Legislature(2011 - 2012)BELTZ 105 (TSBldg)

03/01/2011 02:00 PM LABOR & COMMERCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Note Time Change from 1:30 p.m. --
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
Moved SB 68 Out of Committee
Moved CSSB 92(L&C) Out of Committee
                    ALASKA STATE LEGISLATURE                                                                                  
          SENATE LABOR AND COMMERCE STANDING COMMITTEE                                                                        
                         March 1, 2011                                                                                          
                           2:03 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Senator Dennis Egan, Chair                                                                                                      
Senator Joe Paskvan, Vice Chair                                                                                                 
Senator Bettye Davis                                                                                                            
MEMBERS ABSENT                                                                                                                
Senator Linda Menard                                                                                                            
Senator Cathy Giessel                                                                                                           
COMMITTEE CALENDAR                                                                                                            
SENATE BILL NO. 92                                                                                                              
"An Act relating to dental hygienists, dentists, dental                                                                         
assistants, dental hygiene, and dentistry."                                                                                     
     - MOVED CSSB 92(L&C) FROM COMMITTEE                                                                                        
SENATE BILL NO. 68                                                                                                              
"An Act relating to the examinations, board, loans, records, and                                                                
lobbying contracts of the Alaska Commercial Fishing and                                                                         
Agriculture Bank; and providing for an effective date."                                                                         
     - MOVED SB 68 FROM COMMITTEE                                                                                               
SENATE BILL NO. 87                                                                                                              
"An Act  establishing a  program in  the Department  of Commerce,                                                               
Community,  and Economic  Development  for payment  of grants  to                                                               
health care  providers for care of  patients who are 65  years of                                                               
age or older."                                                                                                                  
     - HEARD AND HELD                                                                                                           
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: SB  92                                                                                                                  
SHORT TITLE: DENTISTS/DENTAL HYGIENISTS/ASSISTANTS                                                                              
SPONSOR(s): SENATOR(s) EGAN                                                                                                     
02/21/11       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/21/11       (S)       L&C, FIN                                                                                               
02/24/11       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                      
02/24/11       (S)       Heard & Held                                                                                           
02/24/11       (S)       MINUTE(L&C)                                                                                            
03/01/11       (S)       L&C AT 2:00 PM BELTZ 105 (TSBldg)                                                                      
BILL: SB  68                                                                                                                  
SHORT TITLE: COMMERCIAL FISHING & AGRICULTURE BANK                                                                              
SPONSOR(s): SENATOR(s) COGHILL                                                                                                  
01/26/11       (S)       READ THE FIRST TIME - REFERRALS                                                                        
01/26/11       (S)       L&C, FIN                                                                                               
02/24/11       (S)       L&C AT 1:30 PM BELTZ 105 (TSBldg)                                                                      
02/24/11       (S)       Heard & Held                                                                                           
02/24/11       (S)       MINUTE(L&C)                                                                                            
03/01/11       (S)       L&C AT 2:00 PM BELTZ 105 (TSBldg)                                                                      
BILL: SB  87                                                                                                                  
SHORT TITLE: GRANTS FOR SENIORS' MEDICAL CARE                                                                                   
SPONSOR(s): SENATOR(s) FRENCH                                                                                                   
02/11/11       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/11/11       (S)       L&C, FIN                                                                                               
03/01/11       (S)       L&C AT 2:00 PM BELTZ 105 (TSBldg)                                                                      
WITNESS REGISTER                                                                                                              
DANA OWEN                                                                                                                       
Staff to the Senate Labor and Commerce Committee                                                                                
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Explained CSSB 92 (L&C) version D.                                                                        
JOSH BANKS                                                                                                                      
Staff to Senator Coghill                                                                                                        
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Available to answer questions on SB 68 for                                                                
the sponsor.                                                                                                                    
SENATOR FRENCH                                                                                                                  
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Sponsor of SB 87.                                                                                         
ANDY MODEROW                                                                                                                    
Staff to Senator French                                                                                                         
Alaska State Legislature                                                                                                        
Juneau, AK                                                                                                                      
POSITION STATEMENT: Provided sectional analysis  of SB 87 for the                                                           
PAT LUBY, Advocacy Director                                                                                                     
AARP Alaska                                                                                                                     
Anchorage, AK                                                                                                                   
POSITION STATEMENT: Supported SB 87.                                                                                          
JON SHERWOOD, Director                                                                                                          
Medicaid Special Projects                                                                                                       
Division of Health Care Services                                                                                                
Department of Health and Social Services (DHSS)                                                                               
POSITION  STATEMENT:  Explained how  SB  87  would work  for  his                                                             
ACTION NARRATIVE                                                                                                              
2:03:13 PM                                                                                                                    
CHAIR DENNIS EGAN  called the Senate Labor  and Commerce Standing                                                             
Committee meeting  to order at 2:03  p.m. Present at the  call to                                                               
order were Senators Paskvan, Davis, and Chair Egan.                                                                             
          SB  92-DENTISTS/DENTAL HYGIENISTS/ASSISTANTS                                                                      
CHAIR  EGAN announced  SB 92  to  be up  for consideration  [CSSB                                                               
92(L&C) version I was before the committee.]                                                                                    
DANA  OWEN, staff  to the  Senate Labor  and Commerce  Committee,                                                               
said there is a new committee substitute (CS), version D.                                                                       
SENATOR PASKVAN moved to adopt CSSBL 92(L&C) 27-LS0403\D.                                                                       
CHAIR EGAN objected for discussion purposes.                                                                                    
MR. OWEN explained that this  version contains two recommendation                                                               
changes. On page 4, line 2,  reference to the board requiring the                                                               
fees  has  been  deleted;  testimony   said  the  department  was                                                               
supposed  to set  the fees  in  consultation with  the board.  In                                                               
section 5, on  page 4, lines 12-26, language has  been updated to                                                               
make notification  less specific than original  language that had                                                               
the department  notifying licensees by mail.  New language allows                                                               
notification and renewal over the Internet.                                                                                     
CHAIR EGAN found  no questions and moved to  report CSSB 92(L&C),                                                               
version  D, from  committee with  individual recommendations  and                                                               
attached fiscal note(s). There were no objections and it was so                                                                 
2:06:32 PM                                                                                                                    
At ease from 2:06 to 2:07 p.m.                                                                                                  
2:07:27 PM                                                                                                                    
          SB  68-COMMERCIAL FISHING & AGRICULTURE BANK                                                                      
CHAIR EGAN announced SB 68 to be up for consideration.                                                                          
JOSH BANKS, staff to Senator Coghill, sponsor of SB 68, said he                                                                 
would answer questions.                                                                                                         
SENATOR PASKVAN moved to report SB 68 from committee with                                                                       
individual recommendations and attached fiscal note(s). There                                                                   
were no objections and it was so ordered.                                                                                       
2:08:16 PM                                                                                                                    
At ease from 2:08 to 2:09 p.m.                                                                                                  
2:09:06 PM                                                                                                                    
            SB  87-GRANTS FOR SENIORS' MEDICAL CARE                                                                         
CHAIR EGAN announced SB 87 to be up for consideration.                                                                          
SENATOR FRENCH, sponsor of SB 87, read the sponsor statement                                                                    
into the record as follows:                                                                                                     
     Our  Medicare system  is broken  in  Alaska.  Too  many                                                                    
     seniors cannot find a  primary care doctor.  Physicians                                                                    
     who do  accept Medicare patients are  losing money with                                                                    
     each visit, as  the cost of providing  care exceeds the                                                                    
     federal reimbursement rate.                                                                                                
     We  can't  wait  for  the  federal  government  to  fix                                                                    
     Medicare;  instead,   we  need  to  act   today.   This                                                                    
     legislation  will immediately  improve seniors'  access                                                                    
     to primary care services in Alaska.                                                                                        
     SB  87  establishes  a  grant   fund  for  health  care                                                                    
     providers serving Alaskans who  are sixty-five years of                                                                    
     age  or  over.  The  grants  will  be paid  to  medical                                                                    
     providers  that   increase  primary  care   access  for                                                                    
     Alaska's   seniors.   All   health  care   providers  -                                                                    
     including   physicians,    nurse   practitioners,   and                                                                    
     physician assistants - would be eligible for grants.                                                                       
     Access  to primary  care improves  health outcomes  and                                                                    
     reduces medical  costs.  Instead  of waiting  for small                                                                    
     ailments  to  become  serious  problems,  primary  care                                                                    
     prevents  expensive  medical  treatments.   Instead  of                                                                    
     requiring an  emergency room visit, primary  care keeps                                                                    
     our seniors healthy.                                                                                                       
     Without  this bill,  doctors  can't  afford to  provide                                                                    
     seniors with these  crucial preventative services.  For                                                                    
     most  primary care  visits,  a  physician receives  $60                                                                    
     less  from  Medicare  than they  receive  from  private                                                                    
     health insurance.   In some instances,  physicians lose                                                                    
     well over $100 per visit.                                                                                                  
     This legislation  is an ounce  of prevention  that will                                                                    
     prevent the need for a  pound of cure.  It makes fiscal                                                                    
     sense.  Our seniors have paid  into the Medicare system                                                                    
     all  their   life.   I  urge   your  support   of  this                                                                    
     legislation, to make sure that  our seniors receive the                                                                    
     care that they deserve.                                                                                                    
SENATOR FRENCH explained that Senator Begich was able to insert                                                                 
a provision that states would be able to make up difference in                                                                  
Medicare payments.                                                                                                              
ANDY MODEROW, staff to Senator French, went through a sectional                                                                 
analysis of SB 87 as follows:                                                                                                   
     -Section  1  of  this  bill,  on  page  1,  lines  5-7,                                                                    
     provides a short title for the  act.  That title is the                                                                    
     Alaska Medical Care for Seniors Act.                                                                                       
     -Section 2  of the  bill, starting on  page 1,  line 8,                                                                    
     adds  a new  article  in title  18,  which pertains  to                                                                    
     Health, Safety and Housing.                                                                                                
     -Section  18.28.200 establishes  this grant  program in                                                                    
     the  department  of  commerce, community  and  economic                                                                    
     development. The  goal is outlined  by the  second part                                                                    
     of subsection (a), which states  the purpose of the law                                                                    
     is to assist  in the provision of  primary medical care                                                                    
     for seniors by health care providers in this state.                                                                        
     -Health care  provider is  described on  page 2  of the                                                                    
     bill,  and includes  physicians, osteopaths,  physician                                                                    
     assistants,  nurses, physical  therapists, occupational                                                                    
     therapists  or  chiropractors  licensed in  Alaska  and                                                                    
     qualified to provide primary care services.                                                                                
     -Section  18.28.200(b) on  page 1  lines 13-14  directs                                                                    
     the  department  to  award grant  funding  to  eligible                                                                    
     providers, if funding is made available.                                                                                   
2:15:35 PM                                                                                                                    
     -Section 18.28.200(c)  starts on  page two line  1, and                                                                    
     requires  the  department  to  adopt  regulations  that                                                                    
     carry  out   the  program.   It  requires   that  these                                                                    
     regulations  match federal  law,  and  include (in  the                                                                    
     order listed in the bill):                                                                                                 
        An application and award procedure                                                                                     
        Eligibility requirements based on the lack                                                                             
          of ability for the provider to receive                                                                                
          adequate compensation for their services                                                                              
        Proof that a grant is necessary to increase                                                                            
          primary care availability                                                                                             
        A priority for providers that serve a high                                                                             
          percentage of medically underserved                                                                                   
          populations where patients over 65 have been                                                                          
          turned away.                                                                                                          
        A 'bang for your buck' provision that gives                                                                            
          priority to providers which will show the                                                                             
          greatest increase of patients for the lowest                                                                          
          grant amounts                                                                                                         
        Any other requirements to carry out this                                                                               
     -Section 18.28.200(d)  - now  we are  on page  2, lines                                                                    
     16-20 -  specifically disallows grant funds  being used                                                                    
     to  supplement  the care  of  patients  with public  or                                                                    
     private health coverage  that adequately compensates an                                                                    
     applicant  for   primary  care,   as  defined   by  the                                                                    
     Department of Health and Social Services commissioner.                                                                     
     -Section 18.28.200(e) allows for  DCCED to consult with                                                                    
     and enter  agreements to DHSS, to  the extent permitted                                                                    
     by law.                                                                                                                    
     -Section  18.28.200(f)  provides  definitions  in  this                                                                    
     legislation - we've discussed them above.                                                                                  
        Finally on page 3, line 1, Section 3 of the bill                                                                        
     provides Revisor instructions.                                                                                             
2:17:01 PM                                                                                                                    
SENATOR PASKVAN,  focusing on  language on  page 2,  lines 13-14,                                                               
asked if  the health care  provider charges just $10  more, wuold                                                               
they  have  a higher  priority  to  get  the grant  than  another                                                               
provider that  wants $50 more. He  wanted to know how  that would                                                               
SENATOR FRENCH replied  it's not just the lowest  price that they                                                               
are willing  to do the job  for, but someone who  can demonstrate                                                               
the greatest  increase in service  for the lowest  grant amounts.                                                               
So, it's a  combination of, "I'll see X many  more patients for X                                                               
many dollars."                                                                                                                  
2:17:41 PM                                                                                                                    
PAT  LUBY,  Advocacy  Director,  AARP  Alaska,  supported  SB  87                                                               
creating  a grant  system that  would  provide a  method for  the                                                               
state to supplement federal Medicare  reimbursement. He said many                                                               
Medicare  beneficiaries  cannot  find a  primary  care  provider.                                                               
Physicians and advanced nurse practitioners  lose money when they                                                               
see a Medicare  beneficiary. They hope SB 87  will provide enough                                                               
of  an incentive  so that  primary care  providers will  see more                                                               
Medicare beneficiaries  and stop turning patients  away when they                                                               
reach their 65th birthday.                                                                                                      
SENATOR DAVIS asked the Department  of Health and Social Services                                                               
(DHSS) representative how he felt about the bill.                                                                               
2:19:51 PM                                                                                                                    
JON SHERWOOD, Medicaid Special Projects,  Division of Health Care                                                               
Services, Department  of Health and Social  Services (DHSS), said                                                               
he was prepared to talk about  the DHSS' role in this bill. Under                                                               
SB 87 the primary responsibility  is with Department of Commerce,                                                               
Community and Economic Development  (DCCED). A specific provision                                                               
in  the federal  law the  sponsor referenced  would prohibit  the                                                               
State Medicaid Agency (his department)  from operating this grant                                                               
program. The  bill gives them  a role to help  identify medically                                                               
underserved populations and look  at adequate reimbursement. They                                                               
are  comfortable   in  working   with  DCCED  to   fulfill  those                                                               
SENATOR  DAVIS asked  him  why federal  law  prohibits DHSS  from                                                               
administering this.                                                                                                             
MR. SHERWOOD  answered that the  federal Affordable Care  Act and                                                               
its amendments provide that the  grant program cannot be operated                                                               
by the state Medicaid agency.                                                                                                   
SENATOR DAVIS asked  if it could be done now  because the law was                                                               
changed, that it has to be done by some other agency.                                                                           
MR. SHERWOOD said that was correct.                                                                                             
SENATOR PASKVAN asked  if he saw a need for  this type of service                                                               
- to increase the number of people who might receive care.                                                                      
MR.  SHERWOOD  replies yes.  They  have  received complaints  and                                                               
observations from  dual eligible  Medicaid/Medicare beneficiaries                                                               
that  they have  trouble accessing  primary care  in many  of the                                                               
major communities. Typically for doctors  in the state of Alaska,                                                               
Medicaid  pays  more  than  Medicare, but  under  the  rules  for                                                               
Medicare, the state  can't pay a Medicare provider  more than the                                                               
Medicare-allowed amount. So,  it limits the state  even for their                                                               
dual eligibles.                                                                                                                 
2:23:28 PM                                                                                                                    
CHAIR EGAN thanked him for testifying  and said he would hold the                                                               
bill for  further hearing.  Finding no  further business  to come                                                               
before the committee, he adjourned the meeting at 2:24 p.m.                                                                     

Document Name Date/Time Subjects
SB 87 Sponsor Statement.PDF SFIN 3/28/2011 9:00:00 AM
SL&C 3/1/2011 2:00:00 PM
SB 87
SB 87 Sponsor lttr to Parnell.PDF SL&C 3/1/2011 2:00:00 PM
SB 87
SB 87 ISER analysis.PDF SL&C 3/1/2011 2:00:00 PM
SB 87