Legislature(2017 - 2018)HOUSE FINANCE 519
02/02/2018 01:30 PM FINANCE
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HOUSE BILL NO. 215 "An Act relating to program receipts; and relating to fees for services provided by the Department of Health and Social Services." 1:36:03 PM Vice-Chair Gara MOVED to ADOPT the proposed committee substitute for HB 215, Work Draft 30-LS0673\O (Glover, 1/15/18). Co-Chair Seaton OBJECTED for discussion. ELIZABETH DIAMENT, STAFF, REPRESENTATIVE PAUL SEATON, addressed the changes in the legislation. The bill would amend AS 44.29.022(a) to grant the Alaska Department of Health and Social Services the authority to collect fees to support the administration of public health programs. She stated that during the Finance Subcommittee process in 2017, The Division of Public Health had been identified as a division that could be charging additional fees where appropriate and reasonable to support its mission. She stated that the division was not currently able to charge fees for all its potential health related services. HB 215 would give the department the authority to charge fees for any public health services provided under AS 18.05.010, and Tobacco Control Programs under AS 44.29.020. The bill would also consolidate all services listed under AS 37.05.14 provided by the department under one subsection. 1:38:31 PM Ms. Diament addressed changes in the legislation. She shared that during hearings in the previous committee a stakeholder concern had been voiced considering public and stakeholder input and the regulatory process. Basically, by taking the discussion of charging fees out of the legislative process and putting it into the regulatory process, the public would not have adequate input in the initial planning stages. She explained that within the regulatory process, public comment came after the regulations were drafted. She said that discussion had been held during the interim, which had resulted in the crafting of Section 3: Section 3 (page 2, line 26) Adds a new sub section to AS 44.29.022 requiring the commissioner of health and social services to consult with stakeholders, including at least one public meeting, before a notice of proposed action is made regarding the development of new fees under AS 44.29.020(a) (14) or AS 18. She relayed that the department had already planned to hold the meetings and that there was precedence in statute for requiring meetings for setting fees in other situations. Co-Chair Seaton asked if there were questions about the CS. He WITHDREW his OBJECTION. There being NO OBJECTION, it was so ordered. 1:40:12 PM JILL LEWIS, DEPUTY DIRECTOR, DIVISION OF PUBLIC HEALTH, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, provided a PowerPoint presentation, "HB 215 DHSS: Public Health Fees" dated February 2, 2018 (copy on file). She relayed that the division focused on services that protected the public's health status through programs that protected that health of every Alaskan and community. She stated that public health services controlled infectious diseases, prevented chronic diseases and injuries, promoted healthy lifestyles, and protected maternal and child health. She spoke to Slide 2: HB215 DHSS: Public Health Fees ? Public Health is able to charge fees for certain clinical services: ? Maternal and child health services ? Nutrition services ? Preventive medical services ? Health education ? Public health nursing services ? Laboratories Ms. Lewis relayed that the fees that the division could collect were limited to the list on Slide 2. She turned to Slide 3, which offered a pie chart that illustrated the various funding sources for the division. She noted that the red represented the general fund receipts and that the pie slice that was slightly removed reflected the approximately $7 million in fees currently collected. This was out of the $117 million budget overall. Vice-Chair Gara noted that the fiscal note specified that the bill would raise $400,000 per year. He did not believe it would replace the funding in an alcohol abuse treatment fund and the tobacco fund, which were both at risk of disappearing. Ms. Lewis reported that the division did not receive funds from the alcohol related fund but did receive funds from the Tobacco Fund, approximately $8 million per year (reflected on the slide) and over the last 6 years there had been declining revenues in the tobacco fund. The decline had prompted the division to join with partners in reducing expenditures from the fund. She noted that there was a $375,000 decrement in the FY 19 Governor's budget to to help the sustainability of the fund in the long-term. She expected that further reductions would be made in the future to assure that the division spent within its means. She said that the fees that would be collected would not be part of the Tobacco Fund but would go into the General Fund Program Receipts and would be redirected back into the program that generated the fees. 1:43:55 PM Representative Guttenberg Aske where new money was coming into the division. He mentioned vaccine assessments and wondered how they were being paid for. He probed the details of who paid the fees. Ms. Lewis responded that she would address the question as she proceeded in her presentation. She had examples of initial fees that would be pursued, identified services that the division had not been able to provide due to lack of revenue. She continued to Slide 4: HB215 DHSS: Public Health Fees ? Public health lacks fee authority for other services and functions: o Professional services o Data extraction and analysis o Training and expert consultation o Administrative functions o Inspections and certifications o Program administration She reiterated that the division currently lacked fee authority for many services and functions and had look at expanding clinical fee collections. She said that it had been determined that the division was maximizing the fees that it was able to collect and that the greatest opportunity for additional fee collection was in administrative functions and professional services. 1:46:41 PM Ms. Lewis moved to Slide 5: HB215 DHSS: Public Health Fees ? Fees waived if ? not in the public interest ? not economically feasible to collect ? undermines the division's public health mission ? Services not denied because of inability to pay ? Sliding fee schedules ? Limited to the actual cost ? Regulations required for each new fee 1:47:44 PM Representative Neuman wondered about the waived fees. He asked whether there were any indications of the fees being waived more in one area of the state than another. Ms. Lewis answered that the department was required to do a state report on waived fees. She returned to Slide 2 and stated that the fees for public health nursing services were calculated on a sliding scale based on income. Representative Neuman believed the issue was important. He noted that there was currently much discussion about the economy and that it was important to identify the "needier" areas of the state. He cited Page 1 of the bill. He noted that the program receipts were listed as dedicated receipts - $8 million of $100 million - he wondered why they were not fund coded as general fund program receipts so that the legislature could more easily track the funds. Ms. Lewis answered that the fees the department collected would be designated general fund (DGF) and were part of the General Fund (GF). 1:50:40 PM Representative Kawasaki referenced Slide 5. He noted the third bullet under the "Fees waived if" line: ? undermines the division's public health mission He asked where this language was located in statute. Ms. Lewis answered that the third bullet was not in statute. She detailed that the third bullet was the division's philosophy of how to approach fees. She said that a fee would not be in the public interest if it undermined the division's health mission. Representative Kawasaki noted the examples of area of fee implementation listed on the fiscal note. He asked about the first bullet and wondered whether the payee would be the clinic or an individual patient. Ms. Lewis answered that the clinic would pay the fee for the inspected radiologic device. Representative Kawasaki looked at the other bullets on the fiscal note. He queried who would be directly paying the listed fees. Ms. Lewis responded that it would likely be some type of organization rather than an individual. She said that the administrative fee for the loan repayment program would be paid by the employers of the practitioners who were receiving the loan repayment program. The custom, statistical, and epidemiological analysis and other types of data that could be charged for, would depend of who was requesting the information, which could be from a wide variety of entities. 1:53:33 PM Representative Tilton asked about the forth bullet on the fiscal note: * The division has turned away requests to assist with community health assessments and community action plan development. The division lost the capacity for this service when the position funded with unrestricted general funds was eliminated in recent budget cuts. The ability to charge fees would enable us to once again support local efforts for healthier communities. No new positions are needed; the division will utilize existing positions. ($125.0 DGF) Representative Tilton noted that the note went on to reflect that no new positions were needed and asked whether the division would need to fill the lost position mentioned in the bullet point. Ms. Lewis answered that if the division was looking to fund a position it would utilize existing positions. She said that the division had roughly 426 positions, with 50 current vacancies. She said that priorities across the division were considered when addressing vacancies. She said that using existing positions before seeking additional staffing was the preferred practice of the division. Representative Guttenberg referenced a letter provided to the committee by ASHNHA dated January 31, 2018 (copy on file). He asked whether the committee would hear from the organization. Co-Chair Seaton relayed that the committee could hear from them later in the meeting. 1:55:50 PM Representative Neuman asked whether the money in the fiscal note had been included in the FY 19 budget for the department. Ms. Lewis replied that the department had no additional fees reflected in the bill included in the FY 19 budget. She said that could analysis and discussions with stakeholders would need to happen first. Representative Neuman asked whether the department expected additional money for FY 19 as a result of the legislation. Ms. Lewis answered that the services were not being provided by eh department currently and that no additional funding had been requested or expected. 1:57:51 PM Representative Guttenberg asked for ASHNHA's initial concerns about the bill. He asked about the changes in the current version. JEANNIE MONK, VICE PRESIDENT, ALASKA STATE HOSPITAL AND NURSING HOME ASSOCIATION (ASHNHA), replied that the organization' original concern was that there would be an opportunity for shareholders to provide input prior to the beginning of the regulation process. Representative Guttenberg asked how the fees would affect the hospital in the state and other clinics. Ms. Monk answered that anytime additional regulatory burden was put on a health organization someone had to pay for the cost. She did not believe the bill would result in increased costs to users. Vice-Chair Gara understood that the process was new. He wondered whether the extra layer of stakeholder feedback in the regulatory process would add to the cost of fee changes. Ms. Lewis answered that the department would be able to absorb the cost associated with meeting with stakeholders. the costs. She noted that the stakeholders would vary for each individual fee. She said that the division had always intended to receive input from stakeholders. She reminded the committee that the fees under discussion were fees that were not currently levied, and it was necessary to make sure that the fees would not undermine the public health mission and that the fees were set up in a reasonable way. 2:02:34 PM Representative Kawasaki wondered how deep Title 18 would go when added to the administration of public health. He was uncertain that he was comfortable with the language as it was written. He requested a comprehensive list of the fees that could manifest in the future that would be covered under regualtion. Ms. Lewis answered that the four on the fiscal note were the only four yet identified. She said that broader fee authority had been requested because public health was not free and reasonable fees could develop in the future. She added that any fee that would be needed in the future would include public and stakeholder input. 2:05:05 PM Ms. Monk announced that the written comments from ASHNHA could be found in member packets. She said that the association supported the legislation with the increased stakeholder involvement prior to the initiation of new fees. Co-Chair Neuman wondered whether the bill would affect pioneer homes. Ms. Monk did not think that the bill spoke specifically to fees that would impact either hospitals or nursing homes but gave them the opportunity to charge the fees. Whether pioneer homes, which were part of the association, would be affected would depend on the fee. Representative Neuman was interested to know whether the bill would impact Pioneer Homes. Representative Kawasaki asked for detail on who ASHNHA represented. Ms. Monk replied that ASHNHA Represented Alaska's hospitals and skilled nursing facilitates. All tribal hospitals, nursing homes, community health centers, rural health clinics: ASHNHA represented a wide spectrum of services provided under the umbrella of a hospital or skilled nursing facility. 2:08:59 PM TOM CHARD, CHAIR, SHARP COUNCIL, STATE LOAN REPAYMENT, HEALTH PRACTITIONER SUPPORT AND ACCESS, JUNEAU, provided information about the council and its 18 members that included dentists, doctors, and other. To date the organization had administered 250 contracts with sites across the state. He shared that the council had considered the bill and had ultimately voted to support the bill and administrative fees that may result from the program. 2:12:16 PM Co-Chair Seaton CLOSED public testimony. Vice-Chair Gara had a question for Legislative Legal Services. He asked whether any other process in regulation required by statute the additional consultation for a change to regulation. KATE GLOVER, LEGISLATIVE LEGAL, JUNEAU (via teleconference), she could not say with certainty that nothing else existed in statute. She said that the Administrative Procedure Act required consultation after a proposal, this bill would require it beforehand. Representative Guttenberg expressed concern that the bill would further bifurcate public health. He stressed that the state needed to get control of the finances of the healthcare community. Ms. Lewis explained that AS 44.64.213 authorized an agency to contact a person about the development of the regulatory action and to answer question from a person that was relevant to the development of a regulatory action. She said that other consultations between departments were required but did not pertain to the regulatory process. 2:16:43 PM Vice-Chair Gara asked about the intent of the committee pertaining to bill action. Co-Chair Seaton answered the intent was to move the bill if it was the will of the committee. Representative Neuman wanted to offer a conceptual amendment that would require two meetings instead of one for stakeholder discussions. Co-Chair Seaton said that the bill would be held until the following Monday. 2:18:42 PM AT EASE 2:19:03 PM RECONVENED Co-Chair Seaton noted that the bill was already scheduled for the following Wednesday. HB 215 was HEARD and HELD in committee for further consideration.