02/11/2010 09:15 AM Senate FINANCE

SENATE BILL NO. 199                                                                                                           
                                                                                                                                
     "An Act providing for a two-year funding cycle for                                                                         
     medical assistance coverage for dentures."                                                                                 
                                                                                                                                
9:28:08 AM                                                                                                                    
                                                                                                                                
Senator Ellis  shared a story  about a gentleman  who visited                                                                   
his  office and  threatened  to  commit suicide  following  a                                                                   
negative interaction  with employees  at the Medicaid  Dental                                                                   
Program.  The interaction  was negative  because of  statutes                                                                   
and regulations  concerning dentures and the  Medicaid Dental                                                                   
Program.  The  gentleman  qualified for  dentures  under  the                                                                   
Medicaid Dental Plan,  but was told that he had  to choose to                                                                   
have either  his upper or  lower dentures installed.  To this                                                                   
person, the  situation was of  dire concern as he  was unable                                                                   
to  chew with  only  one set  of  dentures.  The bill  allows                                                                   
patients to forward fund the complete  set of dentures versus                                                                   
waiting two years for the entire set of dentures.                                                                               
                                                                                                                                
Senator Ellis explained  that studies have shown  that if the                                                                   
government   helps  people  with   dental  health   expenses,                                                                   
expensive  fiscal  health problems  are  prevented.  Allowing                                                                   
patients to  receive a full set  of dentures during  the same                                                                   
fiscal year  is crucial for oral  health and will  reduce the                                                                   
impact on Medicaid  patients and Alaska's dentists.  The bill                                                                   
allows  patients  who are  eligible  for dentures  under  the                                                                   
Medicaid Adult  Dental Program  to forward fund  the complete                                                                   
set  of dentures.  Current law  limits patients  to $1150  in                                                                   
preventative  or  restorative  services.  The bill  does  not                                                                   
increase  eligibility for  the total  amount of benefits,  it                                                                   
simply  allows them  to access  the funding  they would  have                                                                   
received the  next fiscal year  to complete a procedure  in a                                                                   
cost effective manner.                                                                                                          
                                                                                                                                
9:33:45 AM                                                                                                                    
                                                                                                                                
JON SHERWOOD, DIRECTOR, OFFICE  OF PROGRAM REVIEW, DEPARTMENT                                                                   
OF  HEALTH  AND  SOCIAL  SERVICES  (DHSS),  stated  that  the                                                                   
department  conceptually  approves  of the  legislation.  The                                                                   
department  agrees that it  is best  for patients to  receive                                                                   
two  sets  of  dentures  in  the  same  appointment.  If  the                                                                   
legislation  passes,  patients  would receive  both  sets  of                                                                   
dentures in the  same year. He acknowledged  that the current                                                                   
system  does not  always work.  The  department does  project                                                                   
that  the expenditures  will  increase  as most  people  will                                                                   
address denture needs in the first  few years. The department                                                                   
projects costs  of approximately  $900 thousand in  the first                                                                   
year, with $300 thousand from  general funds. The second year                                                                   
projection  includes $467  thousand in  the second year  with                                                                   
$200  thousand  from  general   funds.  Administrative  costs                                                                   
include automating the two year  limit. He expressed concerns                                                                   
about the automation prior to  freezing the claims processing                                                                   
system, which  requires one position  for one year  if manual                                                                   
tracking is required.                                                                                                           
                                                                                                                                
9:37:53 AM                                                                                                                    
                                                                                                                                
Co-Chair Stedman expressed concern  about the fiscal note and                                                                   
the positions needed. Potential  positive fiscal effects also                                                                   
exist as  savings for  people traveling  from rural  areas to                                                                   
receive dentures.                                                                                                               
                                                                                                                                
Mr. Sherwood  added that if  system changes were  implemented                                                                   
prior to the freeze, then the  new position is not necessary,                                                                   
which  would reduce  the  cost. He  spoke  about research  to                                                                   
identify means  of quantifying  potential savings.  He stated                                                                   
that  the  department  did  not   see  many  travel  expenses                                                                   
associated  with providing  a  second set  of dentures.  Some                                                                   
expenses incurred  are the result  of emergency  room visits.                                                                   
He stated  that the  department lacked  data about  potential                                                                   
savings for the state.                                                                                                          
                                                                                                                                
                                                                                                                                
Senator Thomas  commented on the  fiscal notes.  He requested                                                                   
further   estimates  of   state  expense.   He  asked   about                                                                   
contractual  agreements   for  the  department's   electronic                                                                   
changes.   Mr.  Sherwood   responded   that  the   department                                                                   
contracts with the Affiliated  Computer Systems (ACS) for the                                                                   
operation of the current claims processing system.                                                                              
                                                                                                                                
Senator Thomas  asked if the  technical changes were  made in                                                                   
conjunction with  dental offices. Mr. Sherwood  answered that                                                                   
the  changes  would happen  on  a  technical level.  The  new                                                                   
system will track  expenditures over two years,  but will not                                                                   
affect the interaction with dental offices.                                                                                     
                                                                                                                                
Senator  Thomas  hoped to  recruit  insight from  the  dental                                                                   
practitioners  about  the  filing  of  claims.  Mr.  Sherwood                                                                   
responded  that the change  is internal  and does not  affect                                                                   
the interface with dental offices.                                                                                              
                                                                                                                                
9:44:26 AM                                                                                                                    
                                                                                                                                
Co-Chair Stedman  asked if the administration  has a position                                                                   
on  the  bill. Mr.  Sherwood  stated  that  SB 199  is  under                                                                   
consideration by  the administration, although  a position is                                                                   
not currently stated.                                                                                                           
                                                                                                                                
Co-Chair Stedman reviewed the fiscal notes.                                                                                     
                                                                                                                                
9:45:42 AM                                                                                                                    
                                                                                                                                
DAVID  LOGAN, ALASKA  DENTAL SOCIETY  spoke in  favor of  the                                                                   
legislation. He opined that the  bill is appropriate for many                                                                   
reasons. The bill serves patients  and dentists. He addressed                                                                   
the  medical cost  of removing  damaged  teeth. He  explained                                                                   
that multiple  trips are often required for  the construction                                                                   
of  dentures. He  noted  that travel  costs  often dwarf  the                                                                   
denture  expenditures.  He shared  a professional  story.  He                                                                   
pointed  out that  SB  199  allows rehabilitation  for  those                                                                   
patients in need of both upper and lower dentures.                                                                              
                                                                                                                                
9:50:01 AM                                                                                                                    
                                                                                                                                
Senator   Thomas  compared   the  dental   and  the   billing                                                                   
procedures.  Dr.   Logan  pointed  out  that   the  procedure                                                                   
requires molds and dentures constructed  at the same time. He                                                                   
recalled a meeting with the Medicaid  Dental Program allowing                                                                   
insight into  the process of  claims and billing.  He thought                                                                   
that  potential  problems  are  yet unknown  for  the  dental                                                                   
society.                                                                                                                        
                                                                                                                                
MARK PRATOR, ALASKA  DENTAL SOCIETY, WASILLA,  spoke in favor                                                                   
of the legislation.  He stated  that he does accept Medicaid.                                                                   
He pointed out that he donates  approximately half of his fee                                                                   
for the  denture procedure,  in order to  be able  to provide                                                                   
the   service  for   the  fee   provided   by  Medicaid.   He                                                                   
acknowledged that  the cost of  travel increases each  time a                                                                   
person travels  for an  appointment. He  also saw savings  in                                                                   
emergency  room visits.  In the  past, he  has remade  entire                                                                   
sets of dentures as one set must  fit well against the other.                                                                   
                                                                                                                                
Co-Chair Stedman  asked if the  department planned to  take a                                                                   
positive  or negative  position  on  the bill.  Mr.  Sherwood                                                                   
noted  that  the  administration's   position  has  not  been                                                                   
established. Co-Chair  Stedman encouraged the  administration                                                                   
look at  the bill  with consideration.  Senator Thomas  urged                                                                   
the administration to address  SB 199 during this session for                                                                   
the benefit  of the patients  and the state.  Senator Huggins                                                                   
encouraged the department to consider the legislation.                                                                          
                                                                                                                                
9:58:37 AM                                                                                                                    
                                                                                                                                
Senator Ellis  stated that  governor Murkowski brought  adult                                                                   
dental  Medicaid.  The end  of  the sunset  led  to the  cost                                                                   
savings  intention,  but  he  opined  that it  was  not  well                                                                   
thought   out.  He  expressed   desire   to  work  with   the                                                                   
department. He opined  that the cost control  measure was ill                                                                   
advised.                                                                                                                        
                                                                                                                                
SB  199  was   HEARD  and  HELD  in  Committee   for  further                                                                   
consideration.