Legislature(2023 - 2024)SENATE FINANCE 532
03/07/2023 09:00 AM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB58 | |
| SB55 | |
| SB38 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 58 | TELECONFERENCED | |
| + | SB 55 | TELECONFERENCED | |
| += | SB 38 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE FINANCE COMMITTEE
March 7, 2023
9:02 a.m.
9:02:29 AM
CALL TO ORDER
Co-Chair Olson called the Senate Finance Committee meeting
to order at 9:02 a.m.
MEMBERS PRESENT
Senator Donny Olson, Co-Chair
Senator Lyman Hoffman, Co-Chair
Senator Jesse Kiehl
Senator Kelly Merrick
Senator David Wilson
MEMBERS ABSENT
Senator Bert Stedman, Co-Chair
Senator Click Bishop
ALSO PRESENT
Emily Ricci, Deputy Commissioner, Department of Health;
Valerie Rose, Fiscal Analyst, Legislative Finance Division;
Senator Bill Wielechowski, Sponsor; Kali Spencer, Staff,
Senator Wielechowski; Sylvan Robb, Director, Division of
Corporations, Business and Professional Licensing,
Department of Commerce, Community and Economic Development;
Kris Curtis, Legislative Auditor, Juneau;
PRESENT VIA TELECONFERENCE
Dr. Anne Zink, Chief Medical Officer, Department of Health,
Palmer; Dr. Mishelle Nace, Pediatric Physician, Fairbanks;
Brooke Ivy, Alaska Children's Trust, Anchorage; Jamie
Morgan, Government Relations, American Heart Association,
Sacramento; Antonia Leonard, Self, Eagle River;
SUMMARY
SB 38 INTERFERENCE WITH EMERGENCY SERVICES
SB 38 was REPORTED out of committee with and with
three do pass and one no recommendation; and with
two new zero fiscal notes from the Department of
Administration, and three zero fiscal notes: FN
3(COR), FN 4(LAW), FN 5(DPS).
SB 55 EXTEND STATE MEDICAL BOARD
SB 55 was HEARD and HELD in committee for further
consideration.
SB 58 MEDICAID ELIGIBILITY: POSTPARTUM MOTHERS
SB 58 was HEARD and HELD in committee for further
consideration.
SENATE BILL NO. 58
"An Act relating to Medicaid eligibility; expanding
eligibility for postpartum mothers; conditioning the
expansion of eligibility on approval by the United
States Department of Health and Human Services; and
providing for an effective date."
9:04:24 AM
EMILY RICCI, DEPUTY COMMISSIONER, DEPARTMENT OF HEALTH,
introduced herself. She displayed the presentation, "SB 58:
Postpartum Medicaid Extension" (copy on file).
9:04:55 AM
DR. ANNE ZINK, CHIEF MEDICAL OFFICER, DEPARTMENT OF HEALTH,
PALMER (via teleconference), pointed to slide 3, "What is
Postpartum Medicaid Extension:
.notdef SB 58 extends postpartum Medicaid coverage for new
mothers from 60 days to 12 months.
.notdef The original 60 days postpartum period for Medicaid
came from Congress in 1986. The data are clear:
postpartum health issues occur far beyond 60 days.
.notdef SB 58 is an evidence-based action that supports
growing families and will improve maternal health
outcomes for Alaskans.
.notdef Continued health care coverage is associated with
detection and early intervention which improve long-
term maternal and child health outcomes.
Dr. Zink pointed to slide 4, "What Are the Stakes?
The United States is the only developed country where
maternal mortality rates are worsening.
Dr. Zink looked at slide 5, "What Are the Stakes?
.notdef Pregnancy-related deaths occur well beyond the 60-
day postpartum period.
.notdef 29 percent of pregnancy-related deaths in the U.S.
not including those caused by accidents, homicides,
and suicides occur 43 to 365 days postpartum.
.notdef For every pregnancy-related death, there are 70 to
80 cases of severe maternal illness and morbidity in
the postpartum period.
.notdef Medicaid-enrolled women are especially vulnerable to
pregnancy- related death as they are more likely to
experience chronic conditions, pre-term or low-weight
births, and severe maternal morbidity.
Dr. Zink addressed slide 6, "Pregnancy-Associated Deaths in
Alaska:
.notdef In 2021, Alaska's overall pregnancyassociated death
rate exceeded the previous 5-year average by 109
percent
.notdef Among deaths in 2015-2019: 73 percent occurred >6
weeks post-delivery
.notdef Among deaths reviewed by Alaska's Maternal and Child
Death Review (MCDR) committee during 2016-2022, 88
percent were potentially preventable, and 44 percent
were associated with barriers to health care access
Dr. Zink looked at slide 7, "What can Alaska do about it?
Section 9812 of the American Rescue Plan Act (ARPA)
added the time-limited option for allowing states to
extend postpartum coverage from the required 60 days
to 12 months for eligible beneficiaries through March
1, 2027.
The Consolidated Appropriations Act of 2023 (CAA-2023)
revised ARPA to make the optional coverage extension
permanent.
Co-Chair Hoffman looked at slide 6, and noted the number of
deaths per 100,000 was twice in rural Alaska than in urban
Alaska in 2020 and 2021. He remarked that in the Yukon
Kuskokwim Delta, there was a prematernal home which housed
pregnant people from outlying villages for the last
trimester. He wondered whether there was any indication
that the mortality rate for the region was reduced because
of that expectant mother requirement.
Dr. Zink agreed to provide that information. She noted that
the numbers were quite low, so it was difficult to pull out
each region.
9:10:54 AM
Co-Chair Olson noted that 72 percent of deaths occurred
after six weeks post-delivery. He wondered whether those
were deaths of the children or deaths of the mother.
Dr. Zink replied that those were death of the mother.
Co-Chair Olson looked at slide 4, and queried the reason
for the higher mortality rate in the United States.
Dr. Zink replied that access to health care coverage was a
major challenge in Alaska and the other states. She
remarked that there were many factors that affected the
mother such as substance abuse and depression. She agreed
to provide additional details.
Senator Kiehl asked about the services that the bill would
enable the state to provide to lead to better outcomes.
Dr. Zink remarked that 72 percent of the maternal mortality
rates from 2012 to 2021 were related to substance, drug,
and alcohol abuse disorder, which would be put into a
category of potentially preventable. She shared a story of
a patient who was sober during her pregnancy, but after the
birth she became depressed and started using drugs again.
She did not have health insurance to get treatment options.
She stated that the woman reenrolled in Medicaid to obtain
access to treatment.
Co-Chair Olson wondered whether a person from rural Alaska
who gave birth in an urban hospital would be considered a
rural or urban death.
Dr. Zink replied believed that it would be considered a
rural death, because it was based on residency. She
deferred to Ms. Nace.
9:15:05 AM
DR. MISHELLE NACE, PEDIATRIC PHYSICIAN, FAIRBANKS (via
teleconference), stated that she would need to confirm the
statistics in determining the differentiation.
9:15:52 AM
Ms. Ricci pointed to slide 8, "Why a Bill?
.notdef The Legislature must approve all optional groups for
Medicaid coverage in statute AS 47.07.020
.notdef Women who are eligible for Medicaid in Alaska based
on their pregnancy currently only receive coverage for
60 days postpartum
.notdef In Alaska, 51 percent of births are covered by
Medicaid
Senator Wilson wondered how long it would be for the bill
to be enacted after its passage.
Ms. Ricci replied that it would take effect by July 2024.
Co-Chair Olson wondered if all of the requirements were
federally mandated before the bill could take effect.
Ms. Ricci replied that the regulations were state
requirements, but there was one federal requirement.
9:20:00 AM
Dr. Zink looked at slide 9, "Benefits to Alaskans
.notdef Improves maternal health outcomes
.notdef Prevents gaps in health care coverage and
improves health care access
.notdef Improves maternal mental health
.notdef Mental health conditions contributed to 31
percent of pregnancy-associated deaths in Alaska
between 2014 and 2018
.notdef 14 percent of Alaskan mothers who had a baby in
2020 had symptoms of postpartum
depression
.notdef Addresses disparities in maternal health outcomes
.notdef Medicaid plays a vital role in addressing
disparities in maternal mortality and morbidity
rates
.notdef Improves child health outcomes
.notdef Parental enrollment in Medicaid is associated
with a 29 percent higher probability that a
child will receive an annual well-child visit
Dr. Zink pointed to slide 10, Cost Savings:
.notdef The costs for providing Medicaid coverage for new
mothers who would have otherwise lost or experienced a
gap in coverage have been estimated using historical
Medicaid claims data, but these costs do not take into
account potential savings and offsetting factors.
.notdef Savings from averted severe maternal morbidity:
Medicaid-enrolled pregnant women with severe maternal
morbidity cost an average of $10,134 annually compared
to $6,894 for those without.
.notdef Savings from prevention: Preventing gaps in coverage
ensures access to primary and preventive care,
including management of chronic conditions and
screening for mental health conditions, substance use,
and intimate partner violence.
Co-Chair Hoffman wondered how the bill applied to those
hospitals by Alaska Native health corporations.
Dr. Zink replied that the bill would apply to anyone who
was covered by pregnancy Medicaid coverage, both tribal and
non-tribal.
Dr. Zink looked at slide 11, Alaska Supports SB 58:
Extending Postpartum Medicaid Coverage is supported
by:
- The American College of Obstetricians and
Gynecologists (ACOG)
- The American Medical Association
- The American Academy of Pediatrics
- The Society for Maternal-Fetal Medicine
- The American College of Physicians
- The American Academy of Family Physicians
- The American Hospital Association
- The American Psychiatric Association
- The American College of Cardiology
- The American Osteopathic Association
- The March of Dimes
Co-Chair Olson asked for an example of extreme maternal
morbidity, and the costs associated with that.
Dr. Zink replied that an example would be someone with
chronic hypertension, or someone with a development of a
clot. She stated that once the coverage was lost, a person
was less likely to have follow up care or preventative
care.
9:25:51 AM
Co-Chair Olson wondered how often eclamptic or preeclamptic
symptoms were seen post-partum.
Dr. Zink responded that those only would apply to the first
six weeks post-delivery, however women could have chronic
hypertension that can be exacerbated during pregnancy and
require long term coverage. She deferred to Dr. Nace.
Dr. Nace stated that about one quarter to one third of the
conditions would happen in the 62 day to one year post
delivery time period.
Co-Chair Olson stressed that it was a significant number.
Ms. Ricci continued to discuss slide 11. She stressed that
there was an initial upfront cost of approximately $2.6
million in UGF associated with the bill on an annual basis.
Dr. Zink pointed to slide 12, "Healthy Families
Initiative. She stated that the slide showed the overall
life impacts of the mother and baby. She stressed the
significant impact of untreated mental health.
9:31:12 AM
Dr. Zink discussed slide 13, "Healthy Families Initiative:
Strong families are the foundation of a healthy
society and a vibrant economy.
.notdef 4-year statewide investments in the health and
well-being of Alaskan families
.notdef Governor Dunleavy proposed $9.5M (UGF) in FY 24
operating budget for Healthy Families activities
within DOH:
.notdef Postpartum Medicaid extension
.notdef Office of Health Savings
.notdef TB and congenital syphilis mitigation
.notdef Fresh Start Campaign
Dr. Zink pointed to slide 15, "Section 1:
Adds a new section (o) to AS 47.07.020, authorizing
the department to implement an extension of postpartum
Medicaid coverage up to the maximum period authorized
under federal law.
Co-Chair Olson asked whether the current congenital
syphilis trend was increasing or decreasing.
Dr. Zink replied that syphilis was rapidly on the rise.
9:35:06 AM
Ms. Ricci pointed to slide 17, "Section 3:
Amends the uncodified law to establish the requirement
that the commissioner of health notifies the revisor
of statutes within 30 days of federal approval of the
state plan amendment.
Ms. Ricci addressed slide 18, "Section 4:
Establishes that the postpartum extension takes effect
on the day after the date the commissioner notifies
the revisor of statutes as described above.
Co-Chair Olson queried the anticipated number of
participants in the program.
Ms. Ricci replied that she estimated at least 1556
participants that would have lost coverage entirely, and
another 2300 that would have had gaps in coverage.
9:38:06 AM
VALERIE ROSE, FISCAL ANALYST, LEGISLATIVE FINANCE DIVISION,
(LFD) addressed the bill's fiscal note.
Co-Chair Olson queried the limit of federal funding for the
bill.
Ms. Rose replied approximately $6.4 million was needed in
additional federal authority for the department.
9:40:50 AM
Co-Chair Hoffman wondered whether the implementation of the
fiscal note would follow the same process for the initial
60 days.
Ms. Rose deferred to the department.
Co-Chair Hoffman wondered whether there would be additional
requirements to access those funds statewide.
Ms. Rose deferred to the department.
Co-Chair Hoffman said he would accept a written response.
Co-Chair Olson OPENED public testimony.
9:42:42 AM
BROOKE IVY, ALASKA CHILDREN'S TRUST, ANCHORAGE (via
teleconference), spoke in support of the bill.
9:44:54 AM
JAMIE MORGAN, GOVERNMENT RELATIONS, AMERICAN HEART
ASSOCIATION, SACRAMENTO (via teleconference), testified in
support of the legislation.
Co-Chair Olson queried the specific types of cardio
myopathies.
9:47:32 AM
ANTONIA LEONARD, SELF, EAGLE RIVER (via teleconference),
expressed concern about state-funded medical coverage.
Co-Chair Olson CLOSED public testimony.
9:50:57 AM
Ms. Zink addressed the question about the question of
maternal death related to COVID-19 vaccinations. She stated
that an internal maternal death review board reviewed all
maternal deaths by exploring all factors that would
contribute to the death. She noted that seven were suicide,
seven were drug and alcohol overdoses, eight were homicide
and assault, eight were injury, nine were pregnancy related
medical causes, and nine were other medical causes. She
stated that the medical causes were primarily heart disease
and diabetes.
Ms. Ricci thanked the committee.
SB 58 was HEARD and HELD in committee for further
consideration.
SENATE BILL NO. 55
"An Act extending the termination date of the State
Medical Board; and providing for an effective date."
9:54:05 AM
SENATOR BILL WIELECHOWSKI, SPONSOR, introduced himself.
9:54:39 AM
KALI SPENCER, STAFF, SENATOR WIELECHOWSKI, stated that SB
55 extended the termination date of the State Medical Board
to June 30, 2031. She stated that the recommendation came
from an audit performed by Legislative Audit.
9:57:43 AM
SYLVAN ROBB, DIRECTOR, DIVISION OF CORPORATIONS, BUSINESS
AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE,
COMMUNITY AND ECONOMIC DEVELOPMENT, stated that there was a
small fiscal note that reflected the continued costs to the
State Medical Board.
Co-Chair Olson asked about the significance and cost of
investigations.
Ms. Robb responded that investigation costs were not within
the fiscal note. She stated that the governors budget
proposed changing the investigation fund source.
Co-Chair Olson spoke of the cost of investigations. He
asked about the current number of investigations.
Ms. Robb said that the fiscal note reflected the cost of
running the board.
10:00:07 AM
KRIS CURTIS, LEGISLATIVE AUDITOR, JUNEAU, spoke to the
sunset audit of the board.
10:04:17 AM
AT EASE
10:04:56 AM
RECONVENED
Co-Chair Olson OPENED and CLOSED public testimony.
Senator Wielechowski stated that he did not have further
comments.
Ms. Spencer thanked the committee.
10:05:41 AM
Senator Wilson recalled that there was a new cost shift for
investigations and wondered whether a percentage of the fee
could be used for investigations. He felt that shifting the
entire cost to UGF might be too great.
Ms. Robb stated that the investigative fees would be for
the 21 boards that were covered by the Division of
Corporations, Business, and Professional Licensing. She
shared that the percentage had been examined in the past,
such as the Board of Midwives. She stressed that spreading
the set fee for every licensee, was because of the
differential of the number of licensees.
Senator Wilson felt that determining a fee to cover
investigations would not be impossible.
Ms. Robb replied that she could examine a way to determine
the fee.
Senator Wilson felt that maybe there could be a nominal fee
to offset that cost.
Co-Chair Olson wondered whether the State Medical Board
still had a long wait period to receive a license.
Ms. Robb replied that the current licensing time was
approximately eight to ten weeks.
10:10:56 AM
Co-Chair Olson wondered whether the delay was related to
podiatrists and physicians assistants.
Ms. Robb agreed to provide that information.
SB 55 was HEARD and HELD in committee for further
consideration.
SENATE BILL NO. 38
"An Act establishing the crime of interference with
emergency communications."
10:12:07 AM
Senator Wilson thanked the committee for hearing the
legislation.
Co-Chair Olson noted that there were five fiscal notes.
Senator Wilson MOVED to REPORT SB 38 with individual
recommendations and attached fiscal notes. There being NO
OBJECTION, it was so ordered.
SB 38 was REPORTED out of committee with and with three do
pass and one no recommendation; and with two new zero
fiscal notes from the Department of Administration, and
three zero fiscal notes: FN 3(COR), FN 4(LAW), FN 5(DPS).
ADJOURNMENT
10:14:09 AM
The meeting was adjourned at 10:14 a.m.