Legislature(2023 - 2024)BUTROVICH 205
02/27/2024 03:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Presentation: Department of Health Response to Legislative Budget & Audit Findings | |
| SB240 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | SB 240 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 240-SCHOOL DISTRICT MEDICAL ASSISTANCE
3:51:51 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 240 "An Act relating to medical
assistance coverage for rehabilitative, mandatory, and optional
services furnished or paid for by a school district on behalf of
certain children."
3:52:24 PM
HEIDI HEDBERG, Commissioner, Department of Health (DOH),
Anchorage, Alaska, introduced SB 240 on behalf of the
administration stating it aims to improve access to school-based
services for all Medicaid-eligible children. She explained that
SB 240 supports access by removing statutory barriers. The bill
offers convenient options for parents seeking care for their
children, supports parent-directed services within the school
setting, promotes early intervention, and eliminates obstacles
that prevent schools from leveraging federal Medicaid matching
funds. Additionally, it increases the flexibility for schools to
seek Medicaid reimbursement for eligible children.
3:53:40 PM
EMILY RICCI, Deputy Commissioner, Department of Health (DOH),
Anchorage, Alaska, moved to slide 3 and provided a brief
overview of school-based services in Alaska under the Medicaid
program. She explained that these services, delivered in a
school setting as specified in Alaska's Medicaid state plan,
include speech-language therapy, occupational therapy, physical
therapy, behavioral health, and nursing services. Currently,
state law mandates that for a service to be Medicaid
reimbursable for a Medicaid-eligible student, it must be
outlined in the student's Individual Educational Plan (IEP), and
the student must have a disability.
3:55:23 PM
MS. RICCI noted that SB 240 would remove the requirement for
these services to be covered under an IEP, thus broadening the
scope of services for which schools can seek Medicaid
reimbursement. She emphasized the challenges schools face in
navigating Medicaid reimbursement due to their primary role as
educators rather than healthcare providers. She mentioned that
SB 240 addresses the administrative barrier of the statutory
requirement that the service be covered under an IEP, but
acknowledged that other challenges remain, which the department
is prepared to help school districts overcome. She stated that
currently, only six out of 54 school districts in Alaska
leverage Medicaid reimbursement for services, including
Anchorage, Delta Greeley, Fairbanks, Juneau, Ketchikan, and
Matsu. Kenai participated until the 2019-2020 school year. She
noted that speech, occupational, and physical therapy make up
about 96 percent of the reimbursed services in schools.
3:57:10 PM
MS. RICCI moved to slide 4 and began discussion of the Healthy
Families Initiative. She expressed that SB 240 would increase
access to care for students in a convenient location for
parents, aligning with the governor's Healthy Families
initiative, particularly focusing on Healthy Beginnings and
healthcare access.
3:57:40 PM
LEAH VAN KIRK, Deputy Director, Healthcare Policy Advisor,
Department of Health, Juneau, Alaska, moved to slides 5 -6 and
said SB 240 allows schools to seek Medicaid reimbursement for
services provided to all children covered by Medicaid, enabling
access to services in a familiar, daily setting. She emphasized
that removing statutory requirements increases schools'
flexibility to seek reimbursement when a child is eligible. The
federal Medicaid match of 65 percent is crucial for schools,
particularly when they already provide some services without
seeking reimbursement. Additionally, SB 240 gives schools the
option to offer services to children who previously couldn't
access them, allowing decisions on service provision to include
more children who may not have qualified before.
3:59:08 PM
CHAIR WILSON noted that the federal match of 65 percent is a
little higher than the usual 50 percent match for most Medicaid
services. He asked who pays for the remaining 45 percent.
MS. RICCI clarified that the federal match rate could vary
between 50 percent and 65 percent, depending on the student's
enrollment status, such as whether they are covered by the
Children's Health Insurance Program (CHIP) or another Medicaid-
qualifying status. She noted that the current system is
cumbersome for both school districts and the Division of
Healthcare Services. Currently, school districts pre-fund the
state's match for services, which the Division then uses to draw
down the federal match, passing both the federal and state funds
back to the districts. However, under this system, districts
must provide the state match upfront, which complicates the
process. She mentioned that the presentation would later cover
new federal options for Medicaid reimbursement, such as roster
billing or a per-student-per-month mechanism, which could be
reconciled quarterly, as potential solutions to these
challenges. She added that many school systems have failed to
leverage federal matching funds due to the complexity of the
process.
4:01:25 PM
CHAIR WILSON asked that during the presentation the Department
discuss billing and why SB 240 has a zero fiscal note.
4:01:40 PM
MS. RICCI explained that SB 240 has a zero fiscal note because
the services are already available to Medicaid-enrolled children
in community settings. SB 240 is removing an administrative
barrier that would also make services available in a school
setting. The anticipated slow increase in the utilization of
school-based services is partly due to the need to resolve
administrative challenges in creating a reimbursement system
that works for both Medicaid and school districts. She mentioned
that workgroups have been established, with the first meeting
scheduled for next week, to begin discussions with school
districts. Additionally, the Department is applying for a grant
to cover implementation costs and necessary contractual support.
She emphasized that SB 240 results in a cost shift from acute
settings to more early intervention and prevention. Addressing
students' needs before they become acute results in a cost shift
rather than new costs to the system.
4:03:15 PM
SENATOR DUNBAR agreed with Ms. Ricci's final statement,
expressing hope that if the bill passes, an economics student or
researcher will conduct a dissertation over the next 10 years to
track potential cost reductions in other areas due to early
intervention. He noted that Alaska is not the first state to
implement this type of school-based, non-Individualized
Education Program (IEP) dependent services, and it would be
interesting to observe if there are downstream cost savings as
Alaska joins other states in providing these services.
4:04:01 PM
MS. VAN KIRK moved to slide 7 and emphasized that the SB 240
supports parents by providing another setting for their children
to receive services, reducing the transportation challenges
parents face, such as leaving work to transport their child to
and from appointments. She highlighted the importance of this
support, especially as children's re-engagement with health
services has declined nationally since the pandemic. The Centers
for Medicare and Medicaid Services (CMS) is working to increase
flexibility for delivering school-based services and simplify
the administrative process for schools to submit Medicaid
claims. She also pointed out that children are more comfortable
receiving services in the familiar school environment, which is
beneficial for trauma-informed care. She clarified that the bill
does not add any new services but gives schools the option, not
a mandate, to submit claims for reimbursement through Medicaid.
4:05:51 PM
CHAIR WILSON asked if SB 240 requires school districts to hire
mental health professionals directly or can districts contract
providers.
4:06:03 PM
MS. VAN KIRK responded that services could be provided either by
a school district employee or through a contracted provider.
4:06:17 PM
MS. RICCI moved to slide 8 and reiterated the benefits SB 240
would provide Alaskans:
[Original punctuation provided.]
Families and Children
• Provides more convenient choices for parents
seeking care for their children
• Increases access to services for children
• Promotes early intervention and prevention
System Efficiencies
• Reduces administrative burden
• Maximizes federal Medicaid match
MS. RICCI added that early intervention and prevention were
consistently emphasized during the Department's work on the
behavioral health roadmap. She noted that there was a strong
desire for increased school-based services in nearly every
region visited, making this bill responsive to stakeholder
feedback. She reminded the committee that there are
administrative burdens that involve process issues that need to
be worked through, such as figuring out how to apply the new
Medicaid flexibilities to the current system in a way that
provides flexibility to school districts in Alaska. It also
provides opportunities to maximize federal matching funds.
4:07:29 PM
MS. VAN KIRK moved to slide 9 and noted that new flexibilities
were released in May 2023 to encourage schools to claim
reimbursement for school-based services. She mentioned that 25
states have updated regulations and statutes to allow
reimbursement for services beyond those included in an
Individualized Education Program (IEP). She emphasized the
state's efforts to connect with stakeholders, including schools,
behavioral health organizations, current service providers, and
the Department of Education, to identify effective systems and
reduce the administrative burden currently limiting
participation. With only six school districts currently
submitting Medicaid reimbursement claims, the goal is to
increase that number, which will take work and require
stakeholder engagement.
4:08:57 PM
MS. VAN KIRK announced the initiation of a stakeholder
engagement process, with the first meeting scheduled for Friday,
involving various organizations, divisions, and departments. The
state is also applying for a grant from the Centers for Medicare
and Medicaid Services (CMS) to support the implementation of
school-based services, with a focus on ensuring rural
communities can participate. She highlighted concerns about
small rural school districts navigating Medicaid and mentioned
that the state is exploring models from other states to address
these challenges. She reiterated that school-based services were
identified as essential in every region during the behavioral
health roadmap process and stressed that Medicaid-reimbursable
services are a critical component, though not the complete
solution, in meeting the needs of youth across the state.
4:10:41 PM
CHAIR WILSON asked what the cost to the state is if the grant
for starting up the program is not awarded.
MS. VAN KIRK explained that the grant provides an opportunity to
explore improvements, such as data systems that would enhance
schools' ability to submit claims to Medicaid. She described it
as a chance to envision and build a more effective system than
the current one. She noted that stakeholder engagement and
support for this bill were already planned before the grant's
release, and consultation support has been engaged to guide the
process.
4:11:43 PM
MS. RICCI stated that the grant would enhance conversations and
bring sophistication to healthcare systems as the department
enters the planning phase. However, she assured that even if the
grant is not awarded, department staff will continue to support
stakeholder engagement, planning, and implementation for school-
based services.
4:12:31 PM
CHAIR WILSON inquired about the dollar amount of the grant.
MS. VAN KIRK replied the grant is $2.5 million over three years.
4:12:47 PM
CHAIR WILSON raised concerns about the challenges small
healthcare providers, such as independent Licensed Professional
Counselors (LPCs), face when billing Medicaid, particularly due
to frequent audits. He acknowledged that technical assistance is
often provided but questioned whether the state is considering
setting up its own billing and claims management service for
school districts. He noted that managing billing and denials is
a significant resource burden, especially for small clinics, and
suggested that a state-supported service could alleviate this
burden. He emphasized that while larger districts or third-party
providers might manage these tasks efficiently, smaller rural
districts might struggle, highlighting concerns from these
districts and the need for stakeholder engagement.
MS. VAN KIRK stated that stakeholder engagement would address
the concerns raised, including topics like billing and Medicaid
services. She confirmed that school districts participating in
Medicaid billing would help guide the work and contribute to
related discussions.
4:14:12 PM
MS. RICCI discussed the new flexibilities released by the
Centers for Medicare and Medicaid Services (CMS) in May of the
previous year, which other states are expanding upon. These
flexibilities address the challenges school districts face with
traditional Medicaid billing, such as managing billing, denials,
and authorizations. She mentioned that some of these
flexibilities include waiving the requirement for Medicaid to
pursue third-party liability for school-based services, allowing
for a larger error rate, extending time for time studies, and
exploring alternatives to direct billing, such as a per-pupil-
per-month mechanism or roster-based services reconciled
quarterly.
MS. RICCI emphasized that the department would work with school
districts to apply these theoretical flexibilities to their
practical needs. She acknowledged the challenges, such as
managing documentation and tracking in a roster-based system and
expressed optimism that these CMS flexibilities could be
translated into a system that is not administratively cumbersome
for school districts.
4:16:04 PM
MS. RICCI moved to slide 11 and said SB 240 is relatively simple
and the sectional analysis has one section:
[Original punctuation provided.]
Sectional Analysis
Section 1
This section removes the requirement that Medicaid
services provided in a school setting are limited to
those covered under an Individual Education Plan
(IEP).
4:16:51 PM
CHAIR WILSON expressed a potential concern regarding SB 240. He
noted that the bill allows school districts to provide
behavioral modification services within the school setting,
which might enable schools to bypass the Individualized
Education Plan (IEP) process. He pointed out that students on
IEPs have a different funding mechanism, with a differential
rate of 13 to 1. He questioned whether school districts might
opt to avoid the IEP process to access services through the
program, which could result in less funding for those schools.
4:17:57 PM
MS. VAN KIRK recommended the question be deferred to the
Department of Education and Early Development (DEED). She noted
that stakeholders have mentioned that children referred for
services, such as speech therapy, often do not meet the required
level of acuity for those services to be provided in the school
setting. She explained that SB 240 would allow and improve
access to services for children who currently do not meet that
level of need.
4:18:38 PM
DEBORAH RIDDLE, Operations Manager, Division of Innovation and
Education Excellence, Department of Education and Early
Development (DEED), Juneau, Alaska, explained that there are
different levels of funding for special education. Intensive
special education funding is allocated for students with the
most significant disabilities at a rate of 13 times the base
student allocation, but most students do not fall into this
intensive category. She indicated that allowing students who do
not qualify for an IEP to receive needed services would not
constitute bypassing the IEP process.
CHAIR WILSON asked if there is a difference in the funding rate
for students who are not classified at the intensive level of
special needs compared to those who are.
4:19:35 PM
MS. RIDDLE replied no, they're counted as special education
students. That is one of the multipliers. However, the 13 times
the base student allocation applies only to students who are two
standard deviations away from the norm for their specific
disability.
CHAIR WILSON asked if there is a multiplier for a special needs
child who qualifies for an IEP.
MS. RIDDLE replied that is true.
4:20:07 PM
CHAIR WILSON asked whether the availability of an easier process
for obtaining services might result in fewer children being
placed on IEPs, given whatever the rate multiplier is for those
children.
MS. RIDDLE explained that the Individuals with Disabilities
Education Act (IDEA) has specific rules for identifying children
and the services provided through an IEP. She offered to follow
up with more detailed information but suggested that services
like speech therapy would still be provided through an IEP.
However, if additional services are needed, such as in the case
of her autistic grandson who receives both in-school and outside
services, it would be beneficial if all services could be
provided within the school setting. She used this as a scenario
to illustrate the potential benefits.
4:21:05 PM
CHAIR WILSON clarified that his question focused on simpler
behavioral health modifications for which some children have
IEPs. He noted that the IEP process is not easy to administer,
especially in schools with limited resources. Drawing from his
experience as a substitute teacher, he observed that teachers
often spend significant time on IEP conferences and related
tasks, sometimes wishing they could instead focus on teaching
while other professionals provide the necessary services. He
asked how SB 240 might address the administration of such
services to ease the burden on teachers.
4:21:44 PM
SENATOR DUNBAR said he found the IEP question intriguing and
shared his limited experience with a different school district
where too many IEPs were issued, sometimes inappropriately, as a
pressure release valve for the district. He clarified that this
experience was outside of Alaska and hoped such practices would
not occur in Alaska.
4:22:14 PM
SENATOR DUNBAR commented on the drafting of SB 240, noting that
issues can arise with non-exhaustive lists in legislation. He
suggested that in Section 1, line 6, rather than using the
phrase "including a child with a disability," it might be
clearer to simply delete "with a disability." This change would
avoid implying that only children with disabilities are eligible
for the services, aligning with the bill's intent to make
services available to any eligible child. He clarified that
while this was just a drafting note and not significant enough
to propose an amendment, he wanted it on record to ensure the
correct interpretationthat any eligible child, with or without
a disability, can access these services. He asked if he was
misinterpreting the intent of that line.
4:23:23 PM
MS. VAN KIRK replied that Senator Dunbar was not misinterpreting
line 6.
SENATOR DUNBAR sought confirmation that deleting the phrase
would have had the same effect.
4:23:34 PM
MS. VAN KIRK explained that the phrasing in the drafting was
intentional to avoid any unintended impact on children with
disabilities. The goal was to clearly reference both children
with and without disabilities, ensuring that the bill does not
negatively affect any existing guidelines or protections for
children with disabilities.
SENATOR DUNBAR asked for clarification, emphasizing that the
dispositive point is whether the child is eligible for the
services, regardless of whether they have a disability. He
sought confirmation that eligibility, not the presence of a
disability, is the key consideration.
MS. VAN KIRK replied that is correct.
4:24:24 PM
CHAIR WILSON opened public testimony on SB 240.
4:24:49 PM
TREVOR STORRS, President, Alaska Children's Trust, Anchorage,
Alaska, testified in support of SB 240, which would expand
school-based services to all Medicaid-eligible children. As an
organization focused on preventing child abuse and neglect, he
emphasized that SB 240 would promote the health and well-being
of Alaska's children by providing families with better access to
healthcare resources, reducing the risk of abuse and neglect. SB
240 aligns state law with federal guidance, allowing schools to
be reimbursed for services provided to all Medicaid-eligible
students, not just those with an IEP. This expansion supports
parent directed services within the school setting, early
intervention, prevention, and increased healthcare access, which
are vital for Alaska's children and families.
4:27:08 PM
CHAIR WILSON closed public testimony on SB 240.
4:27:31 PM
MS. RICCI thanked the committee for hearing SB 240.
4:27:59 PM
CHAIR WILSON [held SB 240 in committee.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| FY25 LBA SHSS Presentation 2.27.24.pdf |
SHSS 2/27/2024 3:30:00 PM |
SHSS 2.27.24 - LBA Audit Findings DOH Response |
| SB 240 Version A.pdf |
SHSS 2/27/2024 3:30:00 PM |
SB 240 |
| SB 240 Sponsor Statement Version A.pdf |
SHSS 2/27/2024 3:30:00 PM |
SB 240 |
| SB240 Sectional Analysis.pdf |
SHSS 2/27/2024 3:30:00 PM |
SB 240 |
| SB 240 Fiscal Note 1.pdf |
SHSS 2/27/2024 3:30:00 PM |
SB 240 |
| SB 240 Fiscal Note 2.pdf |
SHSS 2/27/2024 3:30:00 PM |
SB 240 |
| SB 240 Fiscal Note 3.pdf |
SHSS 2/27/2024 3:30:00 PM |
SB 240 |
| SB240 Summary Version A.pdf |
SHSS 2/27/2024 3:30:00 PM |
SB 240 |
| SB 240 Final SHSS 2_27_24.pptx - Read-Only.pdf |
SHSS 2/27/2024 3:30:00 PM |
SB 240 |
| SB240 AMHT LOS 2.26.24.pdf |
SHSS 2/27/2024 3:30:00 PM |
SB 240 |
| SB 240 HB343 Letter of Support - ACT.pdf |
SHSS 2/27/2024 3:30:00 PM |
HB 343 SB 240 |
| SB 240 VOA Alaska - Letter of Support.pdf |
SHSS 2/27/2024 3:30:00 PM |
SB 240 |
| SB240 HB343_ASD Support Letter.pdf |
SHSS 2/27/2024 3:30:00 PM |
HB 343 SB 240 |
| Leg Audit Recommendations SHSS 1.19.24.pdf |
SHSS 2/27/2024 3:30:00 PM |
SHSS Feb. 27, 2024 - LB&A Audit Findings for Dept of Health |