Legislature(2015 - 2016)CAPITOL 106
04/05/2016 03:00 PM House HEALTH & SOCIAL SERVICES
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| HB345 | |
| HB334 | |
| HB315 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 345 | TELECONFERENCED | |
| += | HB 334 | TELECONFERENCED | |
| += | HB 315 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 315-ELECTRONIC VISIT VERIFICATION: MEDICAID
4:37:41 PM
CHAIR SEATON announced that the final 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."
4:38:03 PM
REPRESENTATIVE VAZQUEZ moved to adopt the proposed committee
substitute (CS) for HB 315, labeled 29-LS1287\N, Glover, 4/1/16,
as the working draft.
CHAIR SEATON objected for discussion.
4:38:35 PM
TANEEKA HANSEN, Staff, Representative Paul Seaton, Alaska State
Legislature, explained that the proposed committee substitute
would narrow the approach for the electronic visit verification
(EVV) system for the first few years by directing the Department
of Health and Social Services to establish pilot projects for
these EVV systems. She reported that Section 1 of the proposed
CS was legislative intent language, stating that it was the
intent of the legislature to protect vulnerable Alaskans and the
integrity of the medical assistance program by reducing the
number of fraudulent claims and insuring that services were
provided to medical recipients. She relayed that it would use
technology to improve accountability for personal care services
and home and community based services delivered to medical
assistance recipients.
MS. HANSEN discussed Section 2, uncodified law, as this
established a pilot project and directed the Department of
Health and Social Services to adopt standards for an electronic
visit verification (EVV) system under this project. This system
would be used to verify visits conducted to provide personal
care services in the home or other setting and visits conducted
to provide home and community based services. She noted that
this should establish the providers eligible to participate and
require that the EVV system will document, at a minimum, the
name of the provider, or their employee, the recipient, the date
and time the contractor begins and ends the delivery of
services, and the location of services. She explained that
subsection (b) stated that DHSS would review the EVV systems
implemented under this section and prepare a report with
recommendations for statewide application of an EVV system,
which would be due on or before January 1, 2018, and delivered
to the Alaska State Legislature.
4:41:20 PM
CHAIR SEATON removed his objection to the proposed committee
substitute, Version N. There being no further objection, it was
adopted as the working draft.
REPRESENTATIVE WOOL asked whether the pilot program was at the
discretion of the department for hiring a vendor or creating it
in-house.
CHAIR SEATON explained that this would be clarified in a yet to
be introduced amendment. He offered some possibilities for the
pilot projects to ensure that the department had the flexibility
"to get something that will work and that people are willing to
participate in." In response to Representative Wool, he pointed
out that there was a fiscal note and testimony from the
department.
4:44:07 PM
DEB ETHERIDGE, Deputy Director, Central Office, Division of
Senior and Disabilities Services, Department of Health and
Social Services, asked for clarification to which fiscal note
was being referenced.
CHAIR SEATON clarified that the fiscal note was for the original
bill and included information about the vendor.
MS. ETHERIDGE said that she could speak on some of the
anticipated costs associated with the pilot project. She said
that she had not calculated the necessary statistically valid
sample for an effective pilot program, although consultations
with industry experts and other states had indicated that the
transaction fee per transaction was about $0.15, with each visit
consisting of two transactions. She noted that the cost would
depend on the number of services a person received each day.
She suggested that a pilot project for only personal care
services, and not for home and community based services, would
have fewer per day transactions. She reported that a person
could have personal care services three times each day, although
this could change if there were home and community based
services, as well. She stated that the draft fiscal note had
anticipated costs for two visits each day, five days each week,
and 20 days each month.
CHAIR SEATON asked if this yielded an overall savings.
MS. ETHERIDGE replied that the savings were associated with a
1.5 percent efficiency found in administrative claims for
Medicaid. She explained that there would be an actual time
associated, and there would be a savings as the time for service
would no longer be rounded.
4:48:31 PM
CHAIR SEATON pointed out that the savings in other states had
accrued in the first year, although, as the providers adjusted,
those savings did not continue.
MS. ETHERIDGE expressed her agreement, noting that there was
considerable savings in small populations, which did not always
continue when moved into a larger population. She stated that
the pilot program was a good way to ensure the savings.
CHAIR SEATON asked that the pilot program be large enough to be
statistically significant, so there would be a better idea for
its savings on a larger scale. He asked if the pilot would be
designed for different locations.
MS. ETHERIDGE replied that this would be necessary, as some
associated expenditures which were difficult to anticipate were
with connectivity, and it would be necessary to pay for a
solution. She relayed that it would be necessary to target
different areas in the state to ensure an understanding for the
costs, and then to realize the savings.
REPRESENTATIVE WOOL suggested that some savings would be a
result of reduction in fraud if the verification system was
working. He surmised that these savings would diminish as
"people sort of start playing by the rules."
MS. ETHERIDGE stated that the expectation was for ongoing
compliance and adherence when billing for services using the EVV
system, and an overall reduction and savings was anticipated for
each year. She referenced a concern by Representative Seaton
that some states had implemented the EVV system without
allocating enough funds for a system which provided recognition
of a service provider in the home. She said that this required
extra funding, noting that, without it, the verifications were
not as valid. She shared that it was necessary to weigh the
cost of the solution against the cost of the Medicaid program.
She reported that any additional administrative costs on the
service from the Medicaid program were captured in a cost report
and would be reflected in the reimbursement. She said that all
of these factors were considered when implementing programs for
the state.
REPRESENTATIVE WOOL mused that the EVV system would eliminate
fraud, and the resultant criminal convictions for fraud, as the
care and the time was accurately recorded. He suggested that
the costs should then stabilize.
MS. ETHERIDGE clarified that most authorized services were in 15
minute units, and it was anticipated that more people would
receive their authorized services.
REPRESENTATIVE VAZQUEZ added that there was also a quality
assurance component with the verification program, noting that
Florida and Oklahoma had savings over the first few years.
4:55:55 PM
REPRESENTATIVE WOOL observed that the system appeared to be
necessary, and that the pilot program could determine if it
would work and if there would be a savings.
CHAIR SEATON explained that the purpose of the pilot was to
determine if the data could be fully utilized and avoid
implementing a big system to cover the entire state and solve
all the problems at one time, which could then fail.
4:58:13 PM
CHAIR SEATON moved to adopt proposed Amendment 1, labeled 29-
LS1287\N.5, Glover, 4/5/16, which read:
Page 2, following line 19:
Insert a new subsection to read:
"(b) The Department of Health and Social Services
may consider a third-party vendor system for the pilot
project under this section."
Reletter the following subsection accordingly.
4:58:42 PM
REPRESENTATIVE VAZQUEZ objected for the purpose of discussion.
She said that she supported the proposed amendment as it
provided the department with further flexibility for
implementing the program.
4:59:03 PM
REPRESENTATIVE VAZQUEZ removed her objection. There being no
further objection, Amendment 1 was adopted.
4:59:29 PM
CHAIR SEATON moved to adopt proposed Conceptual Amendment 1,
which read:
Page 2 line 7: replace "and" with "or"
There being no objection, Conceptual Amendment 1 was adopted.
5:01:02 PM
CHAIR SEATON moved to adopt proposed Conceptual Amendment 2,
which read:
Page 2 line 23: Delete "January" and replace with
"July"
There being no objection, Conceptual Amendment 2 was adopted.
5:01:46 PM
CHAIR SEATON moved to adopt Conceptual Amendment 3, which read:
Page 2 lines 5, 8, 10: Delete "standards" and replace
with "regulations"
CHAIR SEATON explained that the purpose of this proposed
amendment was to clarify for the Department of Health and Social
Services that it was not necessary for a standards based pilot,
but instead, as they were adopting regulations, they had the
freedom to adopt a pilot with a vendor, from a current
provider's system, or another design.
5:02:35 PM
REPRESENTATIVE TARR objected for discussion. She asked if, as
it was a pilot program, this had been developed with standards
language, instead of regulations, because regulations would make
it necessary for the formal process of drafting regulations.
CHAIR SEATON asked if the use of "regulations" [in the proposed
conceptual amendment] would interfere with the interpretation of
formal regulations, or could "guidelines" replace "standards"
and retain the meaning.
MS. ETHERIDGE, in response, said that Department of Health and
Social Services would prefer to have "guidelines" or "standards"
[in the proposed conceptual amendment] for flexibility in order
to implement the pilot program on a timely basis and then the
department could adopt regulations if necessary to ensure
funding through the Medicaid program.
CHAIR SEATON asked which would be better.
REPRESENTATIVE VAZQUEZ interjected that the usage of
"regulations" was for a formal process, and could be overly
burdensome for a pilot project. She expressed her agreement
with the intent to avoid confusion by not imposing a standards
based. She suggested that "standards" be replaced by
"guidelines" [in the proposed conceptual amendment] to avoid any
confusion.
MS. ETHERIDGE expressed her agreement.
5:06:22 PM
REPRESENTATIVE VAZQUEZ moved to adopt a friendly amendment to
Conceptual Amendment 3, which read:
Page 2 lines 5, 8, 10 Delete "standards" and replace
with "guidelines"
[The committee treated the friendly amendment as adopted.]
REPRESENTATIVE TARR removed her objection. There being no
further objection, Conceptual Amendment 3, as amended, was
adopted.
5:07:40 PM
REPRESENTATIVE TARR pointed out that there needed to be
consideration for the unique circumstances of Alaska, that cost
effectiveness and quality assurance be considered, and that
expectations be realistic. She reminded that, as personal care
attendant services were only provided for individuals able to
live independently, a no-show was often reported by the client.
She declared her support of the personal care attendant program
to allow people to stay in their homes and be closer to their
families.
5:11:50 PM
REPRESENTATIVE VAZQUEZ moved to report CSHB 315, labeled 29-
LS1287\N, Glover, 4/1/16, as amended, out of committee with
individual recommendations and the accompanying fiscal notes.
There being no objection, CSHB 315(HSS) was moved from the House
Health and Social Services Standing Committee.
CHAIR SEATON said that new fiscal notes for Version N would be
forthcoming.