Legislature(1993 - 1994)
03/19/1993 03:00 PM House HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 171 - MEDICAID COVERAGE FOR HOSPICE CARE DORIS LUM, MANAGER OF VALLEY HEALTH SERVICES AT VALLEY HOSPITAL IN PALMER, testified via teleconference from Palmer in support of HB 171. She said she hoped to provide hospice service at less cost to residents of the Mat-Su Valley. While Alaska has no certified hospice as yet, she hopes to provide hospice care in a fiscally responsible way and to provide mechanisms to do so across the state. The patient base for hospice care is too small to support a hospice unless the facility could be qualified to receive payment through Medicaid. She said the bill would improve the level of service for hospice patients and would be a good deal for the state government. Number 068 JUDY MATHIS, AIDE TO REP. RON LARSON, PRIME SPONSOR OF HB 171, made herself available in Juneau to answer questions on HB 171. REP. BRICE asked Rep. Larson's feelings on changing the bill's effective date. Number 085 DAVE WILLIAMS, H&SS PLANNER, DIVISION OF MEDICAL ASSISTANCE IN THE DEPARTMENT OF HEALTH AND SOCIAL SERVICES, testified in Juneau that the department had asked for the bill's effective date to be delayed from July 1, 1993, to January 1, 1994, because the department did not believe it could hire people or perform the work quickly enough to begin the program by July 1, 1993. He said the bill would require much work on its management information (computer) system to handle four waivers and other changes. REP. BRICE asked Ms. Mathis if she believed Rep. Larson would believe the delay was reasonable. MS. MATHIS indicated that she did. REP. BRICE offered to make a motion for an amendment changing HB 171's effective date to January 1, 1994. Number 109 CHAIR TOOHEY asked a clarifying question on the effective date of the bill and how it related to the change in Medicaid billing services the bill would allow. REP. BRICE said he had asked why the Department of Health and Social Services had asked for the change in effective date for HB 171, and said Mr. Williams had answered his question. He said the change would be appropriate, barring opposition from the sponsor. Number 128 CHAIR TOOHEY asked what difference the change would make. MR. WILLIAMS stated the department could not make the changes to its management information system necessary to meet the bill's conditions by July 1, 1993. He added, though, that no provider was ready to take advantage of the bill's provisions right away, and a six-month delay in the bill's effective date would not harm anyone. Number 140 CHAIR TOOHEY asked if there was any reason the department could not implement the bill's provisions, starting slowly if necessary, by July 1, 1993. REP. BRICE offered his opinion that the sooner the changes got on-line, the better. But he also acknowledged that the department had other priorities relating to other Medicaid waivers that might come before HB 171, which might explain the request for a delay. Number 161 CHAIR TOOHEY called a brief at-ease at 3:26 p.m., and called the meting back to order at 3:28 p.m. REP. VEZEY noted that the bill's effective date was July 1, but the bill does not mandate that the program be in place by July 1. He also questioned the reasonableness of the bill's $10,000 fiscal note from the Department of Health and Social Services, saying the program must surely cost more than $10,000. Number 176 REP. OLBERG said he understood the fiscal note as reflecting the cost of doing the computer work necessary to put the program in place, not of operating the program. MR. WILLIAMS said the fiscal note reflected the cost of changes in the information system to allow the department payment system to process payments to hospices. He said the bill would likely not cost the state any more money. He said the bill would not extend Medicaid coverage to anyone who did not already have it. He said the cost of hospice care for a terminally ill Medicaid patient would be the same as or less than the cost of caring for such a patient in a nursing home or through a home care provider. Number 200 REP. VEZEY stated that without a fiscal note he could not tell how many new people were expected to sign up for health care services under Medicaid. He asked whether Medicaid paid much money for hospital services. MR. WILLIAMS replied that Medicaid paid a great deal for hospital services, especially for terminally ill patients. He said Medicare certification was difficult to obtain. Number 225 REP. VEZEY interrupted, commenting that the program in question was not Medicare, but Medicaid. MR. WILLIAMS clarified that Medicare was a federal insurance program, and that Medicaid often relies on Medicare certification requirements. A hospice would normally have to be certified by the Medicare program in order to receive payment for its services through the Medicaid insurance program, he said. REP. VEZEY commented he believed that Medicaid covered things that Medicare did not. MR. WILLIAMS said that was often true. But in the case of hospice service, Congress first passed certification for hospice care for Medicare, and later allowed hospices that were certified under Medicare to collect from the Medicaid program. He added that he did not anticipate more people availing themselves of hospice care. Those who are terminally ill and likely to die within six months will be receiving service through home care providers or hospices. Hospices are places where the terminally ill go to die, not places where they are encouraged to get well, which means a special kind of service. Number 248 REP. VEZEY said the prospect of care for the terminally ill was an unpleasant thought and one that few people dwell on, but it is nonetheless important to consider. Number 252 RITCHIE SONNER, EXECUTIVE DIRECTOR OF HOSPICE AND HOME CARE OF JUNEAU, testified in Juneau in support of HB 171. She said Juneau has no Medicare-certified hospices, but Medicare has waived the certification requirement in Juneau, allowing her organization to provide hospice services. She said some Juneau residents receive hospice services through other funding sources, but Hospice and Home Care would like to channel those funds to different directions if those clients could qualify for Medicaid. She echoed Mr. Williams' statement that it would not cost the state any more to allocate hospice services under Medicaid, as people already receive other state funded services. She said hospices allow people to die in dignity and comfort, surrounded by family and friends and not in sterile, often frightening institutions. Number 281 CHAIR TOOHEY called for more public testimony and, hearing none, closed public testimony and asked the will of the committee. REP. BRICE moved passage of HB 171 from the committee with individual recommendations. CHAIR TOOHEY asked for objections, and, hearing none, indicated that HB 171 was passed with individual recommendations. CHAIR TOOHEY then brought HB 178 to the table.
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