Legislature(2015 - 2016)CAPITOL 106
02/23/2016 03:15 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB227 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 227 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 227-MEDICAL ASSISTANCE REFORM
3:17:51 PM
CHAIR SEATON announced that the only order of business would be
HOUSE BILL NO. 227, "An Act relating to medical assistance
reform measures; relating to administrative appeals of civil
penalties for medical assistance providers; relating to the
duties of the Department of Health and Social Services; relating
to audits and civil penalties for medical assistance providers;
relating to medical assistance cost containment measures by the
Department of Health and Social Services; relating to medical
assistance coverage of clinic and rehabilitative services; and
providing for an effective date."
CHAIR SEATON stated that the proposed amendments to HB 227 would
be introduced, and not formally adopted, for consideration at
this meeting.
3:18:47 PM
REPRESENTATIVE VAZQUEZ introduced proposed Amendment 1, labeled
29-LS1096\H.7, Glover, 2/19/16, which read:
Page 5, line 5:
Delete "may not be less than 50"
Page 5, lines 5 - 10:
Delete "[, AS A TOTAL FOR THE MEDICAL ASSISTANCE
PROGRAMS UNDER AS 47.07 AND AS 47.08, SHALL BE 0.75
PERCENT OF ALL ENROLLED PROVIDERS UNDER THE PROGRAMS,
ADJUSTED ANNUALLY ON JULY 1, AS DETERMINED BY THE
DEPARTMENT, EXCEPT THAT THE NUMBER OF AUDITS UNDER
THIS SECTION MAY NOT BE LESS THAN 75]"
Insert ", as a total for the medical assistance
programs under AS 47.07 and AS 47.08, shall be 0.75
percent of all enrolled providers under the programs,
adjusted annually on July 1, as determined by the
department, except that the number of audits under
this section may not be less than 75"
REPRESENTATIVE VAZQUEZ explained that the proposed amendment
reverted the number of audits to the number previously required.
She declared that requiring 75 audits was not an extreme
hardship, and she expressed agreement that the providers should
not be subjected to a simultaneous federal audit. She said
these audits were very important to maintain the integrity of
the system, and to minimize fraud, waste, and abuse.
CHAIR SEATON tabled the proposed amendment for later
discussions.
3:20:31 PM
REPRESENTATIVE VAZQUEZ introduced proposed Amendment 2, labeled
29-LS1096\H.8, Glover, 2/20/16, which read:
Page 8, lines 2 - 7:
Delete all material.
Page 8, line 8:
Delete "(4)"
Insert "(2)"
Page 8, line 13:
Delete "(5)"
Insert "(3)"
Page 11, line 12:
Delete "applications for waivers and"
Insert "application for a waiver"
Page 11, line 13:
Delete "options under AS 47.07.036(d)(1) - (3)"
Insert "under AS 47.07.036(d)(1)"
Page 11, line 16:
Delete "applications"
Insert "application"
Page 11, lines 17 - 18:
Delete ", a section 1915(i) option under 42
U.S.C. 1396n, and a section 1915(k) option under 42
U.S.C. 1396n were"
Insert "was"
Page 11, line 20:
Delete "programs"
Insert "program"
Page 11, line 21:
Delete "waivers"
Insert "waiver"
Page 11, lines 21 - 22:
Delete "(A)"
Page 11, line 24:
Delete ";"
Insert "."
Page 11, lines 25 - 27:
Delete all material.
REPRESENTATIVE VAZQUEZ explained that this proposed amendment
would delete the references and material with regard to the
options 1915(i) and 1915(k), as these proposed to further expand
the regular Medicaid state plan beyond the newly expanded
Medicaid group. She declared that this was "a pure expansion of
our existing Medicaid program and the department has yet to
provide the legislature with very robust studies or data that
support their growth assertions that adding these options will
save money." She stated that an addition of these "populations"
without careful consideration of all the ramifications could put
the Medicaid program in jeopardy, as this included a group of
people that were not yet clearly defined by Department of Health
and Social Services. She acknowledged that, although the
1915(k) option was paid with a 56 percent federal match, it
expanded the number of services provided to beneficiaries and
expanded the scope of services beyond what was currently
available through waivers. She stated that the 1915 options did
not include a cap on services or a wait list for individuals.
She expressed agreement that it was necessary to include mental
health services, substance abuse, and traumatic brain injuries,
although the proposed option could also provide services to
those with Alzheimer's and related dementia. She suggested that
robust studies were necessary to show the number of eligible
individuals and the cost to the state, as, without a cap or a
waitlist, this could place an undue fiscal hardship on the
state. She noted that it was unclear whether Centers for
Medicare and Medicaid Services (CMS) would allow any
modifications or withdrawal from these options. She opined that
both these options could become entitlement programs. As there
was not withdrawal from these entitlements, she offered her
belief that it was unclear whether this could cause Alaska to
lose further federal funding for Medicaid.
CHAIR SEATON tabled the amendment for later discussions.
3:24:41 PM
CHAIR SEATON introduced proposed Amendment 3, labelled 29-
LS1096\H.5, Glover, 2/19/16, which read:
Page 6, line 3, following "audit.":
Insert
"The department may not assess interest under
this subsection if a provider
(1) identifies and reports an overpayment
to the department independent of an audit conducted
under this section; and
(2) repays the amount of the overpayment to
the department within five months after the date the
provider received the overpayment."
CHAIR SEATON explained that this proposed amendment added
clarification to Section 5 of the proposed bill that DHSS may
not assess interest against a provider who self-identified for
overpayments received if the provider independently identified
the overpayment and repaid this in a timely manner, within five
months. He said that Section 5 would encourage timely repayment
of overpayments, and would encourage providers to be proactive
in self-identifying and repaying the overpayments.
CHAIR SEATON tabled the amendment for later discussions.
3:26:16 PM
CHAIR SEATON offered proposed Amendment 4 labeled 29-LS1096\H.6,
Glover, 2/19/16, which read:
Page 9, line 30:
Delete "DEMONSTRATION"
Insert "PILOT"
Page 9, line 31:
Delete "January"
Insert "July"
Page 9, line 31, through page 10, line 1:
Delete "design and implement a demonstration
project"
Insert "contract with a third party to establish
a care coordination pilot project for approximately
500 voluntary participants who are eligible for
medical assistance under AS 47.07.020(b)(14)"
Page 10, lines 2 - 4:
Delete "The demonstration project shall provide
for the voluntary enrollment of approximately 500
recipients who are eligible for medical assistance
under AS 47.07.020(b)(14). The Department of Health
and Social Services shall"
Insert "The care coordination pilot project must
focus on nutritional sufficiency and"
Page 10, line 6:
Delete "demonstration"
Insert "care coordination pilot"
Page 10, line 7:
Delete "demonstration"
Insert "care coordination pilot"
Page 10, line 9:
Delete "demonstration"
Insert "care coordination pilot"
Page 10, line 15, following "(July 2013).":
Insert "Two years after the date the Department
of Health and Social Services first enrolls recipients
in the care coordination pilot project, the Department
of Health and Social Services shall deliver a report
to the senate secretary and the chief clerk of the
house of representatives and notify the legislature
that the report is available. The report shall
describe the results of the care coordination pilot
project, any difference in the pre-term birth rate for
participants in the pilot project as compared to the
pre-term birth rate for the state, and the estimated
savings to the state resulting from the pilot
project."
CHAIR SEATON explained that this proposed amendment changed the
project under Section 15 from a demonstration and research
project designed and implemented by DHSS to a care coordination
pilot project contracted with a third party. He stated that, as
the department did not normally pursue research projects, it was
not well suited to efficiently manage a project. He reported
that the focused effort for this was already underway in South
Carolina, so that Alaska could see if there could be a reduction
in pre-term births and related costs that other states had
experienced.
CHAIR SEATON tabled the amendment for later discussions.
3:28:01 PM
CHAIR SEATON offered proposed Amendment 5, labelled 29-
LS1096\H.9, Glover, 2/22/16, which read:
Page 7, lines 14 - 26:
Delete all material.
Renumber the following bill sections accordingly.
Page 7, line 31, through page 8, line 1:
Delete "provided to Indian Health Service
beneficiaries through the Indian Health Service and
tribal health facilities"
Insert "for recipients of behavioral health
services, as defined by the department by regulation"
Page 11, line 13:
Delete "sec. 12"
Insert "sec. 11"
Page 11, following line 27:
Insert a new bill section to read:
"* Sec. 17. The uncodified law of the State of
Alaska is amended by adding a new section to read:
IMPLEMENT FEDERAL POLICY ON TRIBAL MEDICAID
REIMBURSEMENT. (a) The Department of Health and Social
Services shall collaborate with Alaska tribal health
organizations and the United States Department of
Health and Human Services to implement changes fully
in federal policy that authorize 100 percent federal
funding for services provided to American Indian and
Alaska Native individuals eligible for Medicaid.
(b) In this section, "Alaska tribal health
organization" means an organization recognized by the
United States Indian Health Service to provide health-
related services."
Renumber the following bill sections accordingly.
Page 12, lines 6 - 7:
Delete "and the provisions of secs. 12(e), 12(f),
15, and 16"
Insert "the provisions of AS 47.07.036(e) and
(f), added by sec. 11 of this Act, and the provisions
of secs. 14 and 15"
Page 12, line 22:
Delete "sec. 16"
Insert "sec. 15"
Page 12, line 23:
Delete "sec. 18"
Insert "sec. 19"
Page 12, line 25:
Delete "sec. 16"
Insert "sec. 15"
Page 12, line 27:
Delete "Section 12(e) of this Act"
Insert "AS 47.07.036(e), added by sec. 11 of this
Act,"
Page 12, line 29:
Delete "added by sec. 12(e) of this Act"
Insert "of AS 47.07.036(e), added by sec. 11 of
this Act,"
Page 12, line 31:
Delete "Section 12(f) of this Act"
Insert "AS 47.07.036(f), added by sec. 11 of this
Act,"
Page 13, line 2:
Delete "added by sec. 12(f) of this Act"
Insert "of AS 47.07.036(f), added by sec. 11 of
this Act,"
Page 13, line 4:
Delete "Section 15"
Insert "Section 14"
Page 13, line 6:
Delete "sec. 15"
Insert "sec. 14"
Page 13, line 8:
Delete "sec. 16"
Insert "sec. 15"
Page 13, line 11:
Delete "sec. 12(e) of this Act"
Insert "AS 47.07.036(e), added by sec. 11 of this
Act,"
Page 13, line 14:
Delete "sec. 12(f) of this Act"
Insert "AS 47.07.036(f), added by sec. 11 of this
Act,"
Page 13, line 17:
Delete "sec. 15"
Insert "sec. 14"
Page 13, line 20:
Delete "17(a)"
Insert "16(a)"
CHAIR SEATON explained that the proposed amendment reflected the
CMS policy guidance from October 2015 which indicated the
willingness by CMS to re-evaluate the current interpretation for
Section 19.05(b) of the Social Security Act to allow 100 percent
federal medical assistance percentages (FMAP) for more and
expanded services for American Indian and Alaska Native
beneficiaries. This would include medical travel and services
provided by non-tribal providers with contractual agreements
with Indian Health Service facilities.
CHAIR SEATON tabled the amendment for later discussions.
CHAIR SEATON stated his desire for testimony on the effect of
these amendments in the current budget.
3:30:37 PM
CHAIR SEATON opened public testimony.
3:31:36 PM
BECKY HULTBERG, President/CEO, Alaska State Hospital and Nursing
Home Association, offered some brief, broad comments, which she
described as "tweaks to the [proposed] bill." She stated that
proposed HB 227 did several important positive things, as it
articulated a vision in its intent language for the Medicaid
program when it speaks about prevention as a core value, payment
reform, public - private partnerships, and general cost
reduction in the Medicaid program. It also established payment
reform demonstration projects, and would change the health care
delivery and payment systems, even as this would take hard,
difficult work at all levels. She expressed appreciation for
the use of pilot projects to test these new payment and delivery
models, and for the inherent flexibility in the proposed bill
for allowing for different kinds of pilot projects in different
regions. She expressed appreciation for the proposed amendment,
labelled 29-LS1096\H.5, Glover, 2/19/16, although she encouraged
"some sidebars to be put around the issue of overpayments so
that providers who self-report are not penalized in the same
way." She declared support for the efforts to reduce redundant
audits, noting that it was important for the state to have the
tools to address fraud and abuse, but not to add administrative
burden to low risk providers. She pointed out that
"administrative burden equals cost." She declared that the
proposed bill was able to strike an appropriate balance between
tools and enforcement and to ensure an efficient health care
system. She reported that the proposed bill focused on primary
care through development of a primary care case management
system, which she labeled as a building block for system change
as well as the intent to more fully utilize telemedicine. She
declared that reform was a long term endeavor, and that this
would probably not be the last year to address it.
3:36:21 PM
CHAIR SEATON asked if the five month window for self-reporting
mistakes was reasonable.
MS. HULTBERG replied that she would respond at a later date,
although she encouraged the reporting of overpayments. She
pointed out that, as the state did not pay interest on
underpayments, appropriate sideboards were necessary for whether
the providers should pay interest on overpayments.
3:37:43 PM
MS. HULTBERG, in response to Chair Seaton, stated that it was
possible that the bill language encompassed the project, and she
expressed commitment to the emergency room utilization project
and the emergency room physicians. She suggested amending the
proposed bill to include the project in statute as the intent of
the proposed bill was to better manage cost and utilization of
super utilizers.
CHAIR SEATON asked about the inclusion of dental health in the
proposed bill.
MS. HULTBERG suggested asking the Alaska Dental Society, and she
noted that ASHNA supported more access to dental care as it
would decrease emergency room visits that could have been more
easily treated in other less expensive settings.
3:41:07 PM
KATE BURKHART, Executive Director, Alaska Mental Health Board,
Advisory Board on Alcoholism & Drug Abuse, Division of
Behavioral Health, Department of Health and Social Services,
declared that her comments were on behalf of these boards only.
She shared that the boards had participated in the conversations
about Medicaid reform and redesign with the current and previous
administrations for more than eight years. She shared that, as
an external stakeholder, the board engaged Medicaid recipients,
those who relied on the services, in order to learn how to "best
reform the system." She echoed the comments from Ms. Hultberg
about the emphasis on preventative care as an underpinning
philosophy for reform. She reported that these efforts were a
focus on improving quality and access to care, as well as cost
containment, which she stated were a priority for the boards and
the constituents. They supported a sustainable system. She
expressed appreciation for the flexibility of the proposed bill
to pursue a variety of projects to help ensure that the
behavioral health would become a robust system to allow all of
the Medicaid reform efforts to be successful. She stated that
behavioral health was the lynchpin of reform, as it was "such a
cost driver of the system." She explained that the state plan
options and the 1115 waiver allowed movement of funding for
programs from general funds to Medicaid funding. She referenced
Section 9 of the proposed bill, expanded access to the super
utilizer program, and reported that the majority of the
participants had behavior health disorders, that access and
quality of care was improved, and that the cost for service had
been decreased. This provided support and guidance for people
to receive the necessary services in a timely fashion. Moving
on to Section 12 regarding the state plan options and the 1115
waiver, she offered her belief that this would improve the
delivery for home and community based services, and refinance
services that currently relied heavily on general funds. She
discouraged any amendment to remove the state plan options from
the proposed bill. She opined that the 1115 waivers could have
the most impact on the behavioral health system, as these were
very flexible. She moved on to Sections 13 & 14 of the proposed
bill, which were designed to increase access to behavioral
health services by removing the requirement that an entity be a
Division of Behavioral Health grantee in order to bill
behavioral health Medicaid. She declared that this was an
effective way to increase access. She cautioned that a
statutory change was only the start, as there would also need to
be regulatory changes in order to accomplish this goal. She
reiterated that administrative burden equaled cost, pointing out
that the administrative burden for community behavior health
providers billing Medicaid was already "pretty significant."
She declared support for the reform efforts.
CHAIR SEATON asked for more details about the 1915(i) & (k)
waivers, and the reasons for keeping them in the proposed bill.
3:47:34 PM
MS. BURKHART relayed that the boards had been most focused on
the 1915(i) waiver as these were the home and community based
services that benefited the most disabled, and she offered her
understanding that this state plan option would allow people
highly impaired by disability to receive more coordinated and
comprehensive home and community based services. She declared
that this was not adding people, it was just changing the
delivery system as many of these people were currently being
served by general fund programs. She relayed that the boards
had engaged in the process for the 1915(i) and (k) state plan
options as they had recognized that people with serious mental
illness and chronic substance use disorders that were highly
impaired would be in an institution, whether that was prison,
homelessness, or the psychiatric hospital, except for the
receipt of home and community based services. This was a
mechanism to better serve this group of constituents, while
financing in a more sound way. She relayed that it appeared
that, to achieve the recommendations in the administrations'
report, the 1115 was a more flexible option, although this did
not mean that an individual with a serious mental illness, so
impaired that they would meet the ultimate functional criteria
set in 1915(i), would not be eligible for services. She
reported that, for behavioral health, the focus would be on the
1115 waiver and not the 1915 state plan options. She stated
that the commitment by the boards to the state plan option was
because they had thought it was the answer until they realized
that the answer could be the 1115 waiver.
CHAIR SEATON relayed that the committee was attempting to better
understand who would be available and qualify for the services.
He stated that it was a complex situation.
3:53:31 PM
VALERIE DAVIDSON, Commissioner, Office of the Commissioner,
Department of Health and Social Services (DHSS), echoed the
previous comments from Ms. Hultberg that the states which do
health reform and do it well, also do it continually, year after
year. She expressed appreciation for the flexibility included
in the proposed bill, as it allowed more available tools to
address concerns. She stated support for maintaining the
1915(i) and (k) options in the proposed bill, as it allowed
another way to provide services in a more efficient way, and to
ensure the necessary care, while saving general fund dollars for
the state. She referenced the 1115 option as another tool
available for behavioral services. She declared that behavioral
health was the key to make the necessary changes in health
reform. She expressed appreciation for the flexibility to DHSS
within the proposed bill to allow the tailoring of programs and
services for cost effectiveness and efficiency. She stated that
it made sense "to have a more comprehensive tool box rather than
start removing tools from the tool box that really limit our
ability to make meaningful change and meaningful reform."
JON SHERWOOD, Deputy Commissioner, Medicaid and Health Care
Policy, Office of the Commissioner, Department of Health and
Social Services, acknowledged the correctness of the earlier
testimony by Ms. Burkhart regarding the 1915(i) and (k)
opportunities.
CHAIR SEATON reiterated his request for more graphics to better
understand the services. He directed attention back to
Amendment 5 and its reference that the behavioral health 1115
waiver was available to replace tribal waivers.
3:59:08 PM
REPRESENTATIVE STUTES asked Department of Health and Social
Services for the amount of dollars cut from the budget versus
the transfer of state dollars to federal dollars.
COMMISSIONER DAVIDSON replied that the Medicaid program had been
cut about $100 million in the general fund, and she offered to
provide the details.
CHAIR SEATON talked about the anticipated savings to the general
fund versus the total funding expended in the state. He pointed
out that an objective of [Medicaid] expansion was to increase
health services provided while cutting the general fund. He
acknowledged that it was good to know the economic impact from
the increase of federal dollars to the needed health care
services.
4:01:13 PM
COMMISSIONER DAVIDSON offered some updated information to the
committee, sharing that DHSS posted a graphic on its website
that included the Medicaid data for each month. This graphic
showed how many people had enrolled in Medicaid Expansion, along
with the demographics. There was also regional information for
all Medicaid enrollees. Through January, there were an
additional 10,416 Alaskans covered by Medicaid Expansion, with
$34.29 million paid in new claims, which was 100 percent
reimbursable from federal dollars.
REPRESENTATIVE WOOL asked if the 10,000 enrollees was close to
the expectations.
COMMISSIONER DAVIDSON replied that the number was probably on
track to the projections for the end of FY16. She reported that
almost 42,000 Alaskans would be eligible, and it had been
projected for about 22,000 Alaskans to enroll in the first year.
She noted that a bit of an uptick in enrollment was usually seen
at this time of year because of the individual insurance
mandate.
COMMISSIONER DAVIDSON, in response to Representative Wool, said
that the expectation was for about 22,000 enrollees in the first
year. She reported that, should the number be higher, it would
mean more federal dollars coming in to Alaska, as it was 100
percent federal match in this first year. She directed
attention to the $34.29 million paid in claims in January, and
shared that this number would always lag a bit, as providers had
a one year timely filing limit. She said that smaller providers
often sent in claims sooner, whereas the larger providers often
waited to more easily process the claims in larger batches. She
pointed out that 54 percent of the Medicaid enrollees through
January were children, with 2 percent of these being children
experiencing disabling conditions. She stated that 8 percent of
all the Medicaid enrollees were a result of expansion.
4:05:19 PM
CHAIR SEATON noted that a number of people had claimed
difficulty with getting enrolled. He asked if there had been a
wide distribution of information explaining the mechanism for
application.
COMMISSIONER DAVIDSON replied there had been quite a few
outreach efforts. She stated that the fastest way to enroll was
on healthcare.gov, sharing that DHSS had worked with navigator
programs which enrolled individual Alaskans in health care
plans, regardless of eligibility for Medicaid or market place
plans. She said that hospitals allowed individuals already in
the hospital to enroll in Medicaid, which for some individuals
could be the fastest means.
CHAIR SEATON emphasized that a focus of the House Health and
Social Services Standing Committee was to get people signed up
for appropriate health care through primary care. He expressed
his desire to get the sign up information out to the public.
4:08:24 PM
COMMISSIONER DAVIDSON suggested that pregnant women call the
DHSS fast track hot line, as access to good prenatal care lead
to better outcomes for the mother and the baby. She reported
that, through the budget process during the last year, DHSS had
received $1.3 million through the Alaska Mental Health Trust
Authority (AMHTA) to fund a number of positions to "gear up for
Medicaid Expansion." She noted that most of the positions were
in the Division of Public Assistance, with some additional
positions in the Health Care Services to help process the
claims. She reported that $1.5 million had been reduced from
the DHSS budget in the Division of Public Assistance, for
positions which helped enroll beneficiaries. She noted that the
justification had been that, since the new enrollment system for
public assistance would be automated, those existing positions
could go away. She pointed out that the changes in the new
enrollment system for public assistance were not due to go into
effect until 2017 and 2018. She said that DHSS had anticipated
the funding from AMHTA would add to the positions, but the
budget reduction had resulted in an actual loss of funding. She
acknowledged that the department had learned to "do with what we
have, but it certainly was a challenge to be able to step up to
meet those new enrollment projections when we thought we were
going to have more positions to be able to meet the demand and
actually ended up with a net fewer positions to do that."
CHAIR SEATON asked for more information to ensure that this
would not happen again.
MR. SHERWOOD added that the Division of Public Assistance
maintained a separate hot line, listed on its website, for
people with medical urgencies to help with prompt facilitation
of applications.
4:13:25 PM
BRUCE RICHARDS, Director, External Affairs, Central Peninsula
Hospital, testified that it was time "to set the stage for
changing the payment models." He stated that Alaska was
currently in a fee for service model, and that the proposed
legislation contained several demonstration programs that would
allow for piloting different types of demonstrations. He
reported that Central Peninsula Hospital was working toward
possibly piloting one of the demonstrations, directing attention
to page 8, line 27 of the proposed bill, which authorized the
demonstration for coordinated care utilizing a global payment
fee structure. He shared that the hospital had been working
with Moda Health on a model currently operating in Eastern
Oregon, and that the language would allow them to proceed
forward. He reported that data released earlier from the
Journal of the American Medical Association compared the 2011
baseline data with the 2014 data which showed that in-patient
care cost had decreased by 14.8 percent, and that per member per
month spending on out-patient care had also decreased by about
2.4 percent. He emphasized that, although out-patient spending
trends masked a 19.2 percent increase in spending on primary
care services, this was a primary care home based model, with a
focus on primary care "to keep people healthy and keep them from
becoming ill and spending those resources and mis-utilization of
them." He stated that the aforementioned Eastern Oregon model
had reduced emergency room utilization by 21 percent. He
reported that the hospital was looking at covering the Medicaid
population in the entire Kenai Peninsula. He explained that
community care organizations (CCOs) differed from the
traditional accountable care organizations (ACOs) which were
more closely associated with Medicare, not Medicaid, as they
accepted full financial risk, the global payment model. He
pointed out that the organizations were both locally governed,
were accountable for access, quality and health spending, and
both emphasized primary care medical homes. He said that both
required robust data systems to support the integrated networks
for clinical and business functions. He shared that a CCO would
operate on a fixed global budget, reduce medical cost inflation,
improve the quality of care and outcomes, and create a healthier
population. He offered his belief that the demonstration would
put Medicaid on a predictable and sustainable path by reducing
the growth trend in the per capita Medicaid expenditures. He
stated that the current Alaska trend of growth per capita for
Medicaid expenditures average more than 6 percent annually. He
suggested that the CCO was the next step beyond traditional
managed care, based on the funding structure and the risk
bearing nature of the program. He emphasized that providers
would no longer be paid for treating illness, but instead, for a
"highly coordinated system that prevents illness and the high
cost associated with it." He stated that the CCO structure
required a great deal of front end work, which the hospital was
currently working on with Moda Health. He listed some of the
work, which included payment structures, shared savings
distribution, metrics for accountability, and development of
quality targets. He reported that there was currently an
analysis of the entire Medicaid population to better understand
the needs, in order to build a program which fit the population.
He suggested a minor language change to the proposed bill which
would provide the most flexibility for program design. On page
8, line 27, delete "design and" in order to allow maximum
flexibility for work with Department of Health and Social
Services, and to no longer require the department to design the
program.
CHAIR SEATON suggested that Mr. Richards review proposed
Amendment 4, labeled 29-LS1096\H.6, Glover, 2/19/16.
4:21:33 PM
REPRESENTATIVE WOOL expressed his understanding for the
incentives of fee for service and for its increase in fees. He
asked if there was incentive in a global payment system to
decrease fees, and whether it was projected for fees to flatten.
MR. RICHARDS replied that the main goal of the Eastern Oregon
model was to flatten and bend the cost curve of Medicaid
expenditures, and reduce it by a percentage per capita. He
reported that the incentive to providers was to flatten that
cost curve.
REPRESENTATIVE WOOL opined that there was not a fee for service
in a global system because there was a per month per capita
payment.
MR. RICHARDS replied that, although it would continue to be a
fee for service model, the CCO would still get a global payment
and the payment would be distributed through the fee for service
mechanism; however, this would be done through a network
comprised and put together by the CCO, which allowed for the
potential of shared savings with the providers. He noted that
the state would be paying on a global level, and the incentive
was to reduce the utilization of the population and the cost per
capita for each Medicaid enrollee.
4:24:19 PM
CHAIR SEATON asked if a vertical integration with primary care
doctors into the hospital setting was integral to the global
payment model or could it include providers not in this vertical
integration.
MR. RICHARDS replied that it was both, as the hospital had
employed primary care providers, as well as independent medical
staff. He stated that the program would be built and negotiated
to include the services needed by the enrolled beneficiaries.
He opined that the primary care based model would prevent some
of the occurrences and save those expenses incurred for a
specialist or the emergency room.
4:26:32 PM
[Public testimony was closed.]
[HB 227 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 227 proposed amendment H.8 - Vazquez.pdf |
HHSS 2/23/2016 3:15:00 PM |
HB 227 |
| HB 227 proposed amendment H.5- Seaton.pdf |
HHSS 2/23/2016 3:15:00 PM |
HB 227 |
| HB 227 Proposed Amendment H.6_Seaton.pdf |
HHSS 2/23/2016 3:15:00 PM |
HB 227 |
| HB 227 proposed amendment H.7- Vazquez.pdf |
HHSS 2/23/2016 3:15:00 PM |
HB 227 |
| HB 227 response- CMS Tribal Policy Proposed Change 10.2015.pdf |
HHSS 2/23/2016 3:15:00 PM |
HB 227 |
| Department Response- 2.16.2016- medicaid dual eligibles.pdf |
HHSS 2/23/2016 3:15:00 PM |
|
| Response to committee questions from 2.16.2016_ASHNHA.pdf |
HHSS 2/23/2016 3:15:00 PM |
HB 227 |
| HB 227 Proposed Amendment H.9- Seaton.pdf |
HHSS 2/23/2016 3:15:00 PM |
HB 227 |