Legislature(1993 - 1994)

03/19/1993 03:00 PM House HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
  HB 171 - MEDICAID COVERAGE FOR HOSPICE CARE                                  
  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                                                                   
  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                                                                   
  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                                                                   
  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                     
  Number 281                                                                   
  CHAIR TOOHEY called for more public testimony and, hearing                   
  none, closed public testimony and asked the will of the                      
  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                             
  CHAIR TOOHEY then brought HB 178 to the table.                               

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