02/29/2024 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Alaska Board of Nursing | |
| HB371 | |
| HB343 | |
| HB344 | |
| HB226 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | HB 344 | TELECONFERENCED | |
| *+ | HB 371 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| *+ | HB 343 | TELECONFERENCED | |
| += | HB 226 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 29, 2024
3:04 p.m.
MEMBERS PRESENT
Representative Mike Prax, Chair
Representative Justin Ruffridge, Vice Chair
Representative CJ McCormick
Representative Dan Saddler
Representative Jesse Sumner
Representative Zack Fields
Representative Genevieve Mina
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
CONFIRMATION HEARING(S)
State Board of Nursing
Michael Collins - Wasilla
- CONFIRMATION(S) ADVANCED
HOUSE BILL NO. 371
"An Act relating to medical review organizations; relating to
the definitions of 'health care provider' and 'review
organization'; and relating to the duties of the chief medical
officer in the Department of Health."
- HEARD & HELD
HOUSE BILL NO. 343
"An Act relating to medical assistance coverage for
rehabilitative, mandatory, and optional services furnished or
paid for by a school district on behalf of certain children."
- HEARD & HELD
HOUSE BILL NO. 344
"An Act relating to medical assistance demonstration projects
established by the Department of Health."
- HEARD & HELD
HOUSE BILL NO. 226
"An Act relating to the Board of Pharmacy; relating to
insurance; relating to pharmacies; relating to pharmacists;
relating to pharmacy benefits managers; relating to patient
choice of pharmacy; and providing for an effective date."
- MOVED CSHB 226(HSS) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 371
SHORT TITLE: MEDICAL REVIEW ORGANIZATIONS
SPONSOR(s): REPRESENTATIVE(s) RUFFRIDGE BY REQUEST
02/20/24 (H) READ THE FIRST TIME - REFERRALS
02/20/24 (H) HSS
02/29/24 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 343
SHORT TITLE: SCHOOL DISTRICT MEDICAL ASSISTANCE
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
02/20/24 (H) READ THE FIRST TIME - REFERRALS
02/20/24 (H) HSS
02/27/24 (H) HSS AT 3:00 PM DAVIS 106
02/27/24 (H) <Bill Hearing Rescheduled to 02/29/24>
02/29/24 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 344
SHORT TITLE: MEDICAL ASSIST. DEMONSTRATION PROJECTS
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
02/20/24 (H) READ THE FIRST TIME - REFERRALS
02/20/24 (H) HSS
02/29/24 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 226
SHORT TITLE: PHARMACIES/PHARMACISTS/BENEFITS MANAGERS
SPONSOR(s): SUMNER
01/16/24 (H) PREFILE RELEASED 1/8/24
01/16/24 (H) READ THE FIRST TIME - REFERRALS
01/16/24 (H) HSS, L&C, FIN
02/27/24 (H) HSS AT 3:00 PM DAVIS 106
02/27/24 (H) Heard & Held
02/27/24 (H) MINUTE(HSS)
02/29/24 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
MICHAEL COLLINS, Appointee
State Board of Nursing
Wasilla, Alaska
POSITION STATEMENT: Testified as appointee to the State Board
of Nursing.
SABINA BRAUN, Staff
Representative Justin Ruffridge
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: On behalf of the prime sponsor by request,
Representative Ruffridge, presented the sectional analysis of HB
371.
LINDSEY KATO, Director
Division of Public Heath
Department of Health
Juneau, Alaska
POSITION STATEMENT: Offered invited testimony in support of HB
371.
JEANNIE MONK, Senior Vice President
Alaska Hospital & Healthcare Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 371 and HB 344.
HEIDI HEDBERG, Commissioner
Department of Health
Anchorage, Alaska
POSITION STATEMENT: On behalf of the bill sponsor, House Rules
by request of the governor, introduced HB 343 and HB 344.
EMILY RICCI, Deputy Commissioner
Department of Health
Anchorage, Alaska
POSITION STATEMENT: On behalf of the bill sponsor, House Rules
by request of the governor, co-offered PowerPoint presentations
during the hearings on HB 343 and HB 344.
LEAH VAN KIRK, Healthcare Policy Advisor
Department of Health
Anchorage, Alaska
POSITION STATEMENT: On behalf of the bill sponsor, House Rules
by request of the governor, co-offered a PowerPoint presentation
during the hearing on HB 343.
TREVOR STORRS, President & CEO
Alaska Children's Trust
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 343.
ANNE ZINK, Chief Medical Officer
Department of Health
Anchorage, Alaska
POSITION STATEMENT: On behalf of the bill sponsor, House Rules
by request of the governor, co-offered a PowerPoint presentation
on HB 344.
OWEN HUTCHINSON, Healthcare & Homelessness Integration Manager
Alaska Coalition on Housing and Homelessness
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 344.
BRIAN LEFFERTS, Director
Division of Public Heath, Yukon-Kuskokwim Health Corporation
Bethel, Alaska
POSITION STATEMENT: Testified in support of HB 344.
BRYNN BUTLER, Housing Coordinator
City of Fairbanks
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 344.
ACTION NARRATIVE
3:04:39 PM
CHAIR PRAX called the House Health and Social Services Standing
Committee meeting to order at 3:04 p.m. Representatives
Ruffridge, Sumner, Fields, Mina, and Prax were present at the
call to order. Representatives McCormick and Saddler arrived as
the meeting was in progress.
^CONFIRMATION HEARING(S)
CONFIRMATION HEARING(S)
^Alaska Board of Nursing
Alaska Board of Nursing
3:05:55 PM
CHAIR PRAX announced that the first order of business would be
the confirmation hearing on the governor's appointment for the
Alaska Board of Nursing.
3:06:19 PM
MICHAEL COLLINS, Appointee, Alaska Board of Nursing, gave his
background and said he believes in community involvement and
wants to serve the state. He expressed his wish to be a public
voice and said he can offer a transparent voice to aid the board
and to assist in public awareness.
3:08:56 PM
REPRESENTATIVE MINA asked what Mr. Collins sees as the biggest
issue currently facing nursing today.
MR. COLLINS answered licensing and getting nurses [hired] as
quickly as possible.
3:10:08 PM
CHAIR PRAX open public testimony on the confirmation hearing.
After ascertaining there was no one who wished to testify, he
closed public testimony.
3:11:30 PM
CHAIR PRAX stated that the House Health and Social Services
Standing Committee has reviewed the qualifications of the
governor's appointees and recommends that the following name be
forwarded to a joint session for consideration: Michael
Collins, Alaska Board of Nursing. He said that signing the
report regarding appointments to boards and commissions in no
way reflects an individual member's approval or disapproval of
the appointee, and the nomination is merely forwarded to the
full legislature for confirmation or rejection.
3:11:47 PM
The committee took a brief at-ease at 3:11 p.m.
HB 371-MEDICAL REVIEW ORGANIZATIONS
3:12:08 PM
CHAIR PRAX announced that the next order of business would be
HOUSE BILL NO. 371, "An Act relating to medical review
organizations; relating to the definitions of 'health care
provider' and 'review organization'; and relating to the duties
of the chief medical officer in the Department of Health."
3:12:51 PM
REPRESENTATIVE JUSTIN RUFFRIDGE, Alaska State Legislature, as
prime sponsor by request, presented HB 371. He explained the
Department of Health brought forward the request for the bill
and asked to be able to modify the public health review
organization process, which seeks to eliminate avoidable deaths,
injuries, and illnesses of Alaskans. This is done by examining
clinical and other records and identifying areas of concern.
The proposed legislation would allow "medical provider types" to
be a part of these review organizations, update language, and
ensure access to data is timely.
3:14:02 PM
SABINA BRAUN, Staff, Representative Justin Ruffridge, Alaska
State Legislature, on behalf of Representative Ruffridge, prime
sponsor by request, gave a sectional analysis of HB 371
[included in the committee packet], which read as follows
[original punctuation provided]:
Section 1
AS 18.23.030(a) is amended to add an exemption to
disclosure of data and is described in Sec 2.
Section 2
AS 18.23.030 is amended to add a new subsection
allowing a review organization to publish a report
containing data or information acquired in the
exercise of its duties, ensuring the report does not
violate federal or state law regarding confidentiality
of a person or decedent.
Section 3
AS 18.23.070(3) Changes the definition of healthcare
provider in reference to a review organization to mean
a person licensed, certified, or otherwise permitted
by law to provide health care services in the ordinary
course of business or practice of a profession and
removes the list of specific provider types.
Section 4
AS 18.23.070(5)(A) and AS.18.23.070(5)(B) are not
modified by HB 371.
AS 18.23.070(5)(C) The review organization membership
is approved by the Chief Medical Officer in the
Department of Health and removes the provision that at
least 75 percent of the committee members must be
health care providers.
AS 18.23.070(5)(D) Allows all nationally-recognized
groups that accredit health care organizations to have
review organizations. Current law limits this to the
Joint Commission on Accreditation of Healthcare
Organizations (JCAHO).
3:15:53 PM
MS. BRAUN began a PowerPoint Presentation [hard copy included in
the committee packet], titled "HB 371 Medical Review
Organizations." She covered slide 2, which read as follows
[original punctuation provided, with some formatting changed]:
Why?
To review injuries, deaths, and illness in order to
provide insight for public policy and health
interventions to improve Alaskan's health.
How?
In-depth review of deaths, injuries, and illnesses by
examining clinical records and additional data.
Who?
Hospitals, clinics, associations of health care
providers, professional standards organizations, the
State Medical Board, health care accreditation
organizations, and those established by the
Commissioner of Health to review public health issues.
MS. BRAUN, at slide 3, "Intent," emphasized the intent of the
bill to increase flexibility. Noting current statute on this
issue is vague, she showed slide 4, "HB 371 - Changes to
Existing Statutes," which read as follows [original punctuation
provided]:
• Allows a review organization to publish a report
containing data or information acquired in the
exercise of its duties, ensuring the report does not
violate federal or state law regarding confidentiality
of a person or decedent.
• Broadens who can serve on the review organizations.
• Changes who can approve Department of Health
morbidity or mortality review organizations from the
Alaska State Medical Board to the Chief Medical
Officer in the Department of Health.
• Removes composition requirement of 75% health care
providers.
• Broadens who can establish review organizations.
MS. BRAUN showed slide 5, "Reasoning," which read as follows
[original punctuation provided]:
• This bill increases flexibility to ensure
appropriate representation across diverse review
committees.
• This bill removes the current list of health care
providers allowed to be on the review committee. This
bill modifies the requirement of the health care
committee of having 75% health care providers. The
current definition of health care providers in the
current statute is narrow and missing key types.
• Current law requires that the Alaska State Medical
Board approve members of Department of Health review
organizations, not allowing for efficient and
effective decision making tailored to committee needs.
MS. BRAUN drew attention to slide 6, which shows three examples
of current medical review committees/boards, and she highlighted
two of them: the Maternal Child Death Review Committee, on
which she said it would be helpful to have a midwife; and the
Overdose Fatality Review Committee, on which she said it would
be helpful to have an Alaska State Trooper. In conclusion, she
offered to answer questions.
3:19:23 PM
LINDSEY KATO, Director, Division of Public Heath, Department of
Health, offered invited testimony in support of HB 371. She
said morbidity and mortality review organizations are
instrumental in determining the causes and contributing factors
of death, illness, and injury. The intent is to provide insight
and recommendation toward public policy and interventions. She
noted that the Maternal Child Death Review Committee has been
instrumental in providing recommendations that have resulted in
changes to training within the Office of Childrens Services and
updating law enforcement forms used in investigation. Ms. Kato
stated that unfortunately current statute is ambiguous in terms
of whether the agencies are allowed to report current findings
with those in the best position to help make changes, such as
legislators. She echoed Ms. Braun's statement about the current
limitation of 75 percent health care providers making up the
review organizations, and the department would like to have a
wider sampling of people to be on the review committees and
boards. She also noted that the current statute mandating that
the State Medical Board approve members of DOH's review
organizations is cumbersome, and that moving that authority to
the chief medical officer in the department would "create a more
efficient and effective process." She emphasized the importance
of review committees/boards and the need for flexibility. She
offered to answer questions.
3:22:18 PM
REPRESENTATIVE MINA asked Ms. Kato how many medical review
committees currently exist in Alaska.
LINDSEY noted the two previously mentioned and the newly formed
Congenital Syphilis Review Board. She added that there is also
interest in the issue of suicide. In response to a follow-up
question regarding the ambiguity of statute relating to
reporting, she said there have been modified reports given as a
result rather than formal reports. She added that trends and
issues identified have to be censored in the reports.
3:23:41 PM
CHAIR PRAX asked for additional information regarding the
committees.
MS. KATO gave examples about how often the various committees
meet. In response to follow-up questions, she said the reviews
include detailed public safety reports, including those from law
enforcement and OCS, as well as medical reports. She offered
her understanding that there are no legal implications related
to these reviews. She reiterated that the groups meet
currently; the desire is for there to be a broader list of who
can serve on them.
3:26:01 PM
CHAIR PRAX opened public testimony on HB 371.
3:26:40 PM
JEANNIE MONK, spokesperson, Alaska Hospital & Healthcare
Association (AHHA) [formerly the Alaska State Hospital & Nursing
Home Association (ASHNHA)] testified in support of HB 371. She
noted that the review organizations are also used by entities
outside of Alaska. She said medical review committees are an
important tool used by hospitals to discuss information related
to the care and treatment of patients and support improvements
in care. She said AHHA supports all of the changes proposed
under HB 371. She noted that AHHA is a partner with the state
and works with the Maternal Child Death Review Committee, and
AHHA thinks removing the 75 percent limit will benefit that
committee by allowing a more diverse committee. She said AHHA
also supports the aforementioned change to the state medical
officer as a means of providing "more efficient and effective
decision making." She noted that AHHA is currently in the
process of forming an association with these organizations,
bringing together hospitals and nursing homes. She said AHHA
thinks the clarification related to the sharing of reports and
recommendations will help in using the information more
effectively. She urged the committee to forward HB 371 through
the committee process.
3:29:05 PM
MS. MONK, in response to Chair Prax, confirmed that the review
organizations conduct conversations about issues and then share
findings "without disclosing any confidential information."
3:29:54 PM
CHAIR PRAX, after ascertaining there was no one else who wished
to testify, closed public testimony on HB 371.
3:30:51 PM
CHAIR PRAX announced that HB 371 was held over.
HB 343-SCHOOL DISTRICT MEDICAL ASSISTANCE
3:30:57 PM
CHAIR PRAX announced that the next order of business would be
HOUSE BILL NO. 343, "An Act relating to medical assistance
coverage for rehabilitative, mandatory, and optional services
furnished or paid for by a school district on behalf of certain
children."
3:31:39 PM
HEIDI HEDBERG, Commissioner, Department of Health, on behalf of
the bill sponsor, House Rules by request of the governor,
introduced HB 343. She said the proposed legislation would
improve access to school-based services "for all eligible
Medicaid children." It would remove statutory [language] that
limits access to those services. She said HB 343 would provide
more convenient choices for parents seeking care for their
children and increase flexibility for schools seeking Medicaid
reimbursement for eligible children. She turned to Emily Ricci
and Leah Van Kirk to offer a presentation.
3:32:45 PM
EMILY RICCI, Deputy Commissioner, Department of Health, on
behalf of the bill sponsor, House Rules by request of the
governor, co-offered a PowerPoint presentation [hard copy
included in the committee packet] during the hearing on HB 343.
She began on slide 3, which read as follows [original
punctuation provided, with some formatting changes]:
Medicaid can only reimburse for school-based services
if the child has a disability and the services are
included in the student's individualized education
plan (IEP).
Only 6 out of 54 school districts currently submit
claims for Medicaid reimbursement.
Speech, Occupational, and Physical Therapy make up 96
percent of reimbursed services.
MS. RICCI explained that within the federal umbrella are state-
supported services for children in a school-based setting. She
noted that the services that districts can bill Medicaid for to
receive reimbursement are limited within the smaller set of
services outlined in the state plan. They are limited to
services available through a student's individualized
educational plan (IEP). She said this creates challenges for
school districts. She said HB 343 addresses one administrative
barrier; others are being addressed by the department with
stakeholders. She named the districts currently submitting
claims for Medicaid reimbursement: Anchorage, Delta/Greely,
Fairbanks, Juneau, Ketchikan, and Matanuska-Susitna (Mat-Su).
MS. RICCI turned to slide 4, "Healthy Families Initiative" - the
governor's initiative - which focuses on "Healthy Beginnings,"
"Health Care Access," and "Health Care Communities." She said
HB 343 focuses on improving and increasing access to care for
students. She turned the presentation over to Leah Van Kirk.
3:36:49 PM
LEAH VAN KIRK, Healthcare Policy Advisor, Department of Health,
on behalf of the bill sponsor, House Rules by request of the
governor, co-offered a PowerPoint presentation [hard copy
included in the committee packet] during the hearing on HB 343.
She touched upon slide 5, regarding what HB 343 would do, and
she echoed that it would improve access for students that can
receive school-based services. It would allow schools to bill
for Medicaid services without having those services included in
the IEP. She said the bill would create opportunities to
provide services to children that may not need an IEP. Further,
HB 343 would provide an option, not a mandate. She said if a
parent cannot find services in the community, they may be able
to access those services in the school.
3:39:38 PM
MS. RICCI continued with slide 8, "Benefits to Alaskans," and
talked about early intervention and prevention and avoiding
emergency room visits or acute level of care. She said the
department sees HB 343 as reducing administrative burden and
maximizing the federal Medicaid match.
MS. VAN KIRK drew attention to slide 9, "Why now?," and said
that by reducing the administrative burden on schools, they
would be more likely to deliver school-based services. She said
25 states thus far have "reduced the requirement" and provide
services to those who do not have a disability or have an IEP.
She indicated that after removing statutory barriers via HB 343,
the next step would be to engage stakeholders and identify
methodologies that work for school districts. She made note of
letters of support that had been received. She stated that DOH
is applying for a grant to support efforts.
MS. RICCI added that the process of speaking with stakeholders
is beginning, and removing the statutory provision is essential
to that process.
3:45:00 PM
MS. RICCI, in response to a question from Chair Prax, said she
is not certain how many of the six aforementioned districts
utilize school staff to provide services, but she has seen them
contract with outside providers "to come in and offer services
in the school setting."
3:47:49 PM
MS. RICCI, in response to a question from Representative Mina
about the second paragraph of one of the fiscal notes, offered
her understanding that the reference to an increase of 50
percent refers to current participation. She added that the
department sees this as a long process with incremental growth.
In response to Representative Saddler, she further clarified
that 50 percent pertains to the number of children in school
districts.
3:49:35 PM
MS. RICCI, in response to Chair Prax, indicated that a work
group would figure out a flexible system that includes the needs
of smaller school districts.
3:50:28 PM
MS. RICCI next covered the sectional analysis of HB 343, on
slide 11, which read as follows [original punctuation provided]:
Sectional Analysis
Section 1
This section removes the requirement that Medicaid
services provided in a school setting are limited to
those covered under an Individual Education Plan (IEP)
3:51:10 PM
CHAIR PRAX open public testimony on HB 343.
3:51:35 PM
TREVOR STORRS, President & CEO, Alaska Children's Trust (ACT),
testified in support of HB 343. He thanked the governor and DOH
leadership for taking this step to increase health care access
for children. He explained that ACT supports policies that
promote the health and wellbeing of Alaska's children. He
talked about the importance of ensuring that families have
access to the knowledge, skill, support, and resources to
thrive. He echoed the statements of the presenters about the
current status for reimbursement and said HB 343 would allow
schools to be reimbursed for services provided to all students
eligible for Medicaid. He emphasized that the expansion of
school-based Medicaid services would support families by
providing opportunities for parents to access health services
for their children, increase the convenience for the families
seeking that care, and promote parent-directed services within
the school setting. Further, he echoed that increasing services
would encourage early intervention and prevention. He spoke
about the flexibility and support for Alaska communities that
would result from HB 343.
3:54:17 PM
CHAIR PRAX, after ascertaining there was no one else who wished
to testify, close public testimony on HB 343.
3:55:22 PM
MS. RICCI, in response to a question from Representative Saddler
regarding whether there would be an increase in positions such
as therapists in each school rather than one that travels from
school to school indicated that would be up to each school to
decide based on the needs of students and what the community can
support. In response to follow-up question regarding the cost
to the state, she said the services will be built up over time,
and she noted these are not additional services but an
additional setting in which existing services can be provided.
Overall, she said, the department does not believe that HB 343
would result in additional cost to the Medicaid component. She
explained that the department thinks of this as a cost shift,
not an expansion of services.
3:58:46 PM
REPRESENTATIVE FIELDS gave his interpretation of the
presentation that instead of a parent taking their child to a
Medicaid covered appointment after school, they could take them
to the appointment at the school, and this could be a more
efficient system but is not necessarily "more care."
CHAIR PRAX announced that HB 343 was held over.
3:59:47 PM
The committee took a brief at-ease at 3:59 p.m.
HB 344-MEDICAL ASSIST. DEMONSTRATION PROJECTS
4:00:21 PM
CHAIR PRAX announced that the next order of business would be
HOUSE BILL NO. 344, "An Act relating to medical assistance
demonstration projects established by the Department of Health."
4:01:11 PM
HEIDI HEDBERG, Commissioner, Department of Health (DOH), offered
a brief introduction to HB 344 on behalf of the bill sponsor,
House Rules by request of the governor. She handed the
presentation of the bill over to Emily Ricci and Dr. Anne Zink.
4:01:53 PM
EMILY RICCI, Deputy Commissioner, Department of Health, co-
offered a PowerPoint presentation of HB 344 [hardcopy included
in the committee packet] on behalf of the bill sponsor, House
Rules by request of the governor. She opened on slide 2, "Total
Health Care Expenditures per Capita 2024," which includes a map
and states: "Medicaid is a critical tool to improving Alaska's
health care delivery system and patient outcomes." She
explained that Medicaid covers nearly 38 percent of Alaskans.
Health care costs in Alaska are high. She recommended Medicaid
as "a vehicle that the state can leverage" to "influence the
system" to improve health outcomes.
MS. RICCI moved to slide 3, "Alaska Medicaid Utilization," which
has a graph showing that 5 percent of beneficiaries in Medicaid
account for about half of Medicaid spending; within those, about
10 percent of beneficiaries account for approximately two-thirds
of Medicaid spending. Those with acute needs account for a
significant portion of "overall health care spend." She stated
the importance of evaluating where money is spent for the best
outcome and health of Alaskans.
MS. RICCI turned to slide 4, "Alaska Emergency Department
Utilization," noting that "a small number of individuals can
have a large impact on the system, particularly when they have
acute needs that are not being consistently met." She then
turned to Dr. Zink to continue with slide 4.
4:04:59 PM
ANNE ZINK, MD, Chief Medical Officer, Department of Health,
picked up on the PowerPoint presentation of HB 344, on behalf of
the bill sponsor, House Rules by request of the governor. She
gave an example of a patient who visited the emergency room 300
times in a year and said the system was failing him. She said
the purpose of the [section 1115 waiver under 42 U.S.C.
1315(a)], which would be established under HB 344, is to
facilitate figuring out what the "highest needs utilizers" need
is and how the state can spend money in a way reduces emergency
room visits and to figure out what key services outside the
hospital are available.
DR. ZINK turned to slide 5, "Chronic Conditions and Medical
Utilization," and she said it is intuitive that an increase in
chronic conditions equates to "more spend within the health care
system."
4:06:37 PM
MS. RICCI, in response to a question from Representative Sumner
as to what the top conditions resulting in the highest Medicaid
spend are, named mobility impairment as the highest. She also
named, in descending order, blood conditions, cardiovascular
disease, congenital disorders, diabetes, and drug and alcohol
abuse.
DR. ZINK added that not all conditions are modifiable, and DOH
is focusing on those conditions it can respond to with
intervention. She also noted that the waiver would not be done
"in isolation." She said there is a short program for
addressing chronic diseases in addition to looking at the
waiver.
MS. RICCI referred back to slide 3 and emphasized consideration
of a better way to meet the needs of and support individuals and
take advantage of opportunities for cost savings.
4:09:24 PM
DR. ZINK moved on to slide 6, "Learning from Alaskans," and she
highlighted the produce prescription program in the
Yukon/Kuskokwim Region that is specifically for people with
diabetes to help them improve their eating and has a side
benefit of helping those who grow produce in the region.
4:10:23 PM
DR. ZINK, in response to a question from Representative Sumner,
said this prescription program cannot supplant the Supplemental
Nutrition Assistance Program (SNAP). The waiver would be
specific to the patient and condition. She then noted the case
coordination project, shown on slide 6, which takes place at
Bartlett Regional Hospital. The program addresses those "MVP"
patients with high medical and social needs, with a focus on
bringing the community together to address transportation,
housing, and care needs in an attempt to keep those patients out
of the hospital where the cost of care is greater.
DR. ZINK turned to the next slide, "What Are Health-Related
Needs?," to a list of points on the left half of the slide,
which read as follows [original punctuation provided]:
Under the 1115 waiver, health-related needs services
must be:
theta Medically necessary
theta The choice of the beneficiary
theta Individually tailored
theta Distinct from population-based health interventions
(must supplement not supplant existing services)
DR. ZINK said this is concerning the top of the treatment
pyramid [shown on the right half of the slide]. She reiterated
that this looks at a limited number of people, who have a high
cost to the system and where medically tailored interventions
can make a big difference for them.
4:12:56 PM
DR. ZINK, in response to a question from Representative Mina
regarding how relevant a program from last year is to expanding
case coordination for high utilizers through the proposed
waiver, confirmed that the high utilization Mat-Su (HUMS)
program is similar to the MVP program in Juneau.
4:14:04 PM
DR. ZINK, in response to a question from Representative Saddler
regarding the expansive scope of "health related needs," shared
that one challenge the department has had is that the waiver can
be interpreted "as much more than it is." It is an opportunity
that the Centers for Medicare and Medicaid have made available.
She said 16 states have already implemented waivers along this
line, and DOH needs to show that "it is cost neutral" and
services are being used in the most cost-efficient way that is
the most beneficial for the patient. Using transportation in
example, she said this is about providing a ride to someone
leaving the hospital who may need it but not about providing
cars to everyone. In response to a follow-up question, she gave
examples of how the parameters of medical necessity are
established. She said the waivers could be based on health
conditions. She noted that DOH needs to do actuarial work after
coming to the legislature to begin the process.
4:17:26 PM
MS. RICCI, in response to a question from Representative Saddler
regarding chronic conditions, answered that the waiver will be
aimed at the 10 percent of the population driving 30 percent of
the costs. For each potential condition, the question will be
asked, "What is influencing this condition?" She talked about
not recycling back into the system to restabilize individuals.
She indicated that HB 344 is addressing the questions of why
some outcomes do not reflect the amount of money that is being
invested into the system and whether simple things effecting the
outcomes can be addressed. In response to a follow-up question,
she recapped the percentages shown on a previous slide.
4:20:53 PM
DR. ZINK returned to the PowerPoint to give examples of care
needs. She highlighted nutritional support services and gave
examples to illustrate the points on slide 8, "Example:
Nutrition Supports," which read as follows [original punctuation
provided]:
• Poor nutrition contributes to worsening medical
conditions and escalates to hospitalization
• During discharge planning, food insecurity is
identified as a need
• Nutrition services are tailored to address specific
medical needs
• Stabilizes after post-acute event
• Encourages timely discharge
• Maintains independent living
DR. ZINK brought attention to another example on slide 9,
"Example: Cycling Through API" [the Alaska Psychiatric
Institute], and gave examples that illustrated the slide, which
read as follows [original punctuation provided]:
• Co-occurring mental health and chronic health
diagnoses
• Unstable living conditions lead to poor medication
management
• Multiple admissions and delays in discharge
• Higher level of care than is medically necessary
4:23:41 PM
MS. RICCI discussed slide 10, "Tailoring Medicaid to Meet
Alaska's Needs," which read as follows [original punctuation
provided]:
• Medicaid is a state-federal partnership
• New federal support for Medicaid innovation
• 1115 waivers allow states to implement specific
strategies reflecting their population's unique needs
and priorities
MS. RICCI said the 16 states using the waivers are customizing
them to meet the needs of their state. She said DOH envisions
Alaska would take the same approach. She moved on to slide 11,
which asks the following questions:
Who are we serving?
What are we paying for?
How are we paying for it?
MS. RICCI said this is within the context of community-based
health settings or hospitals and facilities. It is a holistic
view to support Alaskans.
4:25:44 PM
DR. ZINK advanced to slide 12, "Goals," and highlighted that
they are to improve health outcomes and decrease downstream
costs. She said DOH has listened to a lot of other states that
have rolled out a waiver-use plan and the key takeaway is that
the process is a slow one, which provides the opportunity to
reflect and adjust.
MS. RICCI drew attention slide [13], "Why a bill?," which read
as follows [original punctuation provided]:
• Gives the Department the necessary authority to
pursue a new 1115 waiver opportunity for health-
related needs
• A health-related needs 1115 waiver would be distinct
from Alaska's existing 1115 waiver
• Allows the Department to conduct actuarial analysis
and develop the waiver application
4:27:21 PM
MS. RICCI, in response to a question from Representative Fields
as to whether actuarial analysis could encompass private sector
savings that impact the state, said DOH is working with
contractors, and that is something the department would like
them to look at. She added that in the context of cost-savings
for Medicaid 1115 waivers, the parameters of cost-savings are
specific to the Medicaid program.
4:28:44 PM
DR. ZINK, in response to a question from Representative Mina as
to whether the 1115 waiver could address individuals who are in
need of home- and community-based services, said there are other
waivers via Medicaid that could potentially be utilized, and she
emphasized the specificity of waivers.
MS. RICCI turned to slide 14, "Leveraging an 1115 Waiver to
Address Health-Related Needs," which read as follows [original
punctuation provided, with some formatting changes]:
Time-limited and medically necessary interventions
spanning:
Nutrition and Food Security
Workforce Development
Transportation
Temporary Housing
Case Management
MS. RICCI highlighted a distinction of case management that is
necessary to support individuals as they move from using these
services on a temporary basis to using them sustainably outside
the Medicaid program on a permanent basis. She said there are
new opportunities in the area of workforce development that DOH
will consider.
MS. RICCI next covered slide 15, "Financial Considerations,"
which read as follows [original punctuation provided]:
• Budget Neutrality: Centers for Medicare and Medicaid
Services requires budget neutrality for all 1115
waivers.
• Alaska Medicaid Spending: The legislature authorizes
Medicaid spending annually.
• Efficiencies in Care: There is strong evidence that
addressing health-related needs improves health
outcomes and reduces costs.
MS. RICCI noted that states have "the ability to leverage
federal savings at the beginning of the waiver to help stand up
the infrastructure necessary to support the changes that the
waiver is demonstrating."
4:32:57 PM
DR. ZINK brought attention to slide 16, "Sectional Analysis,"
which read as follows [original punctuation provided]:
Section 1.
Adds a new section (h) to AS 47.07.036. Sectional
Analysis 16
• Authorizes the department to apply for an 1115
waiver to establish one or more demonstration projects
focused on addressing health-related social needs for
Alaska Medicaid recipients in one or more specific
geographic areas.
• Defines "health-related needs" as social or economic
conditions that contribute to an individual's poor
health outcomes.
MS. RICCI added that this was modeled after the Medicaid reform
work of Senate Bill 74 [passed during the Twenty-Ninth Alaska
State Legislature].
DR. ZINK brought attention to slide 17, which outlines the
process and read as follows [original punctuation provided]:
Preparation
• Partner Engagement
• Tribal Engagement
• Technical Assistance
• Legislative Input & Authority
Development
• Actuarial Analysis
• Partner Engagement
• Tribal Consultation
• Waiver Proposal Drafting
Consultation
• Tribal Consultation
• CMS Negotiation
• Public Comment
Approval
• CMS Approval
• Annual Budget Process
Implementation
• Infrastructure and Capacity Building
• Services Available to Eligible Alaskans
Review
• Required Annual Reporting to CMS
• Annual Budget Process
• Renewal Opportunities
4:37:22 PM
MS. RICCI, in response to a question from Representative Saddler
regarding the capacity of DOH to apply for waivers, indicated
there is an Office of Health Savings within the Office of the
Commissioner. She said DOH needs three positions and mentioned
supportive positions in the Department of Law (DOL). She talked
about short-term and long-term perspectives and longevity. She
also mentioned the Division of Insurance can help with the
necessary contractual work.
DR. ZINK added that federal partners "see a real benefit in
moving this direction." She mentioned there are other
supportive partners, as well.
4:39:47 PM
REPRESENTATIVE RUFFRIDGE expressed appreciation of the partners
available and the hope that health care costs can be driven
down.
4:40:51 PM
CHAIR PRAX opened public testimony on HB 344.
4:41:22 PM
JEANNIE MONK, Senior Vice President, Alaska Healthcare &
Hospital Association (AHHA), testified in support of HB 344.
She said AHHA appreciates the demonstration projects DOH has
developed allowing collaboration between the department and
health care providers to create change. She noted that Alaska
has a "closed" health care system and, thus, it is a suitable
environment for testing and innovation. She stated that
hospitals feel the impact of health-related social needs daily
and address those needs. She relayed that AHHA members would
welcome the opportunity to partner with DOH to develop
demonstration projects and address problems. She reminded
committee members that in 2016, AHHA, [at that time named the
Alaska State Hospital and Nursing Home Association (ASHNHA)],
played a significant role in the development of Senate Bill 74.
She said AHHA sees HB 344 as building on that previous work and
thinks the proposed changes are complementary. She emphasized
the current need in Alaska for "systems change," and AHHA
strongly supports maximizing opportunities related to the 1115
waivers. She highlighted that rather than go to the emergency
room, people could have their needs met outside of the hospital.
She concluded with thanks to the committee for its consideration
of HB 344.
4:44:40 PM
OWEN HUTCHINSON, Healthcare & Homelessness Integration Manager,
Alaska Coalition on Housing and Homelessness, testified in
support of HB 344. He offered background information related to
the coalition, including that it is a United States Department
of Housing and Urban Development designated lead agency for
continuum of care for everyone in Alaska outside of Anchorage.
He said the coalition, on its own, is unable to care for all
homeless people in Alaska. In 2023, 18,000 people accessed
homeless services; 43 percent of them self-reported a disabling
condition, and 37 percent reported being Alaska Mental Health
Trust beneficiaries. He noted that 1115 waivers of varying
types are already being used in 47 states; in Arkansas and
Arizona, waivers allow service to people with serious mental
illness and substance abuse disorders. He said the coalition
sees improved health outcomes by addressing "the social
determinants of health in coordination with their medical care."
He mentioned an actuarial report from 2020 that revealed
"supportive housing" costs at approximately $50 per day per
person compared to API, which costs over $1,000 per day per
person. He said a waiver would help "reduce the number of
people accessing homeless services and increase the outflow into
housing." He thanked the committee for its consideration of HB
344 and urged members to pass it out of committee.
4:48:01 PM
BRIAN LEFFERTS, Director, Division of Public Heath, Yukon-
Kuskokwim Health Corporation (YKHC), testified in support of HB
344. He said this is an incredible opportunity for the state
and the Yukon-Kuskokwim Region and would result in improved
health outcomes. He offered information regarding YKHC and said
the region has many challenges that make health care access
difficult and expensive. He reported that there is strong
evidence suggesting that focusing on health-related social needs
can prevent the need to access costly and difficult to access
health care services, and this improves the quality of life
while also improving the overall strain on YKHC's overburdened
health care system, allowing the corporation to focus its
resources on other health care needs. He related that YKHC is
eager to work with DOH to pilot the 1115 Medicaid waivers
through demonstration projects to help meet basic needs. He
concluded by asking the committee to support HB 344.
4:49:58 PM
BRYNN BUTLER, Housing Coordinator, City of Fairbanks, testified
in support of HB 344 and gave "a passionate plea" to the
legislature to support it. She described the proposed
legislation as "a beacon of hope" for Alaskans in desperate need
of supported services. She said evidence clearly shows that
house-related needs "are the cornerstone of health outcomes,
accounting for up to 50 percent of the equation." Without
housing and transportation needs met, an individual's health
suffers. She opined that it is time for the state to "pave the
way for tailored services that will prevent negative health
outcomes" and shift focus to "cost-effective and preventative
intervention." She talked about breaking free from "the cycle
of costly intervention" and "embracing a new era of supportive
services." She asked to see "champions of change."
4:52:03 PM
CHAIR PRAX, after ascertaining there was no one else who wished
to testify, closed public testimony on HB 344.
4:52:17 PM
REPRESENTATIVE SADDLER stated that he had been involved with
Senate Bill 74 and appreciates the cost-saving aspect of the
work being done on HB 344.
4:53:08 PM
CHAIR PRAX thanked the presenters and announced that HB 344 was
held over.
4:53:39 PM
The committee took a brief at-ease at 4:53 p.m.
HB 226-PHARMACIES/PHARMACISTS/BENEFITS MANAGERS
4:55:05 PM
CHAIR PRAX announced that the final order of business would be
HOUSE BILL NO. 226, "An Act relating to the Board of Pharmacy;
relating to insurance; relating to pharmacies; relating to
pharmacists; relating to pharmacy benefits managers; relating to
patient choice of pharmacy; and providing for an effective
date." [Before the committee, adopted as a working document on
2/27/24, was the proposed committee substitute (CS) to HB 226,
Version 33-LS0955\S, Wallace, 2/9/24, ("Version S").]
4:55:29 PM
REPRESENTATIVE SADDLER moved to report CSHB 226, Version 33-
LS0955\S, Wallace, 2/9/24, out of committee with individual
recommendations and the accompanying fiscal notes.
4:55:54 PM
REPRESENTATIVE RUFFRIDGE objected to declare conflict, stating
that he is currently a licensed pharmacist in the state of
Alaska and owns and operates multiple pharmacies.
[UNIDENTIFIED SPEAKERS] stated objections [to the declaration of
conflict].
4:56:12 PM
REPRESENTATIVE RUFFRIDGE removed his objection. There being no
further objection, CSHB 226(HSS) was reported out of the House
Health and Social Services Standing Committee.
4:56:40 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:57 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 344 Fiscal Note DOH-MS.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 344 |
| HB 344 Presenter List Version A.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 344 |
| HB 344 Sectional Analysis Version A.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 344 |
| HB 344 Sponsor Statement.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 344 |
| HB 344 Summary Version A.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 344 |
| HB 344 Version A.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 344 |
| HB 371 Sponsor Statement.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 371 |
| HB 371 Sectional Analysis.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 371 |
| HB 371 Version A.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 371 |
| HB 344 CPH Letter of Support.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 344 |
| Michael Collins Nursing App_Redacted.pdf |
HHSS 2/29/2024 3:00:00 PM |
Governor's Appointee |
| Michael Collins Nursing Resume_Redacted.pdf |
HHSS 2/29/2024 3:00:00 PM |
Governor's Appointee |
| HB 371 Fiscal Note DOH-PHAS.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 371 |
| HB 344 Presentation.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 344 |
| HB 371 Presentation.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 371 |
| HB 343 VOA Alaska Support.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 343 |
| HB 343 AKBHA Support.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 343 |
| HB 343 ASD Support Letter.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 343 |
| HB 371 ACOG letter of support.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 371 |
| HB 344 AHHA Letter of Support.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 344 |
| HB 344 Aids Assoc. Letter of Support.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 344 |
| HB 344 ANTHC Support.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 344 |
| HB 371 AHHA Letter of Support.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 371 |
| HB 344 Trust LOS Support.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 344 |
| HB 371 Alaska AWHONN .pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 371 |
| HB 371 CJA Letter of Support.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 371 |
| HB 343 Providence Support.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 343 |
| HB 343 Trust LOS 2.26.24.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 343 |
| HB 371 MCDR Support.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 371 |
| HB 344 Angel Support.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 344 |
| HB 343 ACSA Letter of Support.pdf |
HHSS 2/29/2024 3:00:00 PM |
HB 343 |