Legislature(2017 - 2018)HOUSE FINANCE 519
02/02/2018 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB215 | |
| HB142 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 142 | TELECONFERENCED | |
| + | HB 215 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE BILL NO. 215
"An Act relating to program receipts; and relating to
fees for services provided by the Department of Health
and Social Services."
1:36:03 PM
Vice-Chair Gara MOVED to ADOPT the proposed committee
substitute for HB 215, Work Draft 30-LS0673\O (Glover,
1/15/18).
Co-Chair Seaton OBJECTED for discussion.
ELIZABETH DIAMENT, STAFF, REPRESENTATIVE PAUL SEATON,
addressed the changes in the legislation. The bill would
amend AS 44.29.022(a) to grant the Alaska Department of
Health and Social Services the authority to collect fees to
support the administration of public health programs. She
stated that during the Finance Subcommittee process in
2017, The Division of Public Health had been identified as
a division that could be charging additional fees where
appropriate and reasonable to support its mission. She
stated that the division was not currently able to charge
fees for all its potential health related services. HB 215
would give the department the authority to charge fees for
any public health services provided under AS 18.05.010, and
Tobacco Control Programs under AS 44.29.020. The bill would
also consolidate all services listed under AS 37.05.14
provided by the department under one subsection.
1:38:31 PM
Ms. Diament addressed changes in the legislation. She
shared that during hearings in the previous committee a
stakeholder concern had been voiced considering public and
stakeholder input and the regulatory process. Basically, by
taking the discussion of charging fees out of the
legislative process and putting it into the regulatory
process, the public would not have adequate input in the
initial planning stages. She explained that within the
regulatory process, public comment came after the
regulations were drafted. She said that discussion had been
held during the interim, which had resulted in the crafting
of Section 3:
Section 3
(page 2, line 26)
Adds a new sub section to AS 44.29.022 requiring the
commissioner of health and social services to consult
with stakeholders, including at least one public
meeting, before a notice of proposed action is made
regarding the development of new fees under AS
44.29.020(a) (14) or AS 18.
She relayed that the department had already planned to hold
the meetings and that there was precedence in statute for
requiring meetings for setting fees in other situations.
Co-Chair Seaton asked if there were questions about the CS.
He WITHDREW his OBJECTION. There being NO OBJECTION, it was
so ordered.
1:40:12 PM
JILL LEWIS, DEPUTY DIRECTOR, DIVISION OF PUBLIC HEALTH,
DEPARTMENT OF HEALTH AND SOCIAL SERVICES, provided a
PowerPoint presentation, "HB 215 DHSS: Public Health Fees"
dated February 2, 2018 (copy on file). She relayed that the
division focused on services that protected the public's
health status through programs that protected that health
of every Alaskan and community. She stated that public
health services controlled infectious diseases, prevented
chronic diseases and injuries, promoted healthy lifestyles,
and protected maternal and child health. She spoke to Slide
2:
HB215 DHSS: Public Health Fees
? Public Health is able to charge fees for certain
clinical services:
? Maternal and child health services
? Nutrition services
? Preventive medical services
? Health education
? Public health nursing services
? Laboratories
Ms. Lewis relayed that the fees that the division could
collect were limited to the list on Slide 2. She turned to
Slide 3, which offered a pie chart that illustrated the
various funding sources for the division. She noted that
the red represented the general fund receipts and that the
pie slice that was slightly removed reflected the
approximately $7 million in fees currently collected. This
was out of the $117 million budget overall.
Vice-Chair Gara noted that the fiscal note specified that
the bill would raise $400,000 per year. He did not believe
it would replace the funding in an alcohol abuse treatment
fund and the tobacco fund, which were both at risk of
disappearing.
Ms. Lewis reported that the division did not receive funds
from the alcohol related fund but did receive funds from
the Tobacco Fund, approximately $8 million per year
(reflected on the slide) and over the last 6 years there
had been declining revenues in the tobacco fund. The
decline had prompted the division to join with partners in
reducing expenditures from the fund. She noted that there
was a $375,000 decrement in the FY 19 Governor's budget to
to help the sustainability of the fund in the long-term.
She expected that further reductions would be made in the
future to assure that the division spent within its means.
She said that the fees that would be collected would not be
part of the Tobacco Fund but would go into the General Fund
Program Receipts and would be redirected back into the
program that generated the fees.
1:43:55 PM
Representative Guttenberg Aske where new money was coming
into the division. He mentioned vaccine assessments and
wondered how they were being paid for. He probed the
details of who paid the fees.
Ms. Lewis responded that she would address the question as
she proceeded in her presentation. She had examples of
initial fees that would be pursued, identified services
that the division had not been able to provide due to lack
of revenue. She continued to Slide 4:
HB215 DHSS: Public Health Fees
? Public health lacks fee authority for other services
and
functions:
o Professional services
o Data extraction and analysis
o Training and expert consultation
o Administrative functions
o Inspections and certifications
o Program administration
She reiterated that the division currently lacked fee
authority for many services and functions and had look at
expanding clinical fee collections. She said that it had
been determined that the division was maximizing the fees
that it was able to collect and that the greatest
opportunity for additional fee collection was in
administrative functions and professional services.
1:46:41 PM
Ms. Lewis moved to Slide 5:
HB215 DHSS: Public Health Fees
? Fees waived if
? not in the public interest
? not economically feasible to collect
? undermines the division's public health mission
? Services not denied because of inability to pay
? Sliding fee schedules
? Limited to the actual cost
? Regulations required for each new fee
1:47:44 PM
Representative Neuman wondered about the waived fees. He
asked whether there were any indications of the fees being
waived more in one area of the state than another.
Ms. Lewis answered that the department was required to do a
state report on waived fees. She returned to Slide 2 and
stated that the fees for public health nursing services
were calculated on a sliding scale based on income.
Representative Neuman believed the issue was important. He
noted that there was currently much discussion about the
economy and that it was important to identify the "needier"
areas of the state. He cited Page 1 of the bill. He noted
that the program receipts were listed as dedicated receipts
- $8 million of $100 million - he wondered why they were
not fund coded as general fund program receipts so that the
legislature could more easily track the funds.
Ms. Lewis answered that the fees the department collected
would be designated general fund (DGF) and were part of the
General Fund (GF).
1:50:40 PM
Representative Kawasaki referenced Slide 5. He noted the
third bullet under the "Fees waived if" line:
? undermines the division's public health mission
He asked where this language was located in statute.
Ms. Lewis answered that the third bullet was not in
statute. She detailed that the third bullet was the
division's philosophy of how to approach fees. She said
that a fee would not be in the public interest if it
undermined the division's health mission.
Representative Kawasaki noted the examples of area of fee
implementation listed on the fiscal note. He asked about
the first bullet and wondered whether the payee would be
the clinic or an individual patient.
Ms. Lewis answered that the clinic would pay the fee for
the inspected radiologic device.
Representative Kawasaki looked at the other bullets on the
fiscal note. He queried who would be directly paying the
listed fees.
Ms. Lewis responded that it would likely be some type of
organization rather than an individual. She said that the
administrative fee for the loan repayment program would be
paid by the employers of the practitioners who were
receiving the loan repayment program. The custom,
statistical, and epidemiological analysis and other types
of data that could be charged for, would depend of who was
requesting the information, which could be from a wide
variety of entities.
1:53:33 PM
Representative Tilton asked about the forth bullet on the
fiscal note:
* The division has turned away requests to assist with
community health assessments and community action plan
development. The division lost the capacity for this
service when the position funded with unrestricted
general funds was eliminated in recent budget cuts.
The ability to charge fees would enable us to once
again support local efforts for healthier
communities. No new positions are needed; the
division will utilize existing positions. ($125.0
DGF)
Representative Tilton noted that the note went on to
reflect that no new positions were needed and asked whether
the division would need to fill the lost position mentioned
in the bullet point.
Ms. Lewis answered that if the division was looking to fund
a position it would utilize existing positions. She said
that the division had roughly 426 positions, with 50
current vacancies. She said that priorities across the
division were considered when addressing vacancies. She
said that using existing positions before seeking
additional staffing was the preferred practice of the
division.
Representative Guttenberg referenced a letter provided to
the committee by ASHNHA dated January 31, 2018 (copy on
file). He asked whether the committee would hear from the
organization.
Co-Chair Seaton relayed that the committee could hear from
them later in the meeting.
1:55:50 PM
Representative Neuman asked whether the money in the fiscal
note had been included in the FY 19 budget for the
department.
Ms. Lewis replied that the department had no additional
fees reflected in the bill included in the FY 19 budget.
She said that could analysis and discussions with
stakeholders would need to happen first.
Representative Neuman asked whether the department expected
additional money for FY 19 as a result of the legislation.
Ms. Lewis answered that the services were not being
provided by eh department currently and that no additional
funding had been requested or expected.
1:57:51 PM
Representative Guttenberg asked for ASHNHA's initial
concerns about the bill. He asked about the changes in the
current version.
JEANNIE MONK, VICE PRESIDENT, ALASKA STATE HOSPITAL AND
NURSING HOME ASSOCIATION (ASHNHA), replied that the
organization' original concern was that there would be an
opportunity for shareholders to provide input prior to the
beginning of the regulation process.
Representative Guttenberg asked how the fees would affect
the hospital in the state and other clinics.
Ms. Monk answered that anytime additional regulatory burden
was put on a health organization someone had to pay for the
cost. She did not believe the bill would result in
increased costs to users.
Vice-Chair Gara understood that the process was new. He
wondered whether the extra layer of stakeholder feedback in
the regulatory process would add to the cost of fee
changes.
Ms. Lewis answered that the department would be able to
absorb the cost associated with meeting with stakeholders.
the costs. She noted that the stakeholders would vary for
each individual fee. She said that the division had always
intended to receive input from stakeholders. She reminded
the committee that the fees under discussion were fees that
were not currently levied, and it was necessary to make
sure that the fees would not undermine the public health
mission and that the fees were set up in a reasonable way.
2:02:34 PM
Representative Kawasaki wondered how deep Title 18 would go
when added to the administration of public health. He was
uncertain that he was comfortable with the language as it
was written. He requested a comprehensive list of the fees
that could manifest in the future that would be covered
under regualtion.
Ms. Lewis answered that the four on the fiscal note were
the only four yet identified. She said that broader fee
authority had been requested because public health was not
free and reasonable fees could develop in the future. She
added that any fee that would be needed in the future would
include public and stakeholder input.
2:05:05 PM
Ms. Monk announced that the written comments from ASHNHA
could be found in member packets. She said that the
association supported the legislation with the increased
stakeholder involvement prior to the initiation of new
fees.
Co-Chair Neuman wondered whether the bill would affect
pioneer homes.
Ms. Monk did not think that the bill spoke specifically to
fees that would impact either hospitals or nursing homes
but gave them the opportunity to charge the fees. Whether
pioneer homes, which were part of the association, would be
affected would depend on the fee.
Representative Neuman was interested to know whether the
bill would impact Pioneer Homes.
Representative Kawasaki asked for detail on who ASHNHA
represented.
Ms. Monk replied that ASHNHA Represented Alaska's hospitals
and skilled nursing facilitates. All tribal hospitals,
nursing homes, community health centers, rural health
clinics: ASHNHA represented a wide spectrum of services
provided under the umbrella of a hospital or skilled
nursing facility.
2:08:59 PM
TOM CHARD, CHAIR, SHARP COUNCIL, STATE LOAN REPAYMENT,
HEALTH PRACTITIONER SUPPORT AND ACCESS, JUNEAU, provided
information about the council and its 18 members that
included dentists, doctors, and other. To date the
organization had administered 250 contracts with sites
across the state. He shared that the council had considered
the bill and had ultimately voted to support the bill and
administrative fees that may result from the program.
2:12:16 PM
Co-Chair Seaton CLOSED public testimony.
Vice-Chair Gara had a question for Legislative Legal
Services. He asked whether any other process in regulation
required by statute the additional consultation for a
change to regulation.
KATE GLOVER, LEGISLATIVE LEGAL, JUNEAU (via
teleconference), she could not say with certainty that
nothing else existed in statute. She said that the
Administrative Procedure Act required consultation after a
proposal, this bill would require it beforehand.
Representative Guttenberg expressed concern that the bill
would further bifurcate public health. He stressed that the
state needed to get control of the finances of the
healthcare community.
Ms. Lewis explained that AS 44.64.213 authorized an agency
to contact a person about the development of the regulatory
action and to answer question from a person that was
relevant to the development of a regulatory action. She
said that other consultations between departments were
required but did not pertain to the regulatory process.
2:16:43 PM
Vice-Chair Gara asked about the intent of the committee
pertaining to bill action.
Co-Chair Seaton answered the intent was to move the bill if
it was the will of the committee.
Representative Neuman wanted to offer a conceptual
amendment that would require two meetings instead of one
for stakeholder discussions.
Co-Chair Seaton said that the bill would be held until the
following Monday.
2:18:42 PM
AT EASE
2:19:03 PM
RECONVENED
Co-Chair Seaton noted that the bill was already scheduled
for the following Wednesday.
HB 215 was HEARD and HELD in committee for further
consideration.