Legislature(2017 - 2018)SENATE FINANCE 532
04/16/2018 01:30 PM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB151 | |
| HB176 | |
| HB213 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 176 | TELECONFERENCED | |
| += | HB 213 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 151 | TELECONFERENCED | |
CS FOR HOUSE BILL NO. 176(FIN)
"An Act relating to medical assistance reimbursement
for emergency medical transportation services; and
providing for an effective date."
2:20:47 PM
REPRESENTATIVE ADAM WOOL, SPONSOR, introduced himself.
ROB EARL, STAFF, REPRESENTATIVE ADAM WOOL, introduced
himself.
2:21:00 PM
Representative Wool explained that the bill would set up a
mechanism that the Department of Health and Social Services
(DHSS) could use to gain access to federal funds that could
then be dispersed to municipalities to further reimburse
them for medical transport, both ground and air. He relayed
that, currently, emergency medical services (EMS) were only
compensated for a fraction of the costs associated with
transporting a Medicaid beneficiary. The bill requests that
the federal government amend Alaska's Medicaid plan to
include supplemental reimbursements for medical transport.
He said that the Title 19 Social Security Act allowed for a
certain reimbursement for states. Tribal transports would
be reimbursed at 100 percent. He noted other states that
had enacted similar programs. He stated that in 2017,
Alaska had 21,000 claims for ground transport, averaging
$800, unreimbursed by Medicaid, for each transport. Based
on those numbers, the state could receive roughly $8.5
million to recoup some of the transport costs. He furthered
that there had been 281 claims in air transport in 2017,
averaging $17,000 for each incident. Based on those numbers
the state could receive $2 million in unreimbursed costs.
He stated that the number of transports was increasing in
the state due to the opioid crisis. He cited the document
"HB 176 Flow Chart"(copy on file).
2:25:23 PM
Mr. Earl looked at the document titled, "Flow Chart" (copy
on file). The chart illustrated the flow of funds for
medical transport:
Explanation Based on Hypothetical $1000 Transport
Cost The Provider is reimbursed $400 under regular
state Medicaid for a $1000 transport. This leaves a
$600 UCC. Under HB 176, the Provider then sends $300
to DHSS (Supplemental) and CMS matches with the $300
federal share. DHSS then sends $600 back to the
Provider. The Provider recoups $700 of the $1000
Transport Cost ($400 Regular State Medicaid + $300
Federal Share). Administrative fees (expected to be
nominal) will be deducted from the reimbursement to
the Provider.
2:27:00 PM
Vice-Chair Bishop asked what would happen in the
hypothetical scenario if the bill were not to pass.
Mr. Earl replied that the provider would get the $400, but
that the bill would offer significant help.
2:27:18 PM
Vice-Chair Bishop said that the non-reimbursable rate of
transport was reaching crucial levels in his district.
2:27:53 PM
Co-Chair MacKinnon queried how the department would process
the $800 piece of paperwork.
2:28:11 PM
Representative Wool looked at the fiscal note, which
reflected that one person would need to be hired to process
the paperwork. The cost would be passed on to the federal
government in the overall cost of the uncompensated portion
of the transportation bill. The 50/50 split for the
administrative cost was between the federal government and
municipalities.
2:28:59 PM
Vice-Chair Bishop understood that the position started at
Range 18, or $97,000 annually.
2:29:26 PM
Co-Chair MacKinnon asked whether the state would need to
apply for a waiver.
Representative Wool replied that a negotiated new contract
would need to be approved by the Center for Medicaid
Services (CMS); approval was expected.
2:30:02 PM
Co-Chair MacKinnon asked whether the program involved a
waiver or a contract.
Representative Wool deferred to the department for
confirmation.
2:30:44 PM
MARGARET BRODIE, DIRECTOR, DIVISION OF HEALTHCARE SERVICES,
ANCHORAGE (via teleconference), shared that the bill would
not require a waiver but would require a state plan
amendment.
2:31:05 PM
Co-Chair MacKinnon asked how ling the state plan amendment
process would take.
Ms. Brodie replied that the state plan was amended on a
regular basis; the entire process could take 30 days to 9
months.
Co-Chair MacKinnon asked whether the state had been
certified for its Medicaid system.
Ms. Brodie responded that the system had yet to be
certified.
2:31:48 PM
Co-Chair MacKinnon asked where the state was in the
certification process.
Ms. Brodie said that the department had received an email
from CMS and was in the process of setting up a
teleconference to discussed issues that had been raised.
She said that some of the issues raised by CMS were
optional and not mandatory for certification.
Co-Chair MacKinnon asked whether the state had covered all
of the critical outstanding issues.
Ms. Brodie relayed that the one issue outstanding was that
of the National Correct Coding Initiative Editing Sequence.
The issue should be cleared up by the end of April 2018.
2:33:10 PM
Co-Chair MacKinnon understood that there were other issues
still unresolved.
Ms. Brodie asserted that there were no critical defects in
the system. She added that the defects that were relevant
did no impact claims payments.
2:34:04 PM
Co-Chair MacKinnon expressed appreciation for the work done
by Ms. Brodie and her team.
2:34:49 PM
JEFF TUCKER, PRESIDENT, ALASKA FIRE CHIEFS ASSOCIATION,
KENAI (via teleconference), spoke in support of the bill.
He noted that there was zero cost to the state to implement
the program. [Mr. Tucker has a letter of support on file.]
2:37:38 PM
Co-Chair MacKinnon asked whether he was comfortable with
the 50/50 split between municipalities and the federal
government.
Mr. Tucker replied in the affirmative.
2:38:31 PM
Co-Chair MacKinnon understood that claims would be paid one
per year.
Mr. Tucker said that the payment timing would be set up in
the plan; the processing of the claims could be set up
monthly, quarterly, or annually.
2:39:15 PM
Senator Micciche warned that EMS organizations might over
invest, and the federal government could discontinue the
program.
Mr. Tucker believed that any federal program carried the
same risk. He noted that the program had existed for over
30 years.
2:40:56 PM
Co-Chair MacKinnon noted that the State of Alaska was
picking up approximately 60 percent of all healthcare
costs, at a 30 percent higher fixed cost for medical
services than the rest of the nation. She asked whether the
bill would provide another federal dollar that would drive
costs up further.
Mr. Tucker replied that he did not know whether the
legislation would drive up the cost.
2:42:25 PM
Senator Micciche lamented that medical procedures under
Medicaid were high. he was concerned that they would
increase for transport related services under the bill.
Mr. Tucker did not believe so. He stated that most
transport was provided by local municipalities or volunteer
organizations and were non-profit or publicly funded. He
believed that the bill would result in the fully realized
cost of services already being provided.
2:44:48 PM
RICH ETHERIDGE, FIRE CHIEF, JUNEAU, spoke in strong support
of the legislation. He relayed that the call volume for
emergency transportation was increasing rapidly and without
staffing increases. He understood that the program would
offset the costs that were already being incurred.
2:47:47 PM
Vice-Chair Bishop understood that the intent of the
legislation was to help municipalities collect on expenses
already incurred and not to buy new equipment.
Mr. Etheridge replied in the affirmative. He said that a
few more personnel would be needed to drive the ambulances
that were already part of the fleet.
2:48:21 PM
Co-Chair MacKinnon spoke again of the high cost of
healthcare in Alaska. She felt that Medicaid reimbursements
led to the increase in costs in the private sector.
Mr. Etheridge could not speak to the private sector. He
replied that local municipalities were required to justify
any cost increases.
2:49:54 PM
Co-Chair MacKinnon said that it was easier to raise a fee
that was being reimbursed by the federal government and the
state. She asserted that the more services provided by the
state and federal governments, the higher the private
sector cost to receive the services.
2:50:27 PM
Senator Micciche warned that the smaller districts needed
to remember that the program was not guaranteed into the
future.
2:51:33 PM
Co-Chair MacKinnon asked whether the opioid crisis had
contributed to an increase in emergency transportation
calls.
Mr. Etheridge replied that there had been a 16 percent
increase from 2016 to 2017. In 2018 there had already been
a 12 percent increase in the call volume. Medicaid cases
constituted 25 percent of the calls received.
2:52:20 PM
Co-Chair MacKinnon asked whether EMS directed indigent
patients to DHSS to sign up for Medicaid.
Mr. Etheridge replied in the negative. He said that
hospital employees helped people to obtain services. He
said that the fire department generally ended up absorbing
the costs.
2:53:05 PM
BRITTANY SMART, FAIRBANKS NORTH STAR BOROUGH/MAYOR'S
OFFICE, FAIRBANKS (via teleconference), testified that the
borough supported the legislation. She shared that the
borough charged $1000 per ambulance transport, plus mileage
charges; however, the average Medicaid reimbursement was
only $455 per patient. During 2016, approximately 30
percent of the patients transported by borough EMS
providers were Medicaid beneficiaries, accruing more than
$430,000 in uncompensated costs.
2:54:26 PM
Co-Chair MacKinnon CLOSED public testimony.
2:54:32 PM
AT EASE
2:54:54 PM
RECONVENED
2:54:57 PM
AT EASE
2:55:21 PM
RECONVENED
2:55:24 PM
DAVID TEAL, DIRECTOR, LEGISLATIVE FINANCE DIVISION,
explained the fiscal notes. He used the $1000 hypothetical
example illustrated on the flow chart. He said that the
administrative costs were projected at approximately
$110,000, per year. He noted that local municipalities
would be reimbursed - the state would receive nothing and
would be charged nothing.
2:58:16 PM
Co-Chair MacKinnon said that the fiscal note under
discussion was note #3(copy on file). She furthered that
the second note under discussion was #4(copy on file).
Mr. Teal said that the funding sources on the fiscal notes
gave the illusion that the bill would cost the state $22
million, but that it was a net zero fiscal note. He
stressed that the fiscal notes reflected a zero cost to the
state.
3:00:44 PM
Vice-Chair Bishop interjected that the bill was budget
neutral.
3:01:07 PM
Senator Micciche asked whether the vision was that the
department would change municipalities or medical
transportation service providers a few dollars per
transport to recoup costs.
3:01:36 PM
Mr. Teal said that the state position would be paid for
with interagency receipts that came from what EMS paid to
the state. The state commission would be paid by
municipalities.
3:02:13 PM
Senator Micciche thought that the full cost would be
reimbursed, and the state would be compensated for costs.
Mr. Teal replied in the affirmative. He reiterated that the
state would not be fronting money; the municipality would
pay and then the federal government would be matching those
funds.
3:04:09 PM
Vice-Chair Bishop said that the plan was all contingent on
the federal government.
3:04:17 PM
Co-Chair MacKinnon asked for the location in the bill that
said that the state would not be fronting the money and
would not reimburse prior to receiving the federal funds.
Ms. Brodie replied that she did not know where in the bill
the language was located.
3:05:13 PM
Co-Chair MacKinnon believed that such a safeguard should be
written into the bill.
Representative Wool agreed.
3:05:40 PM
Co-Chair MacKinnon expressed concern that the state was
covering much of the cost of Medicaid in the state at the
expense of driving up private sector costs.
Ms. Brodie replied that the bill was for government
entities exclusively and would not include private sector
transportation.
3:07:32 PM
Co-Chair MacKinnon felt that there had been conflicting
information given during the meeting. She believed that the
inclusion of Tribal entities meant that private entities
had to be included in the bill.
Ms. Brodie replied that tribal entities were considered
government entities.
3:08:13 PM
Senator Micciche cited Page 2, line 10. He asked whether
there was no one enrolled at the department who was a
medical assistance provider that was a private entity. He
said that he was unaware of any air transportation
providers that were not private entities.
Ms. Brodie replied that there were private entities that
provided transport and that one of those entities was
partially owned by a Tribal entity.
3:09:04 PM
Senator Olson informed the committee that the North Slope
Borough had a leer jet and a king air aircraft for air
transport.
3:09:33 PM
Co-Chair MacKinnon relayed that the bill would be reviewed
again for consistency.
Ms. Brodie stated that there would not be a change in the
rate paid to private providers.
3:10:28 PM
Representative Wool referred to an earlier asked question.
He believed that answer could be found on Page 1, lines 8
through 13:
Except as provided in (b) of this section, the amount
of the supplemental reimbursement paid to a provider
must be equal to the amount of federal financial
participation that the department receives for the
nonfederal matching funds paid by the provider through
intergovernmental transfers or certified public
expenditures, less any administrative fee described in
(d) or (e) of this section.
3:10:45 PM
Co-Chair MacKinnon added that answers to questions about
the private section could be found on Page 2, lines 8
through 14:
(c) An emergency medical transportation service
provider is eligible to participate in the program if
the provider
(1) is enrolled with the department as a medical
assistance provider;
(2) voluntarily enters into an agreement with the
department to participate in the program;
(3) is owned or operated by the state, a
political subdivision of the state, or a
federally recognized tribe or tribal
organization;
3:10:48 PM
Representative Wool offered to walk through a Sectional
Analysis.
3:11:15 PM
Co-Chair MacKinnon determined that it would be unnecessary.
3:12:10 PM
Co-Chair MacKinnon announced that concerns and amendments
were due to her office by 5pm the following day.
CSHB 176(FIN) was HEARD and HELD in committee for further
consideration.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 176 AML Letter.pdf |
SFIN 4/16/2018 1:30:00 PM |
HB 176 |
| HB176 Sponsor Statement.pdf |
SFIN 4/16/2018 1:30:00 PM |
HB 176 |
| HB176 Flow Chart.pdf |
SFIN 4/16/2018 1:30:00 PM |
HB 176 |
| HB176 Letters of Support.pdf |
SFIN 4/16/2018 1:30:00 PM |
HB 176 |
| HB176 - Explanation of Changes.pdf |
SFIN 4/16/2018 1:30:00 PM |
HB 176 |
| HB 213 Letter to House Finance - Dept. of Revenue.pdf |
SFIN 4/16/2018 1:30:00 PM |
HB 213 |
| HB 213 Letter to House Finance - Dept. of Law.pdf |
SFIN 4/16/2018 1:30:00 PM |
HB 213 |
| HB 213--Supportive Letter.pdf |
SFIN 4/16/2018 1:30:00 PM |
HB 213 |
| HB 213 Support letter.pdf |
SFIN 4/16/2018 1:30:00 PM |
HB 213 |
| HB 213 Summary of Changes ver. R 2-8-18.pdf |
SFIN 4/16/2018 1:30:00 PM |
HB 213 |
| HB 213 Summary of Changes Ver U to N.A 4-12-2018.pdf |
SFIN 4/16/2018 1:30:00 PM |
HB 213 |
| HB 213 Sectional Analysis.pdf |
SFIN 4/16/2018 1:30:00 PM |
HB 213 |
| HB 213 Sectional Analysis Ver N.A 4-12-2018.pdf |
SFIN 4/16/2018 1:30:00 PM |
HB 213 |
| HB 213 Actual vs. POMV bar chart.pdf |
SFIN 4/16/2018 1:30:00 PM |
HB 213 |