Legislature(2015 - 2016)CAPITOL 106
03/22/2016 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB315 | |
| HB334 | |
| HB328 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 315 | TELECONFERENCED | |
| *+ | HB 334 | TELECONFERENCED | |
| *+ | HB 328 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 315-ELECTRONIC VISIT VERIFICATION: MEDICAID
3:14:18 PM
VICE CHAIR LIZ VAZQUEZ announced that the first order of
business would be HOUSE BILL NO. 315, "An Act relating to an
electronic visit verification system for providers of certain
medical assistance services."
3:14:37 PM
ANITA HALTERMAN, Staff, Representative Liz Vazquez, Alaska State
Legislature, paraphrased from the Sponsor Statement [included in
members' packets], which read, in part:
This bill requires the implementation and use of EVV
systems for PCA services in Alaska. The EVV systems
monitor and verify home health services delivered by
PCAs by tracking whether home visits occurred and the
time spent in the home. The EVV system will verify in
real time the physical location of the provider (PCA)
and the recipient after they both "sign in" and "sign
out" of the EVV system. The "sign in" and "sign out"
is usually done by land-line or cell phone and the
location is verified by the EVV program. Thus, the EVV
system reduces waste, abuse and fraud by capturing and
reporting actual time worked by the PCA or home care
provider. The goal of HB 315 is to ensure the State
only pays providers for approved services rendered by
appropriate home health agency personnel while within
the recipients' home or other authorized setting. This
ensures that Medicaid recipients receive services as
authorized. It is anticipated that billing errors,
fraud, and abuse will be reduced significantly through
verification of home visits through these efforts.
As Alaska's population is aging, the demand for PCA
and home care services will increase. Accordingly, it
is will become increasingly more important to ensure
that home care is delivered properly and that publicly
funded resources are being managed and spent
appropriately. It is anticipated that Alaska has the
potential to realize savings of between $15 million
and $37 million dollar.
MS. HALTERMAN relayed that some of the major benefits of the
proposed HB 315 included that the technology could potentially
provide early identification for adult protective service issues
by identifying neglect situations and triggering alerts to the
agencies when a care giver did not show up at the home, which
would also realize savings for reducing payment of services not
rendered. She directed attention to supportive documents which
addressed the return on investment [included in members'
packets].
3:17:02
MS. HALTERMAN paraphrased from some proposed changes [included
in members' packets] from the original bill to a not yet
introduced committee substitute (CS) for HB 315, labeled 29-
LS1287\W, Glover, 2/18/16 [included in members' packets], which
read:
Upon reviewing the bill as it had been written, I'd
realized that home and community based and personal
care attendant services are NOT always provided in the
home but that sometimes they are provided in other
settings. The language change on version W addresses
the need for more flexibility with language to
accommodate the various settings where services may be
provided. The addition of language to allow for "other
approved settings" addressed that issue.
3:17:50
MS. HALTERMAN moved on to paraphrase proposed changes [included
in members' packets] from the not yet introduced Version W to a
not yet introduced committee substitute (CS) for HB 315, labeled
29-LS1287\E, Glover, 3/21/16 [included in members' packets],
which read:
Version E keeps the change made in version W and adds
a few others as follows:
1. Prior to requesting a hearing over this bill, SDS
inquired of our office about the development of the
new system they appear to have thought they were to
develop in light of language used in versions A and W
of this bill. The changes to version H make it clear
that the Department shall procure an electronic visit
verification system and not develop one of their own.
The development of a system would be costly and the
Department alerted me on March 16, 2016 that this bill
would likely have a $5 million dollar fiscal note,
this lead us to understand that they had not
understood the intent of this bill. In addition, the
changes in version H also add a stipulation that the
system must allow providers to electronically document
the service in near real-time where it is technically
feasible. This will allow us to address allowing more
flexibility in remote areas with no telephone, cell
phone or computer access. It has been discovered that
vendors appear to offer another solution for those
settings that actually is entered after the visit
occurs. These vendors offer a unique number to assure
that the above information is collected and stored
when technology solutions are not feasible. The bill
ensures that any vendor must be capable of meeting
these requirements.
2. The PCA providers have raised issues with a third
party employment relationship concern that has been
addressed by the Federal Department of Labor and our
office felt the need to place assurances in the bill
that address this issue. We do not intend to replace
the role of the PCA provider or Home and Community
based provider agencies in the role of employer. In
order to address that concern, we changed the language
of the bill in order to ensure the providers still
have the ability to be alerted to concerns that need
to be managed by the agency. Therefore it seems
advisable to add language that requires the vendor to
alert the provider agency of any gaps or missed
appointments in order for them to remediate the issue.
The state also should have the option to receive these
alerts and the new CS addresses that issue.
3. The final change addresses integration concerns
that agencies raised. Some claim to have proprietary
systems that they feel will no longer be usable with a
vendor based EVV system. The final version E adds a
new section that addresses this by requiring the
vendor to integrate any existing EVV systems into the
vendor solution.
4. We had leg legal define "real time" as "within a
couple of minutes of the occurrence". This was done in
order to identify any gaps in service or to allow
adult protective service issues to be identified as
early as possible for the most vulnerable
beneficiaries.
3:21:34 PM
MS. HALTERMAN summarized that the bill "is easy to use, it
doesn't require hardware or software, and it does assure that
the services that are paid for by state government are actually
being rendered within those homes."
3:21:50 PM
VICE CHAIR VAZQUEZ opened public testimony.
3:22:15 PM
ALLISON LEE, State Director; Chair, Rescare Alaska, Alaska PCA
Providers Association, stated support for electronic visit
verification (EVV) systems for PCA (personal care attendant)
services, and pointed to some issues with the not yet proposed
committee substitute. She directed attention to a white paper
stating general support for the proposed bill [included in
members' packets], and she noted that the Department of Health
and Social Services had the authority to establish requirements
for EVV without any legislation.
3:23:55 PM
DENISE TOCCO, Sandata Technologies, stated support for proposed
HB 315, and reported that Sandata Technologies was a vendor
currently which offered EVV systems in seven states, and had
been providing this EVV technology to payers and providers for
the past 36 years. She stated that the EVV systems had proven
to remove fraud and improve quality by ensuring that only visits
that were properly verified were allowed to be submitted as
claims. She declared that the third party outcomes showed that
EVV programs could reduce claims costs by as much as 50 percent
without changing the benefit structure or care delivery model,
as the savings were a result of the removal of fraud. She
estimated that EVV systems could provide a "minimum claims
reduction of 5 percent," which represented an estimated $50
million savings in the first year prior to any Federal Medical
Assistance Percentages (FMAP). She relayed that Centers for
Medicare & Medicaid Services (CMS) had recently approved
enhanced FMAP rates at 90 percent for one time fees and 75
percent for recurring fees for two states with EVV programs.
She declared that proposed HB 315 was an important first step
toward improving efficiency and insuring care, after which the
Department of Health and Social Services could evaluate and
procure an EVV solution that works best for Alaska. She
suggested that Sandata Technologies recommended a single vendor
solution in order to maximize program savings, and increase
quality of care with consistent monitoring and alerts. She also
recommended that an EVV solution be required to integrate with
existing provider software systems, to help maintain the
investments made by local providers. She shared that the
majority of home care providers in most states had not made an
investment in technology and would welcome solutions to help
automate their businesses. She reported that EVV solutions were
sold as a software service, and that there was not any software
or hardware to buy. She relayed that it would take four to six
months to implement a statewide program. She reiterated support
for the proposed HB 315.
3:26:32 PM
MS. TOCCO, in response to Representative Tarr, said that she was
affiliated with Sandata Technologies, a vendor providing EVV
software to state programs.
REPRESENTATIVE TARR asked if Sandata anticipated an interest in
providing the services, should the proposed bill pass.
MS. TOCCO replied that Sandata would like to bid on any public
procurement as a result of the proposed bill.
3:28:52 PM
GREY MITCHELL, Director, Division of Labor Standards & Safety,
Department of Labor & Workforce Development, in response to
Representative Tarr, explained that he did not have any specific
information about the services, as his involvement was for the
potential impacts on labor laws and any EVV requirement issues
that may impact the state.
3:29:42 PM
MS. TOCCO, in response to Representative Tarr, offered an
explanation as an industry vendor, and not specifically as a
representative from her company. She explained that non-urban
visits could be verified through a variety of ways, including
telephonic verification of visits, cellular GPS solutions, home-
based device solutions, and she acknowledged that the geography
of Alaska offered some unique challenges. She shared that her
company had operated in many large states with rural areas,
where connectivity could be a challenge, and the company, and
other vendors, had found multiple solutions for verification of
visits.
3:30:44 PM
REPRESENTATIVE WOOL asked about the changes in technology over
the past 36 years that Sandata Technologies had been in
business.
MS. TOCCO replied that her company had used telephones, and had
held the original patents on electronic visit verification (EVV)
although that had since expired.
3:31:16 PM
CONNIE SIPE, Executive Director; Co-Chair, Center for Community,
Alaska PCA Providers Association, reported that Alaska PCA
Providers Association represented the largest provider companies
in Alaska. She stated support of the proposed bill, in concept,
and directed attention to the aforementioned white paper
[included in members' packets]. She expressed desire to work on
the not yet introduced committee substitutes. She relayed that
the Medicaid expenditures for PCAs in the last year had been
about $89 million in Alaska, pointing out that the provider
agencies were "economic engines in the communities where we
provide many, many hours of jobs and work." She reported that
the white paper had urged a standards based method, used by
Washington and other states, which had set a standard for the
kind of EVV systems to be used statewide, so that the providers
could use an integrated software system. She noted that the
State of Alaska was still requiring hard copy time sheets signed
by the worker and the client. She offered belief that one
uniform state system could be very inefficient as there were
large providers from multiple states with different systems.
She expressed concern with a real time window as it imposed an
implied monitoring obligation that could be difficult to staff.
She relayed information from a CMS seminar during which some
states had been told they were "joint employers" of personal
care attendants, as indicated by an EVV system with real time
access by the state. She stated that, as there were not any
clear federal regulations, this was currently based on
interpretation by the U.S. Department of Justice. She pointed
out that this could affect the state's liability for overtime
pay to a personal care attendant. She pointed out that,
although the aggregate cost of Medicaid spent on personal care
attendants seemed large, this was so much less per client than
the cost of nursing homes. She reported that the personal care
attendants were the lowest paid per unit service in the Alaska
Medicaid system.
3:37:24 PM
REPRESENTATIVE TARR relayed that this issue had arisen in the
past, as there had been a re-evaluation of the time allotted for
personal care services (PCAs). She relayed that some services
had been re-scheduled into 15 minute increments, which she
opined had scaled back the amount of time allocated to patients.
She asked if this was putting a lot of strain on the system to
provide the services in the allotted time, and possibly taking
away from provider time with the client.
MS. SIPE reported that Medicaid costs for the PCAs had come down
from over $100 million annually, partially as an effort by the
Department of Health and Social Services to become more
prescriptive about the amount of time and service. She noted
that, in other states, many consumers did not have land line
phones, and not all PCAs had a cell phone or availability of a
land line. She expressed concern for this, sharing that
sometimes workers were met by a crisis immediately upon arrival
at a job, and were not able to sign-in right away. She reminded
that the agencies were in a constant back and forth with workers
and clients, so were much more aware of the goings-on, and that
this provider information and data were kept available to the
state upon request.
3:41:01 PM
REPRESENTATIVE TARR asked how frequently the association was
audited.
MS. SIPE relayed that the state would draw 50 of the higher risk
service providers each year, of which a number were PCA agencies
and home and community based providers. She shared that her
agency included 10 providers and had been audited three times,
although never found to have any problems. She noted that, as
they were subject to audit for seven years, they kept the
records for that far back.
3:42:30 PM
VICE CHAIR VAZQUEZ asked about the periods of time for the three
audits.
MS. SIPE offered her belief that the state audits were for
service in 2006, then again for services in 2010 and in 2011.
VICE CHAIR VAZQUEZ asked about the compensation received from
the Department of Health and Social Services for every 15
minutes of service.
MS. SIPE stated that the Medicaid base rate for personal care in
Anchorage, although there were some regional adjustments because
of cost, was $6.10 for each 15 minute unit. She reported that
many PCAs in this area had Certified Nursing Assistant (CNA)
certificates, and asked to be paid $15 - $16 per hour. She
added that all the unpaid costs, support costs, and supervisory
costs were also paid out of this, as they only billed for the
actual services delivered. She pointed out that the agency paid
the travel time, as it was not billed to Medicaid.
MS. SIPE, in response to Vice Chair Vazquez, said that the
regional cost in SE Alaska was 9 percent higher, adding about $2
per hour. She relayed that the PCAs started at $14.58 or
$15.02, and, dependent on prior experience, could start higher,
up to $16 per hour. She said that it was difficult to pay less
than $16 per hour in Anchorage, although in smaller communities
in SE Alaska PCAs were sometimes paid $14.50 - $15 per hour.
VICE CHAIR VAZQUEZ asked if the agency offered health insurance.
MS. SIPE replied that the agency would be obligated to start
providing health insurance for people with variable hours,
fluctuating around 30 hours per week, on July 1. She stated
that it was likely they would not be able to provide this, and
would then also have to drop the health insurance for 40 hour
per week workers as the agency could not afford to pay the
insurance premiums. She acknowledged that this would result in
the payment of penalties. She reported that the monthly
insurance premium for a worker with no dependents was $950 per
month, with a fairly high deductible. She stated that it was
not possible to pay these premiums for those only working 30
hours per week. She shared that the agency was looking at lower
cost policies with higher deductibles that would still meet the
Patient Protection and Affordable Care Act (PPACA) requirements.
She said that part time workers received the required benefits
of unemployment insurance, a small Christmas bonus, and an
occasional paid holiday each year. She reported that the
[profit] margin was very low as there was a lot of paid time for
training, no-shows, supervisors, billing clerks, compliance
staff, and "other things."
[HB 315 was held over.]