Legislature(2017 - 2018)SENATE FINANCE 532
03/29/2018 09:00 AM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB105 | |
| SB104 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 122 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 104 | TELECONFERENCED | |
| += | SB 105 | TELECONFERENCED | |
SENATE BILL NO. 105
"An Act relating to the licensure of marital and
family therapists; relating to professional liability
insurance for marital and family therapists; relating
to medical assistance for marital and family therapy
services; and providing for an effective date."
9:04:53 AM
Co-Chair MacKinnon discussed a brief history of the bill.
The committee opened and closed public testimony on the
bill on February 27, 2018. The committee had been working
on compromise language to satisfy the concerns raised by
members as well as the general public.
Vice-Chair Bishop MOVED to ADOPT proposed committee
substitute for SB 105, Work Draft 30-LS0442\N (Radford,
3/28/18).
Co-Chair MacKinnon OBJECTED for discussion.
SENATOR DAVID WILSON, SPONSOR, deferred to his staff, Mr.
Zepp, to review the committee substitute changes.
GARY ZEPP, STAFF, SENATOR DAVID WILSON, reviewed the
Summary of Changes document (copy on file):
Version J to Version N
Section 1Amended
Page 2, lines 16-24: The required total number of
hours for the supervision of an Associate Marital and
Family Therapist was corrected to 1,700 hours.
The previous version incorrectly reflected 1,500 hours
as the required total hours.
Version R also clarifies that 100 hours of individual
supervision and 100 hours of group supervision
conducted one or more supervisors is included in the
1,700 hours.
Section 1 - Deleted
Page 2, lines 29-31: The requirement for $30,000 of
professional liability insurance was deleted.
Insurance to cover state investigative costs is not
currently available as envisioned. A national company
does offer professional liability insurance, but the
coverage would reimburse the licensee for their
investigative costs and not the state investigator
costs. The idea of professional liability insurance
was to pay for state investigative costs and keep
downward pressure on the state investigative costs so
that the costs wouldn't be allocated amongst current
licensees and increase their existing license fees.
Mr. Zepp continued to read the summary of changes:
Section 2 Amended
Page 3, lines 5 -13: Properly re-state the titles for
the healthcare professions listed that are authorized
to provide group supervision of an Associate Marital
and Family Therapist while in training.
The titles of certain healthcare professionals were
verified by the State Medical Board.
Section 4 and 5 - Deleted
Page 4, lines 8 Page 5, line 1: Sections 4 and 5
were deleted because SB 169, which has passed the
Senate and is in the other body, amends the same
statutes (AS 47.07.030) previously contained in
sections 4 and 5 of SB 105.
SB 169 amends statute by replacing a psychiatrist with
a physician, to expand the direct supervisory capacity
in providing behavioral health clinic services. As
well as removing the 30% on - site requirement and
replacing that by requiring a physician in person or
available via a communication device.
SB 105, as amended, is fully supported by the Board of
Marital and Family Therapists. Please see the two
letters of support from the Board.
9:09:42 AM
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
further OBJECTION, it was so ordered. She invited Senator
Wilson to comment on the bill.
Senator Wilson discussed the bill. He explained the main
purpose of the bill was to add the marital and family
licensed therapist to the list of providers that were able
to bill Medicaid allowing more access to services. The bill
would enhance behavioral health capacity for underserved
Alaskans who were on long waitlists to access services. He
stated that the bill would offer opportunities for clinics
to provide services at a lower cost. He elaborated that the
way in which recruitment happened currently for licensed
social workers with a Master of Social Work (MSW) degree
took a significant amount of time, about 1 year or 1.5
years, to recruit. For some clinics, the cost of
recruitment was over $100,000. The bill would result in a
more abundant source of providers that were equally
qualified to provide behavioral health services at a lesser
cost with easier access.
Senator Micciche asked the sponsor to explain the benefit
of the bill and identify how much money would be saved in
the long run. Senator Wilson replied that without having
access to psychiatric services and providers at a lower
cost, patients were going to the emergency room (ER). The
cost for treatment at an ER often cost the state 10 times
more than providing the services through local community
clinics. He noted previous testimony by representatives
from some of the community health centers who confirmed
their facilities could provide behavioral health services
at a lower cost than an ER. The Mat-Su Health Foundation
reported the number of people accessing their ER and their
inability to meet the needs of patients because of a lack
of capacity. He also noted hearing testimony from 85
licensed psychiatrists in the State of Alaska. The Mental
Health Working Group confirmed that their studies stated
that Alaska needed an additional 106 to 184 psychiatrists
to meet the national average and to cover the need in the
state. He was hoping that patients could address their
issues through a lower acuity of care instead of them being
escalated to a higher acuity of care, which was more
devastating to the individual and costlier to the state.
9:13:47 AM
Senator Olson asked if the sponsor had checked with health
corporations regarding the changes to the bill. Senator
Wilson asked if Senator Olson was referring to the native
health corporations or some of the larger providers.
Senator Olson wondered, if he called up Maniilaq Health
Center, whether they would be able to confirm that the bill
sponsor had reached out to them about the proposed changes
in the bill. Senator Wilson stated that Maniilaq Health
Center was a member of the Alaska Primary Care Association
(APCA), who was in full support of the legislation. He
hoped Maniilaq Health Center would support the bill being a
member of APCA. He relayed that half of the members of APCA
were tribal entities that operated the community health
centers. The trade association was in full support and had
been lobbying to help support the bill.
Senator Olson referenced the name change in Section 4 and
5. He asked if the Senator had talked with any of the
physician groups such as the Alaska State Medical
Association about the changes moving from psychiatrists to
physicians. Senator Wilson responded in the negative. His
office had worked with the department on the legislation.
They were in full support of the change from psychiatrist
to physician to meet more of the federal definitions and
guidelines with conforming language.
Senator Olson asked who "they" were. Senator Wilson
specified Director Burns of the Department of Health and
Social Services (DHSS).
Co-Chair MacKinnon stated that the committee had removed
from the bill another bill that was carried by another
sponsor, Senator Giessel, regarding supervision and the
definition Senator Olson referred to. Currently in Alaska
state statute, in any individual medical provider's office
a psychiatrist was required 30 percent of the time. She
conveyed her point that there were two pieces of
legislation that would affect the same portion of statute.
With that in mind, she had a concern that the legislature
would be dependent on two pieces of legislation by two
different legislators ending across the finish line at the
same time to accomplish what the legislature wanted to
accomplish. Senator Wilson's bill allowed the billing and
was not speaking directly to supervision. She asked if she
was correct. Senator Wilson clarified that the bill
addressed both supervision and the expansion of MSW's being
able to bill Medicaid.
Co-Chair MacKinnon directed her question around
supervision. She asked about supervision in terms of the
bill the committee had heard previously and whether it had
to do with 30 hours. Mr. Zepp answered in the affirmative.
He noted that the previous version of the bill in Sections
4 and 5 fell into the Medicaid billion section of the bill.
In thinking of SB 105 there were two silos. The first silo
was the training issue for an associate which was what the
senator as trying to streamline and expand. The second silo
was under the Medicaid billing to provided marital and
family therapists under the optional Medicaid services, so
they could bill and seek reimbursement. The Senator removed
Sections 4 and 5 because Senator Giessel's bill clarified
direct supervision from a physician with certain
guidelines.
9:18:52 AM
Co-Chair MacKinnon stated that she was willing to support
the billing portion of the legislation because of seeing
the results of an opioid epidemic in Alaska and other
mental health needs that were being under-represented in
communities across the state. She added that she thought
supervision was important, and that Senator Giessel's bill
along with Senator Wilson's bill both needed to reach the
finish line.
Senator Micciche thought both bills being discussed were
advantageous to the clients and to the state. Co-Chair
MacKinnon echoed the comments of Senator Micciche.
9:20:53 AM
RANDALL BURNS, DIRECTOR, DIVISION OF BEHAVIORAL HEALTH,
DEPARTMENT OF HEALTH AND SOCIAL SERVICES (via
teleconference), discussed fiscal note OMB component 2660.
The fiscal note specifically addressed the portion of the
bill related to the addition of marriage and family
therapists to the optional Medicaid statutes. The division
had estimated what was thought to be a fair amount of
additional costs to the Medicaid budget as the result of
adding Marriage and Family therapists to the list of
professions that could bill Medicaid for their services. He
found that the bill would only apply to about 633 Medicaid-
eligible recipients in the first year.
Mr. Burns continued that most of the marriage and family
therapists worked in clinics and did not bill Medicaid
directly. There was no way of knowing how many of those
individuals would opt to leave a clinic to start up a
practice independently or start billing independently. The
division tried to be conservative in its calculations. The
division estimated approximately $1 million. He continued
that $660,000 of the amount would be in federal match to
the state's commitment of about $340,000. There was a small
charge for FY 19 to make the changes to the state's
Medicaid Management Information System to allow marriage
and family therapists to bill Medicaid directly.
Co-Chair MacKinnon stated that the committee required an
updated fiscal note. She pointed out that the numbers were
correct but the narrative on the back needed to change to
reflect the new committee substitute before the committee.
Mr. Burns stated that he was working on that presently.
Senator Micciche thought the fiscal note addressed
additional costs but did not capture any consideration for
cost avoidance. He asked Mr. Burns if he intended to
include some evaluation of cost avoidance that would result
from the passage of the bill. Mr. Burns stated that he did
not put cost avoidance in the fiscal note of the bill. He
saw it falling within the more wholistic approach of SB 74
and the changes being made to the system by the 1115 waiver
and the process. He thought estimating the savings
resulting from adding marriage and family therapists to the
list would be difficult. The division had not contemplated
making such a representation in the fiscal note being
reviewed.
Co-Chair MacKinnon acknowledged that the number would be
difficult to quantify, as there was a mixture of private
versus government utilization. She indicated that the bill
would contribute to an overall higher cost to the Medicaid
system for the state. It was a new service that would be
provided and reimbursed by the state with a significant
portion of the reimbursement coming from the federal
government in an effort to deploy the resources to those
needing help, to divert ER access, and to lower care
access.
Co-Chair MacKinnon reported that someone from the Alaska
Board of Marital Family Therapy had come online. She asked
for the will of the committee.
9:25:43 AM
AT EASE
9:27:21 AM
RECONVENED
Co-Chair MacKinnon relayed that the public hearing had
closed on the bill. She indicated the committee was in
receipt of her comments. She asked Ms. Cunningham if she
had a brief comment she wanted to make to the committee.
KAREN CUNNINGHAM, ALASKA BOARD OF MARITAL AND FAMILY
THERAPY, ANCHORAGE (via teleconference), testified in
support of the bill. She was a licensed marriage and family
therapist (LMFT)and sat on the Alaska Board of Marital and
Family Therapy. She reported that the board met to discuss
SB 105 and unanimously affirmed their support for the
statutory changes presented in the bill. One of the
responsibilities of the board was to establish minimum
requirements for applicants seeking licensure. Senate Bill
105 called for clarification that the hours required for
licensure were 1700. The breakdown of the hours included
1500 face-to-face clinical hours and 100 hours each of
individual and group supervision. Another responsibility of
the board was to serve and protect public interest. The
proposed legislation worked towards that end by allowing
applicants greater options for supervisors which ultimately
would lead to a greater number of LMFTs in the state.
Currently, there was a limited number of LMFT supervisors
which made it very difficult for new graduates applying for
associate licensures to find an individual and a group
supervisor willing to commit to a minimum of 2 years.
Co-Chair MacKinnon relayed that the committee had written
comments from the board. Ms. Cunningham did not have
anything to add to the letter that had been written. She
appreciated the opportunity to speak.
Co-Chair MacKinnon stated it was her intent to move the
bill. She had an agreement from the sponsor and the boards
that were contacted in support of the new language in the
bill.
Senator Micciche understood the fiscal note and the logic
behind it. He was concerned that the department seemed
unwilling to put on the record that there would likely be
an offset to the costs of the bill. Not all of the
additional services in the state's portfolio of Medicaid
billing had panned out as a cost saving measure. He would
have liked to have heard more from the department that it
recognized there would be an offset rather than a $340,000
UGF match. He hoped the amount would have been lower due to
the offset. With the expansion of Medicaid, additional
services, and new waivers the legislature had not seen the
savings in the waivers that he would have liked to have
seen. He was concerned with UGF spending increases. He
supported the additional services but was worried that the
department was not formally recognizing an offset.
9:31:36 AM
Senator von Imhof relayed that she sat on the Healthcare
Blueprint Committee. The committee was in phase 2 of
identifying areas of concern. The committee was flushing
out the five areas of concern it identified to put together
a recommendation to create a systemic transformation of
Alaska's healthcare system. One of the five areas of
concern was access to primary care providers. She thought
the bill addressed the issue by qualifying a marital
therapist as a provider. She thought the bill was
consistent with the direction of the blueprint committee.
Although the committee was still in progress, she supported
the bill because she believed it provided greater access,
particularly in rural Alaska, by allowing telehealth to be
part of the solution and for rural citizens to have access
to a variety of healthcare providers in numerous forms. The
intent of the systemic change of Alaska's healthcare system
was to lower the cost by having more access to a variety of
healthcare providers and through preventive care versus
costly crisis management. She thought the unquantifiable
downstream savings was a guess but was consistent with the
values of the blueprint committee she sat on.
9:33:54 AM
Co-Chair MacKinnon agreed with Senator Micciche and Senator
von Imhof. She would be supporting the bill because she
believed the bill did what Senator von Imhof had discussed.
She was concerned with providers abusing the system. She
looked at some abuse in the dental field. For instance,
some dentists performed unnecessary extractions on young
children and billing Medicaid. Another example were adults
having all of their teeth removed without a particularly
good reason or back up materials. She continued that as
long as providers behaved in the best interest of the
people that were seeking care from them, the system should
see a decrease. However, if providers decided to use it as
a funding source for their individual practices and started
billing excessively, the system would break.
Co-Chair MacKinnon continued that Alaska's heath care costs
were 30 percent higher than the national average and
America's health care costs were higher than anywhere else
on the planet. Alaskans were faced with a low demographic
and high needs. They were at the mercy of hospitals,
pharmaceuticals, insurance companies, and access to care in
general. Senate Finance and the legislature were working to
provide lower cost care to Alaskans. The bill was a step in
the right direction. It required cooperation from the
providers to be judicious in the way they accessed Medicaid
funding which had a federal match. Senator Miccichie
suggested by moving it from an emergency room to a doctor's
or provider's office the cost would be lower, and the net
of providers would be larger for those seeking services.
Co-Chair MacKinnon continued to discuss the bill. She
thought the department had provided a fiscal note with the
possibility of an increased cost. The department had tried
to quantify it, knowing that there were variables that
could lower the overall cost. She appreciated that the
fiscal note was not indeterminate. She preferred the
legislature striking a balance between understanding the
possible implications and how providers, insurance
companies, hospitals, and pharmaceuticals working together
could meet Alaskans healthcare needs. Like other small
states, Alaska's legislators struggled to lower the costs
for their constituents.
9:37:33 AM
Vice-Chair Bishop made a comment about the general services
line of the fiscal note for the development of business
rules and the Medicaid Management Information System
detailing the parameters for services and reimbursement. He
suggested the department tract the legislation to see if
there was a savings rather than a UGF spend. He thought the
bill should result in a savings.
Co-Chair MacKinnon suggested that Senator Wilson implement
some tracking method for the particular billing code to
look at how providers were using the service. She suggested
a follow-up. She saw the bill as a benefit to hospitals and
providers and she hoped it translated into quality care
that was appropriate and effective for people trying to
access care.
Senator Wilson appreciated the comments from committee
members. He had hoped the bill would increase access to
care. His intention was not to increase the state's burden.
He thanked the committee for hearing the bill.
Co-Chair MacKinnon reflected that Mr. Zepp had been a
pleasure to work with in answering questions from committee
members and from her team. She was thankful that there was
an enthusiastic effort to meet and answer questions that
were difficult to answer.
Vice-Chair Bishop MOVED to report CSSB 105(FIN) out of
Committee with individual recommendations and the
accompanying fiscal notes.
There being NO OBJECTION, it was so ordered.
CSSB 105(FIN) was REPORTED out of committee with a "do
pass" recommendation and with one new forthcoming fiscal
impact note from the Department of Health and Social
Services and one new fiscal impact note from the Department
of Commerce, Community and Economic Development.
9:42:33 AM
AT EASE
9:46:35 AM
RECONVENED
| Document Name | Date/Time | Subjects |
|---|---|---|
| CSSB 104 Bill version Y.pdf |
SFIN 3/29/2018 9:00:00 AM |
SB 104 |
| CSSB 104 Sponsor Statement version Y.pdf |
SFIN 3/29/2018 9:00:00 AM |
SB 104 |
| CSSB 104 Sectional Analysis ver Y.pdf |
SFIN 3/29/2018 9:00:00 AM |
SB 104 |
| SB 105 - Senate Finance Q A.pdf |
SFIN 3/29/2018 9:00:00 AM |
SB 105 |
| SB 105 - Letters of Support.pdf |
SFIN 3/29/2018 9:00:00 AM |
SB 105 |
| CS SB 105 FIN wrok draft v N.pdf |
SFIN 3/29/2018 9:00:00 AM |
SB 105 |
| CSSB 105(FIN) - Summary of Changes.pdf |
SFIN 3/29/2018 9:00:00 AM |
SB 105 |
| SB 104 Von Imhof Document ParentRoadmap_ELA_3.pdf |
SFIN 3/29/2018 9:00:00 AM |
SB 104 |
| SB 104 Von Imhof Document - ParentRoadmap_Math_5.pdf |
SFIN 3/29/2018 9:00:00 AM |
SB 104 |