Legislature(2017 - 2018)ADAMS ROOM 519
02/21/2018 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB321 | |
| HB176 | |
| HB96 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 96 | TELECONFERENCED | |
| += | SB 97 | TELECONFERENCED | |
| += | HB 176 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 321 | TELECONFERENCED | |
HOUSE BILL NO. 176
"An Act relating to medical assistance reimbursement
for ground emergency medical transportation services;
and providing for an effective date."
1:54:34 PM
ROB EARL, STAFF, REPRESENTATIVE ADAM WOOL, reviewed a flow
chart titled "HB 176; IGT Flow Chart" (copy on file). He
noted that the providers signified as a blue circle
encompassed municipalities, fire departments, and tribal
organizations. He exemplified a scenario of a patient
transport cost of $1 thousand that was reimbursed via state
Medicaid for $400 leaving $600 in uncompensated costs. He
indicated that the scenario represented the current
reimbursement schedule. The blue circle to the right of the
provider's circle represented state Department of Health
and Social Services (DHSS) supplemental reimbursement
proposed in HB 176. He expounded that the provider [in the
scenario] would submit a total of $300, which represented
half of the uncompensated cost or non-federal share plus a
20 percent administrative fee charged by DHSS totaling
$360. He remarked that the CS language specified "up to" 20
percent for the administrative fee. The department
submitted a bill to federal Medicaid who would reimburse
the department for $360. He referenced page 2, lines 3
through 7 of the legislation that delineated that "the
provider may not exceed the provider's actual cost for
providing emergency medical transportation?." He noted that
the reimbursement provision was explained in a box on the
lower right of flow chart. He pointed to what the provider
would recoup under the scenario. The department kept the
$120 in administrative fees and the provider recouped $640
out of $1,000 total cost.
1:58:46 PM
Representative Kawasaki asked how the administrative fee
was calculated and who received the fee. He believed the 20
percent fee was high. Mr. Earl answered that the fee was
higher than the actual administrative cost. He explained
that federal rules allowed the embellished administrative
fee. He pointed out that under the scenario the
administrative fee was matched by the federal government.
Representative Kawasaki wondered why the state did not
charge an even higher administrative fee. Mr. Earl
responded that the amount was determined by the amount the
Centers for Medicare & Medicaid Services (CMS) would likely
allow under the state plan amendment negotiations.
Representative Kawasaki asked for the reason the fee was
set at 20 percent. He wondered if it was linked to the
ambulance fee. He asked whether there was a nexus between
the administrative fee and the total amount. Mr. Earl
replied in the negative and added that the 20 percent was
predicated on a guess regarding a likely allowable amount.
The actual administrative cost was roughly 2.6 percent.
Representative Kawasaki surmised that the state was
"getting more money from the federal government" at 20
percent.
2:02:00 PM
REPRESENTATIVE ADAM WOOL, SPONSOR, concurred that the
actual administrative cost was quite a bit less than 20
percent. He elaborated that consultants in other states had
relayed that 20 percent was common, with some states
charging 27 percent. He presumed that 20 percent would be
approved by CMS. The extra money would help the department
and "relieve pressure on the UGF the state was currently
providing." The idea was to not "look a gift horse in the
mouth."
Representative Kawasaki asked how much of the reimbursement
funding would go to the provider doing the transportation.
Mr. Earl answered that under the scenario none of the
administrative fee reimbursement was given to the provider.
Representative Kawasaki surmised that even if a cost of the
ambulance run was more expensive than the amount of
reimbursement the state would not distribute any of the
administrative reimbursement money to the providers.
2:04:04 PM
Representative Wool answered that the administrative
reimbursement did not go back to the provider, it went to
the state. He mentioned that one of the amendments
addressed the issue and allowed the provider to add the 20
percent administrative fee to the overall bill and then
would be reimbursed.
Representative Tilton was concerned about setting a
precedent for a 20 percent administrative fee that seemed
arbitrary. She had previously been involved in DHSS and
recounted discussions regarding administrative fees. She
supported getting as much money back as possible, but she
was concerned over setting a 20 percent precedent that
could apply to other grants and items. Representative Wool
understood the point. He reiterated that the precedent had
already been set in other states and the bill mirrored the
amount. He mentioned the state's obligation to pay
according to Title 19 of the Social Security Act. He agreed
that he would not favor a 20 percent administrative fee
charged "across the board" for every state department
including DHSS. He thought the department could address the
issue. He clarified that the bill proposed "up to" 20
percent. Representative Tilton requested an answer from
DHSS.
2:07:23 PM
MARGARET BRODIE, DIRECTOR, DIVISION OF HEALTH CARE
SERVICES, DEPARTMENT OF HEALTH AND SOCIAL SERVICES (via
teleconference), replied that she had conversations with
the Centers for Medicare and Medicaid recently and
discovered that the administrative fee could only cover the
cost of the administrative position.
Representative Tilton wondered about the state's obligation
to continue the program if the federal government ended its
funding. Mr. Earl referred to page 1, lines 9 through 11
and read: " the amount of the supplemental reimbursement
paid to a provider must be equal to the amount of federal
financial participation?" He declared that if the federal
financial participation went away the program would end.
2:08:44 PM
Co-Chair Foster MOVED to ADOPT Amendment 1, 30-LS0705\O.7
(Glover, 2/20/18) (copy on file):
Page 1, line 13:
Delete "expenses"
Insert "fee described in (d) or (e) of this
section"
Page 2, lines 19-22:
Delete oil material and insert:
"(d) If the department authorizes the use of
intergovernmental transfers under the program, the
deportment shall charge on administrative fee to a
provider to cover the deportment's costs of
administering the program. The administrative fee must
be to equal up to 20 percent of the non-federal share
the provider pays to the department. A provider may
include the administrative fee in the provider's
cost for providing an emergency medical transportation
service to a medical assistance recipient.
(e) If the department authorizes the use of certified
public expenditures under the program, the department
may establish an administrative fee for a provider. If
the department establishes an administrative fee under
this subsection, the department may allow a provider
to include the administrative fee in the provider's
cost for providing an emergency medical
transportation service to a medical assistance
recipient."
Reletter the following subsections accordingly.
Representative Wilson OBJECTED for discussion.
Mr. Earl explained the amendment. The amendment did three
things. First, the fee was changed to equal to 20 percent
versus "up to." Second, the amendment allowed the provider
to add the administrative fee to the cost of the medical
transport. Thirdly, amendment 1 separated out the
Intergovernmental Transfers (IGT) method and the Certified
Public Expenditure (CPE) methodology and allowed the
department to choose the methodology and not the providers.
He pointed to the flow chart and furthered that the
amendment allowed the providers to add the administrative
fee to the total cost of transport. Therefore, under the
scenario the provider would receive a reimbursement of $660
from the department, of which $330 was the federal
supplemental reimbursement. He cited page 2, lines 3
through 7 of the bill that delineated that the amount the
provider received may not exceed actual costs.
2:11:25 PM
Representative Wilson asked who was charging the fee. She
wondered why the bill specified what the provider had to
charge. Mr. Earl answered that the department charged the
provider the fee.
Representative Wool elaborated that he wanted an amendment
to Amendment 1 that would revert to "up to 20 percent." He
confirmed that the charge was from the department to CMS.
Representative Wilson stated that she did not have the
amendment.
2:12:48 PM
Co-Chair Seaton MOVED to ADOPT Conceptual Amendment 1 to
Amendment 1:
Lines 9 and 10, delete "must be equal to" and insert
"may not exceed."
There being NO OBJECTION, it was so ordered.
Representative Wilson asked Ms. Brodie to add clarification
to the administrative fee and what amount was allowable to
charge. Ms. Brodie replied that the federal government
would only allow to charge for actual costs. The department
would estimate the total costs and divide it by the cost of
the administrative position divided by 2 to calculate the
percentage the department would charge at the beginning of
the fiscal year. The calculation would monitor and likely
amend the percentage as the fiscal year progressed.
Representative Wilson asked if the provider could only
charge their actual administrative fees. Ms. Brodie
answered that they could only charge the actual costs that
may include administrative fees.
2:15:16 PM
Representative Wilson surmised that the amendment allowed
providers to recoup their actual administrative and service
costs. Ms. Brodie answered in the affirmative and qualified
that it was permissible as long as the provider did not
charge the administrative fees to another program.
Representative Wilson WITHDREW her OBJECTION.
There being NO OBJECTION, it was so ordered.
2:16:07 PM
Co-Chair Foster MOVED to ADOPT Amendment 2, 30-LS0705\O.5
(Glover, 2/19/18) (copy on file).
Page 2, following line 22:
Insert a new subsection to read :
"(e) This section authorizes the department
to provide supplemental reimbursements for
ground, water, or air emergency medical
transportation service provider only if the
United States Department of Health and Human
Services approves payments to that type of
emergency medical transportation service
provider."
Re-letter the following subsections accordingly.
Page 2, line 30, through page 3, line I:
Delete all material.
Renumber the following paragraphs accordingly.
Page 3, lines 8 ? 25:
Delete all material and insert:
"*See. 2.This Act takes effect immediately under AS
01.10.070(c)."
Representative Wilson OBJECTED for discussion.
Mr. Earl explained the amendment. He reminded the committee
of the concern that adding air transport might jeopardize
the entire program through rejection by CMS. The amendment
separated ground, water, and air transport to allow the
program to continue if federal Medicaid rejected the air
portion. In addition, the amendment deleted the conditional
effective date language on page 2 of the prior version and
added an immediate effective date.
Representative Wilson asked Mr. Earl to restate his
explanation.
Mr. Earl replied that the CS included air transport. He
reiterated that concerns were expressed that federal
Medicaid may deny coverage for air transport. He pointed to
subsection (f) on page 3 of the CS and restated that
ground, water, and air transport were separated and read
the following:
?reimbursements to a ground, 1 water, or air emergency
medical transportation service provider only if the
United States Department of Health and Human Services
approves payments to that type of emergency medical
transportation service provider.
Mr. Earl outlined that if CMS approved any specific type of
emergency transport the program could move forward with the
approved methods of transport.
Representative Wilson WITHDREW her OBJECTION.
There being NO OBJECTION, it was so ordered.
2:18:56 PM
Co-Chair Foster reported that the bill would be held in
committee for an updated fiscal note.
Co-Chair Seaton requested more analysis on how the law was
applied in other states. He noted the earlier discussions
regarding the state's ability to charge more and were
currently not accepting federal dollars that other states
were collecting.
Representative Wool agreed with Co-Chair Seaton. He relayed
that he had been assured by his consultant that other
states were charging a fee of 20 percent and 27 percent.
The department was using the ITE and CPE methodologies,
which might be the source of the discrepancy between Alaska
and the other states. He would follow-up with answers.
Representative Guttenberg asked for clarification about
whether it was a new administrative charge on top of what
was currently being done. He wondered whether the state was
receiving reimbursement differently under the bill. He
asked whether the prior method charged less than 20
percent. He asked if the program was displacing one set of
money for another.
2:21:44 PM
Ms. Brodie replied that there were two different payments:
the initial billing went through the Medicaid Management
Information System with all other weekly bills. She
delineated that subsequently, the department billed the
provider the difference between what they claimed in total
cost and the amount the provider initially received from
DHSS plus the administrative fee. The department made two
payments to the providers. The first payment was the
initial allowable amount. The second payment included a
manual process where the state calculated the amount the
provider owed the department. Once the provider paid the
department it would release the supplemental reimbursement
and the providers own funds.
Co-Chair Seaton asked whether the department employed the
IGT methodology or the current method of payment. Ms.
Brodie answered that the current methodology was used for
the initial payment and the second payment used the new
methodology.
Co-Chair Seaton requested the sponsor speak with the
state's CMS to fully understand what the bill would do.
Representative Wool reminded the committee that the goal of
HB 176 was to obtain more medical transport reimbursement
regardless of the administrative fee.
HB 176 was HEARD and HELD in committee for further
consideration.