Legislature(2019 - 2020)ADAMS 519
03/05/2020 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB127 | |
| HB182 | |
| HB30 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | HB 127 | TELECONFERENCED | |
| += | HB 182 | TELECONFERENCED | |
| += | HB 30 | TELECONFERENCED | |
HOUSE BILL NO. 127
"An Act relating to the practice of dental hygiene;
establishing an advanced practice permit; prohibiting
unfair discrimination under group health insurance
against a dental hygienist who holds an advanced
practice permit; relating to medical assistance for
dental hygiene services; and providing for an
effective date."
1:36:59 PM
Co-Chair Johnston invited the bill sponsor to the table.
REPRESENTATIVE IVY SPOHNHOLZ, SPONSOR, reported that the
bill created an advanced practice permit which would allow
dental hygienists to provide care for underserved
populations at senior centers, healthcare facilities, day
cares and schools. Dental hygienists would be allowed to
provide care to Alaskans who were eligible for Public
Assistance, home bound, or lived in an underserved
community. The permit would be available for dental
hygienists who had a minimum of 4000 hours of clinical
experience and who were approved by the Alaska Board of
Dental Examiners. Alaska would not be the first state to
make such changes. Dental hygienists practiced under
advanced practice permits or similar permits in six other
states. She reported that 40 other states were considered
"direct access" states meaning that dental hygienists could
initiate treatment based on their assessment of a patient's
need without the authorization or the presence of a
dentist.
1:38:31 PM
Co-Chair Johnston OPENED Public Testimony.
1:38:45 PM
DOMINIC WENZELL, DENTIST AND BOARD MEMBER, ALASKA BOARD OF
DENTAL EXAMINERS, ANCHORAGE (via teleconference), reported
that the board agreed the bill addressed the concerns it
initially had with the original Senate version. Members of
the board supported HB 127 in its current form.
1:39:55 PM
KATRINA VIRGIN, PRESIDENT, ALASKA DENTAL HYGIENISTS
ASSOCIATION, KODIAK (via teleconference), supported the
advanced practice permit. The association had seen a great
demand across the state that needed to be filled. The
dental hygienists would like to be able to practice to the
extent of their licensure and abilities.
1:40:38 PM
Co-Chair Johnston CLOSED Public Testimony on the bill. She
indicated individuals from the Department of Health and
Social Services (DHSS) were available online to address
questions regarding the fiscal note.
Representative Tilton referenced the fiscal note with an
OMB component number of 3234 and cited the cost related to
the implementation into the Alaska Health Enterprise System
of $250,000. She asked for an explanation of the cost.
MELISSA HILL, ADMINISTRATIVE OPERATIONS MANAGER, DIVISION
OF HEALTH CARE SERVICES, DEPARTMENT OF HEALTH AND SOCIAL
SERVICES, ANCHORAGE, reported that a portion of the costs
were related to hours needed to work on the adjudication
and payment process. The division needed to add the billing
provider, as it was new to the system. The cost was
approximately $187,000. Once the billing provider was added
to the system, a provider change would be necessary and
would take about 600 hours to complete and cost
approximately $63,000.
Co-Chair Johnston asked about the fiscal note for HB 127 in
comparison to the fiscal notes for SB 105 related to the
Marital and Family Therapist (LMFT) licenses and SB 134 for
licensed professional counselors. The fiscal notes for both
Senate bills were $50,000 compared to $63,000 for HB 127.
She queried the difference. Ms. Hill responded that the
current legislation created a brand-new provider type. The
previous programs could be billed under a health group. If
the division was only doing a provider type change it took
about 600 hours to do the work which cost about $50,000
previously. However, the contractor's cost per hour
increased.
1:44:17 PM
RENEE GAYHART, DIVISION DIRECTOR, HEALTHCARE SERVICES,
DEPARTMENT OF HEALTH AND SOCIAL SERVICES (via
teleconference), reported that there was a price increase
on the modification hours with the contractor which was the
difference between the cost in the previous year of $50,000
with the LMFTs and the cost of $63,000 for licensed
professional counselors. The claims related to both would
be adjudicated through the newly established ASO with
Optum, their behavioral health claims. The only cost to and
through the Healthcare Services fiscal agent was the
enrollment component. The division would not be doing the
adjudication, so the price was not included. However, the
division would be doing the claims adjudication for the
dental hygienists under their new provider type.
Representative Wool asked if 600 hours of programming was
the standard every time a provider type was added into the
system. Ms. Hill responded affirmatively.
Representative Wool asked if it was an industry standard,
or whether the software was particularly cumbersome. Ms.
Gayhart replied that the division had the system in place
with Conduent, the division' fiscal agent since 2013. New
provider types were rarely added to the system. Often, they
were added as rendering providers affiliated to a provider.
She confirmed that the cost was an industry standard for
implementing a new provider type or I.D. She confirmed that
$63,000 was standard for adding the enrollment component.
The work included completing all of the related hard coding
for the system to accept a new provider type.
Representative Wool asked about the additional amount of
$180,000. Ms. Gayhart responded that the amount was related
to claims adjudication. She explained further that the
dental hygienists were currently paid under a dental
provider's number. They had a subset of codes they could
provide for cleaning and other services. Claims
adjudication ensured that as claims came through the
system, they edited to ensure that the particular provider
type was able to bill for the codes and were paid
correctly. Claims adjudication built logic into the system
to pay claims appropriately and to deny claims that should
not be paid.
Representative Wool asked if behavioral health was easier
to enter into the system because it had fewer codes. He
asked if he was accurate. Ms. Gayhart indicated that was
because the particular claims would be run through the
administrative service organization or Optum. They were not
paid through the MMIAS which was Conduent, the fiscal agent
that the dental hygienists would be under. She continued to
explain that the LMFTs and the licensed professional
counselors were being paid through a different system.
1:49:34 PM
Vice-Chair Ortiz was aware the bill was for the purpose of
better-serving underserved folks. He wondered about driving
down other costs. Representative Spohnholz reported it was
difficult to predict cost savings that would result from
the bill. However, with folks getting more preventative
care, they would likely need less surgeries and removals
and have fewer cavities which would, in turn, lead to a
savings for the state in the future. There was a value in
preventative dental care verses only urgent and treatment
related dental. Looking at preventative dental as a whole
saved the state money. She hypothesized that by increasing
access to preventative dental care, the state would save
money down the road.
Vice-Chair Ortiz asked his question because of the
communities on the list that he was aware already had
dentists providing care including the Ketchikan Indian
Community Tribal Health Clinic. Representative Spohnholz
indicated that the practitioner would be paid less and cost
the state less.
Representative Wool noted Representative Spohnholz
asserting that the state would save money in the long run.
He asked, in an underserved area without basic dental
hygiene care, if hygienists would find several problems in
patients that would require a dentist's intervention. He
spoke of his personal experience discovering larger
problems during routine dental services. He wondered if the
sponsor had anticipated or accounted for such scenarios.
Representative Spohnholz suspected there might be an
initial short-term upswing in care from a dentist. However,
in the end it would likely cost the state less.
Co-Chair Foster commented that he supported the bill. He
relayed that the local hospital in Nome, Norton Sound
Health Corporation, served 15 villages in the region and
supported the bill.
Co-Chair Johnston indicated amendments were due on March 9,
2020 by 5:00 p.m.
HB 127 was HEARD and HELD in committee for further
consideration.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 127 Dental Health Provider Shortage Areas 3.3.2020.pdf |
HFIN 3/5/2020 1:30:00 PM |
HB 127 |
| HB127 Letters of Support 05.01.19.pdf |
HFIN 3/5/2020 1:30:00 PM |
HB 127 |
| HB 127 Response to Qusestions HFIN 3.3.2020.pdf |
HFIN 3/5/2020 1:30:00 PM |
HB 127 |
| HB 182 ANDVSA Letter of Support.pdf |
HFIN 3/5/2020 1:30:00 PM |
HB 182 |
| HB 182 RAINN 2.27.20.pdf |
HFIN 3/5/2020 1:30:00 PM |
HB 182 |