Legislature(2017 - 2018)CAPITOL 106
05/09/2017 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB215 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | HB 215 | TELECONFERENCED | |
HB 215-DHSS: PUBLIC HEALTH FEES
3:03:29 PM
CHAIR SPOHNHOLZ announced that the only order of business would
be 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."
3:04:09 PM
JENNY MARTIN, Staff, Representative Paul Seaton, Alaska State
Legislature, explained that the proposed bill came out of the
subcommittee process, when indirect expenditure reports were
reviewed, as ways for the departments to become more self-
sufficient. One of these suggestions had been to consider that
public health centers charge fees not previously allowed. She
shared that further discussions with the Department of Law and
the Division of Public Health [Department of Health and Social
Services] had recognized that the proposed bill was somewhat
limiting, and she asked to explain the proposed amendment.
3:05:22 PM
CHAIR SPOHNHOLZ moved to adopt Amendment 1, labeled 30-
LS0673\D.3, Glover, 5/4/17, which read:
Page 1, lines 5 - 6:
Delete all material and insert:
"(90) the following fees, receipts, income,
and monetary recoveries collected by the Department of
Health and Social Services:
(A) receipts of the Department of Health
and Social Services, Bureau of Vital Statistics;
(B) monetary recoveries of Medicaid
expenditures from recipients, third parties, and
providers under AS 47;
(C) the state's share of overpayments
collected under AS 47.05.080;
(D) income received from a state or federal
agency for children in foster care under AS 47.14.100;
(E) fees received or collected under
AS 44.29.022 for nursing and planning services
provided at health centers, genetic screening clinics
and specialty clinics, the certification of x-ray
machines, the Alcohol Safety Action Program, and other
public health programs and services;
(F) fees received under AS 18.08.080 for
the certification of emergency medical technicians,
emergency medical dispatchers, and emergency medical
technician instructors;
(G) fees received under AS 47.32;
(H) the state's share of child support
collections for reimbursement of the cost of the
Alaska temporary assistance program as provided under
AS 25.27.120, 25.27.130, and AS 47.27.040; and
(I) monetary recoveries under AS 09.58
(Alaska Medical Assistance False Claim and Reporting
Act)."
Page 1, line 10:
Delete "AS 44.29.020(a)(1) - (8)"
Insert "AS 44.29.020(a)(1) - (8) and (14)
[AS 44.29.020(a)(1) - (8)]"
Page 1, line 12:
Delete "AS 18.05.010"
Insert "AS 18"
Page 2, following line 3:
Insert a new bill section to read:
"* Sec. 3. AS 37.05.146(c)(42), 37.05.146(c)(59),
37.05.146(c)(60), 37.05.146(c)(61), 37.05.146(c)(62),
37.05.146(c)(63), 37.05.146(c)(64), 37.05.146(c)(65),
37.05.146(c)(66), 37.05.146(c)(67), 37.05.146(c)(71),
and 37.05.146(c)(88) are repealed."
REPRESENTATIVE EDGMON objected for discussion.
3:05:41 PM
MS. MARTIN paraphrased from the Amendment D.3 statement
[included in members' packets], which read as follows [original
punctuation provided]:
After clarification with the Dept. of Health & Social
Services (DHSS) and the Department of Law it was
determined that only listing AS 18.05.010 (as the
services for which DHSS could create fees) was
limiting for public health. AS 18.05.010 is limited to
DHSS duties under AS 18.05, 18.09, and AS 18.15.355
18.15.395, but public health provides additional
services under other areas of AS 18. For example, if
public health were to get a request to provide data
collection services under AS 18.08 (Emergency Medical
Services), they would not be able to charge fees for
that service. This amendment corrects this issue.
Amendment page 1, line 1-23 to page 2, line 1-2:
changes how public health is listed under AS 37.05.146
(c) AS 37.05.146 (c) is the definition list of
designated general fund program receipts and non-
general fund program receipts that are accounted for
separately, and appropriations from these program
receipts are not made from the unrestricted general
fund. In HB215 ver D, public health programs under AS
18.05.010 were added to the list as number (90). For
reasons noted above, this amendment broadens (90) by
replacing AS 18.05.010 with the language: "other
public health programs and services" (Amendment-line
16). Note: the specific public health programs and
services for which DHSS may establish fees are
specified under AS 44.29.022 (a).
In addition, because the list under (c) includes
programs and services from many different departments
it was determined that the statute could be made
clearer by consolidating other DHSS programs and
services along with public health under (90). From the
current list of 89 program receipts the following
would move under (90):
? current #42 would become (90) (A)
? #59 becomes (B)
? #60 becomes (C)
? #61 becomes (D)
? #62, 63,65, 66 becomes (E)
? #64 becomes (F)
? #67 is now (G)
? #71 is now (H)
? #88 is now (I)
Amendment page 2, line 4-6: adds AS 44.29.020 (a)(14)
to AS 44.29.022 (a) Fees for department services This
will allow public health the option to establish fees
for services and programs it provides through its
tobacco control programs under AS44.29.020(a)(14).
Amendment page 2, line 8-10: replaces AS 18.05.010
with AS 18 under AS 44.29.022 (a) As stated
previously, only listing AS 18.05.010 under AS
44.29.022 (a) was limiting and did not encompass all
the public health services that DHSS provides and for
which they could develop fees. While there are other
departments also listed within AS 18, language under
AS 44.29.022 (a) states that the commissioner of DHSS
may only establish fees for services listed under this
statute that are provided by DHSS.
Amendment page 2, line 12-16: repeals statues moved to
new subsection AS 37.05.146 (c) (90) As noted above,
these statues were moved under (90) to help
consolidate DHSS programs under one subsection.
3:11:16 PM
REPRESENTATIVE EASTMAN asked how the fees would be worked out
for the tobacco control programs.
3:11:33 PM
JILL LEWIS, Deputy Director, Division of Public Health,
Department of Health and Social Services, stated that much of
what had been done in the way of prevention activities would not
have charged fees. She suggested that services through Alaska's
Tobacco Quit Line, including nicotine patches and counseling
services which were currently not charging fees, could have fees
for the services, which would allow for additional funding to
increase the services.
3:12:42 PM
CHAIR SPOHNHOLZ asked if the department could bill insurance, or
would an individual have to bill their own insurance. She noted
that many insurance plans covered tobacco cessation.
MS. LEWIS, in response, said that as the department did not have
the volume to set up a third-party billing system, it would be
cost prohibitive. She explained that the patient was billed
with first party billing, and then patient would send the claim
to the insurance company for reimbursement. She noted that
although the Tobacco Quit Line was an administrative cost, any
extra service would free up funding because it could then be a
first party billing.
3:14:03 PM
REPRESENTATIVE EDGMON removed his objection. There being no
further objection, Amendment 1 was adopted.
3:14:37 PM
CHAIR SPOHNHOLZ opened public testimony on HB 215.
3:14:52 PM
JEANNIE MONK, Vice President, Policy and Programs, Alaska State
Hospital and Nursing Home Association (ASHNHA), shared the
ASHNHA concerns for the proposed bill. They recognized the
serious budget situation facing Alaska and the need to look to
all sides for revenue to support state services. They believe
it is appropriate for the Division of Public Health to explore
when it is possible to charges fees for services provided. She
expressed her support for the proposed amendment to put fees
into designated funds which then go back into those programs.
She expressed concern about the broad latitude being given to
the Division around regulatory compliance as it allowed the
Division of Public Health authority to impose fees for the
administration of public health programs. She stated that this
was a very broad statute which allowed the charging of fees in a
very broad way, and the proposed Amendment 1 broadened this even
further. She noted that currently there was a list in statute
for services to which fees could be charged, all of which have
gone through a public process allowing for comment. They
support allowing public health more latitude to charge user
fees, when appropriate and reasonable, and believe that
stakeholder involvement is important to the process. In their
experience, the regulatory and budget processes alone were often
insufficient to provide appropriate oversight to what fees the
division could impose and what compliance programs they could
build up with this new revenue source. Once the regulation
process is underway there is no opportunity for meaningful
dialogue to impact what is being proposed. They realize public
comment is always an option during the regulation process, but
it is often too late in the process. She declared the desire to
protect health care providers and the public from unnecessary
and growing regulatory and cost burdens. She offered some
examples, which included radiological device fees to support a
second radiological health physicist for registration,
certification, and inspection of radiology devices. They
supported requiring a stakeholder process on the reasonableness
of fees prior to the regulation process and feel this will
strengthen the effort to charge appropriate user fees. They
believe that public health services are a critical part of our
health system and will never be sustainable based on user fees
alone. They advocate for continued funding for public health
functions to protect vulnerable populations and ensure healthy
communities. They want to be sure public health services
continue even when no user fees are available to support them.
3:21:13 PM
REPRESENTATIVE JOHNSTON asked, regarding radiological fees, if
there was federal oversight onsite.
MS. MONK replied that although she did not know all the details,
it was how the device was licensed and accredited. She reported
that the facility had to go through a process outlined at the
federal level to ensure the safety and protection of the
equipment. She said that there were people on site who
inspected and operated the equipment, and their qualifications
were part of the review process.
REPRESENTATIVE SULLIVAN-LEONARD asked if this created a
duplicate oversite from both the state and the federal agencies.
MS. MONK explained that this could be a result should the state
decide to charge a fee to license and inspect these devices that
were already being accredited by a federal agency. She
clarified that currently there was not any duplication. She
suggested that as it was very complicated, there may not have
been awareness of the existing regulations.
3:23:24 PM
REPRESENTATIVE EASTMAN asked if there were any specific
proposals to change the current bill to address these concerns.
MS. MONK replied that she did not have any at this moment. She
suggested that there could be a pre-regulation process, as once
the regulation process began there was not any dialogue allowed.
CHAIR SPOHNHOLZ asked about state institutions which were being
nationally accredited to receive compensation from Medicaid and
whether this was covering all the radiologic equipment.
MS. MONK said that she did not know all the details but noted
that there were a variety of different accreditation
requirements depending on the provided services.
CHAIR SPOHNHOLZ reflected on earlier testimony that authority
had been given some time ago for x-ray equipment. She expressed
concern that there was imaging equipment that was not in
accredited facilities. She acknowledged that members of ASHNHA
were adhering to standards which were much higher to allow
billing to Medicaid and Medicare. She suggested that exclusion
of the authority to the department to do these inspections for a
more targeted population may not be wise.
3:26:33 PM
MS. MONK clarified that she was not advocating to not do
everything possible to ensure safe patient care. She suggested
that the ability to charge fees should not drive this decision,
it should be evidence-based practices. If there was equipment
which was not being inspected adequately, then this should be
addressed. She stated that the bigger concern was for these
important conversations to occur prior to the regulation
process, or there could be double regulations.
CHAIR SPOHNHOLZ expressed her concern that only those who could
afford to pay for data analysis would be able to participate,
and that Ms. Monk had indicated that there was difficulty
getting data back from the department.
MS. MONK said that she had been referring to the Health
Facilities Data Reporting Program, which mandates that all
hospitals and nursing homes, ambulatory surgery centers, and
imaging centers submit data on all their discharges. She said
that this data was assembled into a large data set. She added
that currently facilities could request the data set but that
the cost was $2,000, which was more than many small facilities
could afford to pay. She noted that as the small facilities
would not have the analytical capabilities, ASHNHA had suggested
a standard set of reports be available for access to the data,
outside of paying for it. The smaller facilities needed a way
to turn this large data set into some useful information.
3:30:23 PM
CHAIR SPOHNHOLZ asked about earlier comments that as an external
stakeholder, there was not enough opportunity to participate in
the regulatory process and to provide feedback during a time
that it was really valuable.
MS. MONK reported that once the regulations were drafted, they
were released with a 30-day public comment period. After that,
the department could decide what to do with those comments. She
pointed out that this was not a dialogue process. She
reiterated that it was necessary to have dialogue prior to the
regulations being drafted to help ensure they best meet the
needs of all those impacted. She stated that it could be done,
and she offered her belief that the current administration
generally did this. She expressed her concern, however, that as
general practices change, if this was not outlined as a
requirement in legislation, it was not known what could happen
in the future.
3:32:46 PM
MS. LEWIS clarified that the division was not looking to broaden
its regulatory authority, offering her belief that the intent of
the proposed bill was to work within the existing authority.
She noted that this included oversight of the radiologic devices
as the division already had the statutory authority but had not
implemented the regulations as they did not yet have the
commensurate fee authority. She stated that the division was
not anxious to charge fees, even as they recognized that with
the current budget situation public health was not free health
care. She declared that when there was an ability to pay and it
did not undermine the public health mission, it was incumbent
upon the division to be more self-sufficient. She reported that
inspections were typically fee based in other states. She
stated that they would review the overlap with federal
accreditation, noting that they did not currently have the
regulations for MRI and CT devices, and this process would
include wrapping in the accreditation requirements from the
Centers for Medicaid and Medicare Services. She pointed out
that accreditation was periodic and tended to review whether the
proper policies and procedures were in place and was not there
to validate the compliance or do interim checks. She stated
that it would not serve any purpose to duplicate those elements,
but instead, to focus on the elements not being done. She said
that the division was open for discussion to better improve the
process and to discuss the cost benefit and the burden of fees
on the various stakeholders. She pointed out that the fiscal
note projected an extra year to allow time for meetings and
discussion as to the best approach and reasonable fee. She
spoke about the health facility discharge reporting, and
explained that as they had moved into the Health Analytics and
Vital Records Section, that branch of Public Health had the
authority to institute a fee system and charge fees. She
offered her belief that the division was not charging a fee to a
facility to receive back its own data. She pointed out that any
additional analysis and custom reporting was different. She
expressed her agreement that mandatory reporters should have an
expectation for something to be given back, including access to
their own data and a set of baseline reports.
REPRESENTATIVE SULLIVAN-LEONARD asked if there was currently any
federal oversight for the equipment in public facilities.
3:39:32 PM
MS. LEWIS offered her understanding that although this was not
her area of expertise, accreditation was to accredit the
facility and not the individual machines. She reported that
there were safety elements in the accreditation process, and
there were more general, set standards to comply with federal
and state law. She explained that the state would do the actual
inspection of the individual machines.
3:40:35 PM
REPRESENTATIVE SULLIVAN-LEONARD asked to clarify that the fees
would be to get a health care specialist to oversee the
radiological devices for compliance.
MS. LEWIS offered her belief that the specialist would check to
ensure that policies and procedures were in place, but they were
not going to test or calibrate the machines.
REPRESENTATIVE EASTMAN asked what the driving desire was to do
this, specifically for the radiological devices, as it was not
currently being done.
MS. LEWIS reported that as there had been a proliferation of
these devices, in the Department of Health and Social Services
effort to register, inspect, and certify these devices the
department had discovered its lack of capacity for follow up.
She said there would be a cursory, unofficial inspection of the
CT machines, even though it was not part of the regulatory
process.
REPRESENTATIVE EASTMAN opined that most, if not all, of these
devices had associated service contracts for calibration on a
periodic basis. He asked what about the federal certification
process was not achieving the goal.
MS. LEWIS explained that the manufacturer could adjust the
machine but would not be testing for compliance or validating
the compliance. She suggested that there could be a conflict of
interest for this work. She acknowledged that the department
could review and address this for any future use.
REPRESENTATIVE SULLIVAN-LEONARD shared that the manufacturer
would do any repairs, whereas a specialist would do the
calibrations.
3:44:26 PM
CHAIR SPOHNHOLZ closed public testimony on HB 215.
3:44:47 PM
CHAIR SPOHNHOLZ reported that all the state departments had been
asked to come up with creative new ways to diversify funding,
while working within the regulatory limitations. She
acknowledged that although this was a practical and constructive
way, there were some clear sideboards regarding its authority.
She noted that the department can't charge more than it cost to
provide a service and that safety was a concern. She expressed
her concern that MRIs and other imaging equipment was not being
tested in Alaska. She said that she was glad to see a proposal
to advance this, although she acknowledged a concern by ASHNHA
for enough collaboration in the process. She reiterated that
the fee development process would not be a quick rush.
3:47:38 PM
REPRESENTATIVE EASTMAN suggested that the proposed bill could be
evaluated at the beginning of the next session.
3:48:19 PM
REPRESENTATIVE EDGMON moved to report HB 215, as amended, out of
committee with individual recommendations and the accompanying
fiscal notes. There being no objection, CSHB 215(HSS) moved
from the House Health and Social Services Standing Committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB0215 ver D 4.7.17.pdf |
HHSS 4/18/2017 3:00:00 PM HHSS 4/25/2017 3:00:00 PM HHSS 5/9/2017 3:00:00 PM |
HB 215 |
| HB215 Fiscal Note DHSS--PHAS 4.17.17.pdf |
HHSS 4/18/2017 3:00:00 PM HHSS 4/25/2017 3:00:00 PM HHSS 5/9/2017 3:00:00 PM |
HB 215 |
| HB215 Sectional Analysis ver D 4.7.2017.pdf |
HHSS 4/18/2017 3:00:00 PM HHSS 4/25/2017 3:00:00 PM HHSS 5/9/2017 3:00:00 PM |
HB 215 |
| HB215 Sponsor Statement ver D 4.7.2017.pdf |
HHSS 4/18/2017 3:00:00 PM HHSS 4/25/2017 3:00:00 PM HHSS 5/9/2017 3:00:00 PM |
HB 215 |
| HB215 Supporting Document - Division of Public Health Fee Summary 4.7.17.pdf |
HHSS 4/18/2017 3:00:00 PM HHSS 4/25/2017 3:00:00 PM HHSS 5/9/2017 3:00:00 PM |
HB 215 |
| HB215 Supporting Document - Division of Public Health Funding Sources 4.7.17.pdf |
HHSS 4/18/2017 3:00:00 PM HHSS 4/25/2017 3:00:00 PM HHSS 5/9/2017 3:00:00 PM |
HB 215 |
| HB215 Supporting Document - Draft Amendment D.3 explanation 5.5.17.pdf |
HHSS 5/9/2017 3:00:00 PM |
HB 215 |
| HB215 Draft proposed Amendment D.3 5.5.17.pdf |
HHSS 5/9/2017 3:00:00 PM |
HB 215 |
| HB215 Supporting Document - Fees statutes 5.5.17.pdf |
HHSS 5/9/2017 3:00:00 PM |
HB 215 |