-compliance with
Medicaid expansion in the Patient Protection and Affordable Care
Act. He relayed that in the past there had been special
coverage added to provide assistance to low income Medicare
beneficiaries, which provided premium support to a slightly
broader range of Medicare beneficiaries.
3:51:47 PM
CHAIR SEATON reflected that this amendment would require
legislative approval of Medicaid expansion as it was after the
March 23, 2010 date in the amendment.
3:52:29 PM
REPRESENTATIVE STUTES asked if there was any occasion to add
additional groups other than if there was a federal mandate.
COMMISSIONER DAVIDSON expressed her agreement.
3:52:53 PM
REPRESENTATIVE VAZQUEZ said that there had been discussion
regarding the ability of the executive branch to proceed with
expansion of Medicaid into groups that were not previously
covered, as there was no need for legislative approval. She
opined that the proposed amendment would ensure legislative
approval for further fiscal responsibilities, and would require
that any statement by DHSS that something was "absolutely
required by federal statute" would be "fully vetted and fully
examined by the legislature." She declared that it was a duty
of the legislature to appropriate money for programs.
REPRESENTATIVE STUTES asked if there had ever been an occasion
that a group had been included when it had not been federally
directed.
MR. SHERWOOD replied that current statute required that addition
of any optional group had to be approved by the legislature. He
reported that the proposed amendment would require that the
addition of any groups that were federally mandated would still
have to be approved by the legislature. He said that federally
mandated groups had been added without approval of the
legislature, and he pointed out that it was still necessary for
DHSS to receive budgetary authority from the legislature.
CHAIR SEATON asked if those mandated groups had been narrow or
broad exceptions.
MR. SHERWOOD explained that the most recent mandates had been
narrow, especially around Medicare program changes, which had
shifted coverage, changed the premium and co-pay costs, and
included protections in the Medicaid program for low income
Medicare beneficiaries. He reported that there had been an
expansion of mandatory coverage for children and pregnant women
with higher incomes in the 1980s and early 1990s.
3:56:25 PM
REPRESENTATIVE STUTES asked whether a federal mandate would
supersede the Alaska State Legislature, as otherwise a program
would be in jeopardy.
COMMISSIONER DAVIDSON expressed her agreement.
3:57:04 PM
REPRESENTATIVE VAZQUEZ said that there had recently been state
challenges to the federal government with regard to Medicaid
expansion, resulting in a U. S. Supreme Court determination that
the federal government could not make the states expand the
program.
3:57:55 PM
COMMISSIONER DAVIDSON replied that she was very aware of the
provision, and, as it was not a required coverage, the proposed
amendment was not necessary.
CHAIR SEATON explained that, as the service was optional for the
expansion population, it was not covered by the proposed
amendment which only covered mandated services. He allowed that
it was possible to entirely drop Medicaid, putting the program
at risk by not accepting a mandatory service, and he questioned
whether that was the desired outcome.
REPRESENTATIVE TARR expressed understanding that the legislature
should be involved in the funding, stating that it was her
responsibility to be a participant in the budget process which
provided all the necessary opportunities to ask the tough
questions, delve into the budget details, and question any
requirements.
3:59:20 PM
REPRESENTATIVE VAZQUEZ said that the proposed amendment did not
address mandatory services, but instead addressed the inclusion
of additional groups or categories. She stated that there were
two concepts, the mandatory Medicaid services versus the
optional Medicaid services, with expansion of the program
through the addition of people, and that was what this amendment
addressed.
3:59:56 PM
The committee took an at-ease from 3:59 p.m. to 4:06 p.m.
4:06:34 PM
REPRESENTATIVE STUTES asked for an explanation to any change
resulting from proposed Amendment 9.
STACIE KRALY, Chief Assistant Attorney General, Statewide
Section Supervisor, Human Services Section, Civil Division
(Juneau), Department of Law, explained that proposed Amendment 9
required the Department of Health and Social Services to get
legislative approval to add additional mandatory eligible
individuals to the Medicaid program. It was still necessary for
the department to come to the legislature to add any optional
eligible individuals to the Medicaid program.
REPRESENTATIVE STUTES asked if this requirement was for
federally mandated individuals.
4:07:47 PM
REPRESENTATIVE WOOL asked for clarification that these were
people already covered under the expansion.
COMMISSIONER DAVIDSON explained that this would be for groups
added after March [March 23, 2010], and offered an example for
an addition by the federal Medicaid program of mandatory
coverage for a certain population. As this proposed amendment
would require the Department of Health and Social Services, in
order to comply with federal law, to first go to the legislature
for permission, she opined that the department would be out of
compliance with federal law before the approval was granted.
4:08:45 PM
REPRESENTATIVE VAZQUEZ said that the attorney [Ms. Kraly] did
not answer the question. She stated that the legislature should
know when an additional eligibility category was added to the
Medicaid program.
4:09:57 PM
A roll call vote was taken. Representative Vazquez voted in
favor of Amendment 9, labeled 29-GH1055\A.24, Glover, 3/26/15.
Representatives Foster, Stutes, Wool, Tarr, and Seaton voted
against it. Therefore, Amendment 9 failed by a vote of 1 yea -
5 nays.
4:10:42 PM
REPRESENTATIVE VAZQUEZ moved to adopt Amendment 10, labeled 29-
GH1055\A.25, Nauman/Glover, 3/28/15, which read: [Amendment 10
is provided at the end of these minutes]
CHAIR SEATON objected for discussion.
REPRESENTATIVE VAZQUEZ explained that the proposed amendment
created a Medicaid Task Force to include four representatives
appointed by the Speaker of the House of Representatives, four
senators appointed by the President of the Senate, four public
members selected by the governor based on their knowledge of the
health care systems of the state, Medicaid, and the budget of
the state, and the commissioner of the Department of Health and
Social Services. She said that the Task Force was charged with
delivering a report to the legislature which included policy
options and recommendations to reduce costs related to Medicaid
use in the state; and recommendations, including draft
legislation, to achieve the policy objective proposed by the
task force. She said that the task force would meet as
frequently as necessary, and that it would expire on April 1,
2017. She noted that there would also be a fiscal note. She
opined that it was more critical than ever to resurrect the idea
of a task force.
4:12:32 PM
REPRESENTATIVE STUTES said that, although she was not opposed to
a task force, 13 people was too many as it would be difficult to
get them all together. She stated that she could not support
the proposed amendment as written.
REPRESENTATIVE FOSTER offered his belief that previous task
forces had been created in separate, stand-alone bills.
4:13:19 PM
CHAIR SEATON asked if DHSS had had success with a task force
studying Medicaid.
COMMISSIONER DAVIDSON replied that there had been a number of
Medicaid task forces or working groups. She referenced one that
had met between the fall of 2010 and spring of 2011, which
consisted of 12 members, including 8 legislators. She said that
the final report had identified about $20 million in savings at
that time. She said that the number of reform efforts in the
current proposed bill and the subsequent savings identified
would exceed those task force recommendations. She declared
that DHSS welcomed all opportunities to review reform efforts.
She reiterated that DHSS was continually building upon the
reforms that it had already undertaken. She reported that
another Medicaid reform advisory group had been established
during the prior administration and she listed the ten committee
members which included two legislators, the commissioner, and a
former commissioner. She relayed that the recommendation of
that advisory group had been to forward the recommendations to
the winner of the RFP that had been issued, who would include
the national reform efforts and engage with stakeholders to
bring the recommendations back to DHSS and the legislature. She
declared that further reform efforts had been undertaken by the
Alaska Healthcare Commission, a 14 member group originally
established by executive order of then Governor Palin in
December, 2008, and subsequently through Senate Bill 172. She
listed some of the areas for review to include health care
delivery, reform, and payment reform. She reiterated that DHSS
welcomed any and all opportunities to reform, and that the
department recommended for this task force to be proposed in
stand-alone legislation.
4:16:48 PM
REPRESENTATIVE WOOL concurred with the current reforms, reports,
and outside groups which had already offered recommendations and
stated that the creation of an additional task force was not
necessary at this time.
CHAIR SEATON directed attention to the already existing Alaska
Healthcare Commission, with a similar mission and membership.
He questioned the cost for an additional task force, and pointed
out that the legislature would be reviewing the recommendations
contained in the proposed bill. He maintained his objection to
proposed Amendment 10.
4:18:20 PM
REPRESENTATIVE VAZQUEZ said that the report on the possibility
of a tax on state providers for Medicaid was a separate issue.
She offered her belief that the current task force had expired
and that this proposed amendment would resurrect a task force.
She declared that it was now even more critical in the face of
the approaching $3.5 billion deficit. She directed attention to
the 25 page single statewide audit report dated June 30, 2014,
indicating prior problems which had not been remedied. She
offered her belief that it was time for the department to "allow
some more fiscal accountability."
4:19:54 PM
A roll call vote was taken. Representative Vazquez voted in
favor of Amendment 10, labeled 29-GH1055\A.25, Nauman/Glover,
3/28/15. Representatives Tarr, Foster, Stutes, Wool, and Seaton
voted against it. Therefore, Amendment 10 failed by a vote of 1
yea - 5 nays.
4:21:46 PM
REPRESENTATIVE VAZQUEZ moved to adopt Amendment 11, labeled 29-
GH1055\A.29, Gardner/Glover, 3/27/15, which read:
Page 1, line 5, through page 2, line 13:
Delete all material and insert:
"* Section 1. The uncodified law of the State of
Alaska is amended by adding a new section to read:
MEDICAL ASSISTANCE REFORM: LEGISLATIVE FINDINGS
AND INTENT. (a) The legislature finds that
(1) the current Medicaid program is not
sustainable;
(2) improving the delivery of health care
services to Alaskans requires state government, health
care providers, patient advocates, and other parties
interested in high-quality, affordable health care to
collaborate to
(A) increase the availability of high-
quality health care to Alaskans;
(B) provide greater value for state general
fund dollars spent on the state medical assistance
program;
(C) reduce health care costs;
(D) provide incentives to encourage
Alaskans to take greater responsibility for their
personal health;
(E) reduce or minimize the shifting of
payment for unreimbursed health care costs to patients
with health insurance;
(3) providing greater value for the general
fund dollars spent on the state medical assistance
program requires considering options for delivering
services in a more efficient and cost-effective
manner, including, but not limited to,
(A) offering incentives to encourage health
care providers to achieve measurable performance
outcomes;
(B) improving the coordination of care
among health care providers who participate in the
medical assistance program;
(C) reducing preventable hospital
readmissions; and
(D) exploring methods of medical assistance
reimbursement that promote quality of care and
efficiencies;
(4) it is important to implement additional
fraud, waste, and abuse safeguards to protect and
preserve the integrity and sustainability of the
medical assistance program;
(5) state policymakers have an interest in
testing the effectiveness of wellness incentives in
order to collect and analyze information about the
correlation between wellness incentives and health
status;
(6) the purposes of this Act are to modify
and enhance the state's health care delivery system to
provide access to high-quality, affordable health care
for all citizens of the state.
(b) It is the intent of the legislature that the
Department of Health and Social Services maximize the
use of existing resources in administering the state
medical assistance program."
CHAIR SEATON objected for discussion.
REPRESENTATIVE VAZQUEZ explained that the proposed amendment
changed Section 1 of the proposed bill, "removing statements of
reduced annual growth from 6.45 to 4.8 percent, also removes
governor from the section and emphasizing minimizing wasteful
spending, fraud, and best utilization of general fund dollars."
It "changes legislative intent language to ensure more
meaningful reform efforts are stressed and undertaken." She
declared that the proposed amendment was "more definitive,
especially in the reform side."
COMMISSIONER DAVIDSON offered a recommendation that the language
of the proposed amendment be added to the existing language in
the intent so that all of the intent language in the existing
bill would capture the successes of the department as well as
the vision for reform efforts. She expressed a concern that the
proposed amendment would delete existing language which directed
DHSS to consult with stakeholders and provide a proposal to
authorize a provider tax, recommending that the provision
regarding the provider tax remain in the proposed bill.
4:24:56 PM
REPRESENTATIVE VAZQUEZ, in response to Chair Seaton, said that
she would entertain an amendment to include cost sharing plans
and utilization in the intent language of Section 1. In
response to Chair Seaton's question for inclusion of the section
regarding a provider tax, as recommended by DHSS, she said that
she would object to that. She reiterated that she would support
[an amendment] for cost sharing, but she would oppose addition
of a provision for DHSS to submit a proposal authorizing a
provider tax.
4:25:51 PM
REPRESENTATIVE TARR relayed that she was very comfortable with
the original legislative intent language, which she declared was
more specific to the reforms that were currently being
undertaken by DHSS. She pointed out that an amendment related
to the provider tax proposal had just been adopted. She offered
her belief that it seemed inconsistent to remove it from an
earlier part of the proposed bill.
CHAIR SEATON explained his objection that, as reforms could
include a Medicaid provider tax, or at the least the initiation
of a discussion for this tax, discussion of cost differentials
could not ignore revenue sources. He expressed concern that
page 2, lines 5 - 9, of the proposed bill discussed a
requirement to evaluate options for waivers, which was not
included in the proposed amendment. He maintained his
objection.
REPRESENTATIVE VAZQUEZ said that she would not object to the
inclusion, specifically, of waivers.
CHAIR SEATON maintained his objection.
4:27:55 PM
A roll call vote was taken. Representative Vazquez voted in
favor of Amendment 11, labeled 29-GH1055\A.29, Gardner/Glover,
3/27/15. Representatives Wool, Tarr, Foster, Stutes, and Seaton
voted against it. Therefore, Amendment 11 failed by a vote of 1
yea - 5 nays.
4:29:24 PM
REPRESENTATIVE VAZQUEZ moved to adopt Amendment 12, labeled 29-
GH1055\A.33, Strasbaugh/Glover, 3/28/15, which read:
Page 7, following line 9:
Insert a new bill section to read:
"* Sec. 8. AS 47.07.020(l) is amended to read:
(l) Notwithstanding the eligibility provisions
under (a) and (b) of this section, a person may not
receive medical assistance under this section unless
the person first enrolls in the Medicare program under
42 U.S.C. 1395 and any other federally funded program
providing medical assistance to the extent that the
person is eligible to receive benefits and services
under the program. The department shall adopt
regulations establishing civil penalties for
individuals who receive medical assistance in
violation of this subsection."
Renumber the following bill sections accordingly.
Page 9, line 12:
Delete "sec. 10"
Insert "sec. 11"
Page 9, line 17:
Delete "10"
Insert "11"
Page 9, line 23:
Delete "Sections 13 and 14"
Insert "Sections 14 and 15"
Page 9, line 24:
Delete "by sec. 16"
Insert "in sec. 17"
CHAIR SEATON objected for discussion.
REPRESENTATIVE VAZQUEZ explained that the proposed amendment
clarified that the Medicaid program was the payer of last
resort, and directing attention to lines 5 - 10, she read:
unless the person first enrolls in the Medicare
program under 42 U.S.C. 1395 and any other federally
funded program providing medical assistance to the
extent that the person is eligible to receive benefits
and services under the program. The department shall
adopt regulations establishing civil penalties for
individuals who receive medical assistance in
violation of this subsection.
REPRESENTATIVE VAZQUEZ explained that any individual qualified
to receive Medicare program benefits needed to first apply to
the Medicare program. She stated that the department needed to
establish regulations and civil penalties for individuals who
did not comply.
4:31:11 PM
REPRESENTATIVE VAZQUEZ said that Alaska was currently spending
$1.6 billion on Medicaid, reiterating that Medicaid was the
payer of last resort. She stated that, as this was "a very
fiscally minded, responsible type of amendment," it should be
adopted.
COMMISSIONER DAVIDSON relayed that, as it was already a federal
requirement that Medicaid was the payer of last resort, the
department did not feel that this proposed amendment was
necessary. She explained that, in Alaska, individuals were
required to pursue other coverage. She stated that fines were
not necessary, as DHSS had the authority to terminate
individuals from the Medicaid program if the individual was in
violation. She expressed concern with the statement in the
proposed amendment for "any other federally funded program
providing medical assistance" receiving benefits and services,
pointing out that there were individuals who were Medicaid
beneficiaries who had access to clinics [funded under Section
330 of the Public Health Service Act] which were not considered
coverage, as well as individuals eligible to receive services
from a Veterans' Administration (VA) facility, an Indian Health
Service (IHS) facility, or other federal programs. She
reiterated that Medicaid was already federally required to be
the payer of last resort.
CHAIR SEATON asked if people were required to sign up for
Medicare prior to receiving Medicaid.
MR. SHERWOOD stated that anyone eligible for Medicare needed to
first apply for it, as a condition of eligibility for Medicaid.
If an individual was otherwise eligible for Medicaid, they would
receive it as they were in the application process for Medicare,
and anyone receiving Medicaid who aged into Medicare were
required to enroll in it.
REPRESENTATIVE TARR expressed her concern for the recommendation
of civil penalties in the proposed amendment. She offered her
understanding that an individual who knowingly had fraudulent
action was prohibited from enrolling in Medicaid.
COMMISSIONER DAVIDSON expressed her agreement.
REPRESENTATIVE VAZQUEZ declared that termination of Medicaid
benefits was "probably more draconian than imposing a civil
penalty." She stated that Medicare would often not pay for
something, whereas Medicaid would pay. She asked that the
regulations for this be cited.
MR. SHERWOOD reported that it was under 7 AAC 160.200, and the
cooperation with third party liability was 7 AAC 100.034.
REPRESENTATIVE VAZQUEZ asked for clarification that the
regulation stated that an individual shall be terminated.
4:37:51 PM
CHAIR SEATON asked if there was a problem with elderly veterans
not receiving veterans' benefits.
COMMISSIONER DAVIDSON replied that this was a possibility with
the proposed amendment, as an individual who did not pursue the
coverage as required and then enrolled as a Medicaid
beneficiary, could face civil penalties. She reported that many
veterans in rural communities had not applied for veterans
benefits, and she noted that the Veterans' Administration was
working to enroll veterans.
4:39:22 PM
REPRESENTATIVE STUTES asked if there was a questionnaire during
enrollment for Medicaid that would reveal eligibility for other
benefits. She offered her belief that, as a civil penalty would
go unpaid by the majority of people eligible for Medicaid, a
"larger hammer" was for the loss of benefits.
MR. SHERWOOD expressed his agreement, and clarified that
cooperation with third party resources was a federal requirement
and a condition of eligibility. He shared that 7 AAC 100.034(d)
was the statute containing the aforementioned language to deny
or terminate, although it did provide certain exceptions
consistent with federal law for when there was not enforcement.
4:41:06 PM
CHAIR SEATON maintained his objection.
REPRESENTATIVE VAZQUEZ said that regulations can be changed or
deleted by the department after certain procedures. She said
that she would entertain a conceptual amendment to delete the
civil penalty provision. She offered her belief that it was
especially critical in these fiscal times to ensure that the
state was the payer of last resort.
4:42:13 PM
REPRESENTATIVE STUTES asked for clarification that it was
federally required that the department exhaust all other sources
and that Medicaid was the payer of last resort.
COMMISSIONER DAVIDSON expressed her agreement.
REPRESENTATIVE VAZQUEZ asked if this was simply a state
regulation and not a statute.
COMMISSIONER DAVIDSON replied that it was a state regulation in
compliance with federal law.
REPRESENTATIVE VAZQUEZ asked who "promulgates department
regulations."
COMMISSIONER DAVIDSON replied that the department promulgated
regulations by publishing them, receiving feedback from
individual stakeholders, and then making a final determination.
CHAIR SEATON declared that every regulation would not be put
into statute. He pointed out that there were two processes and
that both were effective.
4:43:38 PM
A roll call vote was taken. Representative Vazquez voted in
favor of Amendment 12, labeled 29-GH1055\A.33,
Strasbaugh/Glover, 3/28/15. Representatives Wool, Tarr, Foster,
Stutes, and Seaton voted against it. Therefore, Amendment 12
failed by a vote of 1 yea - 5 nays.
4:44:17 PM
REPRESENTATIVE VAZQUEZ explained that proposed Amendment 13
restricted services for the [Medicaid] expansion group to only
the nine mandatory services, and not the 27 optional Medicaid
services, which included transportation and chiropractic care.
It also required a report describing the state costs for each of
the optional services.
4:45:11 PM
REPRESENTATIVE VAZQUEZ moved to adopt Amendment 13, labeled 29-
GH1055\A.34, Strasbaugh/Glover, 3/28/15, which read:
Page 7, following line 15:
Insert a new bill section to read:
"* Sec. 9. AS 47.07.030 is amended by adding new
subsections to read:
(g) Notwithstanding (b) - (e) of this section,
for individuals described under AS 47.07.020(b)(16),
the department shall offer only mandatory services
required under 42 U.S.C. 1396a(k) and federal
regulations implementing that section.
(h) The department shall annually prepare a
report describing state costs for each optional
service provided under this section. The department
shall deliver the report to the senate secretary and
the clerk of the house of representatives and notify
the legislature that the report is available."
Renumber the following bill sections accordingly.
Page 9, line 12:
Delete "sec. 10"
Insert "sec. 11"
Page 9, line 17:
Delete "10"
Insert "11"
Page 9, line 23:
Delete "Sections 13 and 14"
Insert "Sections 14 and 15"
Page 9, line 24:
Delete "by sec. 16"
Insert "in sec. 17"
REPRESENTATIVE WOOL objected for discussion.
4:45:25 PM
COMMISSIONER DAVIDSON offered her understanding that the
proposed amendment would "carve out a new benefit plan for the
[Medicaid] expansion population." She opined that it would
limit 42 U.S.C. 1396a(k), a benchmark plan, and would not cover
dental, vision, and hearing. She pointed out that these were
generally covered as optional benefits under Alaska Medicaid.
She explained that, as they were preventive services, they
prevented more costly, additional, emergency room services, and
they benefited people seeking employment. She declared that it
was necessary to see and hear what employers and customers
asked. She explained that optional dental services were added
to the Medicaid program as it was incredibly challenging to get
a job if you had poor teeth. She reiterated that the Medicaid
expansion population would mirror the existing Medicaid program,
so there would be an immediate opportunity to receive the
additional federal revenue of $390,000 each day with 100 percent
federal match. She said that the time to design a new benefit
plan would not be in the department's current capacity. She
declared that the expansion group would follow implementation of
the reform efforts.
CHAIR SEATON asked if some of the optional services were in
place because it was cheaper to provide the necessary service
through optional waivers, instead of a higher level of care
through the mandatory institutional services which would
increase the cost.
COMMISSIONER DAVIDSON expressed agreement, noting that in-
facility care was a mandatory service, whereas home and
community based services were optional services that allowed
individuals to remain at home and in their communities, and at a
much lower cost.
4:48:35 PM
REPRESENTATIVE WOOL maintained his objection.
A roll call vote was taken. Representatives Stutes and Vazquez
voted in favor of Amendment 13, labeled 29-GH1055\A.34,
Strasbaugh/Glover, 3/28/15. Representatives Tarr, Foster, Wool,
and Seaton voted against it. Therefore, Amendment 13 failed by
a vote of 2 yeas - 4 nays.
4:49:42 PM
REPRESENTATIVE VAZQUEZ moved to adopt Amendment 14, labeled 29-
GH1055\A.36, Glover, 3/28/15, which read:
Page 7, line 9, following "regulations.":
Insert "The department may only consider
information provided by a person claiming undue
hardship that the department verifies through a source
other than the person's own statement."
Page 7, following line 15:
Insert a new bill section to read:
"* Sec. 9. AS 47.07.020 is amended by adding a new
subsection to read:
(o) The department shall prepare a report that
describes the total amount that has been recovered or
saved by the ineligibility period imposed under (m) of
this section and the total amount excluded for a
transfer of assets below fair market value under a
hardship waiver under (g) of this section for the
previous calendar year. On or before January 1 of each
year, the department shall deliver the report to the
senate secretary and the chief clerk of the house of
representatives and notify the legislature that the
report is available."
Renumber the following bill sections accordingly.
Page 9, line 12:
Delete "sec. 10"
Insert "sec. 11"
Page 9, line 17:
Delete "10"
Insert "11"
Page 9, line 23:
Delete "Sections 13 and 14"
Insert "Sections 14 and 15"
Page 9, line 24:
Delete "by sec. 16"
Insert "in sec. 17"
CHAIR SEATON objected for discussion.
REPRESENTATIVE VAZQUEZ read from the proposed amendment: "The
department may only consider information provided by a person
claiming undue hardship that the department verifies through a
source other than the person's own statement." She said that
currently DHSS could take a person's statement at face value
that they would experience hardship. She went on to state that
the proposed amendment also required the department to prepare
and submit a report on the savings from the eligibility period
excluding the transfer of assets on or before January 1 of each
year. She explained that this applied to the assets of an
individual who was receiving Medicaid benefits for long term
care, and would assist the state in recovering assets to pay
back the Medicaid program.
4:51:29 PM
MR. SHERWOOD directed attention to page 1, lines 2 - 4, which he
declared was consistent with department practice, and, although
it was not an explicit requirement, the department generally did
verify hardship. He stated that the penalties applied to cases
where individuals were seeking long term care, and other
individuals were familiar with the situation and the care. He
suggested that a caveat to the report would be that, as the
penalty for a transfer of an asset was a period of ineligibility
for services, there would not be any billing or payment of
services. He said that any savings would only be an estimate
and not an actual savings, as there was not necessarily any way
to determine the actual expenses during the ineligibility.
CHAIR SEATON acknowledged that there were a lot of reports, and
he was not convinced that there would be a gain for any real
information from the report. He moved to adopt conceptual
Amendment 1 to proposed Amendment 14: Page 1, delete line 6
through Page 2, line 10. He stated that this would delete the
report which he opined would be somewhat costly and an
administrative burden that would not offer any valuable
information. He expressed his agreement with the rest of
proposed Amendment 14.
REPRESENTATIVE VAZQUEZ objected to proposed conceptual Amendment
1 of Amendment 14, opining that "it would be very helpful to the
legislature to see what endeavors are being made in this arena."
4:54:26 PM
CHAIR SEATON offered his belief that there was nothing to be
gained and that it would just cost money for the report.
REPRESENTATIVE TARR expressed her support for the proposed
amendment with the conceptual amendment, noting that there was
not a lot of help to be gained from a report of estimated cost
savings.
4:55:27 PM
A roll call vote was taken. Representatives Wool, Tarr, Foster,
Stutes, and Seaton voted in favor of Conceptual Amendment 1 to
Amendment 14. Representative Vazquez voted against it.
Therefore, Conceptual Amendment 1 to Amendment 14 passed by a
vote of 5 yeas - 1 nay.
4:56:13 PM
CHAIR SEATON removed his objection to proposed Amendment 14, as
amended. There being no further objection, Amendment 14,
labeled 29-GH1055\A.36, Glover, 3/28/15, as amended, was
adopted.
4:56:51 PM
CHAIR SEATON said that HB 148 would be held over.
AMENDMENTS
The following amendments to HB 148 were either discussed or
adopted during the hearing. [Shorter amendments are provided in
the main text only.]
Amendment 8, labeled 29-GH1055\A.20, Glover, 3/25/15, which
read:
Page 2, line 13, following "program":
Insert ";
(4) the Department of Health and Social
Services shall establish prevention of disease as a
primary model of health care in the state, as
requested by the legislature in Legislative Resolve 16
of the Twenty-Seventh Alaska State Legislature"
Page 2, following line 16:
Insert a new bill section to read:
"* Sec. 3. AS 47.05.010 is amended to read:
Sec. 47.05.010. Duties of department. The
Department of Health and Social Services shall
(1) administer adult public assistance, the
Alaska temporary assistance program, and all other
assistance programs, and receive and spend money made
available to it;
(2) adopt regulations necessary for the
conduct of its business and for carrying out federal
and state laws granting adult public assistance,
temporary cash assistance, diversion payments, or
self-sufficiency services for needy families under the
Alaska temporary assistance program, and other
assistance;
(3) establish minimum standards for
personnel employed by the department and adopt
necessary regulations to maintain those standards;
(4) require those bonds and undertakings
from persons employed by it that, in its judgment, are
necessary, and pay the premiums on them;
(5) cooperate with the federal government
in matters of mutual concern pertaining to adult
public assistance, the Alaska temporary assistance
program, and other forms of public assistance;
(6) make the reports, in the form and
containing the information, that the federal
government from time to time requires;
(7) cooperate with the federal government,
its agencies, or instrumentalities in establishing,
extending, and strengthening services for the
protection and care of homeless, dependent, and
neglected children in danger of becoming delinquent,
and receive and expend funds available to the
department by the federal government, the state, or
its political subdivisions for that purpose;
(8) cooperate with the federal government
in adopting state plans to make the state eligible for
federal matching in appropriate categories of
assistance, and in all matters of mutual concern,
including adoption of the methods of administration
that are found by the federal government to be
necessary for the efficient operation of welfare
programs;
(9) adopt regulations, not inconsistent
with law, defining need, prescribing the conditions of
eligibility for assistance, and establishing standards
for determining the amount of assistance that an
eligible person is entitled to receive; the amount of
the assistance is sufficient when, added to all other
income and resources available to an individual, it
provides the individual with a reasonable subsistence
compatible with health and well-being; an individual
who meets the requirements for eligibility for
assistance shall be granted the assistance promptly
upon application for it;
(10) grant to a person claiming or
receiving assistance and who is aggrieved because of
the department's action or failure to act, reasonable
notice and an opportunity for a fair hearing by the
office of administrative hearings (AS 44.64.010), and
the department shall adopt regulations relative to
this;
(11) enter into reciprocal agreements with
other states relative to public assistance, welfare
services, and institutional care that are considered
advisable;
(12) establish the requirements of
residence for public assistance, welfare services, and
institutional care that are considered advisable,
subject to the limitations of other laws of the state,
or law or regulation imposed as conditions for federal
financial participation;
(13) establish the divisions and local
offices that are considered necessary or expedient to
carry out a duty or authority assigned to it and
appoint and employ the assistants and personnel that
are necessary to carry on the work of the divisions
and offices, and fix the compensation of the
assistants or employees, except that a person engaged
in business as a retail vendor of general merchandise,
or a member of the immediate family of a person who is
so engaged, may not serve as an acting, temporary, or
permanent local agent of the department, unless the
commissioner of health and social services certifies
in writing to the governor, with relation to a
particular community, that no other qualified person
is available in the community to serve as local
welfare agent; for the purposes of this paragraph, a
"member of the immediate family" includes a spouse,
child, parent, brother, sister, parent-in-law,
brother-in-law, or sister-in-law;
(14) provide education and health-related
services and referrals designed to reduce the number
of out-of-wedlock pregnancies and the number of
induced pregnancy terminations in the state;
(15) investigate reports of abuse, neglect,
or misappropriation of property by certified nurse
aides in facilities licensed by the department under
AS 47.32;
(16) establish state policy relating to and
administer federal programs subject to state control
as provided under 42 U.S.C. 3001 - 3058ee (Older
Americans Act of 1965), as amended, and related
federal regulations;
(17) administer the older Alaskans service
grants under AS 47.65.010 - 47.65.050 and the adult
day care and family respite care grants under
AS 47.65.100;
(18) establish guidelines for medical
assistance providers to develop health care delivery
models that encourage adequate nutrition and disease
prevention."
Renumber the following bill sections accordingly.
Page 9, line 12:
Delete "sec. 10"
Insert "sec. 11"
Page 9, line 17:
Delete "10"
Insert "11"
Page 9, line 23:
Delete "Sections 13 and 14"
Insert "Sections 14 and 15"
Page 9, line 24:
Delete "by sec. 16"
Insert "in sec. 17"
Amendment 10, labeled 29-GH1055\A.25, Nauman/Glover, 3/28/15,
which read:
Page 1, line 3, following "Services;":
Insert "creating the Medicaid Task Force;"
Page 9, following line 3:
Insert a new bill section to read:
"* Sec. 13. The uncodified law of the State of
Alaska is amended by adding a new section to read:
MEDICAID TASK FORCE. (a) The Medicaid Task Force
is created in the legislature for the purpose of
making recommendations for potential cost savings
related to the medical assistance program.
(b) The task force consists of 13 members as
follows:
(1) four senators selected by the president
of the senate based on their knowledge of health,
finance, and budgetary issues;
(2) four representatives selected by the
speaker of the house of representatives, based on
their knowledge of health, finance, and budgetary
issues;
(3) the commissioner of health and social
services;
(4) four public members selected by the
governor based on their knowledge of the health care
systems of the state, Medicaid, and the budget of the
state.
(c) The task force shall, not later than
February 1 each year, deliver a report to the senate
secretary and chief clerk of the house of
representatives and notify the legislature that the
report is available. The report must include
(1) policy options and recommendations to
reduce costs related to Medicaid use in the state;
(2) recommendations, including draft
legislation, to achieve the policy objectives proposed
by the task force.
(d) The task force shall meet as frequently as
necessary and may meet between sessions of the
legislature to carry out its responsibilities.
(e) The speaker of the house of representatives
and the president of the senate shall jointly appoint
the chair of the task force from among the legislative
members of the task force. The task force shall meet
at the call of the chair.
(f) A majority of the task force constitutes a
quorum; a vacancy on the task force shall be filled in
the same manner as the original selection or
appointment.
(g) The task force may request data and other
information from the Department of Health and Social
Services and other state agencies.
(h) The staff of the legislator who chairs the
task force shall provide administrative and other
support to the task force.
(i) Public members of the task force serve
without compensation but are entitled to per diem and
travel expenses authorized for boards and commissions
under AS 39.20.180.
(j) The task force expires April 1, 2017."
4:57:10 PM
RECESSED
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
recessed to a call of the chair at 4:57 p.m.
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