Legislature(2017 - 2018)HOUSE FINANCE 519

02/02/2018 01:30 PM FINANCE

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+ teleconferenced
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Heard & Held
-- Public Testimony --
Heard & Held
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
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,                                                                    
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                                                                    
     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                                                                    
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                                                                     
          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                                                                    
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                                                                    
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                                                                    
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                                                                    
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                                                                    
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                                                                    
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                                                                    
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                                                                                                                    
Co-Chair Seaton  noted that the  bill was  already scheduled                                                                    
for the following Wednesday.                                                                                                    
HB  215  was  HEARD  and   HELD  in  committee  for  further                                                                    

Document Name Date/Time Subjects
HB215 Draft Proposed CS Ver O.PDF HFIN 2/2/2018 1:30:00 PM
HB 215
HB215 Explanation of changes Ver J to Ver O 1.18.18.pdf HFIN 2/2/2018 1:30:00 PM
HB 215
HB215 Sponsor Statement ver O 1.17.18.pdf HFIN 2/2/2018 1:30:00 PM
HB 215
HB215 Sectional Analysis ver O 1.17.18.pdf HFIN 2/2/2018 1:30:00 PM
HB 215
HB215 Public Health Briefing Paper 2018.pdf HFIN 2/2/2018 1:30:00 PM
HB 215
HB142 Additional Document - WBA Charts from DOL 1.29.18.pdf HFIN 2/2/2018 1:30:00 PM
HB 142
HB142 Additional Document - Updated facts from DOL 1.29.18.pdf HFIN 2/2/2018 1:30:00 PM
HB 142
HB 142Letter-DOLWD to HFIN 1.30.18.pdf HFIN 2/2/2018 1:30:00 PM
HB 142
HB 142 Letter in Opposition 2.1.2018.pdf HFIN 2/2/2018 1:30:00 PM
HB 142
HB 142-Letter in support DOLWD to HFIN 1.30.18.pdf HFIN 2/2/2018 1:30:00 PM
HB 142
HB 215 DHSS slides HFIN 2-2-2018.pdf HFIN 2/2/2018 1:30:00 PM
HB 215
ASHNHA HB 215 Letter 1-31-18.pdf HFIN 2/2/2018 1:30:00 PM
HB 215
HB142 Support Document - Support Letters 2.1.18.pdf HFIN 2/2/2018 1:30:00 PM
HB 142
HB142 Support Document - Support Letters 2.2.18.pdf HFIN 2/2/2018 1:30:00 PM
HB 142