SB 74: "An Act relating to permanent fund dividends; relating to a medical assistance reform program; establishing a personal health savings account program for medical assistance recipients; relating to the duties of the Department of Health and Social Services; establishing medical assistance demonstration projects; and relating to a study by the Department of Health and Social Services."
00 SENATE BILL NO. 74 01 "An Act relating to permanent fund dividends; relating to a medical assistance reform 02 program; establishing a personal health savings account program for medical assistance 03 recipients; relating to the duties of the Department of Health and Social Services; 04 establishing medical assistance demonstration projects; and relating to a study by the 05 Department of Health and Social Services." 06 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 07 * Section 1. AS 43.23 is amended by adding a new section to read: 08 Sec. 43.23.074. Contribution to personal health savings accounts. A 09 recipient of medical assistance under AS 47.07 who is eligible to receive a permanent 10 fund dividend may elect to have 10 percent of the recipient's annual permanent fund 11 dividend deposited into a personal health savings account established under 12 AS 47.07.038. The department shall establish an application process to allow an 13 applicant, or the parent, legal guardian, or other authorized representative of an
01 unemancipated minor, to request that the department pay 10 percent of the applicant's 02 dividend directly to the applicant's personal health savings account. 03 * Sec. 2. AS 47.05 is amended by adding a new section to read: 04 Sec. 47.05.250. Medical assistance reform program. (a) The department 05 shall adopt regulations to design and implement a program for reforming the state 06 medical assistance program under AS 47.07. The reform program must include 07 (1) procedures to allow a medical assistance recipient to use a personal 08 health savings account under AS 47.07.038 for payment of premiums, copayments, 09 and deductibles if required of the recipient; 10 (2) referrals to community and social support services, including job 11 training; 12 (3) distribution of an explanation of medical assistance benefits to 13 recipients for health care services received under the program; 14 (4) expanding the use of telemedicine for primary care and urgent care; 15 (5) enhancing fraud prevention, detection, and enforcement; 16 (6) reducing the cost of behavioral health, senior, and disabilities 17 services provided to recipients of medical assistance under the state's home and 18 community-based services waiver under AS 47.07.045; 19 (7) pharmacy initiatives; 20 (8) enhanced care management; 21 (9) redesigning the payment process; 22 (10) stakeholder involvement in setting annual targets for quality and 23 cost-effectiveness; 24 (11) to the extent consistent with federal law, reducing travel costs by 25 requiring a recipient to obtain medical services in the recipient's home community, to 26 the extent appropriate services are available in the recipient's home community. 27 (b) Annually, the Department of Health and Social Services shall prepare a 28 report and submit the report to the senate secretary and the chief clerk of the house of 29 representatives and notify the legislature that the report is available within 10 days 30 after the convening of the regular session. The report must include 31 (1) realized cost savings related to reform efforts under this section;
01 (2) realized cost savings related to medical assistance reform efforts 02 undertaken by the department other than the reform efforts described in this Act; and 03 (3) a statement of whether the Department of Health and Social 04 Services has met annual targets for quality and cost-effectiveness. 05 * Sec. 3. AS 47.07 is amended by adding a new section to read: 06 Sec. 47.07.038. Personal health savings account program. The department 07 shall develop and implement a personal health savings account program for the benefit 08 of medical assistance recipients who elect to participate in the program. The program 09 must include 10 (1) consumer education strategies; 11 (2) recipient cost-sharing and copayment structures; 12 (3) a procedure for deposits in and payments from health savings 13 accounts; and 14 (4) a procedure for educating recipients about the application process 15 established by the Department of Revenue under AS 43.23.074 to allow recipients 16 who are eligible to receive a permanent fund dividend to elect to have 10 percent of 17 the dividend annually deposited in a personal health savings account. 18 * Sec. 4. AS 43.23.074; AS 47.05.250; and AS 47.07.038 are repealed October 1, 2022. 19 * Sec. 5. The uncodified law of the State of Alaska is amended by adding a new section to 20 read: 21 MEDICAID MANAGED CARE DEMONSTRATION PROJECT FOR 22 INDIVIDUALS ENROLLED IN DENALI KIDCARE; OPT IN FOR OTHER RECIPIENTS. 23 (a) On or before October 1, 2015, the Department of Health and Social Services shall design 24 and initiate a managed care demonstration project for individuals who qualify for medical 25 assistance under AS 47.07.020(b)(13) or (14) and for other medical assistance recipients who 26 opt in to the managed care demonstration project. The purpose of the demonstration project is 27 to ensure sustainability while reducing the cost of medical assistance payments and increasing 28 access to and improving the quality of care available to all medical assistance recipients. The 29 project developed under this section may include 30 (1) comprehensive care management; 31 (2) care coordination, including the assignment of a primary care case
01 manager located in the local geographic area of the recipient; 02 (3) health promotion; 03 (4) mental health parity as described in 42 U.S.C. 300gg-26.3; 04 (5) comprehensive transitional care from and follow-up to inpatient treatment; 05 (6) individual and family support; 06 (7) referral to community and social support services, including job training. 07 (b) The department may enter into contracts with one or more third-party 08 administrators to implement the project established under this section. The contract must 09 provide for a fee based on a per capita administrative expense that is fair and economical. The 10 department or administrator shall develop a comprehensive system of prior authorizations and 11 presumptive eligibility determinations for payment of services under the project. However, 12 prior authorization may not be required for mental health or primary care services. 13 (c) The department shall designate health care providers or one or more teams of 14 health care providers to provide services that are primary care and patient centered as 15 described by the department for purposes of the project under this section. The department 16 shall enter into necessary provider and fee agreements. For primary care case managers, the 17 fee agreement must include an incentive-based management fee system. The fee agreements 18 may not be based on a fee for service but must be based on performance measures, as 19 determined by the department. The performance measures must include premium payments 20 for centers of excellence according to nationally acceptable criteria and penalties for hospital- 21 acquired infections, readmissions, and failures of outcomes. 22 (d) The project under this section must include additional cost-saving measures that 23 include innovations to 24 (1) reduce travel through the expanded use of telemedicine for primary and 25 urgent care services; to the extent legal barriers prevent the expanded use of telemedicine, the 26 department shall identify those barriers; 27 (2) simplify administrative procedures for providers, including streamlined 28 audit, payment, and stakeholder engagement procedures. 29 (e) The project under this section must include a procedure to allow an election for 30 eligible medical assistance recipients under AS 47.07.020(b)(1) - (12) and (15) to opt in to the 31 managed care project.
01 (f) The department shall adopt regulations necessary to implement this section and 02 request technical assistance from and apply to the United States Department of Health and 03 Human Services for waivers or amendments to the state plan as necessary to implement the 04 project under this section. 05 (g) The project established under this section terminates October 1, 2022. 06 (h) In this section, "department" means the Department of Health and Social Services. 07 * Sec. 6. The uncodified law of the State of Alaska is amended by adding a new section to 08 read: 09 REDUCTION OF NONURGENT USE OF EMERGENCY DEPARTMENT 10 SERVICES BY MEDICAL ASSISTANCE RECIPIENTS; DEMONSTRATION PROJECT. 11 (a) On or before September 1, 2015, the Department of Health and Social Services shall 12 design and implement a demonstration project to reduce nonurgent use of emergency 13 departments by recipients of medical assistance under AS 47.07 and improve appropriate care 14 in appropriate settings for recipients. The project under this section must include 15 (1) to the extent consistent with federal law, a system for electronic exchange 16 of patient information among emergency departments; 17 (2) a process for defining and identifying frequent users of emergency 18 departments; 19 (3) a procedure for educating patients about the use of emergency departments 20 and appropriate alternative services and facilities for nonurgent care; 21 (4) to the extent consistent with federal law, a process to disseminate lists of 22 frequent users to hospital personnel to ensure that frequent users can be identified through the 23 electronic information exchange system described under (1) of this subsection; 24 (5) a process for assisting frequent users with plans of care and for assisting 25 patients in making appointments with primary care providers within 96 hours after an 26 emergency department visit; 27 (6) strict guidelines for the prescribing of narcotics; 28 (7) a prescription monitoring program; 29 (8) designation of medical personnel to review feedback reports regarding 30 emergency department use. 31 (b) The department shall adopt regulations necessary to implement this section and
01 request technical assistance from and apply to the United States Department of Health and 02 Human Services for waivers or amendments to the state plan as necessary to implement the 03 projects under this section. 04 (c) The project established under this section terminates October 1, 2022. 05 (d) In this section, "department" means the Department of Health and Social Services. 06 * Sec. 7. The uncodified law of the State of Alaska is amended by adding a new section to 07 read: 08 MEDICAID CHOICE WAIVER. The Department of Health and Social Services shall 09 apply to the United States Department of Health and Human Services for a waiver under 42 10 U.S.C. 1396n(b) if necessary to implement AS 47.05.250(11), enacted by sec. 2 of this Act. 11 * Sec. 8. The uncodified law of the State of Alaska is amended by adding a new section to 12 read: 13 DEPARTMENT OF HEALTH AND SOCIAL SERVICES FEASIBILITY STUDY. 14 (a) The department shall conduct a study analyzing the feasibility of privatizing services 15 delivered at Alaska Pioneers' Homes, the Alaska Psychiatric Institute, and select facilities of 16 the division of juvenile justice. The department shall deliver a report summarizing the 17 department's conclusions to the senate secretary and the chief clerk of the house of 18 representatives and notify the legislature that the report is available within 10 days after the 19 convening of the Second Regular Session of the Twenty-Ninth Alaska State Legislature. 20 (b) In this section, "department" means the Department of Health and Social Services. 21 * Sec. 9. The uncodified law of the State of Alaska is amended by adding a new section to 22 read: 23 MEDICAID STATE PLAN; INSTRUCTIONS. Not later than January 1, 2016, the 24 Department of Health and Social Services shall amend and submit for federal approval a state 25 plan for medical assistance coverage consistent with this Act. The Department of Health and 26 Social Services shall apply to the United States Department of Health and Human Services for 27 the choice of provider requirement and any waivers necessary to implement the projects and 28 programs described in this Act. 29 * Sec. 10. Section 11 of this Act is repealed October 1, 2022. 30 * Sec. 11. The uncodified law of the State of Alaska is amended by adding a new section to 31 read:
01 MEDICAID REFORM: CONTINGENT EFFECT. AS 43.23.074, enacted by sec. 1 of 02 this Act, AS 47.05.250, enacted by sec. 2 of this Act, and AS 47.07.038, enacted by sec. 3 of 03 this Act, take effect only if the commissioner of health and social services certifies to the 04 revisor of statutes, on or before October 1, 2017, that all of the provisions added by 05 AS 47.05.250, enacted by sec. 2 of this Act, all of the provisions added by AS 47.07.038, 06 enacted by sec. 3 of this Act, and all of the provisions added by secs. 5 - 7 and 9 of this Act 07 have been approved by the United States Department of Health and Human Services.