Legislature(2017 - 2018)BUTROVICH 205
03/21/2018 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB151 | |
| HB215 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 215 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 151 | TELECONFERENCED | |
HB 215-DHSS: PUBLIC HEALTH FEES
2:10:05 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of HB 215. [CSHB 215(FIN) was before the
committee.]
2:11:11 PM
ELIZABETH DIAMENT, Staff, Representative Paul Seaton, Alaska
State Legislature, presented HB 215. She said HB 215 is a House
Finance Committee-sponsored bill. During the DHSS subcommittee
process last year, Public Health was identified as a division
that could be charging additional fees to sustain its
constitutional mission, which is protecting and promoting the
health of all Alaskans. DHSS does charge for some Public Health
services but can only charge for what is listed in statute, AS
44.29.022. The duties that are currently fee-eligible are mostly
clinical in nature, and they include maternal and child health
services, nutrition services, preventive medical services,
public health nursing services, health education, and
laboratories. The Division of Public Health lacks fee authority
for other services and functions, such as professional services
and administrative functions. HB 215 would amend AS 44.29.022 to
grant DHSS the authority to establish and collect reasonable
fees to support the administration of public health programs. HB
215 allows DHSS to decide what fees it will establish through
regulation and a public process.
She explained that fees are limited to the actual cost of
services and that regulation would be required for each new fee.
In the current fiscal environment, it is important that every
agency looks for efficiencies and ways to decrease dependence on
unrestricted general funds.
2:13:38 PM
JILL LEWIS, Deputy Director, Division of Public Health,
Department of Health and Social Services (DHSS), testified on HB
215. She said the Division of Public Health focuses on services
that protect and improve the public's health status. Public
health services control infectious diseases, prevent chronic
diseases and injuries, promote healthy lifestyles, protect
maternal and child health, as well as respond to disasters. HB
215 is needed to allow the division to increase and diversify
its revenue opportunities, so it has the means to support health
operations and reduce reliance on general funds. The widening
gap between public health costs and general funds jeopardizes
their ability to provide services that keep Alaskans safe and
healthy. One of the obstacles is they cannot charge fees for all
services they provide.
She said the DPS budget includes nearly $7 million in general
fund program receipts or about six percent of their total
revenue. These receipts come from clinical services such as
laboratory tests and well-child exams. The new fees will not be
substantial enough to fund all operations, but they will reduce
dependence on other funds. DPS lacks fee authority for things
such as data extraction and analysis, training and expert
consultation, inspections and certifications, and program
administration. This is where their opportunities lie. Budget
cuts have forced some cuts to services that industry and the
public are asking for. The bill makes it possible, when it makes
sense, to recoup costs and do these services. Generally the fees
are optional. If services are not used, then there is no fee.
2:16:55 PM
MS. LEWIS explained that to implement the fees, DPS would reach
out to stakeholders in a series of public meetings leading to
separate regulations for each fee. Collaborating with the public
and stakeholders will help determine what is a reasonable fee
and how to balance the burden on the stakeholders with the
reality that public health doesn't mean free health. Rates are
limited to actual costs of providing the services, not making a
profit. Fees will only be implemented when they are in the
public interest, it is economical to do so, and, most
importantly, doesn't undermine the public health mission. They
don't deny services because of an inability to pay and they
employ a system of sliding fee schedules and waivers to ensure
the fee is applied fairly.
She said DPS understands no one wants to pay fees, but in the
current fiscal environment, the widening gap between public
health costs and state general funds jeopardizes their ability
to provide services that protect Alaskans from preventable
causes of illness, injury, and death.
SENATOR VON IMHOF observed that the slides are high-level
example of what type of data is collected. She asked for an
example of an actual entity, a hospital, a clinic, an
organization that would ask for data.
MS. LEWIS said an example of data analysis is a survey done
every other year with school districts of risk factors for
adolescents. They do a statewide report and school districts ask
for a special analysis to target their students, but DPS does
not have the capacity for that analysis. They might be able to
build that capacity if they could charge a fee for it.
SENATOR VON IMHOF noted that the committee heard that DHSS was
contracting services with Evergreen for certain reports. She
asked if they would provide the underlying data from an existing
report if an entity asked for it, and if there would be a charge
for the information.
2:21:01 PM
MS. LEWIS said there is no straight yes or no answer because
each individual data set has individual concerns about privacy,
who is asking for the data, and why. The department has standard
agreements with entities that are interested in the underlying
data. Much of what they produce in data and reports are
published on the Internet or available in aggregate form. DHSS
collects a lot of data from entities that are required to report
and those entities should be able to get something in return for
providing the information. But if someone wants to look deeper
or have a special analysis that takes extra time, collecting a
fee would be appropriate.
SENATOR VON IMHOF said she understands that is true for
specialized data. Her concern is that if there is data already
collected, she hopes they make it available to people asking for
it. DHSS is a data trove and she would hope that it makes the
data it is already collecting readily available to other
entities.
SENATOR GIESSEL said she commends the department for coming
forward with this bill, in collaboration with the House Finance
Committee. It is long overdue. This not unlike what the Park
Division in the Department of Natural Resources is doing. They
are raising fees and selling logo gear to make their division
more self-sustaining. The Public Health Division provides such
great services to Alaska and should charge for them. She asked
if there was any opposition to this bill in the other body.
MS. LEWIS said in the initial hearing in the House Health and
Social Services Committee, they did hear some concern about
whether the regulatory process allowed for sufficient public
input. Rather than just commit to doing preliminary meetings
with stakeholders, it was put into the bill. That's a good
practice and essential. They need to understand what fee
structure will work for the people who will be paying the fees.
2:25:47 PM
SENATOR GIESSEL said that when a regulation packet goes out,
there is always a public comment period. Ms. Lewis is saying
that they are putting in statute a pre-public comment period
where stakeholders would give feedback before DHSS writes
regulations. She said it is similar to what the Department of
Revenue often does with oil and gas tax regulations. She asked
if her interpretation was correct.
MS. LEWIS said yes and it is helpful to work with partners ahead
of time to scope out what a program or rule might look like. The
Department of Law has guidelines on how to have these
preliminary meetings without getting crossways with the official
regulatory process. She agreed that many departments already use
that process.
2:27:15 PM
CHAIR WILSON asked for a list of the current fees
MS. LEWIS said the list of fees is in regulation 7 AAC 80. A
more comprehensive detailed list is in a fee schedule published
by the Office of Management and Budget every year, where every
fee in the state is listed individually. She agreed to send the
extract of their fees.
CHAIR WILSON said she could provide the links and page numbers
to his office. He asked if the fees collected would go into the
general fund or be designated.
2:29:27 PM
MS. LEWIS said these would be designated general fund program
receipts. In Section 1 of the bill, they are added to the list
of fees already in statute. It helps make it clear that the
intent of fees is to be used for those programs. The legislature
always has the power to appropriate funds, but that makes the
intent clear.
CHAIR WILSON asked what the guesstimate is for revenue.
MS. LEWIS said the fiscal note is for $600,000 in new fees,
which is a comparatively small amount. The division budget is
roughly $117 million from all fund sources, but now there are no
funds for those particular services. This is the way forward to
provide those services.
2:31:37 PM
CHAIR WILSON said he is a huge supporter of public health. He
has been disappointed that a lot of the education services and
other items key for communities have been cut. He agrees with
Senator Giessel that the administration is trying to solve the
problem in providing services.
SENATOR MICCICHE said he is excited to see this bill. There is
already a section in the Fiscal Procedures Act that covers
monetary recoveries by DHSS and Medicaid expenditures and from
recipients and third-party providers under AS 47. He asked if
there are any further discussions on offsetting costs from those
who can afford something.
MS. LEWIS said the department is always looking at its fee
structure. [AS 44.29.022] has a list of what kind of fees the
department may charge for, and specific fee authority is in
other statutes. That particular list includes a fairly broad
authority for things such as child welfare, public assistance,
and juvenile justice, but the public health pieces of that are
very specific. Instead of saying the department has authority
for public health services, it says maternal child health,
health education, public health nursing. Essentially nothing
else is allowed. Public Health is different in the way it is
listed and that is why the bill focuses on that division and
doesn't go broader than that.
2:34:37 PM
CHAIR WILSON opened public testimony.
2:35:09 PM
ALISON KULAS, Executive Director, Alaska Mental Health Board,
Advisory Board on Alcoholism and Drug Abuse, supported HB 215.
She said during this budget crisis it is necessary to look at
other income sources. This won't be a huge revenue gain, but it
is a piece of what they are allowed to do. Reasonable fees and
requiring public input to determine those fees are the key to
the bill. Her board will be one of the voices at the table as
they go through this process. These boards take into
consideration what their community needs and what their
providers need to promote the health and well-being of all
Alaskans. They believe in the mission of public health. All
Alaskans are consumers of what the Division of Public Health
provide.
2:36:52 PM
SENATOR BEGICH asked if both of her boards have analyzed the
impact of this bill and are confident that it will not have an
adverse impact on their beneficiaries, many of whom do not have
the ability to represent themselves.
MS. KULAS responded that that is why they are impressed by the
intent for the public process to establish fees. They look
comprehensively at how to promote the health and well-being of
all Alaskans. They will always keep an eye to ensure that
beneficiaries are protected and that they are not overburdened
by any sort of legislation.
SENATOR MICCICHE opined that the state should be prioritizing
need. Those who can afford to pay allows additional services for
people who can't. The state has not had to worry about that and
has grown its ability to spend money faster than its ability to
manage money. That puts services to everyone at absolute risk.
He said if we get to the point where a broad-based tax is
necessary to pay the bills, there will be a revolution of
opposition to the services the state provides. He suggested
bringing it down to the beneficiary level for those who can
afford to pay, so the state can guarantee services to those who
can't pay. He asked Ms. Kulas for her thoughts.
2:39:35 PM
MS. KULAS said that when she says beneficiaries, she's looking
at the Mental Health Trust beneficiaries, those consumers of
behavioral health services. When looking at models, if people or
agencies can pay, the Trust do want to ensure they are
contributing. But they want to look full picture, so those who
aren't able to pay but really need the services to better
contribute back to society are also afforded those
opportunities. That's why it's great that reasonable fees are
based on the actual service rather than flat fees.
SENATOR MICCICHE said his theory is that every dollar the state
collects from someone who can contribute is a service provided
to someone who can't. The last 15 years the state hasn't had to
consider that, but now it is either cutting out key or in some
cases borderline constitutionally required services because it
can't afford them. He is very supportive of the bill and
appreciates the department bringing it forward. Hopefully the
concept becomes contagious.
CHAIR WILSON said he is supportive but also worried about
potential harm by setting fee schedules. He oversaw a domestic
violence sexual assault shelter and the Mat-Su public health
office would come once a month to provide services. They were
actively involved in their community domestic violence task
force. He doesn't want those services to stop because of fee
schedules, but he is supportive of the legislation overall.
2:42:27 PM
SENATOR MICCICHE asked by what percentage public health nursing
has been reduced over the past four years.
2:42:39 PM
MS. LEWIS said she didn't have numbers in front of her. Public
health nursing is about half of their general fund and the
largest section within the Division of Public Health. They are
mostly general fund supported. Because of that, public health
nursing has absorbed a disproportionate share in their division
because they had nowhere else to take cuts. They have been
reduced 20 percent since 2015. They lost 40 positions. More than
20 were filled at the time and resulted in layoffs.
SENATOR MICCICHE said he just wanted to point that out. That is
why this bill is so important. It's a concept to evaluate. Along
with those positions and that funding, some services went away
that Alaskans count on. He said he's not a bad guy who wants to
rub his hands and see services go away. The more they put their
heads together on similar solutions, the less services will be
cut in the future.
CHAIR WILSON thanked Ms. Lewis for the presentation. He held HB
215 in committee.