Legislature(2015 - 2016)CAPITOL 106
03/08/2016 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB227 | |
| HB344 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 227 | TELECONFERENCED | |
| += | HB 344 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 227-MEDICAL ASSISTANCE REFORM
3:06:23 PM
CHAIR SEATON announced that the first 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."
3:06:54 PM
REPRESENTATIVE VAZQUEZ moved to adopt the proposed committee
substitute (CS) for HB 227, labeled 29-LS1096\N, Glover, 3/7/16,
as the working draft.
CHAIR SEATON objected for discussion.
3:07:55 PM
TANEEKA HANSEN, Staff, Representative Paul Seaton, Alaska State
Legislature, explained the changes made in the proposed
committee substitute, from the document titled "Summary of
Changes Version H to Version N HB 227 - Medical Assistance
Reform." [Included in members' packets.]
MS. HANSEN explained the changes to the bill title, which read:
Title: On line 6 the title has been expanded to
include 'federal reimbursement for Alaska Native
health services,' to reflect the new section 18.
MS. HANSEN moved on to discuss the changes in Section 1, which
read:
Section 1. Subsection (2)(c) has been added to the
legislative intent language. Subsection (2)(c) directs
the Department of Health and Social Services to
collaborate with clinics and centers that have
historically provided behavioral health services.
MS. HANSEN explained the changes to Section 4, which read:
Section 4. Language was placed back into this section
to return the number of annual audits required under
this subsection to the current statutory level of
0.75% of all enrolled providers, with a minimum of 75
audits a years.
3:09:48 PM
MS. HANSEN directed attention to the changes in Section 5, which
read:
Section 5. New subsections (1) and (2) have been added
to AS 47.05.200(b) to state that the department may
not assess interest on overpayments under this section
if a provider self identifies and reports an
overpayment independent of an audit and repays it
within five months of reporting.
3:10:53 PM
MS. HANSEN shared the changes in Section 6, which read:
New Section 6. A new section 6 has been added to the
bill. Section 6 adds subsection (f) to AS 47.05.200
allowing the department to collaborate with medical
assistance providers to create educational material
regarding common provider errors and overpayment
types.
3:11:22 PM
MS. HANSEN pointed out the changes to the previous Section 11,
which read:
Previous Section 11. deleted Section 11 of HB 227
version H has been removed from the bill. The language
originally being removed from AS 47.07.036(b) under
this section is no longer in conflict with new
sections and will remain in statute.
3:12:05 PM
MS. HANSEN described the changes in Section 12, which read:
Section 12. Subsection (d)(1) has been amended to
change the target population for the 1115 waiver
application under this section from tribal health
beneficiaries to recipients of behavioral health
services. Language has been added to subsections
(d)(2) and (3) to state that the department shall
design the applications for the 1915(1) and 1915(k)
options to result in cost savings to the state. The
term 'design' has been deleted from subsection (f) to
clarify that the department will not be required to
design the demonstration project implemented under
this section. Language has been added to subsection
(g) to state that telemedicine can be performed
between a provider and a recipient who are physically
separated.
3:13:51 PM
MS. HANSEN moved on to discuss the changes in Section 15, which
read:
Section 15. This section has been amended to change
the pre-term birth reduction project from a
demonstration project conducted by the department into
a care coordination pilot project contracted with a
third party. The implementation date has been changed
from January of 2017 to July. A report on the success
of the pilot project is required after two years.
3:14:45 PM
MS. HANSEN shared the changes in Section 17, which read:
Section 17. The date of the report required by
subsection (c) has been changed from February 1, 2019
and will now include two separate reports. The first
report is due November 1, 2018, and the second is due
November 1, 2019.
3:16:02 PM
MS. HANSEN noted that a new Section 18 had been added, which
read:
New section 18. A new section has been added to the
uncodified law directing the department to collaborate
with Alaska tribal health organizations and the
federal government to fully implement changes to
federal policy regarding 100% reimbursement for
American Indian and Alaska Native recipients.
Collaboration may include incentives for providers to
participate.
3:16:54 PM
MS. HANSEN concluded with the changes made to Section 22, which
read:
Section 22. The effective date under subsection (d)
has been updated from January 1, 2017 to July 1, 2017
to reflect the date change in section 15 of this bill.
Other sections have been renumbered to reflect these
changes.
CHAIR SEATON directed attention to the chart titled "FY17
Governor's Amended Budget to HB 227 Fiscal Notes" [included in
members' packets] which detailed a compilation of the annual
savings to unrestricted general funds (UGF) from the fiscal
notes, which was $223.2 million after six years.
MS. HANSEN reminded the committee that this chart was generated
by the Legislative Finance Division based on the fiscal notes to
the original bill version, and not on the current committee
substitute, Version N.
CHAIR SEATON noted that any revised fiscal notes would also
include an updated chart.
3:20:57 PM
CHAIR SEATON, in response to Representative Stutes, explained
that the chart incorporated the federal match of 90 percent, and
reflected the savings incurred.
REPRESENTATIVE STUTES clarified that the chart showed the
decrease for the federal match during the upcoming years.
MS. HANSEN pointed out that this was a compilation, with a
different format, from the charts presented at an earlier
meeting.
3:22:41 PM
The committee took an at-ease from 3:22 p.m. to 3:26 p.m.
3:26:25 PM
CHAIR SEATON brought the committee back to order.
REPRESENTATIVE VAZQUEZ asked about the fiscal note labeled OMB
Component 2662.
3:28:25 PM
The committee took an at-ease from 3:28 p.m. to 3:31 p.m.
3:31:12 PM
CHAIR SEATON brought the committee back to order.
REPRESENTATIVE VAZQUEZ directed attention to page 3 of the
fiscal note labeled OMB 2662, and asked about the number of
1915(c) waiver recipients receiving personal care attendant
(PCA) services and the general funds spent.
3:33:10 PM
JON SHERWOOD, Deputy Commissioner, Medicaid and Health Care
Policy, Department of Health and Social Services, in response to
Representative Vazquez, said that there were about 4,000, and
that he would report on the exact number.
REPRESENTATIVE VAZQUEZ reflected that the 1,603 recipients on
1915(c) waivers also receiving personal care attendant (PCA)
services, was just a portion of that total.
MR. SHERWOOD replied that this was correct. He explained that
the 1915(k) option was only available to individuals who met an
institutional level of care. He stated that these people
received home and community based services through the 1915(c)
waiver, and as it was known they met that institutional level of
care, they could be moved into the 1915(k) for personal care
services which had a higher [federal] match rate.
REPRESENTATIVE VAZQUEZ asked if there was a study indicating
this exactly, and not just departmental projections.
MR. SHERWOOD offered his belief that these numbers were directly
from the departmental records.
REPRESENTATIVE VAZQUEZ questioned whether the 1915(i) waiver
would include individuals not currently receiving services.
MR. SHERWOOD explained that the waiver would include individuals
not receiving home and community based services through the
Medicaid program, although it was expected that these
individuals would be receiving services through a state funded
program.
REPRESENTATIVE VAZQUEZ suggested that there would be additional
beneficiaries to the Medicaid program.
MR. SHERWOOD stated that the 1915(i) option did not expand
eligibility for Medicaid, it expanded the number of services
available to people in the Medicaid program. He pointed out
that some people in the Medicaid program were currently
receiving a combination of Medicaid and state funded services,
and this waiver would move all the services into the Medicaid
program.
REPRESENTATIVE VAZQUEZ mused that there were individuals
currently not receiving any Medicaid benefits who would become
Medicaid beneficiaries.
MR. SHERWOOD expressed agreement that there were individuals who
did not currently receive Medicaid home and community based
services benefits who would become beneficiaries of those
services.
REPRESENTATIVE VAZQUEZ asked if this was the same for the other
option.
MR. SHERWOOD asked to what other options she was referring.
REPRESENTATIVE VAZQUEZ suggested that the 1915(k) option would
expand services to existing Medicaid beneficiaries.
MR. SHERWOOD expressed agreement.
REPRESENTATIVE VAZQUEZ asked if there were any individuals
currently not receiving services through the Medicaid program
who would become eligible under the 1915(k) option.
MR. SHERWOOD replied that there were not any recipients who
would be eligible to receive services through the Medicaid
personal care program by adding this option. He stated that
"generally speaking this would not expand eligibility or access
to service."
REPRESENTATIVE VAZQUEZ asked if there were any states which had
developed the (i) or (k) option.
MR. SHERWOOD replied that about 20 states had developed the
1915(i) option, and about 4 states had developed the 1915(k)
option to date.
REPRESENTATIVE VAZQUEZ asked for a list of those states.
MR. SHERWOOD said that he did not remember which states.
CHAIR SEATON pointed out to Representative Vazquez that this had
been previously discussed under the amendment process using the
pie charts [included in members' packets].
3:39:31 PM
REPRESENTATIVE VAZQUEZ stated that she had not been able to
locate any states using either the 1915(i) or (k) options.
MR. SHERWOOD said that he would provide the information.
3:39:55 PM
REPRESENTATIVE TALERICO, addressing the same fiscal note,
labeled OMB 2662, asked for clarification that currently there
were individuals for whom the state paid 100 percent of the
cost, and that this option would cut the cost to the state by
half, by offering a 50 percent federal match.
MR. SHERWOOD replied that this was correct.
3:41:24 PM
CHAIR SEATON removed his objection. There being no further
objection, the proposed committee substitute (CS) for HB 227,
labeled 29-LS1096\N, Glover, 3/7/16, was adopted as the working
draft.
3:41:38 PM
REPRESENTATIVE VAZQUEZ expressed her objection to the committee
substitute, Version N. She said that, although this was going
on the right path, it would take time to implement these ideas
and that it was optimistic to expect to see the savings "until a
year down the road." She stated that the most disconcerting
part of the bill was for the 1915(i) and 1915(k) provisions, as
they would become entitlement programs, which the state would
not be able to terminate. She stated that the current waiver
programs had more flexibility for caps or limits. She said that
using the 1915(i) and 1915(k) options would not allow the state
to place limits, caps or waiting lists, and could create
financial difficulty in upcoming years if the state fiscal
situation did not improve. She noted that, if the state fails
to comply, all the federal funding for Medicaid programs could
be at risk. She declared that there were not any studies to the
costs of these options, and she opined that "no other state has
implemented these options."
3:43:49 PM
REPRESENTATIVE Foster moved to report CSHB 227, labeled 29-
LS1096\N, Glover, 3/7/16, out of committee with individual
recommendations and the accompanying fiscal notes.
3:44:48 PM
REPRESENTATIVE VAZQUEZ objected.
3:44:59 PM
REPRESENTATIVE TARR complimented Representative Vazquez for her
diligence and that she would continue to remain engaged in the
process. She stated her support for the proposed bill and the
opportunity to spend dollars for better outcomes.
CHAIR SEATON expressed his appreciation for the work by the
committee, and he opined that this would save money and improve
health, which would mean longer term health savings.
3:46:45 PM
REPRESENTATIVE VAZQUEZ maintained her objection. She stated
that these programs were essential to needy people, and they
provided a safety net to the most vulnerable populations. She
expressed her interest in the long term viability of these
programs, noting that other states had limited programs. She
offered an example of one state with a two year wait list for
any waiver program. She declared that she wanted to see the
viability of the program, as it was a critical safety net, and
that, given that Medicaid had an annual cost of $1.7 billion
including the federal match, this was a serious matter. She
acknowledged that it was a great idea to have more access to
health care and a healthier population, but that the state was
facing some difficult fiscal issues with no "end in sight." She
expressed appreciation for the effort to maximize the federal
match, although she cautioned restraint to ensure that the
spending did not get out of control.
3:49:34 PM
A roll call vote was taken. Representatives Seaton, Tarr, Wool,
Talerico, Stutes, and Foster voted in favor of the committee
substitute (CS) for HB 227, labeled 29-LS1096\N, Glover, 3/7/16.
Representative Vazquez voted against it. Therefore, CSHB
227(HSS) was reported out of the House Health and Social
Services Standing Committee by a vote of 6 yeas - 1 nay.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 227 Summary of Changes_H to N.pdf |
HHSS 3/8/2016 3:00:00 PM |
HB 227 |
| HB 227 Proposed CS ver N_3.7.2016.pdf |
HHSS 3/8/2016 3:00:00 PM |
HB 227 |
| HB 344 Follow Up DCCED_3.8.2016.pdf |
HHSS 3/8/2016 3:00:00 PM HHSS 3/10/2016 3:00:00 PM |
HB 344 |
| HB 227 Fiscal Note Graphs from Legislative finance_ 3-8-16.pdf |
HHSS 3/8/2016 3:00:00 PM |
HB 227 |