Legislature(2017 - 2018)SENATE FINANCE 532
02/27/2018 09:00 AM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB108 | |
| SB105 | |
| SB165 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 105 | TELECONFERENCED | |
| + | SB 108 | TELECONFERENCED | |
| + | SB 165 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE FINANCE COMMITTEE
February 27, 2018
9:02 a.m.
9:02:03 AM
CALL TO ORDER
Co-Chair MacKinnon called the Senate Finance Committee
meeting to order at 9:02 a.m.
MEMBERS PRESENT
Senator Lyman Hoffman, Co-Chair
Senator Anna MacKinnon, Co-Chair
Senator Click Bishop, Vice-Chair
Senator Peter Micciche
Senator Donny Olson
Senator Gary Stevens
Senator Natasha von Imhof
MEMBERS ABSENT
None
ALSO PRESENT
Senator Cathy Giessel, Sponsor; Fred Parady, Deputy
Commissioner, Department of Commerce, Community, and
Economic Development; Senator David Wilson, Sponsor; Gary
Zepp, Staff, Senator Wilson; Randall Burns, Director,
Division of Behavioral Health, Department of Health and
Social Services; Elizabeth Ripley, CEO, Mat-Su Health
Foundation; Jon Zasada, Policy Director, Alaska Primary
Care Association; Brittany Hartmann, Staff, Senator Anna
MacKinnon; Lori Wing-Heier, Director, Division of
Insurance, Department of Commerce, Community and Economic
Development.
PRESENT VIA TELECONFERENCE
Debora Stovern, Executive Director, Alaska State Medical
Board, Anchorage; Doctor Danny Robinette, Chief Medical
Officer, Foundation Health Partners, Fairbanks; Karen
Cunningham, Vice President, Marriage and Family Therapy
Board, Anchorage; Ken McCarty, Director, Discovery Cove
Recovery and Wellness Center, Eagle River.
SUMMARY
SB 105 MARITAL & FAMILY THERAPY LIC. & SERVICES
SB 105 was HEARD and HELD in committee for
further consideration.
SB 108 MEDICAL CARE/LICENSING/MEDICAL BOARD
SB 108 was HEARD and HELD in committee for
further consideration.
SB 165 COMPREHENSIVE HEALTH INSURANCE FUND
SB 165 was HEARD and HELD in committee for
further consideration.
SENATE BILL NO. 108
"An Act relating to the State Medical Board; relating
to the licensing of physicians, osteopaths, and
podiatrists; and providing for an effective date."
9:03:32 AM
SENATOR CATHY GIESSEL, SPONSOR, discussed the presentation,
"SB 108 State Medical Board" (copy on file).
9:03:51 AM
Senator Giessel highlighted Slide 2, "Purpose":
1. Streamline Physician Licensing
2. Need for office assistants
9:04:26 AM
Senator Giessel discussed Slide 3, "Streamline MD
licensing":
Section 1, 2, 8, 9, 10
State Medical Board to write regulations to
delegate to EXECUTIVE ADMINISTRATOR:
1. review applications and grant license if
requirements are met
2. review applications and issue temporary
license if requirements are met
3. grant certification if requirements are met
4. spells out prohibitions to this delegated
authority
9:06:28 AM
Senator Giessel discussed Slide 4, "Streamline MD
licensing":
Section 10, 11
1. Allows another person, designated by the
board, to help the Executive Administrator to
issue temporary license.
2. Outlines when this could happen
Senator Giessel stated that this change was urgently needed
and widely supported.
9:08:20 AM
Senator Giessel highlighted Slide 5, "Medical Assistants -
Unlicensed Assistive Personnel":
Medical Assistants
trained in "routine medical tasks"
Section 3
authorizes delegation to unlicensed person
prohibits delegation of pain management or opioid
related activities
Senator Giessel offered a brief history of the role of
medical assistance in practice.
9:10:31 AM
Senator Giessel addressed Slide 6, "Medical Assistants -
Unlicensed Assistive Personnel":
Section 6
adds unlicensed assistive personnel, performing
delegated routine medical duties to exception
under "License to practice medicine, podiatry, or
osteopathy"
Section 13
adds "medical assistants" to definition of
"medical professional" under Title 12 Criminal
Procedure
Senator Giessel stated that only licensed medical
professionals could access the state's pharmaceutical
database.
9:12:18 AM
Senator Giessel looked at Slide 7, "Certified Medical
Assistants - NEW entity":
Why?
Prescription Drug Monitoring Program (PDMP)
prohibits access by any unlicensed person
envisioned clinician delegate "look up" before
prescribing
Problem
No licensed people in MD clinic, other than the
MD
Frequent need to check on PDMP
Solution
Alaska's Community Colleges training programs for
CMA
National exams for Certification
Done in most other states. Washington State is one
example
9:14:17 AM
Senator Giessel discussed Slide 8, "CMA (Certified Medical
Assistant) Process defined":
Section 4
Certification - process will be defined in
regulation
Section 5
Title "CMA" and limits its use
Section 12
Penalty for practicing without license as CMA
Senator Giessel addressed Slide 9, "Urgent need for SB
108":
Efficient, expeditious and effective licensing of MDs
Legal clarity for delegation of "routine medical
duties" to unlicensed assistive personnel (medical
assistants)
More legally stringent delegated activities to
licensed entity, Certified Medical Assistant
9:14:29 AM
Senator Giessel discussed Slide 10, "Urgent need for SB
108":
These changes needed this session
Support
State Medical Board (requested)
Department of Commerce
No opposition
9:15:10 AM
Senator Stevens asked how long the temporary license would
last and whether it removed the responsibility to precure a
permanent license.
Senator Giessel replied that the temporary license was
time-limited. She deferred to Ms. Stovern.
9:15:50 AM
Co-Chair MacKinnon wondered whether medical assistants were
licensed in other states.
Senator Giessel replied that other states recognized
certified medical assistants, which was why the national
exams were available.
9:16:13 AM
Senator von Imhof looked at the fiscal note, which
reflected that professional licensing programs were funded
by receipt supported services to fund the two new full-time
positions that the bill would create, which meant that the
expense would be paid by the health professionals that were
involved with the board.
Senator Giessel replied in the affirmative.
9:16:51 AM
Co-Chair MacKinnon wondered whether the structure of the
bill was understood by the entire committee.
9:16:55 AM
Senator Olson asked how the bill would affect heath
corporations in rural Alaska.
Senator Giessel responded that she had not heard from
specific native corporations or native health
organizations. She imagined that if Anchorage was
experiencing issues then rural areas must be as well.
9:18:06 AM
Senator Olson wondered about continuing medical education
(CME) requirements for medical assistants.
Senator Giessel deferred to Ms. Stovern.
9:18:31 AM
Senator Olson asked whether other professionals working
under the per view of the medical board would be affected
by the bill.
Senator Giessel replied that physician's assistants were
affected, because they delegated to unlicensed assisted
personnel and needed to access the PDMP.
9:19:23 AM
Co-Chair Hoffman wondered whether the legislation would
increase the number of certified medical assistants in the
state.
Senator Giessel replied that it was hard to predict whether
the numbers would grow but that it was a growing field of
work.
9:20:32 AM
Senator von Imhof read from the sponsor statement:
The bill provides for physician delegation of
specific, routine activities to unlicensed personnel
working in physician offices.
Senator von Imhof assumed that the "specific, routine
activities" would be within the parameters of their
training and would be spelled out in regulation.
Senator Giessel replied in the affirmative.
9:21:33 AM
Senator Micciche spoke to concerns that had been voiced by
the American Association of Medical Assistants (AAMA) about
confusion surrounding certified medical assistants.
Senator Giessel said that she had been in communication
with the association and had clarified with them the
importance of the bill. She stated that the association
could bring other concerns to the Board of Medicine.
9:22:13 AM
Co-Chair MacKinnon noted that there was a letter in the
packet from the AAMA that offered suggestions on what
initials to give certified medical assistants (copy on
file).
Senator Giessel stated that she was aware of the letter and
had instructed the AAMA to communicate with the Board of
Medicine. She asserted that she was carrying the
legislation on behalf of the board and would not change any
aspects of the bill unless the board agreed.
9:22:50 AM
Co-Chair MacKinnon wondered how many other states
recognized certified medical assistants through licensure
programs. She asked whether the final licensure of a doctor
coming into the state had to be approved by the board, and
after that happened, would a list of physicians officially
approved to practice in the stat be approved by the board.
Senator Giessel deferred the question to Ms. Stovern.
9:24:20 AM
Co-Chair MacKinnon understood that a "clean" application
would not go before the board, but a questionable
application would go before the board for further scrutiny.
Senator Giessel shared that it would be up to the board how
they wanted to review applications approved by the
executive administrator. She said that the issue was not
discussed in the bill.
9:25:02 AM
FRED PARADY, DEPUTY COMMISSIONER, DEPARTMENT OF COMMERCE,
COMMUNITY, AND ECONOMIC DEVELOPMENT, spoke in support of
the legislation. He shared that the workload of the medical
board had dramatically increased due to telemedicine. He
stated that in 2015, the backlog reached 6 months in
application processing time due to the volume of
applications received. He relayed that in FY17, the
division processed 22 percent more medical licenses and 31
percent more nursing licenses than in FY16. He related that
to date in FY18, more licenses had been received than the
entirety of the previous fiscal year. He shared that the
department had worked to streamline the application process
for health care professions. He said that a comprehensive
examination of the application process had been done to
identify areas of friction, or "rubs." He relayed that 27
rubs had been identified, which had been evaluated
individually to determine whether the issue served a public
safety purpose, met a public safety need, or whether the
process was outdated or obsolete. He explained that a
three-pronged approach had been initiated to implementing
solutions to streamlining the licensure process. The areas
of friction were split in three areas: small changes
through board regulations, improvements in technology, and
changes to statute that would allow the department to more
effectively administer programs. He concluded that
legislative support of the bill was the final step in
ensuring Alaska's health care facilities were able to stay
open, while remining fully staffed and able to serve the
public in a timely fashion.
9:32:10 AM
DEBORA STOVERN, EXECUTIVE DIRECTOR, ALASKA STATE MEDICAL
BOARD, ANCHORAGE (via teleconference), stated that under
current statute only the board was authorized to grant
licenses, the board also had the authority to delegate to
her the authority to approve applications for temporary
permits, curtesy licenses, and resident permits. She said
that because the board only met four times per year,
temporary permits allowed applicants with complete files to
practice until the next board meeting, when files would be
considered by the board for approval of a permanent
license. She said that a temporary permit was time-limited
to 6 months and could not be extended. She related that as
part of the licensing streamlining project that Mr. Parady
spoke to, the board had taken actions to improve
application processing, including; in office efficiencies,
changes to application requirements, the inclusion of
participation in programs offered by the Federation of
State Medical Boards, the adoption of regulation for an
expedited temporary permit. She anticipated that once the
legislation passed, the board would continue to delegate
the approval authority to the executive secretary as well
as the licensing supervisor, for the issuance of the
expedited temporary permits. She said that once an
expedited file was complete, it would be referred to the
executive secretary for approval of the permeant license.
Any application with derogatory or adverse information,
discrepancies, or questions and concerns would require a
board review for approval of temporary or permanent
license, as appropriate. She related that under the
legislation much of the temporary licensure would be at the
discretion of the board. She spoke to the CME question
posed by Senator Olson. She said the licensing program
required that assistants maintain their national
certification, which meant they had to complete continuing
medical education. She anticipated that the board would
require something similar with certified medical
assistants.
9:37:11 AM
Senator Stevens wanted a guarantee that no one would be
given a temporary license that did not have the necessary
medical background.
Ms. Stovern responded that temporary permits were issued on
a checklist that had been developed by the board and
delineated all of the requirements for licensure. She said
that the process ensured that all requirements were met,
and all credentials were in place before temporary permits
were issued. The board would be tasked with further
developing that checklist for the enhanced process.
9:38:33 AM
Senator Stevens wanted assurances that the public would be
safe.
Senator Olson commented that he understood Senator
Stevens's concerns but that he had witnessed a lack of
service in rural areas of the state due to the lack of
streamlining in the permitting process.
9:40:16 AM
Co-Chair MacKinnon felt it was important to note that
Senator Olson was a doctor.
Senator Olson said he was first licensed as a medical
doctor in 1984 and had practiced in rural Alaska throughout
his career. He added that he had been on the medical board
from 1995, until he was elected to office.
9:41:50 AM
Senator Micciche asked whether the bill would speed up the
permitting process without reducing the credential
requirements.
Ms. Stovern replied yes. She said that the board considered
that the credentials had been reviewed for the issuance of
a temporary permit and took that into consideration when
granting a permanent license.
9:43:58 AM
Senator Micciche reiterated concern that requirements would
be reduced at the risk of public safety.
9:44:31 AM
Co-Chair MacKinnon understood that Senator Micciche was
requesting assurances that there would be no changes in
requirements for permanent licensure in the state.
Ms. Stovern replied that the requirements would not be
changed.
9:44:47 AM
Senator Stevens requested further information on the
backlog of 290 applications.
Ms. Stovern said that there was not currently a huge
backlog. She related that there had been an influx in
application due to increased telemedicine. She felt that
once streamlining efficiencies were implemented the
application processing time would be significantly reduced.
She relayed that there were some delays in the process that
were outside of the boards control. She stated that once an
application was received by her office it took
approximately one to three weeks to issue a temporary
license. She said that current backlogs were related to
missing documents and credentials in files.
9:47:53 AM
Senator Stevens felt that a 6-month extension would take
care of the current backlog.
Ms. Stovern responded in the affirmative.
9:48:42 AM
DOCTOR DANNY ROBINETTE, CHIEF MEDICAL OFFICER, FOUNDATION
HEALTH PARTNERS, FAIRBANKS (via teleconference), understood
the concern about credentials. He encouraged keeping the
diligent process intact and not changing the standards. He
stressed the importance of a streamlined process for
granting privileges to candidates. He related that he had
lost candidates to other states because the licensing
process had taken too long. He expressed strong support for
the legislation.
9:50:49 AM
Senator Stevens wondered how the bill would help with
efficiency of licensure.
Dr. Robinette thought that granting authority to the
director would save waiting for the next board meeting for
a clean candidate.
9:51:48 AM
Senator Stevens surmised that if an individual had been
given a 6-month extension, but at the end of the 6 months
the file was not complete, he would be denied the
opportunity to continue to work in the state.
Dr. Robinette agreed.
9:52:23 AM
Vice-Chair Bishop asked how much it cost to vet applicants.
Dr. Robinette answered that, including the cost of hiring
temporary staff to manage the workload, the cost was
several hundreds of thousands of dollars. The cost of
recruiting an individual physician was between $30,000 and
$50,000.
9:53:41 AM
Vice-Chair Bishop remarked that the hospital would spend
time vetting the individual, as would the board.
Dr. Robinette agreed, and believed that both vetting
opportunities should exist, he thought that anything that
could be done to streamline the vetting would be helpful.
9:54:33 AM
9:54:55 AM
Co-Chair MacKinnon CLOSED public testimony.
9:55:02 AM
AT EASE
9:55:19 AM
RECONVENED
9:55:22 AM
Co-Chair MacKinnon directed attention to the fiscal note.
9:55:39 AM
Vice-Chair Bishop discussed the fiscal note from the
Department of Commerce, Community and Economic Development
(DCCED). He read from the analysis:
One full-time Records and Licensing Supervisor is
needed to implement this program. Currently, one
existing Records and Licensing Supervisor is spread
among numerous programs; only part of that position's
time is dedicated to medical programs. As a result of
the addition of the certified medical assistant
license type, the workload related to medical programs
supports a dedicated Records and Licensing Supervisor.
If the bill passes the following expenses will be
incurred:
Personal Services: $177.8 (2 full-time positions)
Travel: $1.5 (1 training session per year)
Services: $10.0 (annual legal review)
$5.0 (annual investigations)
$4.5 (regulations project in the first year)
$30.0 (annual core services & allocated
costs)
Supplies: $20.0 (set up for new employees in the first
year)
$2.5 (postage in the first year) $1.0
(office supplies)
Professional licensing programs within the Division of
Corporations, Business and Professional Licensing are
funded by Receipt Supported Services, fund source 1156
Rcpt Svcs (DGF). Licensing fees for each occupation
are set per AS 08.01.065 so the total amount of
revenue collected approximately equals the
occupation's actual regulatory costs.
9:57:42 AM
Co-Chair MacKinnon asked whether Ms. Stovern had comments
pertaining to the AAMA and their concerns with CMAs in
Alaska.
Ms. Stovern replied that the board had not considered the
concerns.
9:58:54 AM
Co-Chair MacKinnon spoke again to the letter from Donald A.
Balasa, Ms. Davis, MBA, CEO and Legal Counsel for the AAMA.
She asked Senator Giessel to speak to her credentials.
Senator Giessel shared that she had been a registered nurse
in Alaska since 1974, and Advanced Nurse Practitioner since
2000. She relayed that she had served on the Board of
Nursing from 2002 to 2010, five of those years she served
as chair of the board. She said that the issue raised by
the AAMA was trivial, as opposed to the legislation, which
would address a critically urgent matter.
10:01:07 AM
Senator Olson asked whether Senator Giessel had received
letters of support of opposition from physician groups.
Senator Giessel said that she had not received letters from
the Alaska State Medical Association or the Association of
Physicians and Surgeons. She reminded the committee that
the Board of Medicine had written the bill.
Co-Chair MacKinnon announced that amendments were due by
5pm the following day.
SB 108 was HEARD and HELD in committee for further
consideration.
SENATE BILL NO. 105
"An Act relating to the licensure of marital and
family therapists; relating to professional liability
insurance for marital and family therapists; relating
to medical assistance for marital and family therapy
services; and providing for an effective date."
10:03:46 AM
SENATOR DAVID WILSON, SPONSOR, read from the Sponsor
Statement:
If enacted, Senate Bill 105 would add licensed Marital
and Family Therapists to the list of independent
licensed practitioners, in order to address the
shortage of Medicaid-eligible behavioral health
providers in the state, afford more options for
beneficiaries, and increase access to care.
He shared that approximately 20 percent of Alaska's adult
population needed mental or behavioral health services;
however, 19 percent of those in need received funding from
Medicaid or the Behavioral Health Fund. He said that
research had shown that Alaska was in need of additional
psychiatrists to meet the state's mental health needs. He
read from the Sponsor Statement:
Currently, licensed marital and family therapists
(MFTs) are only allowed to provide services in
community health clinics of physician mental health
clinics, which limits the number of willing providers
in the mental health care arena. SB 105 expands
medical assistance reimbursement services to cover
those services provided by MFTs.
Specifically, SB 105
• Designated LMFTs as providers eligible to render
and bill for Medicaid-funded services as
independent practitioners under Alaska Statute
47.07.030(b)
• Clarifies supervisory requirements for Marital
Family Therapist Licensees
• Requires Marital Family Therapist Licensees to
carry Liability Insurance for Regulatory
Investigation Fees of at least $30,000
In 2016, the Alaska Board of Marital and Family
Therapy unanimously recommended the statute changes
contained in SB 105.
10:09:44 AM
GARY ZEPP, STAFF, SENATOR WILSON, discussed the Sectional
Analysis (copy on file):
Sections 1 & 2 of the bill impact AS 08.63 "Marital &
Family Therapy" and the subsections 08.63.100
"Qualifications for license to practice" and 08.63.120
"Authorized Supervisors."
Section 1: "Qualifications for license to practice" -
AS 08.63.100
PAGE 2, LINES 17-25: adds a supervision requirement
for martial & family therapists and clarifies that the
required 1,500 hours of clinical contact must include
100 hours of individual supervision and 100 hours of
group supervision and that may be conducted by one or
more supervisors. The intent is to allow doctor A to
supervise and if Doctor A becomes unavailable, doctor
B can continue the supervision a Martial & Family
Therapist associate.
Section 1 continues on:
PAGE 2, LINES 29-31: It requires not less than $30,000
in professional liability coverage for the applicant's
regulatory investigation fees in the state.
Section 2: impacts "Authorized Supervisors"
PAGE 3, LINES 2-18: expands the group supervision to
include professional counselors, marital & family
therapists, physicians who are licensed as a
psychiatrist, an advanced practice registered nurse
who is authorized by the Board of Nursing to practice
as an adult or family psychiatric mental health nurse
practitioner, a psychologist, and a social worker.
Sections 3, 4, & 5 impact AS 47.07 "Medical Assistance
for Needy Persons" and the subsection AS 47.07.030
"Medical Services to be Provided."
Section 3: impacts "Medical Services to be Provided"
PAGE 3, LINE 31: adds marital and family therapy
services to the list of optional services available
through the Dept. of Health & Social Services under
this subsection.
Section 4: impacts "Medical Services to be Provided"
PAGE 4, LINES 8-16: adds a new paragraph (g) to AS
47.70.030 to clarify that the term "direct
supervision" may be performed by one or more
psychiatrists, as long as that supervision takes place
on the premises of the clinic 30 % of the time that
the clinic is open.
The so-called 30% Rule is found in regulation 7AAC
135.030 "Provider enrollment and organization."
Section 5: impacts "Medical Services to be Provided"
PAGE 4, LINES 17-31 & PAGE 5, LINE 1: adds a new
subsection (h) to AS 47.70.030 that allows the
department to reimburse a mental health physician
clinic for services provided by a psychiatrist, or an
individual who works under a psychiatrist and is
licensed to practice as a professional counselor, a
martial & family therapist, a physician assistant, an
advanced practice registered nurse who is authorized
by the Board of Nursing to practice as an adult or
family psychiatric mental health nurse practitioner, a
psychologist, a psychologist associate, and a clinical
social worker.
Section 6: PAGE 5, LINES 2-7: amends the uncodified
law to authorize the Department of Health and Social
Services and the Board of Marital and Family Therapy
to adopt regulations to implement the changes of this
act.
Section 7: PAGE 5, LINE 8: contains the immediate
effective date for Section 6 which refers to the
regulation development.
Section [8]: PAGE 5, LINE 9: provides for a January 1,
2019 effective date for all sections other than
Section 6.
10:13:29 AM
Senator Stevens asked for the licensing timeframe to be
licensed as a marital and family therapist, and whether
temporary licenses could be issued.
Senator Wilson deferred to the invited testimony.
10:14:26 AM
Senator Stevens hoped that the marital and family
therapists would not face the same problems as the medical
practitioners of the previously discussed bill.
Co-Chair MacKinnon OPENED public testimony.
10:15:08 AM
Senator von Imhof assumed that the insurance required in
Section 1 could be obtained after training was complete.
Senator Wilson replied that the insurance language was
intended to cover investigative regulatory issues after
licensure.
10:16:08 AM
RANDALL BURNS, DIRECTOR, DIVISION OF BEHAVIORAL HEALTH,
DEPARTMENT OF HEALTH AND SOCIAL SERVICES, (DHSS) spoke in
support of the bill.
10:16:34 AM
Senator von Imhof read form the Sectional Analysis:
Section 4: impacts "Medical Services to be Provided"
PAGE 4, LINES 8-16: adds a new paragraph (g) to AS
47.70.030 to clarify that the term "direct
supervision" may be performed by one or more
psychiatrists, as long as that supervision takes place
on the premises of the clinic 30 % of the time that
the clinic is open.
Senator von Imhof whether the population of psychiatrists
in rural Alaska could support the requirement in this
section.
Mr. Burns replied that the language was in current
regulation. He said that he was in support of changing the
language at the direction of the committee. He stated that
the division was currently crafting language that was less
burdensome to rural clinics.
10:21:31 AM
AT EASE
10:21:54 AM
RECONVENED
10:21:58 AM
Senator Stevens repeated his question about temporary
licensing and licensing timelines.
Mr. Burns replied that he could not speak to the question.
10:22:54 AM
KAREN CUNNINGHAM, VICE PRESIDENT, MARRIAGE AND FAMILY
THERAPY BOARD, ANCHORAGE (via teleconference), testified in
support of the legislation. She stated that associate
licensure was available; board approval was required before
the license could be issued and there was a 2-year
supervision period. She said that the bill would make the
supervision period more accessible for applicants.
10:24:04 AM
Senator Stevens directed his question to Ms. Cunningham.
Ms. Cunningham replied that applications for associate
licensure were submitted to, and approved by, the board.
Before the application could be submitted the applicant
needed to have a supervision plan laid out for the board to
approve. She relayed that there were currently 18 approved
supervisors in the state.
10:25:41 AM
KEN MCCARTY, DIRECTOR, DISCOVERY COVE RECOVERY AND WELLNESS
CENTER, EAGLE RIVER (via teleconference), testified in
support of the legislation. He shared that the bill would
serve a large need in the state. He expressed concern about
the Section 4 language referenced by Senator von Imhof. He
felt that the language could isolate telemedicine in rural
areas.
10:32:08 AM
ELIZABETH RIPLEY, CEO, MAT-SU HEALTH FOUNDATION, testified
in support of the bill. She said that there were critical
pieces missing for Alaska's continued care for mental
health and substance use disorders; sadly, main paths to
treatment are jails and emergency departments. She relayed
that the Mat-Su Regional Emergency Department was the
number one portal in Mat-Su for people experiencing a
behavioral health crisis, in terms of both volume and cost,
even though the department does not provide behavioral
health services. She shared that in 2016, 3,443 patients
with behavioral health diagnosis went to the Mat-Su
Regional Emergency Department, which resulted in total
charges of $43.8 million, not counting the additional costs
for estimated law enforcement, 911 dispatch, and
transportation. She believed that the state could improve
the situation by providing care in lower cost settings. She
relayed that the average annual growth rate for visits to
the Mat-Su Regional Emergency Department by patients with a
behavioral health diagnosis grew 20 percent between 2015
and 2017, due to the opioid epidemic and lack of treatment
access. She offered further statistics to illustrate the
statewide needs that the bill would address.
10:35:52 AM
Senator Micciche expressed concern with the assumptions
made in the fiscal note. He opined the Medicaid utilization
rate in the state. He voiced concern that the state would
be exposed to increased overutilization.
Ms. Ripley replied spoke of a project called The Alaska
Healthcare Blueprint, which hoped to take a bold look at
the state's health objectives. She asserted that
collaborative work was being done with state partners,
providers, and local delegations to take a comprehensive
view. She contended that significant research had been done
to ensure that health care was being provided efficiently
and effectively. She stressed the need for "whole person
care." She admitted that there would be additional cost
brought on by the bill but that the legislation would be
more cost effective in the long-run.
10:38:47 AM
AT EASE
10:39:10 AM
RECONVENED
Senator von Imhof understood that the cost would be shifted
from expensive emergency room visits to more clinic visits,
where the same population would be served, for the same
ailments but in a different cost environment.
Ms. Ripley agreed.
10:40:19 AM
JON ZASADA, POLICY DIRECTOR, ALASKA PRIMARY CARE
ASSOCIATION, testified in support of the legislation. He
stated that health centers had made major investments in
behavioral health integration and whole person care. He
said that in the last two years there had been a 25 percent
increase in the number of behavioral health providers,
encounters, and patients; over 11,000 Alaskans received
routine behavioral healthcare in Alaska's community health
centers. He lamented that there was a shortage of billable
providers in the state; a study completed in December 2017
revealed that Alaska community heath centers were short 12
to 18 FTE equivalents, which translated into service to
6,000 to 9,000 patients. He stressed that federally
qualified health centers saved the state money by allowing
same-day appointments at a single rate. He stated that if
LMFTs were included in FQHC Medicaid billing a patient
could see a medical provider and a mental health
professional in the same day, for a single charge, instead
of a referral to two sperate charges. He detailed the
various ways in which the bill would serve more patients in
comprehensive, whole-patient settings.
10:43:53 AM
Senator Stevens asked which medical professionals could
currently bill Medicaid.
Mr. Zasada replied that licensed clinical social workers
and psychologists could bill Medicaid.
Co-Chair MacKinnon CLOSED public testimony.
Co-Chair MacKinnon stated that a new fiscal note would be
crafted for consideration during the next bill hearing.
10:45:15 AM
Co-Chair MacKinnon solicited further discussion on the
current fiscal note.
Senator Wilson reiterated that the intent of the bill was
not to create a new expanded care of treatment but to give
patients access to care as primary prevention.
Co-Chair MacKinnon announced that amendments were due the
following day by 5pm.
SB 105 was HEARD and HELD in committee for further
consideration.
SENATE BILL NO. 165
"An Act relating to the Alaska comprehensive health
insurance fund; and providing for an effective date."
10:47:23 AM
BRITTANY HARTMANN, STAFF, SENATOR ANNA MACKINNON, offered a
Sponsor Statement:
In 2015, the individual health care market in Alaska
was in a precarious state. There were only two
insurers with current enrollees in individual
healthcare plans in Alaska, and each insurer was
experiencing significant losses. Average premium rate
increases in 2015 were 38.7% for one insurer and 39.9%
for the other. In 2016, one of Alaska's only two
remaining insurers gave notice that they would be
withdrawing from the Alaska individual market
effective January 2017.
The 29th Legislature passed HB 374 in 2016, which
created the Alaska Reinsurance Program, and allowed
the Division of Insurance to apply for a federal
Section 1332 state innovation waiver under the
Affordable Care Act (ACA). That legislation included a
sunset date of June 30, 2018 to ensure that the
diversion of insurance premium taxes from the general
fund was not relied upon as a long-term funding
mechanism. In July 2017, the waiver was approved by
both the Department of Health and Social Services and
the Department of Treasury based on the application
submitted by the division, which requested pass-
through funding for the Alaska Reinsurance Program.
The federal award for this waiver was approximately
$322 million over five years. The award is to be used,
in conjunction with the Alaska Reinsurance Program, to
continue to stabilize the individual healthcare market
in Alaska.
This legislation extends the sunset provision on the
Alaska comprehensive health insurance fund by six
years, from June 30, 2018 to June 30, 2024 to allow
for the continuation of the Alaska Reinsurance Program
and receipt of the federal funding.
The bill also removes the requirement that funds
collected under AS 21.09.210 (tax on insurers), AS
21.33.055 (unauthorized insurance premium tax), AS
21.34.180 (surplus lines tax) and AS 21.66.110 (annual
tax on title insurance premiums) are to be deposited
into the Alaska comprehensive health insurance fund
within the general fund.
Passage of HB374 by the 29th Legislature has resulted
in stabilization of the individual insurance market.
The Section 1332 state innovation waiver provides
funding for the Alaska Reinsurance Program, through
the Alaska comprehensive health insurance fund. Now
this legislation is necessary to ensure the continued
effectiveness of the Alaska Reinsurance Program, meet
the intent of the waiver, and receive the federal
funding.
10:48:20 AM
Co-Chair MacKinnon relayed that versions the legislation
had appeared before the committee before. She said that the
bill would create a stable market and that the state had
experienced a reduction in premiums because of the
reinsurance program. She shared that the legislation would
rededicate the revenue stream out of the insurance fund and
into the general fund, resulting in a positive fiscal note
of approximately $50 million, annually. She commended the
work of Lori Wing-Heier, Director, Division of Insurance,
Department of Commerce, Community and Economic Development
on the issue of insurance management in the state.
10:51:01 AM
LORI WING-HEIER, DIRECTOR, DIVISION OF INSURANCE,
DEPARTMENT OF COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT,
said that SB 165 would allow the department to continue the
reinsurance program with significant federal funding
because of the 1332 waiver for a period of five years, with
a possible additional one-year extension. She said that in
2016 the legislature had been instrumental in creating the
program, which had proved successful. She stressed that to
collect on anticipated federal funds, the sunset date
needed to be either removed or extended. The sunset
extension would also allow that the premium tax that the
division collected would go back to the general fund, as
was the original intention.
10:53:34 AM
Co-Chair MacKinnon solicited the definition of
"reinsurance."
10:54:16 AM
Vice-Chair Bishop expressed appreciation for Ms. Wing-
Heier's ability to discuss complicated issues in a clear
and simple manner.
Ms. Wing-Heier shared that in the context of the bill,
"reinsurance" meant that if you were an individual in
Alaska that purchased insurance through the individual
market but was then diagnosed with a condition that
generated high cost claims, you would still buy insurance
from Premera (because that is the only carrier in Alaska)
and would never know that your claim had been ceded to the
reinsurance program. The claim is then not paid by Premera
but by the state, which reduced the overall claims expense
for the insurer.
10:56:25 AM
Co-Chair MacKinnon asked why the federal government would
be interested in paying the claims.
Ms. Wing-Heier responded that many Alaskan's premiums were
subsidized by the federal government, without a cap. She
said that when the large claims could be removed from the
calculation, and premiums decreased, the federal government
would save money. That savings returned to the state to
fund the reinsurance program. Had the reinsurance program
not been enacted, the federal government's premiums for low
and moderate-income individuals would have continued to
increase, as would those that did not receive subsidies.
10:58:15 AM
Co-Chair MacKinnon asked about the managed care for
individuals that were high cost drivers in the system.
Ms. Wing-Heier replied that there were very strict
guidelines for managed care of those particular consumers.
She said that the division worked to provide managed care
on every claimant that went through the program.
10:59:20 AM
Senator Stevens asked about the $25 million return from
Premera, and whether similar returns could be expected in
the future.
Ms. Wing-Heier did not expect similar future returns. She
said that claims had dropped significantly in 2017, which
had prompted Premera to contact the division. She said that
the drop in claims had been considered an anomaly. She
explained that when an insurance company filed rates with
the state, a contingency of 3 to 5 percent profit was
included in the rate filing. She stated that Premera had
known that they were in excess of that contingency
percentage. She furthered that Premera involuntarily
approached the state and asked that the money for 2017 be
put back into the reinsurance program. She relayed that a
memorandum of understanding was crafted, without any fault
on the part of Premera, that the money would be returned to
the state.
11:00:55 AM
Senator Stevens asked whether additional insurers were
interested in working with Alaska.
Ms. Wing-Heier replied that she was hopeful. She felt that
any reluctance was not because of the situation in the
state but what was happing on the federal level.
11:01:27 AM
Senator Stevens expressed appreciation for the information.
11:01:40 AM
Senator von Imhof asked whether there was a way that the
state could save as much money as possible in the program
just in case the waiver was not extended a second time.
Ms. Wing-Heier responded that the idea had been considered.
She thought that what was currently being received from the
federal government could carry the program into the 6th
year.
Co-Chair MacKinnon CLOSED public testimony.
11:04:50 AM
Co-Chair Hoffman addressed the zero fiscal note for the
Department of Administration (DOA). He read from the
analysis:
This bill would extend the repeal date of the Alaska
comprehensive health insurance fund statute from June
30, 2018 to June 30, 2024 and, effective July 1, 2018,
would deposit insurance premium tax revenues into the
general fund instead of the Alaska comprehensive
health insurance fund. The general fund and the Alaska
comprehensive health insurance funds are existing
funds and the change should require minimal work with
no significant fiscal impact to the Division of
Finance. Therefore, the Division of Finance submits a
zero fiscal note.
He spoke to the second zero fiscal note from the Department
of Commerce, Community and Economic Development:
This legislation extends the sunset provision on the
Alaska Comprehensive Health Insurance Fund by six
years, from June 30, 2018 to June 30, 2024. This
legislation also removes the requirement that funds
collected under AS 21.09.210 (tax on insurers), AS
21.33.055 (unauthorized insurance premium tax), AS
21.34.180 (surplus lines tax) and AS 21.66.110 (annual
tax on title insurance premiums) are to be deposited
into the Alaska Comprehensive Health Insurance Fund
within the general fund.
11:07:11 AM
Co-Chair MacKinnon understood that the current insurance
receipts that were designated general fund would be re-
routed into the general fund. She wondered about a
projection on the new general fund contribution.
Ms. Wing-Heier relayed that there was approximately $63
million that would be re-routed back to the general fund
and, going forward, all the taxes would go back into the
general fund.
11:08:04 AM
Co-Chair MacKinnon wondered why this was not reflected on
the fiscal note as revenue coming into the general fund.
Ms. Wing-Heier said that she would provide the information
to the committee later.
Co-Chair MacKinnon announced that amendments were due the
following day by 5pm.
SB 165 was HEARD and HELD in committee for further
consideration.
ADJOURNMENT
11:09:37 AM
The meeting was adjourned at 11:09 a.m.