Legislature(2003 - 2004)
03/09/2004 03:07 PM House HES
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
SB 285-MEDICAL ASSISTANCE COVERAGE Number 0086 CHAIR WILSON announced that the first order of business would be SENATE BILL NO. 285, "An Act relating to medical assistance coverage for targeted case management services and for rehabilitative services furnished or paid for by a school district on behalf of certain children; and providing for an effective date." Number 0160 JACQUELINE TUPOU, Staff to Senator Lyda Green, Alaska State Legislature, testified on behalf of Senator Green, sponsor of SB 285. She explained that in Alaska statutes case management [definition] has been limited to three specific groups: substance abusers, chronically mentally ill, and severely emotionally disturbed children. Ms. Tupou told the members that federal Medicaid allows child in need of aid (CINA) case management for all groups that the state determines necessary. This bill would expand the authority to allow for Medicaid billing for expanded CINA case management services, she said. MS. TUPOU told the members that the first of these services that will be [billed to Medicaid is] the family preservation service which has been recognized in numerous studies and surveys as a key tool in addressing these problems. MS. TUPOU said that in 2002 legislation was passed which allowed schools to bill Medicaid for the school-based Medicaid services that are offered. It was discovered that the State of Alaska's definition and the federal definition of rehabilitated services does not align. She explained that there is a housekeeping provision in the bill which would make Alaska's definition as inclusive as the federal definition. Ms. Tupou summarized her comments by saying that it is estimated that this legislation will save approximately $270,000 of general fund money in FY05. Number 0281 JOEL GILBERTSON, Commissioner, Office of the Commissioner, Department of Health and Social Services, testified in support of SB 285, and answered questions from the members. He told the members that the administration strongly supports SB 285. There are two purposes for the bill, he said. First and foremost, it corrects some challenges currently experienced in implementing school-based Medicaid in Alaska. One challenge is that in previous statute the definition of rehabilitative services does not align with the federal definition. As a result the state is restricted to the portfolio of services that can be billed to Medicaid. COMMISSIONER GILBERTSON explained that school-based Medicaid services really has to do with the services schools provide to deal with individual education programs (IEPs), such as transportation services, nursing services, some supplies, speech therapy, occupational therapy, and physical therapy. He added that these are services that the state has an obligation to provide. This change in law simply allows the state to access additional federal revenue to provide that service at a greater level. COMMISSIONER GILBERTSON told the members that as regulations were being drafted to address the law which was passed in a previous session which implemented school-based Medicaid, the Department of Law pointed out that the state statutory definition was not linked to federal statute. This bill would make that correction. He said that a side benefit of this is that it reduces the burden placed on school districts. The legislation recommends that services by a physician or by a practitioner through the IEP be services that can be billed to Medicaid. The current requirement says that the services explicitly have to be at the prescription of the provider. COMMISSIONER GILBERTSON explained that the legislation also addresses targeted case management services. Currently the targeted case management services are restricted by statute to substance abusers, chronically mentally ill adults, and severely emotionally disturbed children. A whole population of children that are served in the child protection system are excluded from targeted case management services as a direct result of their not fitting into these three eligibility categories, he explained. This bill would clear the way to expand these services, he added. Number 0482 COMMISSIONER GILBERTSON told the members that under the new statute the department will be able to provide targeted case management services to children in the Office of Children Services, the Division of Juvenile Justice, the Infant Learning Program, some services provided by Public Health Nursing, and children who are in the education system who have IEPs. Some case management services may also target tribal groups. He added that inclusion of tribal groups also provides the department with the opportunity to work with Native health corporations in rural Alaska and to attract 100 percent federal financing to provide services. COMMISSIONER GILBERTSON said the department firmly supports this bill. He told the members that John Sherwood can answer any technical questions the members might have. Number 0526 CHAIR WILSON asked if she understands correctly that if this bill passes it will be possible for the school districts to be reimbursed for some of the services that are currently being provided. COMMISSIONER GILBERTSON replied that the school districts are not reimbursed with federal dollars. He explained that SB 285 does not introduce any new services. This legislation would simply allow the state to gain additional reimbursement for obligations that state government or school districts are already bearing. Number 0601 REPRESENTATIVE GATTO pointed to page 1, line 2, where it says "paid for by a school district" and asked Commissioner Gilbertson if school districts normally pay for rehabilitative services from districts' funds. He commented that he does not believe that is the case. COMMISSIONER GILBERTSON responded that he would like John Sherwood to comment on that point. He told the members that school districts actually do provide funds and the local match requirement for the school-based Medicaid services. When Ms. Tupou mentioned the $270,000 savings to the general fund, she was only referring to the targeted case management component. The additional federal revenue that will be coming in as a result of this legislation will go directly to the school districts, he explained. He summarized that the total additional revenue that will be coming in will be about $3.5 million. Number 0664 JOHN SHERWOOD, Medical Assistance Administrator, Program Review, Office of the Commissioner, Department of Health and Socials Services, testified on SB 285 and answered questions from the members. He told the members that Commissioner Gilbertson is correct. Currently the services that school districts provide to children under an IEP are required by federal law. He commented that there are no funds appropriated to the school districts to provide these services. School districts commonly refer to these IEP services as "unfunded federal mandates", Mr. Sherwood explained. Number 0711 REPRESENTATIVE CISSNA said she supports this bill, but would like some clarification on how it works. COMMISSIONER GILBERTSON explained that the Department of Health and Social Services operates the Medicaid program at the state level. The department pays the claims, but does not provide the bulk of the services through the department. The services are largely delivered by the school districts or by contractors who work for the school districts in providing the services required by the children's IEPs and special needs services, he said. Commissioner Gilbertson stated that the department is trying to assist districts by providing reimbursement for these federal mandates through a Medicaid financing mechanism. Number 0809 REPRESENTATIVE GATTO asked for clarification of the language on page 1, line 2, where it says "paid for by a school district." He asked if that reflects a situation whereby a student has such needs that the school district has no personnel that can satisfy the requirements so the district must contract with someone to provide the services. COMMISSIONER GILBERTSON replied that is correct. He pointed out that most transportation services for school districts are handled by contract. This legislation would allow for reimbursement for those services through Medicaid by correcting the definition to link with federal rehabilitation services definition, he reiterated. He noted that school-based Medicaid was established by a previous legislature and this bill would help the department to implement it. Number 0888 CHAIR WILSON asked if a small school system that could not afford to hire a full time speech therapist or physical therapist entered into a contract to provide the services, would the school district be reimbursed. COMMISSIONER GILBERTSON replied that if the service was Medicaid eligible, it would be reimbursed. Number 0921 REPRESENTATIVE SEATON moved to report SB 285, 23-LS1530\D, out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, SB 285 was reported out of House Health, Education and Social Services Standing Committee.
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