Legislature(1995 - 1996)
04/12/1996 08:20 AM House FIN
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE BILL NO. 393
"An Act relating to managed care for recipients of
medical assistance; and providing for an effective
date."
REPRESENTATIVE NORMAN ROKEBERG, sponsor of HB 393, spoke in
support of the legislation. He noted that the bill asks the
Department to draft legislation establishing a pilot program
for Medicaid recipients in the state of Alaska. He
emphasized that the legislation will expedite and give
direction to the implementation of managed care. He noted
that Medicaid is the second largest component in the State's
budget after education. He observed that Medicaid funding
has escalated. Over the past five years it has increased
annually by 13.9 percent. He observed that Congress is
focused on replacing Medicaid with MediGrants. MediGrants
would be issued as block grants on a per capita basis. He
emphasized the importance of planning for the implementation
of national Medicaid and welfare legislation. He pointed
out that 94 percent of all states have managed care
principals. Alaska does not have any.
Representative Rokeberg noted that the Department of Health
& Social Services has awarded a contract to develop a report
and plan for the development of a managed care program. He
observed that the state of Oregon expanded services through
savings realized by a managed care program. He emphasized
that nationally 30 percent of the population is uninsured.
He maintained that managed care will work in Alaska. He
observed that there are examples of managed care programs in
other small areas. He noted interest in rural areas. He
asserted that managed care is coming. He maintained that
the Legislature should be involved in the development and
implementation of this major state policy.
Representative Rokeberg provided members with a proposed
committee substitute, Work Draft 9-LS1451\K, dated 4/10/96
(copy on file). He explained that the committee substitute
would clarify the steps needed to implement the pilot
program. "Competition" was also deleted.
Representative Kelly noted that the Department of Health &
Social Services intends to implement the program mandated by
4
HB 393 in June, 1996. Representative Rokeberg stressed that
the Department intends to incrementally implement many of
the procedures that are part of managed care. He noted the
lack of debate regarding the issues surrounding managed
care. He stated that the legislation would mandate that the
process be hastened and that the legislature be involved.
He emphasized the need to review statutes to assure that the
State is capable of implementing a large managed care
system.
In response to a question by Representative Brown,
Representative Rokeberg reiterated that Alaska does not have
any managed care models. He envisioned the establishment of
at least two population groups. He stated that the pilot
could be set in an urban area with a rural component. He
stressed that the group should contain single mothers. He
noted that the program will take many years to implement.
The pilot program will probably not incorporate mental
health and developmentally disabled concerns.
Representative Rokeberg discussed programs in Montana. He
noted that information systems were installed to track
information regarding the program.
In response to a question by Representative Brown,
Representative Rokeberg pointed out that the Medicaid fee
schedule does not reimburse physicians for one hundred
percent of their services.
Representative Brown asked how the single mother in the
pilot program would be affected. Representative Rokeberg
noted that the primary care case management system (PPCCM)
assigns patients a specific physician to manage their entire
care. The physician will be the patients "gatekeeper" in
the utilization of the plan. They would be the primary
provider in addition to managing the patient's health care.
Representative Brown asked if the gatekeeper/doctor will be
able to decide without restrictions what the patient needs.
She asked if the legislation would provide that the Governor
or Department introduce draft legislation as a result of HB
393. Representative Rokeberg noted that the amendment would
require that the Department work through the Governor (copy
on file). Amendment 1 would also delete "authorize" and
insert "provide for" on page 2, line 17.
HARLAN KNUDSON, EXECUTIVE DIRECTOR, ALASKA HOSPITAL AND
NURSING HOME ASSOCIATION testified in support of HB 393. He
stressed that the cost of health care must be contained. He
noted that the strength of managed care is that it provides
an incentive for maintaining the patient's health. He
asserted that managed care can work in Alaska. He
5
emphasized that the legislation directs the Department to
work with the provider community.
Representative Therriault MOVED to adopt Work Draft 9-
LS1451\K, dated 4/10/96. There being NO OBJECTION, it was
so ordered.
Representative Therriault referred to a letter from the
Tanana Chiefs Conference, dated 2/16/96 (copy on file). He
noted that the letter raises questions regarding the
participation of the Indian Health Service. Mr. Knudson
emphasized that no one should be excluded.
Representative Parnell asked if there is a compelling reason
to keep the findings section in HB 393.
BOB LABBE, DIRECTOR, DIVISION OF MEDICAL ASSISTANCE stated
that the findings section directs the Department regarding
the implementation of the pilot. He stated that the
information is helpful. He emphasized the need to make
Alaska's program specific to Alaska.
(Tape Change, HFC 96-115, Side 2)
Mr. Labbe stressed that HB 393 fits with the Department's
plan.
Representative Rokeberg stated that the intent of section 1
is to provide further direction to the Department. He noted
that HB 393 mandates that the Governor bring back to the
Legislature draft legislation. He observed that HB 393 will
essentially sunset after January 1, 1997.
Mr. Labbe pointed out that CSHB 393 (FIN) could be read to
imply that the Department does not have authority to move
forward on its current planning if HB 393 is enacted. This
could inhibit the Department's attempts to manage Medicaid
expenditures.
Representative Parnell MOVED to adopt Amendment 1. There
being NO OBJECTION, it was so ordered.
Representative Parnell MOVED to report CSHB 393 (FIN) out of
Committee with individual recommendations and with the
accompanying fiscal note. There being NO OBJECTION, it was
so ordered.
CSHB 393 (FIN) was reported out of Committee with a "do
pass" recommendation and with a fiscal impact note by the
Department of Health & Social Services, 3/27/97.
| Document Name | Date/Time | Subjects |
|---|