Legislature(2003 - 2004)
03/26/2003 01:32 PM Senate HES
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
SB 108-HEALTH FACILITY MEDICAID RATES/ADV. COM'N
CHAIR FRED DYSON announced SB 108 to be up for consideration.
COMMISSIONER JOEL GILBERTSON, Department of Health and Social
Services (DHSS), said SB 108 deals with rates for health
facilities under the Medicaid program. It would eliminate the
Medicaid Rate Advisory Commission (MRAC), the state's companion
to the Bourne amendment, which deals with rate settings for
facilities. Instead, it would codify rate setting in one office
of rate review in the department.
The MRAC was created in 1984 and was largely responsible for
establishing rate settings for the state's facilities. In 1989,
by executive order, its function was changed to simply serve in
an advisory role and the department retained the rate setting
authority. In response to the Bourne amendment, Alaska put a
fair-rate-for-reasonable-cost provision under Medicaid in
statute. That federal law has been repealed and replaced with
public process requirements dealing with how to go about rate
setting.
SB 108 will bring Alaska statutes into alignment with current
federal law and remove unnecessary provisions, namely that there
are two separate public processes for rate setting. The
department does a variety of rate setting and will do a larger
variety after restructuring - with things like foster care
payments, child care providers, physicians, dentists and
facilities.
COMMISSIONER GILBERTSON said under the restructuring all the
rate settings will be in one office under the commissioner.
There will still be a public process and the methodologies will
go through the regulatory process. The programmatic work that
needs to occur to develop the rate setting will still be
happening in the divisions that administer the programs. He said
right now they don't have the flexibility to vary the
methodologies for rate setting for facilities between a 10-bed
facility and a 200-bed facility. This leads to over-payment for
some facilities and under-payment for others. The actual
consolidation will result in a small savings if the other cost
containment measures are adopted and these bills are passed.
SENATOR GRETCHEN GUESS asked if the two public processes are
being reduced to one.
COMMISSIONER GILBERTSON replied yes, but there would still be
the public process for rate setting in the regulation process.
MS. LARAINE DERR, President, Alaska State Hospital and Nursing
Home Association (ASHNHA), said the Bourne amendment has been
sacred because it creates a fair and reasonable rate. ASHNHA
members are willing to go along with the governor's
recommendation and would be involved in a partnership with the
administration to develop regulations. A letter from one of her
members said:
For my part, please convey to the legislators that we
are very concerned about being able to maintain the
level of access to critical services and recommend
they carefully consider - this isn't in the priority
list, but we need to be able to make decisions about
what our citizens should have and have some sort of
tool to make objective decisions. Therefore, we are
concerned about the removal of the Bourne amendment.
She added that she hadn't had a meeting with ASHNHA members to
talk about all three pieces of legislation, but they would be in
town on [April] 9th and 10th.
SENATOR BETTYE DAVIS asked when the Medicaid Rate Advisory
Commission's status was changed to advisory.
MR. JACK NIELSON, Executive Director, Medicaid Rate Advisory
Commission, replied in 1989.
SENATOR DAVIS asked what the commission had been doing, since it
had been on the books for all those years.
MR. NIELSON replied that current statute requires the commission
to advise the department on payment rates for facilities. They
have been participating in public hearings on facilities and
providing advice to the department on staff proposals. The
commission is also a central point where facilities can go to
learn what is happening with payment rates and Medicaid policy.
SENATOR DAVIS asked if that role could be filled.
MR. NIELSON replied that they would continue to do the public
hearings on the rates, but the commission wouldn't be involved.
TAPE 03-13, SIDE B
SENATOR GARY WILKEN moved to pass SB 108 from committee with
individual recommendations and the attached fiscal note. There
were no objections and it was so ordered.
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