Legislature(2015 - 2016)HOUSE FINANCE 519
04/13/2015 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB190 | |
| HB123 | |
| HB154 | |
| HB105 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 190 | TELECONFERENCED | |
| + | HB 105 | TELECONFERENCED | |
| + | HB 154 | TELECONFERENCED | |
| += | HB 123 | TELECONFERENCED | |
| + | SB 26 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE BILL NO. 190
"An Act relating to a medical assistance reform
program; relating to the duties of the Department of
Health and Social Services; establishing medical
assistance demonstration projects; relating to civil
penalties for medical assistance fraud; relating to
studies by the Department of Health and Social
Services; relating to cost-containment measures for
medical assistance; and providing for an effective
date."
1:36:20 PM
HEATHER SHADDUCK, STAFF, SENATOR PETE KELLY, read from a
prepared statement:
HB 190 begins the process of reform and cost
containment needed to slow the growth of the Alaska
Medicaid program. Medicaid has grown to $1.8 Billion
of the annual operating budget, and has accounted for
22% of the total UGF increases over the last ten
years. The current and former administrations have
testified the Medicaid program, as it stands, is not
sustainable. Low oil prices and billions of dollars
in revenue shortfalls have forced us to change how we
do business. In July 2013, the Medicaid Budget Group
of the Department of Health and Social Services
reported the total spending on Medicaid services will
reach $6.3 billion in 2032, including $2.8 billion in
state matching funds. If we don't act now to bend the
growth curve of Medicaid, many of our most venerable
Alaskans will be without critical health care services
they need.
Ms. Shadduck provided a sectional analysis (copy on file)
of the bill. She read from the document:
Section 1: Adds new sections establishing civil
penalties for false claims for medical assistance and
authorizing the Department of Health and Social
Services (the department) to asses civil penalties
against medical assistance providers.
Ms. Shadduck noted that Section 1 was found on page 1, line
7 of the bill and commented that every dollar averted from
fraud translated into more money available to serve the
"most vulnerable" citizens.
Ms. Shadduck turned to Section 2 that began on page 3, line
5 of the legislation:
Section 2: Requires the Department of Health and
Social Services (the department) to design, adopt, and
implement a medical assistance (Medicaid) reform
program. Requires the department to prepare and submit
a report about reforms, savings, and costs related to
the Medicaid program. Provides for a definition of
"telemedicine."
Ms. Shadduck explained that subsection (a) mandated that
the reform program must include ten items. She read number
one from the legislation:
(1) referrals to community and social support
services, including career and education training
services available through the Department of Labor and
Workforce Development under AS 23.15, the University
of Alaska, or other sources;
Ms. Shadduck related that the state had a multitude of job
training available through its job centers, vocational
rehabilitation offices, Workforce Investment Act programs,
vocational training programs, and support from non-profits.
Ms. Shadduck continued beginning with item two:
(2) distribution of an explanation of medical
assistance benefits to recipients for health care
services received under the program;
(3) expanding the use of telemedicine for primary
care, behavioral health, and urgent care;
(4) enhancing fraud prevention, detection, and
enforcement;
(5) reducing the cost of behavioral health, senior,
and disabilities services provided to recipients of
medical assistance under the state's home and
community-based services waiver under AS 47.07.045;
Ms. Shadduck detailed that number five related to a 1915
"K" or "I" option [federal regulation related to the
Community Choice Act] which was a way to enhance the
current federal match from 50 percent to 56 percent for
option "K" and no federal match to a match of 50 percent
for option "I". The options were eligible for telemedicine
for individuals receiving home care.
Ms. Shadduck continued to read:
(6) pharmacy initiatives;
(7) enhanced care management;
Ms. Shadduck defined that enhanced care management were
methods that taught individuals how to use the healthcare
system. She noted that Medicaide recipients often needed
guidance on how to approach healthcare. She added that
enhanced care management did not detract from preventative
care and included primary healthcare, vaccines, flu shots
and all other appropriate care.
Ms. Shadduck moved to the next item on line 22:
(8) redesigning the payment process by implementing
fee agreements based on performance measures that
include premium payments for centers of excellence
according to nationally acceptable criteria and
penalties for hospital acquired infections,
readmissions, and failures of outcomes;
Ms. Shadduck related that the Department of Health and
Social Services (DHSS) would study the use of bundled rates
for physicians and diagnosis related groups for hospitals.
She exemplified that the provision would foster a
streamlined approach instead of the fee for service model
resulting in one bundled rate for a procedure such as a
knee replacement. Alaska was one of the only states not
currently using the practice in its Medicaid program.
Ms. Shadduck turned to the following items:
(9) stakeholder involvement in setting annual targets
for quality and cost-effectiveness;
(10) to the extent consistent with federal law,
reducing travel costs by requiring a recipient to
obtain medical services in the recipient's home
community, to the extent appropriate services are
available in the recipient's home community.
Ms. Shadduck stated that travel costs needed to be reduced
where possible. She pointed to incidences of consolidating
different needs within one family to make one trip to cover
various appointments as one example. She addressed
subsection (b) beginning on page 3, line 31 that related to
the department's improvements in access to telemedicine.
She related that the state's willingness to collaborate
with the Alaska Native Tribal Health Consortium (ANTHC),
which had an "extensive" network for telemedicine
throughout the state to increase access. She moved to
subsection c on page 7 of the bill. The subsection required
that DHSS submit a report to the legislature on or before
October 15 of each year that contained everything that
legislators needed to monitor for continuing reform of the
Medicaid system. She listed some of the required
information: realized cost savings related to reform;
realized cost savings undertaken by the department; a
statement of whether DHSS had met annual targets for
quality and cost-effectiveness; recommendations for
legislative or budgetary changes: impacts from federal
laws; and the results of demonstration projects. She noted
that subsection (d) [page 5, line 10] provided a definition
for telemedicine.
Ms. Shadduck cited Section 3 located on page 5, line 15 and
read:
Section 3: Requires the department to design and
implement a demonstration project to reduce nonurgent
use of emergency departments by Medicaid recipients.
Ms. Shadduck remarked that the provision enhanced what the
department had already done with its "super-utilizer
program" for individuals using the ER for primary care. The
program directed individuals to the appropriate type of
care or provider. She noted that subsection (5)on page 6,
line 1 delineated a process for referring a frequent
emergency room user (or super-utilizer) to a primary care
provider within 96 hours after an emergency room (ER) visit
directed at. The program included strict guidelines for
prescribing narcotics and a prescription drug monitoring
program. She continued with Section 4 on page 6, line 12
and read:
Section 4: Requires the department and the attorney
general to annually prepare a report regarding fraud
prevention, abuse, prosecution, and vulnerabilities in
the Medicaid program.
Ms. Shadduck directed attention to Section 5 on page 7,
line 6:
Section 5: Requires the department to develop one or
more managed care or case management demonstration
projects through a contract with a third party. The
managed care program would be for individuals enrolled
in all Medicaid programs.
Ms. Shadduck examined subsection (a) [page 7, line 9]. She
shared that Alaska was one of seven states that did not
utilize a "managed health plan" within Medicaid. Recipients
would be managed by traditional insurance carriers, i.e.
Aetna or Premera. Improved outcomes and more "one on one"
care were cited as benefits of the managed health care
model. The provision included comprehensive care management
and care coordination. She exemplified a pregnant woman
enrolled in the Denali Kidcare Program who would be
assigned a primary care case manager and would check-in
regularly with the manager, in order to build relationship
and trust. The relationship enabled the manager to
encourage healthy behavior for the most positive outcome.
The program was focused on the whole person and also
required individual and family support and referral to
community and social support services, including career
training.
1:49:23 PM
Ms. Shadduck noted subsection (b) starting on page 7, line
29 that required the department to enter into contracts
with one or more third-party administrators for the managed
care program. Subsection (c), on page 8, line 5 outlined
the requirements for services and fees between the
department and the third party administrator. She added
that Subsection (d) [on page 8 line 12] mandated the
department to include additional cost-saving measures that
included innovations through a demonstration project by
reducing travel through the expanded use of telemedicine
for primary care. The subsection also "simplified
administrative procedures for providers, including
streamlined audit, payment, and stakeholder engagement
procedures." She turned to Section 6 on page 8, line 20:
Section 6: Requires the department to conduct a study
analyzing the feasibility of privatizing certain
services.
Ms. Shadduck reminded the committee that before any state
service can be privatized a feasibility study must be
performed. The provision was aimed at the Alaska Pioneers'
Homes, the Alaska Psychiatric Institute, and select
facilities of the Division of Juvenile Justice (DJJ). She
expounded that the studies would be tailored for the
specific service. She exemplified that the division had an
underutilized facility in Nome where the Norton Sound
Health Corporation also operated. The state's facility
could be handed over to Norton Sound to run as a
residential psychiatric treatment center, thus avoiding
forcing juveniles to leave their community and receive
"culturally relevant care" paid for with a 50 percent
Medicaid funding match instead of the 100 percent general
fund costs incurred at DJJ facilities. She remarked that
the three entities listed employed 1,192 state employees.
Ms. Shadduck continued with Sections 7, beginning on page 8
line 30:
Section 7: Requires the department to amend the state
Medicaid plan and apply for any waivers necessary to
implement the projects and programs described in the
bill. Requires the Commissioner of Health and Social
Services to certify to the reviser of statutes federal
approval of specified measures.
Ms. Shadduck moved to Section 8 [page 9 line 10]:
Section 8: Allows the department to adopt regulations
necessary to implement the changes made by the Act.
The regulations may not take effect before the dates
the relevant provision of the Act takes effect.
Ms. Shadduck cited Section 9 located on page 9, line 18:
Section 9: Conditional effects.
Ms. Shadduck explained that conditional effects protected
the department from having to follow a law in the event
that the federal government did not authorize a specific
state plan or amendments or waiver needed for
implementation. She identified Sections 10 through 14
[beginning on page 10, line 7] and read:
Sections 10 - 14: Provides for effective dates for
provisos that require waiver and state plan amendment
approvals from the United States Department of Health
and Human Services.
Ms. Shadduck cited the final section [page 10, line 22]:
Section 15: Provides an immediate effective date for
sections 6, 7, and 8.
HB 190 was HEARD and HELD in committee for further
consideration.