03/01/2018 09:00 AM House FINANCE

HOUSE BILL NO. 176                                                                                                            
                                                                                                                                
     "An Act relating to medical assistance reimbursement                                                                       
     for ground emergency medical transportation services;                                                                      
     and providing for an effective date."                                                                                      
                                                                                                                                
9:08:03 AM                                                                                                                    
                                                                                                                                
Co-Chair Foster  reported that the  committee last  heard HB
 on February 20, 2018.                                                                                                       
                                                                                                                                
REPRESENTATIVE  ADAM WOOL,  SPONSOR, indicated  that at  the                                                                    
end of the last meeting there  was a question regarding a 20                                                                    
percent   administrative   fee.   He  related   that   after                                                                    
discussions  with  the  Department   of  Health  and  Social                                                                    
Services (DHSS) it  was determined to change the  fee to the                                                                    
actual cost versus a flat rate percentage.                                                                                      
                                                                                                                                
9:09:32 AM                                                                                                                    
                                                                                                                                
DAVID TEAL, DIRECTOR,  LEGISLATIVE FINANCE DIVISION, pointed                                                                    
out that the fiscal notes  started in FY 20. Technically the                                                                    
fiscal note  was zero  through FY 19.  He drew  attention to                                                                    
the  new  DHSS  fiscal  impact  note  allocated  to  Medical                                                                    
Assistance  Administration  and  explained that  the  fiscal                                                                    
note   showed  its   administrative   costs  [$116.6].   The                                                                    
allocation  for one  full-time position  was  paid for  with                                                                    
Interagency  (IA) receipts  and was  included in  the second                                                                    
DHSS fiscal  note. He turned  to the second new  DHSS fiscal                                                                    
note  allocated to  Health Care  Medicaid Services  and drew                                                                    
attention to  the Services line  that contained  the funding                                                                    
[$116.6] for  the previous fiscal note.  He highlighted that                                                                    
the  total expenditure  was  approximately  $22 million  and                                                                    
noted that state  costs were covered. He  detailed that when                                                                    
the  municipal   fire  departments  provided   services  for                                                                    
Medicaid recipients  they were  reimbursed for a  portion of                                                                    
their costs  and would  subsequently receive  a supplemental                                                                    
reimbursement.   The  department   would  notify   the  fire                                                                    
department that  the supplemental payment was  available and                                                                    
the  amount of  the non-federal  share. The  fire department                                                                    
would pay the  non-federal share to the state  and the state                                                                    
reimbursed  the supplemental  funds to  the fire  department                                                                    
using federal  and non-federal funds.  The state  costs were                                                                    
neutral; the  department assessed  an administrative  fee to                                                                    
the  municipalities that  were  based on  actual costs.  The                                                                    
municipalities  gained  a  federal  match for  some  of  the                                                                    
unreimbursed share.                                                                                                             
                                                                                                                                
9:15:02 AM                                                                                                                    
                                                                                                                                
Co-Chair  Seaton  requested  more  clarity  for  the  FY  20                                                                    
portion of the fiscal notes.  He wanted to better understand                                                                    
the effective dates in Sections 3 and 4 of the bill.                                                                            
                                                                                                                                
MARGARET   BRODIE,  DIRECTOR,   DIVISION   OF  HEALTH   CARE                                                                    
SERVICES,   DEPARTMENT  OF   HEALTH  AND   SOCIAL  SERVICES,                                                                    
reported that  the department would  need to submit  a state                                                                    
plan  amendment to  the Centers  for  Medicare and  Medicaid                                                                    
Services (CMS) that typically took  60 days to 9 months. She                                                                    
elaborated that  the bill was  straight forward  and guessed                                                                    
the  plan   amendment  would  be  approved   quickly.  As  a                                                                    
precaution, she  used a  date farther out  to allow  for the                                                                    
department  to   receive  the  federal  approval   prior  to                                                                    
implementing the program.                                                                                                       
                                                                                                                                
Co-Chair Seaton  referred to Section  4 on page 3,  lines 23                                                                    
through 25 of the bill and read the following:                                                                                  
                                                                                                                                
     Sec.  4. If  AS 47.07.085,  enacted by  sec. 1  of this                                                                    
     Act, takes  effect, it  takes effect  on the  day after                                                                    
     the  date   the  commissioner  of  health   and  social                                                                    
     services  makes  a  certification  to  the  revisor  of                                                                    
     statutes under sec. 2 of this Act.                                                                                         
                                                                                                                                
Co-Chair Seaton  read the corresponding language  in Section                                                                    
3 lines 16 through 22:                                                                                                          
                                                                                                                                
     Sec. 3.  The uncodified law  of the State of  Alaska is                                                                    
     amended by adding a new section to read:                                                                                   
     CONDITIONAL EFFECT. AS 47.07.085,  enacted by sec. 1 of                                                                    
     this  Act, takes  effect only  if  the commissioner  of                                                                    
     health and social services certifies  to the revisor of                                                                    
     statutes  under  sec.  2  of this  Act,  on  or  before                                                                    
     November 1, 2018,  that all of the  provisions added by                                                                    
     AS 47.07.085  have been approved  by the  United States                                                                    
     Department of Health and Human Services.                                                                                   
                                                                                                                                
Co-Chair Seaton wanted to coordinate  the dates and to fully                                                                    
understand the implementation  process. Ms. Brodie responded                                                                    
that the  bill required  regulatory changes and  the process                                                                    
typically took  6 months. The department  requested that the                                                                    
six-month effective  date be included in  the bill. Co-Chair                                                                    
Seaton indicated that the issue  had been brought up and had                                                                    
been dealt with in a previously adopted amendment.                                                                              
                                                                                                                                
Mr.  Teal  interjected  that  through  a  previous  Medicaid                                                                    
program the state  had made advance payments  and was unable                                                                    
to recover  the costs  amounting to  $100 million.  He noted                                                                    
that   delaying  the   effective  dates   for  federal   and                                                                    
regulatory  approval   was  in  response  to   the  previous                                                                    
incident and the  delays insured that the program  had a low                                                                    
financial risk to  the state. He discerned  that in addition                                                                    
to the certification, the state  could recoup the costs from                                                                    
the municipalities if reimbursement was not received.                                                                           
                                                                                                                                
9:20:14 AM                                                                                                                    
                                                                                                                                
Representative  Wilson   asked  that  if  the   program  was                                                                    
eliminated  the state  was not  required to  back fill  with                                                                    
state funding. Ms. Brodie responded in the affirmative.                                                                         
                                                                                                                                
Co-Chair  Seaton  MOVED to  report  CSHB  176 (FIN)  out  of                                                                    
Committee   with   individual    recommendations   and   the                                                                    
accompanying fiscal notes.                                                                                                      
                                                                                                                                
There being NO OBJECTION, it was so ordered.                                                                                    
                                                                                                                                
CSHB  176 (FIN)  was REPORTED  out of  committee with  a "do                                                                    
pass" recommendation  and with  two new fiscal  impact notes                                                                    
by the Department of Health and Social Services.                                                                                
                                                                                                                                
9:21:34 AM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
9:22:06 AM                                                                                                                    
RECONVENED