Legislature(2013 - 2014)HOUSE FINANCE 519
04/10/2013 01:30 PM House FINANCE
| Audio | Topic |
|---|---|
| Start | |
| SB37 | |
| SB16 | |
| SB38 | |
| SB88 | |
| SB38 | |
| SB24 | |
| SB2 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 21 | TELECONFERENCED | |
| += | SB 18 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 37 | TELECONFERENCED | |
| += | SB 16 | TELECONFERENCED | |
| += | SB 38 | TELECONFERENCED | |
| += | SB 88 | TELECONFERENCED | |
| += | SB 2 | TELECONFERENCED | |
| += | SB 24 | TELECONFERENCED | |
SENATE BILL NO. 88
"An Act authorizing the state bond committee to issue
certificates of participation to finance the
construction and equipping of residential housing to
serve the Anchorage campus of the Alaska Native
Medical Center; and authorizing the Department of
Administration to enter into a lease-purchase
agreement for the benefit of the Alaska Native Tribal
Health Consortium."
2:22:22 PM
SENATOR PETE KELLY, SPONSOR, addressed the bill. He spoke
to increased costs in Medicaid. He pointed to the Medicaid
task force who made some recommendations and initiated the
conversation about containing Medicaid costs. One
recommendation was to move people who were utilizing
Medicaid services while eligible for Tribal Health into
hospitals eligible for Tribal Health grants that reimbursed
at 100 percent. With Medicaid, the state paid 50 percent
and Medicaid paid 50 percent. The bill incentivized care
for hospitals that pay 100 percent. The department
estimated an $8.8 million saving per year with
implementation of the legislation.
Co-Chair Stoltze asked about a direct appropriation or a
bond. Senator Kelly replied that the net savings would be
$8.8 million per year. He furthered that the bill would
bond for the Alaska Native Medical Center (ANMC) in
Anchorage for housing of patients that would then receive
100 percent grant funding from Medicaid. He anticipated
even greater savings with time.
2:25:41 PM
Co-Chair Stoltze pointed to construction opportunities for
the capital side of the issue and savings on the operating
side. Senator Kelly affirmed.
HEATHER SHATTUCK, STAFF, SENATOR PETE KELLY, explained that
the state was responsible for multiple pieces when paying
Medicaid. The populations with high-risk pregnancies in
rural areas benefitted greatly. She believed that the
cultural aspect would incentivize Alaska natives who were
Medicaid eligible to utilize the facility. The facility's
lease was 15 years long and required a memorandum of the
state. The legislation would increase access to tribal
facilities, which was in part contingent on expanding
housing abilities.
Co-Chair Stoltze requested department testimony.
2:30:28 PM
WILLIAM STREUR, COMMISSIONER, DEPARTMENT OF HEALTH AND
SOCIAL SERVICES, discussed his involvement in the bill. He
stated that approximately 40 percent of state services were
delivered within the tribal system. The consequence was a
50 percent reimbursement for 60 percent of services. The
discussion evolved cooperatively with Tribal Health who
determined the greatest needs of tribal members. Maternal
and child health was deemed the greatest need.
Commissioner Streur pointed out that the state spent
approximately $1 million per year for each of the first
three years for a challenged birth. He mentioned an
immunodeficient baby whose prescriptions alone cost $36
thousand per month. One proposal was to bring rural mothers
into urban areas for prenatal services. He projected $1.9
million for increased deliveries per year within the native
system. He added that operating room expansion was
projected to cost $595 thousand.
Commissioner Streur commented on the abundance of ear, nose
and throat problems occurring in rural areas, which if left
untreated could lead to permanent damage to children and
their ability to be fully productive citizens. The proposal
was for increased medical capabilities for those issues. He
added that prenatal outpatient capacity would save $1
million per year and the increased day capacity would save
$600 thousand per year. The total estimate was for $3.8
million in Medicaid savings per year as an offset to the
Tribal Health facility.
2:34:26 PM
Commissioner Streur discussed telemedicine capabilities. He
noted that the telemedicine program at Alaska Native Tribal
Health Consortium (ANTHC) provided a national model. He
believed that the performance measures would be included in
the memorandum of agreement.
2:35:45 PM
Vice-Chair Neuman asked if the facility would be located in
Anchorage. Commissioner Streur replied yes, the facility
would be located on the ANTHC campus and connected by sky
bridge to the Native Medical Center.
Vice-Chair Neuman noted that 60 percent of Alaska natives
did not attend visits with a primary care provider, but
instead chose emergency services. He asked how the Alaska
natives could be convinced to choose the facility over
emergency hospital care. He wondered how the percentage
could be lowered.
2:37:32 PM
Commissioner Streur responded that most native citizens
would arrive at the facility from Anchorage. He noted that
people coming into Anchorage may or may not end up at a
tribal facility. The intent of the legislation was early
outreach and additional services. The prenatal services
would bring young mothers into the facility for care
earlier in their pregnancies. The prenatal service would
encourage deliveries within the Tribal Health system.
2:39:25 PM
Vice-Chair Neuman asked about an opportunity for veteran
services. Commissioner Streur responded that an effort to
increase veteran care was active in Bethel, Nome and
Barrow. He mentioned outreach in other rural areas. The
outreach led to over 100 veterans in the Cordova area. Co-
Chair Stoltze clarified the city of Cordova.
Vice-Chair Neuman hoped to get additional help for veterans
in his area.
2:41:11 PM
Vice-Chair Neuman asked if there was a Neonatal Intensive
Care Unit (NICU) in the facility.
Commissioner Streur replied that the facility did have a
NICU with eight beds as part of the Alaska pediatric
partnership. When the eight beds were full, transfers to
Providence were made. Co-Chair Stoltze assumed that the
prenatal care minimized the need for the NICU. Commissioner
Streur agreed.
Representative Kawasaki pointed to a centrally located
hospital in Fairbanks. He understood that the Fairbanks
Native Association had a facility to house people receiving
care at the new facility. He wondered if the same bonding
mechanism could be used for other facilities across the
state.
2:43:23 PM
Commissioner Streur replied that the efforts to expand
Medicaid type services had been proposed in a variety of
mechanisms since 2006. He advocated for continued
development of the services.
Co-Chair Stoltze mentioned the Mat-Su Valley Tribal Health
facility. He wondered if benefits from that new facility
were observed. Commissioner Streur responded that the
facility was not yet open. He believed that the dental
clinic was the only open portion.
Co-Chair Stoltze believed that the Mat-Su valley had 10 or
11 percent Alaska native population.
2:46:07 PM
ANGELA RODELL, DEPUTY COMMISSIONER, TREASURY DIVISION,
DEPARTMENT OF REVENUE, addressed SB 88, which authorized
the issuance of certificates of participation in the amount
of $35 million. The funding would be used to finance the
construction of a 179 bed facility at the Alaska Native
Medical Center to serve patients and families. The
certificates of participation would be used to finance five
of the six floors in the facility with ANTHC financing the
sixth floor. The costs were capped at $35 million with any
cost overruns born by ANTHC. The ultimate project goal was
to realize annual general fund savings. The total cost to
the state was estimated at $42 million, which included
principal and interest to repay the certificates over a
period of 15 years. The payments were subject to annual
appropriation. The annually required debt service cost
approximately $3 million per year. An assumption was built
in for increased rates. She noted that Department of
Administration (DOA) would enter into a lease agreement
with ANTHC who would be responsible for the design and
building of the facility. Construction invoices would be
submitted to the department with the assistance of
Department of Health and Social Services (DHSS). The state
would maintain the tax exemption on the certificates of
participation.
Representative Wilson asked if the money would be
reimbursed to the state. Ms. Rodell replied that the state
would fund the facility. Medicaid savings would provide the
funding. The facility was a crucial aspect of the savings.
Representative Holmes pointed to page 2, lines 24 through
27. She stated that the bill did not mention participation
by ANTHC. Ms. Rodell clarified that the bill was related to
the $35 million only. The entire project cost exceeded that
amount. The partnership agreement was that ANTHC would
contribute to the construction of the total project.
Representative Holmes noted that subsection (a) referred to
the project as a residential housing facility with all
remaining funding connected to the investment income earned
on the proceeds. She believed the language did not
adequately detail the private partner's participation.
2:52:22 PM
Ms. Rodell answered that she was unsure about acknowledging
the private partner's participation in the legislation
because ANTHC would be contributing equity. Representative
Holmes was supportive of the project and would speak
further with Ms. Rodell about the issue.
Co-Chair Austerman asked if the Department of Revenue (DOR)
would sell the bond. Ms. Rodell replied in the affirmative.
Co-Chair Austerman asked about the federal government's
participation in the project. Ms. Rodell answered that once
the state went forward with the project, the department
would come to the legislature for an annual debt service
request regardless of federal government participation
regarding Medicaid.
Co-Chair Austerman asked for verification that the project
was dependent on the federal government. Ms. Rodell replied
in the affirmative.
Representative Munoz asked if the state would derive
benefit once the facility had been paid off and was
constructed. Ms. Rodell replied that the state would
continue to derive benefit due to the savings.
Representative Munoz clarified that the state shared the
cost of Medicaid with the federal government. She wondered
if the state would derive the financial benefit for the
savings allowed by the presence of the facility. She asked
if the state's contribution to Medicaid would lessen. Ms.
Rodell deferred the question to Commissioner Streur.
Co-Chair Stoltze noted that the legislation would allow for
medical services for additional Alaskans and provide a
permanent accrual of benefit.
2:57:16 PM
Co-Chair Austerman pointed to the fiscal note listing $2.8
million per year paid by the state. Ms. Rodell concurred.
Representative Wilson asked what would happen if the state
did not fund the $3 million annual payment. Ms. Rodell
replied that the state would be in default.
Representative Wilson asked if the state was competing with
the private sector. Ms. Rodell deferred the question.
2:58:41 PM
VALERIE DAVIDSON, SENIOR DIRECTOR, LEGAL AND
INTERGOVERNMENTAL AFFAIRS, ALASKA NATIVE TRIBAL HEALTH
CONSORTIUM (ANTHC), spoke in support of the legislation.
She stated that expanding patient housing would allow an
expansion of services at ANTHC. She provided examples of
patients that would benefit from the facility. The first
story pertained to a pregnant woman from a small village
who experienced complications and needed to be in a
hospital but was unfamiliar with the use of Medicaid
vouchers. She mentioned her own personal experience. She
elaborated on the story. She stated that patients had to
learn navigation of a whole new world in Anchorage when
they were from a village. She provided information on the
proposed facility. She explained how a patient would be
treated in the new facility. She discussed the services
provided at the facility including the cafeteria, shared
kitchen and housing.
3:04:33 PM
Ms. Davidson continued to discuss how the facility would
help various patients of all ages. She furthered that ANTHC
was the highest level trauma center in the state. The
project allowed the state to realize an annual savings of
$8.8 million. The state's required contribution would be
$2.8 to $2.9 million annually. She spoke to the necessary
housing component. She thanked the committee for its time.
Representative Holmes asked if the facility would enhance
the ability for telemedicine services. Ms. Davidson
answered that ANTHC had a program for telemedicine service
which allowed savings in ear, nose and throat services. Her
organization had documented the travel savings because of
the telemedicine services. She stated that the organization
explored expansion of telecardiology services.
Representative Holmes discussed support for the benefits of
telemedicine services.
Co-Chair Stoltze asked ANTHC was under the management of
the Southcentral umbrella. Ms. Davidson replied that the
Southcentral foundation and ANTHC joint-managed the Alaska
Native Medical center.
Co-Chair Stoltze remarked about the partnership. Ms.
Davidson commented on the many benefits of the partnership.
Co-Chair Stoltze asked about the facility in Wasilla known
as Benteh Nuutah. He wondered about its progress.
Ms. Davidson replied that once a facility was able to bill
services that were available by a tribal health facility,
the state immediately saw savings.
3:10:57 PM
Co-Chair Stoltze hoped that there was a decreasing number
of Alaskans that would require Medicaid because of a
thriving economy.
Representative Edgmon asked about the safety aspect of
bringing patients in from villages. Ms. Davidson replied
that the consortium had heard stories about people being
taken advantage of in cab rides to the ANMC. She provided
other stories about patients who did not speak English
well. The housing facility goal was to provide a home away
from home. She shared a personal story related to her
childhood. She furthered that Alaska Native families wanted
what all families wanted. She stated that when there were
opportunities to help the lives of many people it was
important to seize them.
Co-Chair Stoltze inferred that the bill financed a facility
with great opportunities for savings, which included
facilitated transportation for rural patients. Ms. Davidson
replied in the affirmative. The transportation from the
housing to the airport would be provided.
3:16:40 PM
Representative Wilson asked if Medicaid eligibility was a
patient requirement. Ms. Davidson replied that the housing
facility would be available to all eligible individuals.
Co-Chair Stoltze expounded that Medicaid patients utilizing
the facility would benefit state savings. Ms. Davidson
concurred.
Co-Chair Stoltze CLOSED public testimony.
SB 88 was HEARD and HELD in committee for further
consideration.
3:19:14 PM
RECESSED
7:36:27 PM
RECONVENED
| Document Name | Date/Time | Subjects |
|---|