Legislature(2009 - 2010)HOUSE FINANCE 519
04/11/2010 12:30 PM House FINANCE
| Audio | Topic |
|---|---|
| Start | |
| HB296 | |
| HB416 | |
| HB421 | |
| SB199 | |
| HB424 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 296 | TELECONFERENCED | |
| + | HB 416 | TELECONFERENCED | |
| *+ | HB 421 | TELECONFERENCED | |
| += | HB 424 | TELECONFERENCED | |
| + | SB 199 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE BILL NO. 199
"An Act providing for a two-year funding cycle for
medical assistance coverage for dentures."
2:24:31 PM
2:24:55 PM AT EASE
2:29:50 PM RECONVENED
SENATOR JOHNNIE ELLIS, SPONSOR, explained that the
legislation would allow clients covered under the Medicaid
Adult Preventative Dental program (APD) to get a complete
set of upper and lower dentures in same fiscal year. He
remarked that this would allow the client to "chew their
food." The plan to divide the denture benefit into two
fiscal years was adopted as a cost savings measure. He
shared a personal story of a constituent's experience
needing dentures under adult dental Medicaid that spurred
his involvement with the legislation. He relayed that the
constituent was distraught and contemplating suicide
because he could not eat or speak clearly without teeth.
Acquiring half a set of dentures was useless and prolonged
his misery for an entire year. He believed that there will
be a cost savings to the program with the legislation.
2:33:17 PM
Representative Foster wondered what the intent of the
original legislation was; to divide the denture benefit
into two fiscal years. Senator Ellis restated that it was a
cost containment measure intended to divide the benefit
over fiscal years. He felt that overall the program was
"great" and well intended but this aspect was not properly
considered. He believed that this type of situation created
public skepticism toward government and could be easily
remedied to restore credibility.
DR. DAVID LOGAN, DDS, DENTIST, ALASKA DENTAL SOCIETY (via
teleconference), testified in favor of the legislation. He
indicated that the program benefits all parties involved.
The patient's dignity and quality of health would be
restored. The dentist would deliver the denture service
more effectively by performing the same procedures for a
set of dentures once, rather than individually; that also
reduces patient travel expenses for multiple visits from
rural areas. The efficiency would create cost savings to
the state. There would also be a preventative benefit by
the removal of diseased and abscessed teeth before
infection sets in and requires additional dental and
expensive(i.e. emergency room visits) medical services;
creating additional cost savings.
Co-Chair Hawker cited the fiscal note for the Department of
Health and Social Services, FN2 (DHSS), in the amount of
$935 thousand for FY 2011. He noted that the expenditure
decreases to $467.5 thousand in FY 2012 and is zero for the
subsequent years. He wondered if the program has a sunset
provision and asked for an explanation of the fiscal note.
JON SHERWOOD, MEDICAID SPECIAL PROJECTS, DIVISION OF HEALTH
CARE SERVICES, DEPARTMENT OF HEALTH AND SOCIAL SERVICES,
answered that the sunset on the Adult Preventive Dental
program had been eliminated. He furthered that the fiscal
note reflects an initial anticipated increase in
expenditures as APD provides both upper and lower dentures
in the same fiscal year for the first two years. There will
be patients receiving their second year denture along with
new patients entitled to both dentures in the same fiscal
year. The department feels that by the third year the
program will have caught up with the initial impacts of the
expanded benefit.
2:43:11 PM
Co-Chair Hawker asked if the demand for the APD program was
expected to decline. Mr. Sherwood replied that the fiscal
note does not assume a decrease in the out years. Co-Chair
Hawker recalled that in the early years of the APD program
costs were overestimated. Co-Chair Hawker wondered if the
same situation applied to the fiscal note. Mr. Sherwood
explained that fiscal notes reflect the department's best
reasonable estimate of costs.
Representative Austerman asked what the original estimate
of the program's cost was. Mr. Sherwood guessed that it was
approximately $10 million.
Co-Chair Hawker remembered that the original APD bill
placed a limit on the aggregate amount of funds available
for the program in a year. The aggregate cap was removed
from the program when the sunset was eliminated. The
utilization of the program was under anticipated costs at
approximately $7.5 million, half of the amount was federal
funds and half was general funds.
Representative Austerman asked how much money is currently
appropriated for the APD program excluding the fiscal note.
Mr. Sherwood did not know. He wanted to clarify that the
APD program included many other services besides dentures.
2:48:54 PM
Co-Chair Hawker reported that the FY 2009 actual expense
level was $5.9 million, and the FY 2010 total appropriation
was $7.3 million. The FY 2008 governors request was $8.1
million.
Representative Austerman felt that the department should
know the amount currently appropriated in the budget for
the program. Co-Chair Hawker agreed that the fiscal note
request appeared speculative.
Mr. Sherwood explained that the benefit is relatively new
and the fiscal note amount was based on a best estimate of
the legislations impact regardless of the base amount
appropriated.
Representative Gara observed that out of the $935 thousand
fiscal note (FN 2 (DHS)) expenditure, $626.5 thousand are
federal funds and $308.6 thousand are general funds. He
discerned that the "upfront" additional cost for both
dentures this year means the expenditures will be that much
less next year. He felt that over the long term the same
amount of money will be spent and the fiscal note was
misleading; it only appears there will be extra costs. He
deduced that the initial costs will be leveled out to a
zero dollar increment over the long term. He surmised that
the department should request additional funds for services
provided this year but request less for next year.
2:53:46 PM
Representative Kelly commented that he agreed with Rep.
Gara that the increment "washes out" over time and supports
the legislation.
Co-Chair Hawker shared that he authored the initial APD
bill because the only dental Medicaid services available
for adults was for a crisis situation which the patient had
to experience infection or acute pain. He felt that was a
"barbaric" system.
Representative Fairclough asked about differences of sixty
percent and fifty seven percent in the federal match rate
between FY 2011 and FY 2012 depicted on the fiscal note.
Mr. Sherwood explained that the decline in the federal
match rate in FY 2012 is due to the phasing out of the
stimulus funds.
Vice-Chair Thomas asked about the annual denture benefit
limit in terms of lost dentures.
2:58:33 PM
Mr. Sherwood answered that there is a dollar limit on the
amount of annual dental benefit, if replacement dentures
exceeds the limit a patient would have to wait until the
second year. The annual monetary limit is only enough for
an upper or lower denture.
Co-Chair Hawker directed attention to the fiscal note, FN 1
(DHS) that was zeroed out in Senate Finance. He noted that
the fiscal note had requested a personal services
expenditure of $183.3 thousand for two full time employees.
He cited a new fiscal note, from the department in the
amount of $147.9 thousand dollars for one employee for one
year. He asked for an explanation of the request. Mr.
Sherwood indicated that originally the department thought
that the claims processing system could not handle a two
year spending limit and that claims would be processed
manually. Subsequently, the department was able to come up
with a programming solution. The new fiscal note reflects a
request for $50 thousand to enhance the existing claims
processing system or the new system that is currently being
developed. The remaining amount is for one person to track
and process authorizations until the new system can
accommodate automated processing. The person will not be
hired if the automated system is working.
Co-Chair Hawker asked if the position should be classified
as temporary on the fiscal note. Mr. Sherwood affirmed.
Co-Chair Hawker noted that the new fiscal note will become
number four when published and adjusted to reflect the
position as temporary.
Representative Fairclough informed the committee that
dental issues contribute to the suicide rate in the state
and she will support the bill.
Co-Chair Hawker MOVED to report SB 199 out of Committee
with individual recommendations and the accompanying fiscal
notes. There being NO OBJECTION, it was so ordered.
SB 199 was REPORTED out of Committee with a "do pass"
recommendation and with attached new fiscal note by the
Department of Health and Social Services and previously
published fiscal note: FN2 (DHS).
3:08:34 PM AT EASE
6:25:56 PM RECONVENED