Legislature(1999 - 2000)
04/22/1999 06:05 PM Senate FIN
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SENATE BILL NO. 106
"An Act relating to decisions by the commissioner of
health and social services to remand certain health
facility payment decisions back to the hearing
officers; and amending Rule 602, Alaska Rules of
Appellate Procedure."
SENATE BILL NO. 106
"An Act relating to decisions by the commissioner of
health and social services to remand certain health
facility payment decisions back to the hearing
officers; and amending Rule 602, Alaska Rules of
Appellate Procedure."
SENATOR ROBIN TAYLOR requested that the bill be moved to the
amendment process.
Senator Wilken noted that Rick Solie was on teleconference
and had a limited time to testify.
RICK SOLIE, Representing Fairbanks Memorial Hospital,
Fairbanks, (Testified via Teleconference), voiced his
concern with SB 106. He noted that it was the intent of the
Alaska State Hospital and Nurses Association (ASHNA) to work
in a dual track with the legislation, which would move the
legislation, but at the same time work with the departments
to discuss the appeal process and timing. Mr. Solie stated
that Fairbanks Memorial Hospital's concern is that issues
can be resolved within the working group in a timely
fashion. Mr. Solie suggested that it would make more sense
to focus on efforts outside of the Legislative process, such
as addressing the backlog of appeals.
Mr. Solie advised that ASHNA has concerns with the
amendments, particularly Amendment #1. [Copy on File]. He
referenced the report submitted to Committee members from
Donna Herbert, a consultant, identifying the difficulty in
establishing a flat rate. [Copy on File].
Mr. Solie continued that Amendment #2 was reasonable and not
of great concern to his organization. [Copy on File].
Additionally, Amendment #3 addresses the backlog of appeals.
He reiterated that his comments were in opposition to
Amendment #1.
DAN HOUGHTON, Alaska Regional Hospital, Anchorage,
(Testified via Teleconference), stated that he was available
to answer questions. He stated that he would support
passage of SB 106 in its present format.
ELMER LINDSTROM, Special Assistant to Commissioner Perdue,
Department of Health and Social Services, stated that the
Department is opposed to the proposed legislation. He noted
that the rate appeals process is cumbersome and costly. The
Department believes that the reasons for those problems is
that the appeals process is "lost" because the underline
rate setting system is obsolete. The existing rate setting
system is expensive and those costs are largely based on a
federal mandate which has since been appealed. He noted
that there are budget negotiations still in process
requiring $15 million dollar reductions to the Medicaid
budget. Mr. Lindstrom concluded that the existing system
preserves the status quo and the existing system insulates a
portion of the budget more entirely than anything else he is
aware of.
TAPE SFC-99 #107 Side A
Mr. Lindstrom stated that the bottom line is that if the
State is concerned about reforming the system, the issue
should not be distracted. He referenced the letter in
members packet dated April 19th by Commissioner Perdue
regarding the appeals issue at Bartlett Regional Hospital.
He reiterated that the Department could not accept the
underlining premise of SB 106.
Senator Phillips asked if Providence Hospital had any
appeals current at this time. Mr. Lindstrom replied that
there are a number of facilities that have appeals every
rate every year. Of the forty appeals that are outstanding,
one issue accounts for twenty of the appeals. Senator
Phillips voiced a conflict of interest as he is employed by
the Providence Health Care System. He asked to refrain from
voting on the amendments and the bill.
Senator Leman asked if the Department could recommend any
changes for the current "archaic" system in place. He
questioned the opinion of Commissioner Perdue on an
amendment that he had recommended. Mr. Lindstrom agreed
that there was need for legislation to change the current
system. A big portion of the problems is imbedded in State
laws resulting from federal mandates. He deferred the
question regarding the amendments to Mr. Lively, Deputy
Commissioner.
Senator P. Kelly pointed out that some of the ASHNA
Hospitals are in support of the legislation. Mr. Lindstrom
replied that he could not speak for all the facilities,
however, there have been some facilities that have never
appealed a rate. He believed that Fairbanks would fall into
that category.
Mr. Lindstrom spoke to the problems with the proposed
legislation. On the facilities side of the Medicaid budget,
the ability to actively manage the cost control is very
limited. There are only two elements, one on the front end
and the certificate of need process and the second is the
ability to some degree to oppose policy and issues reflected
in the appeals payments process. Those are the only tools
that the State has. He emphasized that this bill would
essentially remove one of those tools.
JAY LIVELY, Deputy Commissioner, Department of Health and
Social Services commented on Amendment #1 in response to
questions from Senator P. Kelly. Mr. Lively pointed out
that the Department has focused mostly on the details of the
appeal process. He commented that the amendment would
charge the Department to go back to determine how current
rates are set and then create an alternate system that would
be less cumbersome.
Senator Wilken referenced Page 2, Line 16 and asked the
recommendation of the Department regarding the most
reasonable amount of time. Mr. Lively responded that the
Department would like to see between 120 and 180 days. Co-
Chair Torgerson interjected that 120 days was not a
reasonable number. He acknowledged that 30 days might be
too "tight".
LORAINE DERR, Representing the Alaska State Hospital and
Nursing Association (ASHNA), Juneau, spoke in support of the
legislation and stated that the problem is that in the
appeals process, there is no finality. The basis of the
bill puts finality to the process. ASHNA would like to see
the process have some sort of completion.
Co-Chair Torgerson explained that he agreed with the bill
and the way it was written, however, he believed that the
legislation does not address the heart of the problem. The
legislation does solve the problem in how quickly it could
move to court, however, the underlining problem is that
there is no agreement on what qualifies an eligible
reimbursement.
Senator Donley MOVED to adopt Amendment #1. Senator Wilken
OBJECTED. Senator Wilken pointed out that there are many
hospital officials that are uncomfortable with Amendment #1.
Co-Chair Torgerson stated that the bill would not be moved
out of Committee if Amendment #1 failed. Senator Adams
commented that it was his preference to work on the bill in
Subcommittee.
Senator Taylor disagreed with comments made by the
Department regarding the legislation and the amendments. He
commented that he would not object to Amendment #1 which
would allow the benefit of finality for legislative
consideration.
Co-Chair Torgerson urged the various factions to come to the
table and create a working document. He acknowledged that
the Legislature does not have the expertise to undertake the
challenge at this time.
Senator Wilken asked if the new rates would be included in
the report. Co-Chair Torgerson commented that there would
be a report provided with the rates, subject to appeal. He
advised that it was his intent to create language, which
would remove all the appeals.
Senator P. Kelly commented that Amendment #1 should be made
into a separate bill rather than incorporated into the
legislation. Co-Chair Torgerson stated that he was not
willing to make that change.
A roll call vote was taken on the motion.
IN FAVOR: Donley, Green, Leman, Parnell, Torgerson
OPPOSED: Adams, P. Kelly, Wilken, Phillips
The MOTION PASSED (5-4).
Co-Chair Parnell MOVED to adopt Amendment #2 which would
insert language on Page 2, Line 17, "unless the facility
requests a delay", and Page 2, following Line 25, inserting
a new subsection: "At the request of any party, the
department may offer a process of voluntary mediation".
There being NO OBJECTION, it was adopted.
Senator Leman questioned if Amendment #3, 1-LS424\G.7,
Bannister, 4/21/99, would be beneficial to the proposed
legislation. [Copy on File]. Senator Leman MOVED to adopt
Amendment #3 and asked to hear from the Department.
Mr. Livey responded that Amendment #3 would provide any
appeal that is remanded back to the hearing officer by the
Commissioner after April 20th but before the effective date,
would also be subject to the 30-day rule.
Senator Taylor questioned the retroactive date and the
effect that the amendment would have on the legislation. He
commented that he was not concerned with passage of the
amendment.
Senator Leman WITHDREW Amendment #3 with the understanding
provided by Commissioner Perdue from an earlier conversation
that the Department would work diligently to achieve
finality. There being NO OBJECTION, it was withdrawn.
Co-Chair Torgerson commented that the bill would be HELD in
Committee in order to work in more detail with the
Department on the fiscal notes.
Co-Chair Parnell requested a brief discussion on the fiscal
notes. He noted the three temporary positions requested in
the fiscal statement.
Mr. Lindstrom commented that new hearing officers would be
needed to deal with the backlog of outstanding appeals. He
emphasized that the most effective way to resolve the
backlog of appeals would be to grant an additional hearing
officer position and the additional resources for the
Department of Law and the Department of Health and Social
Services Commissioner Office to address the concern.
Co-Chair Torgerson requested a check of the length of time
between the 30-60-90-day comparison and the fiscal impacts
that each would bear. Senator Taylor commented that he
would oppose any additional changes to the fiscal note.
Mr. Lively responded that 120 days would be a more
acceptable amount of time.
SB 106 was HELD in Committee for further clarification on
the fiscal notes.
TAPE SFC-99 #107 Side B
ADJOURNMENT
The meeting adjourned at 8:45 P.M.
SFC-99 14 4/22/99 p.m.
| Document Name | Date/Time | Subjects |
|---|