Legislature(2005 - 2006)HOUSE FINANCE 519

04/06/2006 01:30 PM House FINANCE


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 488 OIL AND GAS PRODUCTION TAX TELECONFERENCED
<Bill Hearing Canceled>
-- Testimony <Invitation Only> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= HCR 30 AK CLIMATE IMPACT ASSESSMENT COMMISSION TELECONFERENCED
Moved CSHCR 30(FIN) Out of Committee
+= HB 307 KNIK RIVER PUBLIC USE AREA TELECONFERENCED
Moved CSHB 307(RES) Out of Committee
+= HB 493 SCHOOL CONSTRUCTION BOND REIMBURSEMENT TELECONFERENCED
Moved CSHB 493(FIN) Out of Committee
+= HB 105 MEDICAID FOR ADULT DENTAL SERVICES TELECONFERENCED
Moved CSHB 105(FIN) Out of Committee
3:29:09 PM                                                                                                                    
                                                                                                                                
HOUSE BILL NO. 105                                                                                                            
                                                                                                                                
     An Act relating to coverage for adult dental services                                                                      
     under Medicaid; and providing for an effective date.                                                                       
                                                                                                                                
Representative Foster MOVED to  ADOPT work draft #24-GH108\F,                                                                   
Mischel,  4/5/06,  as the  version  of  the bill  before  the                                                                   
Committee.  There being NO OBJECTION, it was adopted.                                                                           
                                                                                                                                
3:30:03 PM                                                                                                                    
                                                                                                                                
BILL  HOGAN, DEPUTY  COMMISSIONER, DEPARTMENT  OF HEALTH  AND                                                                   
SOCIAL SERVICES,  explained that the Department  is proposing                                                                   
changes to the range of adult  dental services allowed in the                                                                   
Medicaid  program.    The  adult  dental  coverage  currently                                                                   
provides only  emergency dental care.  The  legislation would                                                                   
enhance  the existing  emergency  dental  program to  include                                                                   
preventive and restorative care.   The expanded program would                                                                   
benefit those  most in need  as well  as Alaskan seniors.   A                                                                   
proposed cap of $1150 per year  would allow for a full set of                                                                   
dentures over a two-year period.                                                                                                
                                                                                                                                
3:33:15 PM                                                                                                                    
                                                                                                                                
Mr. Hogan  continued, infections of  the mouth can  result in                                                                   
all sorts  of physical  problems.   Dental infections  can be                                                                   
passed to  unborn infants  and can  keep a person  unemployed                                                                   
given  the decayed  teeth.   The Alaska  Mental Health  Trust                                                                   
(AMHT)  has a mini  grant program,  annually dispersing  over                                                                   
$700  thousand  dollars on  dental  care programs  for  their                                                                   
beneficiaries.   If the bill  passes, those Medicaid  dollars                                                                   
could be used.                                                                                                                  
                                                                                                                                
The  Division of  Vocational  Rehabilitation  has noted  they                                                                   
spend annually  about  $100 thousand dollars  to help  people                                                                   
with  dental concerns,  increasing the  possibility they  can                                                                   
become employed.                                                                                                                
                                                                                                                                
3:34:31 PM                                                                                                                    
                                                                                                                                
JANET  CLARKE, ASSISTANT  COMMISSIONER,  DIVISION OF  FINANCE                                                                   
AND  MANAGEMENT SERVICES,  DEPARTMENT  OF  HEALTH AND  SOCIAL                                                                   
SERVICES, pointed out that the  revised fiscal note was based                                                                   
on  the  committee  substitute   and  was  reduced  from  the                                                                   
original  note.    FY07  number  reduction  of  $3.5  million                                                                   
dollars  estimate   to  $2.6  million  dollars   providing  a                                                                   
reduction to general funds.  The  fiscal note request for the                                                                   
first year assumes coverage for 25% of a full year.                                                                             
                                                                                                                                
Ms. Clarke  explained how the  fiscal note had  been reduced.                                                                   
She mentioned  the utilization assumptions.   In looking back                                                                   
at those  assumptions, it  was changed  to a 15%  utilization                                                                   
the first  year, 25% the second  year and then up to  35% the                                                                   
following year, which reduces some costs.                                                                                       
                                                                                                                                
She indicated how  much the State spends on  emergency dental                                                                   
coverage,  factoring  in  the  savings.    When  HB  105  was                                                                   
introduced  last year,  it was  based  on a  federal-Medicaid                                                                   
percentage of  50%; our congressional delegation  was able to                                                                   
change  that to 57.5%  federal participation,  saving  in the                                                                   
General  Fund requirement.   The Alaska  Mental Health  Trust                                                                   
Authority has agreed  to maintain their funding  level.  AMTA                                                                   
will be  investing significant  dollars during the  next four                                                                   
years.                                                                                                                          
                                                                                                                                
Ms. Clarke pointed out that the  committee substitute sunsets                                                                   
after  FY09.    She  offered   to  answer  questions  of  the                                                                   
Committee.                                                                                                                      
                                                                                                                                
3:37:44 PM                                                                                                                    
                                                                                                                                
Representative  Kelly  inquired  about  the  reallocation  of                                                                   
funding  within  the Department.    Ms. Clarke  advised  that                                                                   
making  cuts  to  the Medicaid  program  is  complicated  and                                                                   
difficult.  She stated that if  the Department is not aligned                                                                   
with the Legislature  on what direction it is  going into the                                                                   
Medicaid program,  there will  be many criticisms  for making                                                                   
such  reductions.     To  find  money  internally   would  be                                                                   
difficult.                                                                                                                      
                                                                                                                                
3:39:14 PM                                                                                                                    
                                                                                                                                
Representative  Kerttula inquired  if  most similar  programs                                                                   
begin  with a sunset.   Ms.  Clarke replied  that there  have                                                                   
been programs with a sunset such  as Senior Care; sunsets are                                                                   
becoming a trend  of this Legislature.   Representative Kelly                                                                   
was  not comforted  with the  sunset  concept, realizing  the                                                                   
enormity of the Department's budget.                                                                                            
                                                                                                                                
3:41:24 PM                                                                                                                    
                                                                                                                                
Representative Hawker  disagreed.  The point  of establishing                                                                   
a short  windowed sunset, offers  the Legislature  the option                                                                   
of  making  a  policy call,  rather  than  creating  it  into                                                                   
perpetuity; the  sunset offers a  trial time.  He  noted that                                                                   
the  bill  has   been  restructured  to  avoid   concerns  of                                                                   
continued growth.                                                                                                               
                                                                                                                                
3:43:22 PM                                                                                                                    
                                                                                                                                
ANDY POPE, JUNEAU,  spoke in support of the  legislation.  He                                                                   
noted  that  he  represented the  seniors  at  Mountain  View                                                                   
Senior Center,  many of whom  are low-income and  have fallen                                                                   
through  the  cracks  of  dental   care  reimbursement.    He                                                                   
commented  that   the  $1100  dollar  threshold   would  help                                                                   
tremendously for  initial dental  care expenses and  then the                                                                   
seniors  could  pay  the  rest   with  their  Permanent  Fund                                                                   
Dividend (PFD).  He urged passage of HB 105.                                                                                    
                                                                                                                                
3:46:17 PM                                                                                                                    
                                                                                                                                
MIKE FORD,  ALASKA NATIVE HEALTH  BOARD, JUNEAU,  stated that                                                                   
they completely  support  HB 105.   The committee  substitute                                                                   
provides a cautious approach and  allows taking a look at the                                                                   
program.   The proposed legislation  is a prudent,  practical                                                                   
and critical for many residents  of the State.  He urged that                                                                   
it pass quickly from Committee.                                                                                                 
                                                                                                                                
3:47:15 PM                                                                                                                    
                                                                                                                                
DR.   KATHINKA   WHITE,   (TESTIFIED   VIA   TELECONFERENCE),                                                                   
REPRESENTATIVE  FOR  THE  ALASKA  PRIMARY  CARE  ASSOCIATION,                                                                   
ANCHORAGE,  testified  in  strong  support  of  the  proposed                                                                   
legislation.   Dental infections  of the tooth,  gums, tissue                                                                   
and bone  are infectious diseases.   Dental problems,  except                                                                   
in early stages, are irreparable and cumulative.                                                                                
                                                                                                                                
Dr. White  stated that oral  disease is associated  with many                                                                   
other  problems.   As many as  80% of  the premature  infants                                                                   
born  in  the   United  States  can  be  attributed   to  the                                                                   
infectious oral  diseases.   Providing emergency  dental care                                                                   
may relieve acute  symptoms.  She urged passage  of the bill,                                                                   
stressing  the  need  to address  oral  health  and  improved                                                                   
access to dental care.                                                                                                          
                                                                                                                                
3:51:04 PM                                                                                                                    
                                                                                                                                
JEFF  JESSE,  (TESTIFIED  VIA  TELECONFERENCE),  CEO,  ALASKA                                                                   
MENTAL HEALTH TRUST AUTHORITY,  ANCHORAGE, reiterated support                                                                   
for  HB 105.   He  mentioned the  seriousness  of the  sunset                                                                   
provision and offered to answer questions of the Committee.                                                                     
                                                                                                                                
3:52:09 PM                                                                                                                    
                                                                                                                                
CARLA   SHELTON,  (TESTIFIED   VIA  TELECONFERENCE),   PARENT                                                                   
ADVOCATE, emphasized the importance  of adult dental services                                                                   
and urged passage of the bill.                                                                                                  
                                                                                                                                
3:55:05 PM                                                                                                                    
                                                                                                                                
EMILY  ENNIS,   (TESTIFIED  VIA  TELECONFERENCE),   EXECUTIVE                                                                   
DIRECTOR, FAIRBANKS RESOURCE AGENCY,  FAIRBANKS, testified in                                                                   
support   of  dental   care  for  adults   &  children   with                                                                   
developmental  disabilities.  Preventative  dental care  is a                                                                   
necessary investment  that goes  hand-in-hand with  the other                                                                   
disability  services offered  by the  State.   She urged  the                                                                   
Committee's support in passage of the legislation.                                                                              
                                                                                                                                
3:56:23 PM                                                                                                                    
                                                                                                                                
STACY  MESSERSCHMIDT,  (TESTIFIED VIA  TELECONFERENCE),  TOK,                                                                   
spoke in support of HB 105.                                                                                                     
                                                                                                                                
3:56:50 PM                                                                                                                    
                                                                                                                                
SYDNEY STREDICKET,  (TESTIFIED VIA TELECONFERENCE),  PARTNERS                                                                   
IN POLICY, spoke in strong support of HB 105.                                                                                   
                                                                                                                                
3:58:00 PM                                                                                                                    
                                                                                                                                
PAT   LUBBY,   (TESTIFIED   VIA   TELECONFERENCE),   ADVOCACY                                                                   
DIRECTOR,  ALASKA  ASSOCIATION  OF  RETIRED  PERSONS  (AARP),                                                                   
ANCHORAGE, noted that Medicaid  has never provided any dental                                                                   
care coverage  and consequently, some older people  stay away                                                                   
from dentists because  they cannot afford it.   The result is                                                                   
bad  oral  health,  which  adds   to  other  physical  health                                                                   
concerns.   He stressed it  is a real  concern faced  by real                                                                   
Alaskans.  He urged  passage of  HB 105, because  it is  good                                                                   
public health legislation.                                                                                                      
                                                                                                                                
MEG MITCHELL,  (TESTIFIED VIA  TELECONFERENCE), HOMER,  cited                                                                   
her   experience    in   working   with    individuals   with                                                                   
disabilities,  noting  the need  for  adults  on Medicaid  to                                                                   
receive dental  care.   She expressed  strong support  of the                                                                   
legislation, pointing  out there are 40,000  adults in Alaska                                                                   
that  need the  coverage but  cannot  afford it.   She  urged                                                                   
passage of HB 105.                                                                                                              
                                                                                                                                
STAN  STEADMAN,  (TESTIFIED  VIA  TELECONFERENCE),  EXECUTIVE                                                                   
DIRECTOR,  CENTER  PENINSULA   HEALTH  CENTER,  ASPEN  DENTAL                                                                   
CENTER, KENAI, stated that his  clinic has seen many patients                                                                   
that desperately need such services.   He urged passage of HB
105.                                                                                                                            
                                                                                                                                
JENNIFER  MCELROY,  (TESTIFIED  VIA  TELECONFERENCE),  DENTAL                                                                   
HYGENIST, SOLDOTNA,  noted the great need for  adult Medicaid                                                                   
recipients to receive dental benefits  and echoed support for                                                                   
passage of the legislation.                                                                                                     
                                                                                                                                
DR.  MARGUERITE  MCINTOSH,  (TESTIFIED  VIA  TELECONFERENCE),                                                                   
FAMILY  DOCTOR,   SOLDOTNA,  testified  in  support   of  the                                                                   
legislation.   As a  family practioner  in private  practice,                                                                   
she noted costs  for medical concerns that begin  with dental                                                                   
issues.   She  pointed out  incidents  of adults  contracting                                                                   
lung infections  resulting from  a lack  of dental  care over                                                                   
the years.  She urged passage of HB 105.                                                                                        
                                                                                                                                
PAMELA   HAWK,   (TESTIFIED   VIA   TELECONFERENCE),   DENTAL                                                                   
OPERATIONS MANAGER FOR ANCHORAGE  NEIGHBORHOOD HEALTH CENTER,                                                                   
ANCHORAGE, noted  that she had  seen many patients  suffering                                                                   
from  dental  infections,  and  that those  people  can  only                                                                   
receive  tooth  extractions.   She  noted,  many  individuals                                                                   
would  like  to  receive  preventative   care  prior  to  the                                                                   
extraction.  She addressed the  high cost for root canals and                                                                   
restorative  treatments;  she  stated  that  dental  care  is                                                                   
completely prohibitive  for anyone that does  not have dental                                                                   
health  benefits  and  insurance.     Ms.  Hawk  thanked  the                                                                   
Committee for consideration of the bill and urged passage.                                                                      
                                                                                                                                
PUBLIC TESTIMONY CLOSED.                                                                                                      
                                                                                                                                
Co-Chair Meyer MOVED  to  ADOPT  Amendment  #1.   Vice  Chair                                                                   
Stoltze OBJECTED.                                                                                                               
                                                                                                                                
SUZANNE  CUNNINGHAM,   STAFF,  REPRESENTATIVE   KEVIN  MEYER,                                                                   
explained  that  the amendment  was  brought  forward at  the                                                                   
request  of the  Department of  Health  and Social  Services,                                                                   
because the wording in the draft  committee substitute was of                                                                   
concern.   The proposed change  to Page 2, Line  6, clarifies                                                                   
that the Department  will pay for preventive  and restorative                                                                   
dental services as well as minimum treatment.                                                                                   
                                                                                                                                
The second  change on  Page 2, Lines  16-18, instead  of only                                                                   
palliative  treatment,  the  Department  requests  "immediate                                                                   
relief  of  pain  and/or  the   spreading  of  infection  and                                                                   
provided by a  licensed dentist".  Janet  Clarke acknowledged                                                                   
they had requested the change for clarity purposes.                                                                             
                                                                                                                                
Vice Chair Stoltze  WITHDREW  his OBJECTION.  There  being NO                                                                   
further OBJECTION, it was adopted.                                                                                              
                                                                                                                                
Representative Weyhrauch MOVED  to ADOPT Amendment  #2.  Vice                                                                   
Chair Stoltze OBJECTED.                                                                                                         
                                                                                                                                
Representative Weyhrauch explained   that   amendment   would                                                                   
remove  the  initial portion  of  the  bill, making  it  into                                                                   
intent  language   and  putting  it  into  a   House  Finance                                                                   
Committee Letter of Intent.                                                                                                     
                                                                                                                                
Representative   Hawker   indicated   his  support   of   the                                                                   
amendment, pointing out the precedent  to include intent in a                                                                   
Letter of Intent rather than in the bill itself.                                                                                
                                                                                                                                
4:12:57 PM                                                                                                                    
                                                                                                                                
Vice Chair Stoltze  REMOVED  his OBJECTION to  the amendment.                                                                   
There being  NO further  OBJECTIONS, conceptual  Amendment #2                                                                   
was adopted.                                                                                                                    
                                                                                                                                
In response  to Co-Chair  Meyer, Representative  Hawker noted                                                                   
that a  great deal of  time was spent  on the revised  fiscal                                                                   
note, which  adequately reflects  an excellent return  on the                                                                   
investment.                                                                                                                     
                                                                                                                                
4:14:32 PM                                                                                                                    
                                                                                                                                
Representative Kelly asked  clarification  between  emergency                                                                   
and continuing care.                                                                                                            
                                                                                                                                
Ms.  Clarke responded  that the  statute clarifies  emergency                                                                   
dental care  very well as the  "immediate relief of  pain and                                                                   
acute  infection".   That  definition  is maintained  in  the                                                                   
legislation.  She  noted that other services  were defined as                                                                   
"preventative and restorative"  and that restorative services                                                                   
were  being   added  in  the  legislation,   while  emergency                                                                   
services remain in tact.  She  reiterated that there is a cap                                                                   
of $1,150 for total restorative services each year.                                                                             
                                                                                                                                
4:17:18 PM                                                                                                                    
                                                                                                                                
Representative Hawker addressed  the criticism of the bill as                                                                   
a "new  program".   He emphasized  that dental services  were                                                                   
provided under  the existing  Medicaid program; he  explained                                                                   
that the readjusted program toward  preventative maintenance,                                                                   
in the hope that emergency services  would then be reduced in                                                                   
the new model.   He stressed the  cap as being unique  to the                                                                   
program, which allows his strong support of the bill.                                                                           
                                                                                                                                
Representative Kelly noted   he   too  supports   the   bill,                                                                   
however, expressed  concern regarding  the sustainability  of                                                                   
the program  within the  Department's budget.   He  noted the                                                                   
escalation of  that Department's  budget in addition  to what                                                                   
is going on with the public employee retirement system.                                                                         
                                                                                                                                
Representative Weyhrauch  MOVED  to  REPORT CS  HB 105  (FIN)                                                                   
out  of Committee  with individual  recommendations and  with                                                                   
the accompanying fiscal notes.   There being NO OBJECTION, it                                                                   
was so ordered.                                                                                                                 
                                                                                                                                
CS HB  105 (FIN)  was reported  out of  Committee with  a "do                                                                   
pass"  recommendation,  House  Finance  Committee  Letter  of                                                                   
Intent and with  fiscal notes #1 and #2 by the  Department of                                                                   
Education &  Early Development and  a new fiscal note  by the                                                                   
Department of Health and Social Services.                                                                                       

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