HOUSE BILL NO. 176 "An Act relating to medical assistance reimbursement for ground emergency medical transportation services; and providing for an effective date." 9:08:03 AM Co-Chair Foster reported that the committee last heard HB 176 on February 20, 2018. REPRESENTATIVE ADAM WOOL, SPONSOR, indicated that at the end of the last meeting there was a question regarding a 20 percent administrative fee. He related that after discussions with the Department of Health and Social Services (DHSS) it was determined to change the fee to the actual cost versus a flat rate percentage. 9:09:32 AM DAVID TEAL, DIRECTOR, LEGISLATIVE FINANCE DIVISION, pointed out that the fiscal notes started in FY 20. Technically the fiscal note was zero through FY 19. He drew attention to the new DHSS fiscal impact note allocated to Medical Assistance Administration and explained that the fiscal note showed its administrative costs [$116.6]. The allocation for one full-time position was paid for with Interagency (IA) receipts and was included in the second DHSS fiscal note. He turned to the second new DHSS fiscal note allocated to Health Care Medicaid Services and drew attention to the Services line that contained the funding [$116.6] for the previous fiscal note. He highlighted that the total expenditure was approximately $22 million and noted that state costs were covered. He detailed that when the municipal fire departments provided services for Medicaid recipients they were reimbursed for a portion of their costs and would subsequently receive a supplemental reimbursement. The department would notify the fire department that the supplemental payment was available and the amount of the non-federal share. The fire department would pay the non-federal share to the state and the state reimbursed the supplemental funds to the fire department using federal and non-federal funds. The state costs were neutral; the department assessed an administrative fee to the municipalities that were based on actual costs. The municipalities gained a federal match for some of the unreimbursed share. 9:15:02 AM Co-Chair Seaton requested more clarity for the FY 20 portion of the fiscal notes. He wanted to better understand the effective dates in Sections 3 and 4 of the bill. MARGARET BRODIE, DIRECTOR, DIVISION OF HEALTH CARE SERVICES, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, reported that the department would need to submit a state plan amendment to the Centers for Medicare and Medicaid Services (CMS) that typically took 60 days to 9 months. She elaborated that the bill was straight forward and guessed the plan amendment would be approved quickly. As a precaution, she used a date farther out to allow for the department to receive the federal approval prior to implementing the program. Co-Chair Seaton referred to Section 4 on page 3, lines 23 through 25 of the bill and read the following: Sec. 4. If AS 47.07.085, enacted by sec. 1 of this Act, takes effect, it takes effect on the day after the date the commissioner of health and social services makes a certification to the revisor of statutes under sec. 2 of this Act. Co-Chair Seaton read the corresponding language in Section 3 lines 16 through 22: Sec. 3. The uncodified law of the State of Alaska is amended by adding a new section to read: CONDITIONAL EFFECT. AS 47.07.085, enacted by sec. 1 of this Act, takes effect only if the commissioner of health and social services certifies to the revisor of statutes under sec. 2 of this Act, on or before November 1, 2018, that all of the provisions added by AS 47.07.085 have been approved by the United States Department of Health and Human Services. Co-Chair Seaton wanted to coordinate the dates and to fully understand the implementation process. Ms. Brodie responded that the bill required regulatory changes and the process typically took 6 months. The department requested that the six-month effective date be included in the bill. Co-Chair Seaton indicated that the issue had been brought up and had been dealt with in a previously adopted amendment. Mr. Teal interjected that through a previous Medicaid program the state had made advance payments and was unable to recover the costs amounting to $100 million. He noted that delaying the effective dates for federal and regulatory approval was in response to the previous incident and the delays insured that the program had a low financial risk to the state. He discerned that in addition to the certification, the state could recoup the costs from the municipalities if reimbursement was not received. 9:20:14 AM Representative Wilson asked that if the program was eliminated the state was not required to back fill with state funding. Ms. Brodie responded in the affirmative. Co-Chair Seaton MOVED to report CSHB 176 (FIN) out of Committee with individual recommendations and the accompanying fiscal notes. There being NO OBJECTION, it was so ordered. CSHB 176 (FIN) was REPORTED out of committee with a "do pass" recommendation and with two new fiscal impact notes by the Department of Health and Social Services. 9:21:34 AM AT EASE 9:22:06 AM RECONVENED