HB 16: "An Act requiring the state medical assistance program to provide certain services; relating to cost containment measures for the state medical assistance program; relating to payment for adult dental services; and providing for an effective date."
00 HOUSE BILL NO. 16 01 "An Act requiring the state medical assistance program to provide certain services; 02 relating to cost containment measures for the state medical assistance program; relating 03 to payment for adult dental services; and providing for an effective date." 04 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 05 * Section 1. AS 47.07.030(b) is amended to read: 06 (b) In addition to the mandatory services specified in (a) of this section and the 07 services provided under (d) of this section, the department shall [MAY] offer [ONLY] 08 the following optional services: case management services for traumatic or acquired 09 brain injury; case management and nutrition services for pregnant women; personal 10 care services in a recipient's home; emergency hospital services; long-term care 11 noninstitutional services; medical supplies and equipment; advanced practice 12 registered nurse services; clinic services; rehabilitative services for children eligible 13 for services under AS 47.07.063, substance abusers, and emotionally disturbed or 14 chronically mentally ill adults; targeted case management services; inpatient
01 psychiatric facility services for individuals 65 years of age or older and individuals 02 under 21 years of age; psychologists' services; clinical social workers' services; marital 03 and family therapy services; professional counseling services; midwife services; 04 prescribed drugs; physical therapy; occupational therapy; chiropractic services; low- 05 dose mammography screening, as defined in AS 21.42.375(e); hospice care; treatment 06 of speech, hearing, and language disorders; adult dental and dental hygiene services; 07 prosthetic devices and eyeglasses; optometrists' services; intermediate care facility 08 services, including intermediate care facility services for persons with intellectual and 09 developmental disabilities; skilled nursing facility services for individuals under 21 10 years of age; and reasonable transportation to and from the point of medical care. 11 * Sec. 2. AS 47.07.036(b) is amended to read: 12 (b) The department, in implementing this section, may not [SHALL TAKE 13 ALL REASONABLE STEPS TO] implement cost containment measures that [DO 14 NOT] eliminate program eligibility or reduce the scope of services required or 15 authorized under AS 47.07.020 and 47.07.030 [BEFORE IMPLEMENTING COST 16 CONTAINMENT MEASURES UNDER (c) OF THIS SECTION THAT DIRECTLY 17 AFFECT PROGRAM ELIGIBILITY OR COVERAGE OF SERVICES]. The 18 department may take cost containment measures that [TAKEN UNDER THIS 19 SUBSECTION MAY] include new utilization review procedures, changes in provider 20 payment rates, precertification requirements for coverage of services, or [AND] 21 agreements with federal officials under which the federal government will assume 22 responsibility for coverage of some individuals or some services for some individuals 23 through such federal programs as the Indian Health Service or Medicare. 24 * Sec. 3. AS 47.07.036(d) is amended to read: 25 (d) Notwithstanding (a) and (b) [(a) - (c)] of this section, the department may 26 (1) apply for a section 1915(i) option under 42 U.S.C. 1396n to 27 improve services and care through home and community-based services to obtain, at a 28 minimum, a 50 percent federal match; 29 (2) apply for a section 1915(k) option under 42 U.S.C. 1396n to 30 provide home and community-based services and support to increase the federal match 31 for these programs from 50 percent to 56 percent;
01 (3) apply for a section 1945 option under 42 U.S.C. 1396w-4 to 02 provide coordinated care through health homes for individuals with chronic conditions 03 and to increase the federal match for the services to 90 percent for the first eight 04 quarters the required state plan amendment is in effect; 05 (4) evaluate and seek permission from the United States Department of 06 Health and Human Services, Centers for Medicare and Medicaid Services, to 07 participate in various demonstration projects, including payment reform, care 08 management programs, workforce development and innovation, and innovative 09 services delivery models; and 10 (5) provide incentives for telehealth, including increasing the 11 capability for and reimbursement of telehealth for recipients. 12 * Sec. 4. AS 47.07.036(e) is amended to read: 13 (e) Notwithstanding (a) and (b) [(a) - (c)] of this section, and in addition to 14 the projects and services described under (d) and (f) of this section, the department 15 shall apply for a section 1115 waiver under 42 U.S.C. 1315(a) to establish one or more 16 demonstration projects focused on innovative payment models for one or more groups 17 of medical assistance recipients in one or more specific geographic areas. The 18 demonstration project or projects may include 19 (1) managed care organizations as described under 42 U.S.C. 1396u-2; 20 (2) community care organizations; 21 (3) patient-centered medical homes as described under 42 U.S.C. 256a- 22 1; or 23 (4) other innovative payment models that ensure access to health care 24 without reducing the quality of care. 25 * Sec. 5. AS 47.07.036(f) is amended to read: 26 (f) Notwithstanding (a) and (b) [(a) - (c)] of this section, and in addition to the 27 projects and services described under (d) and (e) of this section, the department shall 28 apply for a section 1115 waiver under 42 U.S.C. 1315(a) to establish one or more 29 demonstration projects focused on improving the state's behavioral health system for 30 medical assistance recipients. The department shall engage stakeholders and the 31 community in the development of a project or projects under this subsection. The
01 demonstration project or projects must 02 (1) be consistent with the comprehensive and integrated behavioral 03 health program described under AS 47.05.270(b); and 04 (2) include continuing cooperation with the grant-funded community 05 mental health clinics and drug and alcohol treatment centers that have historically 06 provided care to recipients of behavioral health services. 07 * Sec. 6. AS 47.07.067(a) is amended to read: 08 (a) The [SUBJECT TO APPROPRIATION, THE] department shall pay for 09 minimum treatment and for preventative and restorative adult dental services provided 10 under AS 47.07.030(b) and under regulations adopted by the commissioner of health 11 in conformity with applicable federal requirements and this chapter. Regulations 12 adopted under this section must include the following: 13 (1) [EXCEPT AS PROVIDED IN (d) OF THIS SECTION,] a 14 maximum amount of benefits for preventative and restorative adult dental services of 15 $1,150 for each eligible recipient in a fiscal year; and 16 (2) specification of the scope of coverage for preventative and 17 restorative adult dental services. 18 * Sec. 7. AS 47.07.067(d) is amended to read: 19 (d) The [IF THE DEPARTMENT AUTHORIZES OR APPROVES 20 PAYMENT FOR COMPLETE OR PARTIAL DENTURES FOR AN ELIGIBLE 21 RECIPIENT, THE] department may authorize the payment for complete or partial 22 dentures for an eligible recipient in one fiscal year of the maximum payment amount 23 for not more than two fiscal years. [A RECIPIENT IS NOT ELIGIBLE FOR 24 ADDITIONAL BENEFITS UNDER THIS SECTION FOR A TWO-YEAR 25 PERIOD.] 26 * Sec. 8. AS 47.07.036(c) is repealed. 27 * Sec. 9. AS 47.07.067(b) and 47.07.067(c) are repealed. 28 * Sec. 10. The uncodified law of the State of Alaska is amended by adding a new section to 29 read: 30 MEDICAID STATE PLAN FEDERAL APPROVAL. The commissioner of health 31 shall amend and submit to the United States Department of Health and Human Services for
01 approval the state plan for medical assistance coverage consistent with AS 47.07.030(b), as 02 amended by sec. 1 of this Act, AS 47.07.036, as amended by secs. 2 - 5 and 8 of this Act, and 03 AS 47.07.067, as amended by secs. 6, 7, and 9 of this Act. 04 * Sec. 11. The uncodified law of the State of Alaska is amended by adding a new section to 05 read: 06 CONDITIONAL EFFECT; NOTIFICATION. (a) Section 1 of this Act takes effect 07 only if, on or before January 1, 2026, the United States Department of Health and Human 08 Services approves an amendment to the state plan for medical assistance coverage 09 corresponding to the amendment to AS 47.07.030(b) in sec. 1 of this Act or determines that 10 approval is not necessary. 11 (b) Sections 2 - 5 and 8 of this Act take effect only if, on or before January 1, 2026, 12 the United States Department of Health and Human Services approves an amendment to the 13 state plan for medical assistance coverage corresponding to the amendments to AS 47.07.036 14 in secs. 2 - 5 and 8 of this Act or determines that approval is not necessary. 15 (c) Sections 6, 7, and 9 of this Act take effect only if, on or before January 1, 2026, 16 the United States Department of Health and Human Services approves an amendment to the 17 state plan for medical assistance coverage corresponding to the amendments to AS 47.07.067 18 in secs. 6, 7, and 9 of this Act or determines that approval is not necessary. 19 (d) The commissioner of health shall notify the revisor of statutes when the United 20 States Department of Health and Human Services approves or disapproves an amendment to 21 the state plan for medical assistance submitted under sec. 10 of this Act. 22 * Sec. 12. If, under sec. 11(a) of this Act, sec. 1 of this Act takes effect, it takes effect on the 23 day after the date the United States Department of Health and Human Services approves the 24 corresponding amendment to the state plan or determines that approval is not necessary. 25 * Sec. 13. If, under sec. 11(b) of this Act, secs. 2 - 5 and 8 of this Act take effect, they take 26 effect on the day after the date the United States Department of Health and Human Services 27 approves the corresponding amendment to the state plan or determines that approval is not 28 necessary. 29 * Sec. 14. If, under sec. 11(c) of this Act, secs. 6, 7, and 9 of this Act take effect, they take 30 effect on the day after the date the United States Department of Health and Human Services 31 approves the corresponding amendment to the state plan or determines that approval is not
01 necessary.