04/18/2017 03:00 PM House HEALTH & SOCIAL SERVICES

         HB 176-GROUND EMER. MEDICAL TRANSPORT PAYMENTS                                                                     
                                                                                                                                
3:34:57 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that the  final order of business would                                                               
be HOUSE  BILL NO.  176, "An Act  relating to  medical assistance                                                               
reimbursement   for  ground   emergency  medical   transportation                                                               
services; and providing for an effective date."                                                                                 
                                                                                                                                
REPRESENTATIVE ZACH  FANSLER, Alaska State  Legislature, recapped                                                               
HB 176, and  paraphrased from the Sponsor  Statement [included in                                                               
members' packets],  which read  as follows  [original punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
     Emergency   Medical   Transportation  Services   (EMTS)                                                                    
     relates  to the  emergency transportation  of patients.                                                                    
     For  what  is  traditionally  considered  an  ambulance                                                                    
     ride,  EMTS   reflects  Alaska's   unique  geographical                                                                    
     challenges to  include air,  water, and  other approved                                                                    
     medical  transport services.  As  it currently  stands,                                                                    
     Alaska's  emergency  medical  service  providers  incur                                                                    
     additional uncompensated costs  when providing services                                                                    
     to  Medicaid   beneficiaries,  by  as  much   as  sixty                                                                    
     percent.                                                                                                                   
                                                                                                                                
     Reimbursement    for     ground    emergency    medical                                                                    
     transportation  services  occurs   when  the  providers                                                                    
     submit  a billing  to the  department (specifically  to                                                                    
     the  Medicaid  fiscal   agent  Conduent)  for  eligible                                                                    
     services  provided;   the  department   reimburses  the                                                                    
     provider  using  the established  Medicaid  methodology                                                                    
     and   rate;   the  department   submits   documentation                                                                    
     supporting  the   payment  of  the   federal  financial                                                                    
     participation  (FFP)   to  Centers  for   Medicare  and                                                                    
     Medicaid Services  (CMS); and once it  is approved, the                                                                    
     department receives reimbursement for  the FFP from CMS                                                                    
     that  amounts  to  the appropriate  federal  assistance                                                                    
     percentage (FMAP).                                                                                                         
                                                                                                                                
     By enacting  this legislation  along with  an amendment                                                                    
     to the  state Medicaid  plan, public EMS  providers are                                                                    
     eligible  to   access  enhanced  federal   funding  for                                                                    
     emergency medical transportation  of Medicaid patients.                                                                    
     The use  of transfers is clearly  authorized in federal                                                                    
     statute  and is  both  legal and  useful. Further,  CMS                                                                    
     provides  reimbursement  for the  administrative  costs                                                                    
     associated  with  administrating  EMTS by  as  much  as                                                                    
     twenty percent.                                                                                                            
                                                                                                                                
     Anchorage,  Juneau,  Kenai,   and  Ketchikan,  combined                                                                    
     serve approximately forty-eight  percent of the state's                                                                    
     population.  In  2015  (for Kenai)  and  2016  for  the                                                                    
     others, these departments  provided 7,035 transports to                                                                    
     Medicaid  patients,   without  EMTS,   the  departments                                                                    
     received just  $2.1 million in reimbursements;  a total                                                                    
     collective under-compensation of  roughly $3.9 million.                                                                    
     Were they  EMTS eligible,  they could have  collected a                                                                    
     total of $6 million.                                                                                                       
                                                                                                                                
     HB 176  would allow EMS  providers around the  state to                                                                    
     collect  underfunded  costs  from the  effective  date,                                                                    
     providing a  financial boon to those  organizations and                                                                    
     communities.  Even smaller  communities such  as Bethel                                                                    
     can see  over a  quarter of a  million dollars  in EMTS                                                                    
     reimbursements per year.                                                                                                   
                                                                                                                                
     As you can see from  the attached bill packet, there is                                                                    
     widespread support  for HB 176 throughout  the state to                                                                    
     help   our  local   communities  receive   payments  to                                                                    
     actively cover the services they provide.                                                                                  
                                                                                                                                
3:37:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   SULLIVAN-LEONARD    asked   why    the   various                                                               
municipalities  would  not  do this  independently,  without  any                                                               
state oversight.                                                                                                                
                                                                                                                                
REPRESENTATIVE FANSLER  explained that  there needed to  be state                                                               
acceptance to receive this expanded  reimbursement and was not an                                                               
individual decision made by a  municipality.  He pointed out that                                                               
there was no obligation for a municipality to participate.                                                                      
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  asked  if they  would  have  to                                                               
follow the state mandate.                                                                                                       
                                                                                                                                
REPRESENTATIVE FANSLER replied that this was his understanding.                                                                 
                                                                                                                                
CHAIR SPOHNHOLZ  suggested that "authorization" could  be another                                                               
way of framing this.                                                                                                            
                                                                                                                                
3:38:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  directed attention to page  2, line [13],                                                               
of the  proposed bill, and  read:  "is  owned or operated  by the                                                               
state,  a political  subdivision  of the  state,  or a  federally                                                               
recognized tribe  or tribal  organization;"   He asked  about the                                                               
reason for this language, whether  it was dictated by the federal                                                               
government.                                                                                                                     
                                                                                                                                
REPRESENTATIVE FANSLER  said that this language  was required and                                                               
was dictated by the program,  that community programs which could                                                               
receive  this  expanded  Medicaid  reimbursement  could  only  be                                                               
governmental.                                                                                                                   
                                                                                                                                
3:40:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHNSTON asked about  the changes to the committee                                                               
substitute.                                                                                                                     
                                                                                                                                
REPRESENTATIVE FANSLER  explained that  as the original  bill had                                                               
been   written  for   ground  emergency   medical  transportation                                                               
services,  and was  hence  limited, it  had  been recommended  to                                                               
expand  the proposed  bill and  address emergency  transportation                                                               
services.                                                                                                                       
                                                                                                                                
REPRESENTATIVE JOHNSTON  expressed her  concern for  the increase                                                               
in usage of emergency rooms  and ambulances.  She questioned how,                                                               
policy wise,  to put  "sidebars" on  this.   She stated  that the                                                               
original  policy was  to move  individuals away  from the  use of                                                               
emergency services and the emergency  rooms and that the proposed                                                               
bill was not moving in that direction.                                                                                          
                                                                                                                                
3:43:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FANSLER  acknowledged that  he was  very cognizant                                                               
of  these  concerns  for  an enticement  that  people  would  use                                                               
emergency services,  which had  higher costs.   He  declared that                                                               
the  focus of  the  proposed  bill was  for  transportation.   He                                                               
shared that he "would love to  figure out a policy that starts to                                                               
say  let's  have  people  using   their  primary  care  situation                                                               
better."   He  suggested that  there  was a  need for  additional                                                               
service  providers  and  better  education for  defining  a  true                                                               
emergency.   He stated that it  was his belief that  the proposed                                                               
bill did not entice the use  of these services or would "drive up                                                               
the use of emergency rooms."                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHNSTON asked  if he was interested  to putting a                                                               
sunset clause  in the bill,  or an amendment  for accountability,                                                               
which could include  a reporting mechanism.  She  stated that she                                                               
had concerns for the proposed bill.                                                                                             
                                                                                                                                
3:46:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FANSLER replied that he  had no interest in either                                                               
an amendment  or a sunset  provision, at  this time.   He offered                                                               
his belief that public testimony  indicated that the use of these                                                               
services  was increasing  statewide.   He suggested  a cause  and                                                               
effect type  of experiment  prior to  deciding that  the proposed                                                               
bill had  created an increase  in the use of  emergency services.                                                               
He  opined that  the  legislature  was "inclined  to  be our  own                                                               
sunset provision or our own sidebars on these kinds of thing."                                                                  
                                                                                                                                
CHAIR  SPOHNHOLZ  reminded  the  committee  that  emergency  room                                                               
physicians were  working on  a database  of causes  for emergency                                                               
room utilization,  and she suggested  that this may offer  a more                                                               
direct solution to the aforementioned problem.                                                                                  
                                                                                                                                
3:48:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD asked if  CPT codes were used for                                                               
transportation or were the transportation billings separate.                                                                    
                                                                                                                                
REPRESENTATIVE FANSLER said that he  did not know how the medical                                                               
billing was  handled, although he  offered his belief that  a CPT                                                               
code was used.   He clarified that each  municipality handled its                                                               
own transportation for the Medicaid  reimbursement and he offered                                                               
an example for the City of Bethel.                                                                                              
                                                                                                                                
REPRESENTATIVE    SULLIVAN-LEONARD    asked    if    the    basic                                                               
transportation fee  was separate from  any other charges  and how                                                               
was it billed and matched to the patient.                                                                                       
                                                                                                                                
REPRESENTATIVE FANSLER said that he did not know.                                                                               
                                                                                                                                
3:53:24 PM                                                                                                                    
                                                                                                                                
RICHARD  ETHERIDGE,   Chief,  Capital   City  Fire   and  Rescue,                                                               
explained  that most  fire departments  and EMS  departments used                                                               
third party billers.  He said  that the department would fill out                                                               
an EMS report with detailed  descriptions for everything done, as                                                               
there were  different rates for  each type of  transportation and                                                               
care, and  then the  billing company would  sort out  the billing                                                               
codes  to go  to either  the insurance  companies or  Medicare or                                                               
Medicaid.                                                                                                                       
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  asked   if  Medicaid  made  its                                                               
decision based on whether the patient  was injured, or if it only                                                               
paid for transportation.                                                                                                        
                                                                                                                                
MR. ETHERIDGE expressed  his agreement.  He  addressed an earlier                                                               
question  from  Representative  Eastman  regarding  the  outlying                                                               
departments around Anchorage.  He  stated that if an organization                                                               
was  affiliated  with  a  municipality  and  had  a  relationship                                                               
whereby they could bill through  them, that organization would be                                                               
included in this program.                                                                                                       
                                                                                                                                
3:55:13 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ opened public testimony.                                                                                        
                                                                                                                                
3:55:24 PM                                                                                                                    
                                                                                                                                
TOM  WESTCOTT,   President,  Alaska   Professional  Firefighters,                                                               
stated  support  for  proposed  HB   176.    He  said  that  fire                                                               
departments  and EMS  providers around  the state  determined the                                                               
cost of ambulance  transports and charged accordingly.   He noted                                                               
that Medicaid  only reimbursed a  percentage of the  actual cost,                                                               
which lead to local tax payers  needing to make up the difference                                                               
to maintain adequate  EMS services.  He stated  that the proposed                                                               
bill would  allow departments the opportunity  to demonstrate the                                                               
actual  costs of  transports and  be reimbursed  accordingly when                                                               
transporting  Medicaid  patients.     He  pointed  out  that  the                                                               
increase in revenue could then be  spent as seen fit by the local                                                               
government.   He reminded the committee  that as the cuts  at the                                                               
state   level   had   resulted  in   cost   shifting   in   local                                                               
municipalities,  the  proposed  bill  would help  the  cities  to                                                               
better deal with the increased costs.   He pointed out that there                                                               
was about a 12-month lag for implementation of the program.                                                                     
                                                                                                                                
3:57:48 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHNSTON asked about  any statistics for the usage                                                               
of transport for Medicare or Medicaid.                                                                                          
                                                                                                                                
3:58:12 PM                                                                                                                    
                                                                                                                                
MARGARET BRODIE, Director, Director's  Office, Division of Health                                                               
Care  Services, Department  of Health  and Social  Services, said                                                               
that  although they  did keep  statistics, she  did not  know the                                                               
exact  costs to  the  municipalities  because the  transportation                                                               
rates were capped.                                                                                                              
                                                                                                                                
REPRESENTATIVE   JOHNSTON  asked   if  the   statistics  included                                                               
anything regarding the need for transport.                                                                                      
                                                                                                                                
MS.   BRODIE  said   that  the   statistics  only   included  the                                                               
transportation  although projects  had reviewed  the claims  data                                                               
for emergency rooms  in alignment with the  transportation to see                                                               
how much was for real emergency transport.                                                                                      
                                                                                                                                
REPRESENTATIVE JOHNSTON asked if this was an ongoing project.                                                                   
                                                                                                                                
MS.  BRODIE, in  response  to  Representative Johnston,  reported                                                               
that this had  been done as "a pilot type  project to ensure that                                                               
the use of emergency services aren't being abused."                                                                             
                                                                                                                                
4:00:04 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ closed public testimony on HB 176.                                                                              
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
4:01:59 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ brought the committee back to order.                                                                            
                                                                                                                                
4:02:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EDGMON  moved to  report  CSHB  176, Version  30-                                                               
LS0705\J,  Glover,  4/7/17,  out  of  committee  with  individual                                                               
recommendations and  the accompanying fiscal notes.   There being                                                               
no objection, CSHB  176(HSS) was moved from the  House Health and                                                               
Social Services Standing Committee.