Legislature(2017 - 2018)HOUSE FINANCE 519
02/16/2018 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB284 || HB285 || HB286 || HB321 | |
| HB176 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 284 | TELECONFERENCED | |
| += | HB 285 | TELECONFERENCED | |
| += | HB 286 | TELECONFERENCED | |
| += | HB 321 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 176 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE BILL NO. 176
"An Act relating to medical assistance reimbursement
for ground emergency medical transportation services;
and providing for an effective date."
2:14:18 PM
REPRESENTATIVE ADAM WOOL, SPONSOR, explained HB 176. He
stated that the bill allowed reimbursement to local fire
departments and emergency medical transport providers to
get more fully reimbursed when transporting a Medicaid
payment. He stated that, currently, the maximum
reimbursement was $400 for an ambulance ride, but the
service cost more than $400 to the departments. He stated
that it allowed for the Department of Health and Social
Services (DHSS) to apply for reimbursement from the federal
government. He explained that many states had similar
allowments. He noted that currently, the response services
were only compensated a fraction of the cost, so this bill
allowed for 50 percent more of the funding.
Representative Wilson queried more information about the
numbers.
Representative Wool replied that $600 was mission. He
stated that the provider would send in $300 to the state;
the state would apply and receive $600 from the federal
government; and $600 would be returned to the department,
with a net of $300.
Representative Wilson asked who was paying for the other
$400.
Representative Wool responded that Medicaid paid for the
$400. He stated that typically Medicaid was paid for with
50 percent from the state and 50 percent from the federal
government.
Representative Wilson surmised that $1000 would be charged
for the ambulance. The first $400 would come from the state
Medicaid program. She stated that, once the other $600 was
sent, the state would pay an additional $300 and another
$300 from the federal government. She wondered whether the
$600 totally came from the federal government.
Representative Wool replied that the entire $600 would come
from the federal government. He deferred to other
testifiers for more information.
2:20:38 PM
ROB EARL, STAFF, REPRESENTATIVE ADAM WOOL, returned to the
example of the $1000 ambulance ride. He explained that the
first $400 would be paid through state Medicaid, which was
funded divided in half between the state and federal
government. He stated that there would be a $600 non-
reimbursed cost, so the provider would submit their non-
federal match of $300 to DHSS. He explained that DHSS would
then receive $300 from the federal government, and would
return the entire $600 to the provider. Therefore, the
provider would net $300.
Representative Wilson wondered about the 20 percent
administrative fee.
Mr. Earl responded that the administrative fee could be up
to 20 percent of the entire transport cost.
Representative Wilson wondered whether there was a cap, so
the department could not go higher than 20 percent.
Mr. Earl replied that there was a state plan amendment that
DHSS would apply for federal Medicaid. He stated that, at
that state, the 20 percent was able to be added to the
provider's costs. Then they could apply for the larger
reimbursement.
Representative Guttenberg felt that the example "low-balled
the cost." He queried a maximum allowable amount for
reimbursement. He wondered whether there was a need to
include medivac air transport.
Representative Wool reported that they would be adding air
and water transport to the bill. He stated that Alaska had
many remote areas. He did not believe that there was a
maximum allowable reimbursement, because the transport of
longer hauls was expensive.
2:25:10 PM
Vice-Chair Gara supported the concept of the bill. He felt
that the fiscal note showed that of the $21 million annual
cost to the state, $11 million would come directly from the
federal government and the other $10 million would be some
form of statutory designated receipts. He queried the state
cost of the bill.
Representative Wool responded that the $21 million was not
a cost, rather it was a net gain to the state. He stated
that $11 million of that gain was from the federal
government, and $10 million was from the providers.
Co-Chair Seaton asked for a bubble flow chart. He thought
it would make it easier to follow the numbers. He asked for
an example to be included.
Representative Wool agreed to provide that information.
Representative Grenn wondered whether there would be a
change in percentage depending on a cost change.
Representative Wool believed there was no change in the
percentage based on cost of service.
Representative Pruitt wondered whether there was a general
fund expenditure.
Representative Wool responded affirmatively. He indicated a
person to manage the program would be paid for with GF
dollars.
Representative Pruitt remarked that the Anchorage Fire
Department would send the state $300, which would be
submitted to the federal government, and the full $600
would be returned to the fire department. He surmised that
the concept was that the fire department would receive $300
from the federal government. He wondered why the federal
government would want to participate in the program.
Representative Wool replied that the example was correct.
He stated that there was something in federal law that
required the federal government to make those payments.
Representative Pruitt wondered whether the other states
required the local community to go through the state to
access the federal money; or would the state take on the
role to request all. He queried the number of states that
had the program, and how the models compared to the bill.
Representative Wool replied that California, Washington,
Montana, Nevada, Texas, and Florida had similar programs in
place. He furthered that Oregon, Nebraska, Kansas, and
Illinoi had pending programs. He deferred to Mr. Clough for
more states' information.
2:32:44 PM
SCOTT CLOUGH, ALASKA FIRE CHIEFS, PORTLAND, OREGON (via
teleconference), stressed that the program was not a new
program. He shared that it was an entitlement program that
was part of Title 19 of the Social Security Act. He stated
that every state participated in the program in some form.
He shared that the concept was in effect in Alaska. He
remarked that there was no limit to the program, in the
reimbursement section. He stated that as an entitlement
program, it was a cost-based program. He shared that other
Medicaid programs had an upper payment limit (UTL), but the
UTL was tied to cost in this program. He used California as
an example, and remarked that the cost per transport in the
larger cities were approximately $500 to $600. He stated
that, conversely, there were remote areas in California
that saw transport costs of $4000 to $5000 on the federal
program. He stressed that the cap was the cost of the
transport service. He noted that the program was an
opportunity for the local government to share in the
federal government's Medicaid program. He shared that, if
an agency had a $1000 cost of transport, they would
currently receive Medicaid funds from the state for $400.
He furthered that there was an uncompensated cost of $600.
He shared that, instead of the state participating in
federal financial participation, local government would be
allowed to participate in federal financial participation
at the same rate. He remarked that 50 percent of the
uncompensated cost was the non-federal share was the
partnership of the fire department and the federal
government. He stated that the federal government would
match the 50 percent.
2:37:50 PM
Mr. Clough shared that the program was voluntary and the
individual local government providers were asking to
participate. Therefore, there could not be an expenditure
to the state. He shared that the state may need to hire a
full-time equivalent (FTE) employee for program oversight,
but the cost of that hire must be paid for by the
participating parties. He stressed that there would never
be exposure to the GF. He agreed to provide some
illustrations to help describe the 20 percent. He stressed
that the state had the right to charge a fee for the
services, because the program was voluntary. He explained
that the fee was arbitrary as it related to the cost of the
charge. He stated that Indiana charged 27 percent and
California charged 20 percent. He stated that the 20
percent fee was a cost associated with the ambulance
transport.
2:41:58 PM
RICH ETHERIDGE, JUNEAU FIRE CHIEF, JUNEAU FIRE DEPARTMENT,
stressed that fire departments across the state were seeing
unprecedented calls for service and decreasing revenues. He
stressed that the call volume in the Juneau Fire Department
increased 16 percent the year prior, and the year prior it
increased 14 percent. He furthered that the call volume had
already increased 10 percent from the year prior, so there
was no expectation of flattening the call volume. He shared
that the bill would help to make up the debt portion of the
budget. He remarked that he estimated that Juneau would
receive approximately $500,000, which was enough money to
put another ambulance into service.
2:45:18 PM
Co-Chair Seaton queried the percentage of Medicaid runs,
compared to the total.
Mr. Etheridge responded that Medicaid runs were
approximately 25 percent of the call volume. He furthered
that smaller communities with larger Medicaid population,
the Medicaid runs could be 80 percent or 90 percent of
their call volume. He shared that the Juneau Fire
Department saw approximately 5000 incidents per year, and
80 percent of those 5000 incidents were medical calls.
Co-Chair Foster OPENED Public Testimony.
KATHIE WASSERMAN, EXECUTIVE DIRECTOR, ALASKA MUNICIPAL
LEAGUE, spoke in support of the bill. She stressed that the
bill allowed for the municipalities to access needed funds
through other avenues. She shared that the money was
revenue neutral, so there would be no cost to the state.
Vice-Chair Gara shared that he did not recall receiving an
email from his community on their stance on the bill. He
noted that each communities' tax caps were different. He
wondered whether the bill would raise the revenue to the
municipality, if Anchorage were to leverage $3 million.
Ms. Wasserman answered that she thought it most communities
would put the money in their general fund, and then pass it
to the fire department to cover those costs.
Vice-Chair Gara stressed that he was a cosponsor of the
bill.
Representative Wilson felt that the bill would be positive
for every community. She assumed that the City of Anchorage
would apply the money to their general fund, because the
city "took care of their police departments and fire
stations." She stated that it was different than the
Fairbanks North Star Borough, because there were "fire
service areas." She wondered whether there was that
distinction in the bill.
Ms. Wasserman replied that each community would participate
differently in the program.
2:50:24 PM
BILL HOWELL, BETHEL FIRE DEPARTMENT, BETHEL (via
teleconference), testified in support of the legislation.
He stated that the bill would match what the fire
department had as its discretionary budget. The department
had a conservative estimate of a cost of $1,200 per
ambulance run, and they were losing money annually from
Medicaid runs. He remarked that the Bethel Fire Department
provided an important public service and were looking at
ways to provide training and keep the service going. He
asked the committee to pass the legislation.
2:53:01 PM
JIM STYERS, FAIRBANKS FIRE CHIEF, FAIRBANKS (via
teleconference), spoke in favor of the bill. He detailed
that the bill would impact the city and its citizens. The
state's budget situation was trickling down and impacting
municipalities. He was fully supportive of the bill.
2:55:32 PM
ALEX BOYD, ANCHORAGE FIRE DEPARTMENT, ANCHORAGE (via
teleconference), spoke in support of the bill. He announced
that the Anchorage Fire Department was seeing a 38 percent
increase in transports. He stated that, currently, they
were answering 28 thousand transports in the City of
Anchorage. The costs were going up while the support was
going down.
Representative Pruitt asked if Mr. Boyd saw any impact
based on the tax cap.
Mr. Boyd responded that he was unfamiliar with how the
collection of the funds would impact the tax cap, but felt
that there may potential to relieve the tax encumbrances by
alleviating some of the potential bond propositions.
Representative Pruitt had not heard this information from
anyone in the community. He did not want to unknowingly
cause any other challenges.
2:58:44 PM
Co-Chair Foster CLOSED Public Testimony.
Co-Chair Foster asked that amendments be turned into his
office by the following Tuesday.
Co-Chair Seaton asked if Ms. Brodie was available for
questions.
Co-Chair Seaton wondered whether the program treated
regular Medicaid patients and Medicaid expansion patients
in the same manner.
MARGARET BRODIE, DIRECTOR OF HEALTH CARE SERVICES,
DEPARTMENT OF HEALTH AND SOCIAL SERVICES (via
teleconference), responded that the patients were treated
the same. She furthered that the department received a
higher federal match for the Medicaid expansion population.
Co-Chair Seaton wondered whether there would be a higher
match for the Medicaid expansion client in the program.
Ms. Brodie replied that there would not be a charge of 50
percent regardless of the client. She stated that there
would be an examination of the claims, and then there would
be an appropriate match request.
Co-Chair Seaton queried the percentage for the match
portion for the transport for the Medicaid expansion
patients.
Ms. Brodie responded that the department would apply the
same match requirements as the original claim paid out.
Representative Guttenberg wondered how the bill would apply
across the state, because of the different systems of
emergency medical transport.
Ms. Brodie replied that it would be anyone who provided the
match for the unpaid share. She stressed that all the
entities already enrolled in the Medicaid program, and met
all the other requirements.
3:03:35 PM
Representative Guttenberg indicated that the concern was
the tax cap for various communities. He surmised that there
would not be a detrimental effect of every entity, should
they not file for the program.
Ms. Brodie agreed.
Vice-Chair Gara noted that the only state cost was for the
administrative position, which would be reimbursed by fees.
Ms. Brodie relayed that there were no state funds, because
the match would be provided through the fees.
Vice-Chair Gara indicated there had been some testimony
that the fee could be capped at a lower amount. He noted
that the department would not charge more than was needed
for the position.
Ms. Brodie replied in the affirmative. She stated that the
department would only charge the amount of the costs, which
were currently 0.28 percent.
Representative Wilson understood that the bill did up to 20
percent.
Ms. Brodie responded, "That's correct."
HB 176 was HEARD and HELD in committee for further
consideration.
Co-Chair Foster relayed the agenda for the following
meeting on Monday, February 19, 2018.
| Document Name | Date/Time | Subjects |
|---|---|---|
| DHSS Review WDR-HB176-2-6-18.pdf |
HFIN 2/16/2018 1:30:00 PM |
HB 176 |
| HB176 Sponsor Statement 2.13.18.pdf |
HFIN 2/16/2018 1:30:00 PM |
HB 176 |
| HB176 Additional Documents - HB 176 GEMT Summary 2.13.18.pdf |
HFIN 2/16/2018 1:30:00 PM |
HB 176 |
| HB176 Supporting Documents - LTRs of Support 2.13.18.pdf |
HFIN 2/16/2018 1:30:00 PM |
HB 176 |
| Combined_Budget_Amendments_Detail_Backup_2-13-18.pdf |
HFIN 2/16/2018 1:30:00 PM |
HB 284 HB 286 |
| HB 286 HB 284 FY2019 Combined Amendment Summary and Detail.pdf |
HFIN 2/16/2018 1:30:00 PM |
|
| HB 286 HB 284 FY2018_Supplemental_Summary_Feb_13.pdf |
HFIN 2/16/2018 1:30:00 PM |
HB 284 HB 286 |
| HB 286 HB 284 FY2019_Amendment_Summary_Feb_13.pdf |
HFIN 2/16/2018 1:30:00 PM |
HB 284 HB 286 |