Legislature(2005 - 2006)CAPITOL 106

02/08/2005 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HB 82 EXTEND SUICIDE PREVENTION COUNCIL TELECONFERENCED
Moved Out of Committee
*+ HB 105 MEDICAID FOR ADULT DENTAL SERVICES TELECONFERENCED
Heard & Held
*+ HB 106 SENIOR CARE PROGRAM TELECONFERENCED
Heard & Held
Bills Previously Heard/Scheduled
HB 105 - MEDICAID FOR ADULT DENTAL SERVICES                                                                                   
                                                                                                                                
[Contains discussion of HB 106.]                                                                                                
                                                                                                                                
3:26:31 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON announced  that the next order of  business would be                                                               
HOUSE  BILL NO.  105,  "An  Act relating  to  coverage for  adult                                                               
dental services  under Medicaid;  and providing for  an effective                                                               
date."                                                                                                                          
                                                                                                                                
REPRESENTATIVE  SEATON  moved  to adopt  the  proposed  committee                                                               
substitute  (CS)  for  HB   105,  Version  24-GH1081\G,  Mischel,                                                               
2/7/05,  as the  working  document.   There  being no  objection,                                                               
Version G was before the committee.                                                                                             
                                                                                                                                
3:27:37 PM                                                                                                                    
                                                                                                                                
JOEL GILBERTSON,  Commissioner, Department  of Health  and Social                                                               
Services (DHSS), explained that HB 105  and HB 106 are a combined                                                               
effort to establish  better senior care.   The administration and                                                               
the twenty-third legislature  established the SeniorCare program.                                                               
He said  that together  SeniorCare and  the state  have addressed                                                               
the issue of  high prescription costs by  forming the multi-state                                                               
prescription  drug  purchasing  plan and  establishing  a  senior                                                               
information  office.   He  reported that  Alaska  has a  vibrant,                                                               
growing senior population  and that senior services  need to grow                                                               
alongside that  population.  He  said that  HB 105 is  a proposal                                                               
from  Governor Murkowski,  to strengthen  oral health  and dental                                                               
services offered to low income seniors.                                                                                         
                                                                                                                                
COMMISSIONER  GILBERTSON  relayed  that  the  administration  has                                                               
worked very  constructively with  the Alaska Mental  Health Trust                                                               
Authority  on   a  collaborative  project  to   focus  on  dental                                                               
services.   The current Medicaid  coverage for adults,  adults is                                                               
defined  as those  over  the age  of 21,  is  restricted only  to                                                               
emergency dental services.   Thus, seniors and  adults covered by                                                               
Medicaid  have  no access  to  oral  health  care outside  of  an                                                               
emergency setting; emergency services  include the requirement to                                                               
remove  immediate pain  and acute  infection.   He said  that the                                                               
administration  and  the  Alaska Mental  Health  Trust  Authority                                                               
perceive this  as a  "tremendous health  care problem  facing our                                                               
state."   Oral health care is  an important piece of  health care                                                               
for individuals  and the  state needs  to invest  in preventative                                                               
measures, he  noted.  He said  that HB 105 allows  state Medicaid                                                               
coverage  for preventative  and restorative  care.   In order  to                                                               
provide  immediate  service, and  to  keep  the proposed  program                                                               
stable  as the  state  addresses the  pent-up  demand needs,  the                                                               
benefits  are capped  at $1,150  per  person annually.   The  cap                                                               
ensures that  each year,  over a  period of  two years,  a senior                                                               
could  purchase  one-half  of  a  complete set  of  teeth.    The                                                               
services available  at the $1,150  threshold would  cover either:                                                               
one exam, 4 bitewing radiographs,  basic cleaning, 8 restorations                                                               
and/or  extractions; or  one  exam  and an  upper  or lower  full                                                               
denture.    The  fiscal  note estimates  41,000  adults  will  be                                                               
eligible for the expanded Medicaid dental benefits.                                                                             
                                                                                                                                
COMMISSIONER  GILBERTSON relayed  that  the federal  contribution                                                               
through  fiscal  year  (FY)  2011  will  cover  approximately  66                                                               
percent  of the  costs  for those  individuals  eligible for  100                                                               
percent of  federal reimbursement.   The state general  fund (GF)                                                               
will constitute  25 percent  and the  Alaska Mental  Health Trust                                                               
Authority  about  9  percent  of  the  matching  funds.    It  is                                                               
anticipated  that  the  program  will  be  operational  the  last                                                               
quarter  of  FY  06,  so   costs  that  year  are  calculated  at                                                               
approximately 25 percent  of the FY 07 costs  and adjusted higher                                                               
to allow for pent  up demand, he said.  He  noted, that over time                                                               
the Alaska  Mental Health Trust  Authority commitment  to funding                                                               
the GF portion of the "Medicaid match" will diminish.                                                                           
                                                                                                                                
3:37:20 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON said that when  she visits the dentist, she receives                                                               
more than four x-rays, and  the proposed program only covers four                                                               
bitewings x-rays.  She asked  if the participating dentists would                                                               
be informed about the allowable number of x-rays.                                                                               
                                                                                                                                
3:38:28 PM                                                                                                                    
                                                                                                                                
JON  SHERWOOD,  Medical   Assistant  Administrator,  Division  of                                                               
Finance &  Management Services, Department  of Health  and Social                                                               
Services (DHSS),  relayed that under the  HIPAA [Health Insurance                                                               
Portability and Accountability Act]  rules there is a requirement                                                               
to ascertain  how much of  a benefit foreign  authorizations have                                                               
allowed, and  essentially obtain the prior  authorization and the                                                               
approval to pay for the  service.  He relayed that non-electronic                                                               
methods  are  also  available to  check  on  prior  authorization                                                               
status.                                                                                                                         
                                                                                                                                
3:39:36 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  GILBERTSON   added  that   the  vast   majority  of                                                               
providers  require  prior authorizations  and  that  most of  the                                                               
transactions are electronic.  However,  the providers that do not                                                               
use  electronic   interaction  with  the  state   use  telephonic                                                               
communication.                                                                                                                  
                                                                                                                                
3:40:28 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  GILBERTSON, in  response to  Representative Seaton,                                                               
relayed that  the FY 06  fiscal note reflects the  operating cost                                                               
for one  quarter.  The  pent up demand  will take three  years to                                                               
alleviate,  after   which  there  will  be   a  more  traditional                                                               
inflation factor for  the program.  The GF  portion will increase                                                               
at a  higher rate  because concurrently  with the  program growth                                                               
there will be  diminishing support from the  Mental Health Trust,                                                               
he said.                                                                                                                        
                                                                                                                                
3:41:51 PM                                                                                                                    
                                                                                                                                
MR.  SHERWOOD,  in  response to  Representative  Seaton,  related                                                               
that:                                                                                                                           
                                                                                                                                
     The  assumption in  this fiscal  note  would be  [that]                                                                    
     approximately  66   percent  of   the  cost   would  be                                                                    
     federally  funded.   And that's  a  combination of  the                                                                    
     regular match rate and the  match rate we would receive                                                                    
     from  ...  [the] 100  percent  federal  match rate  for                                                                    
     services  provided  through  tribal  facilities,  which                                                                    
     would be a significant portion.                                                                                            
                                                                                                                                
3:42:33 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  GILBERTSON related  that the  calculations for  the                                                               
fiscal note assumed the 50-50 match rate.                                                                                       
                                                                                                                                
3:43:25 PM                                                                                                                    
                                                                                                                                
MR.  SHERWOOD, in  response  to  Representative McGuire,  relayed                                                               
that  the subsection  B  of version  G "refers  to  the ...  base                                                               
treatment, the treatment people are  already eligible for; ... it                                                               
says that  the limits  we impose,  under the  previous paragraph,                                                               
don't apply  to that  emergency treatment of  dental care,  so we                                                               
wouldn't  somehow come  in and  inadvertently limit  and restrict                                                               
the care we are already offering for these individuals."                                                                        
                                                                                                                                
3:44:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  McGUIRE  reiterated   that  the  only  difference                                                               
between the  original HB 105 and  Version G is the  definition of                                                               
minimum  treatment.     She   asked  what   the  administration's                                                               
reasoning was for the definition change.                                                                                        
                                                                                                                                
3:44:56 PM                                                                                                                    
                                                                                                                                
MR. SHERWOOD said he did not know.                                                                                              
                                                                                                                                
3:45:31 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  GILBERTSON, in  response to  Representative Seaton,                                                               
related  that  the "access  issue  around  dental services  is  a                                                               
legitimate  one"  and  that while  many  dentists  take  Medicaid                                                               
patients,  many do  not.   The Dental  Association of  Alaska has                                                               
stated its  reasons for refusing Medicaid,  such as reimbursement                                                               
issues, clients not showing for  appointments, and the reluctance                                                               
of clients to  sign the provider agreement  required for Medicaid                                                               
providers.     He   said  that   the  DHSS   is  addressing   the                                                               
association's issues with  the Department of Law  (DOL), in order                                                               
to provide  advisory guidance.   He related  his belief  that the                                                               
department  has gone  out of  its way  to make  Medicaid a  "good                                                               
product,"   He  stated that  the state  needs more  providers and                                                               
more dentists  willing to take  Medicaid, and offered  his belief                                                               
that the  governor's proposal  is the  right thing  to do  and it                                                               
tells seniors, "we care."                                                                                                       
                                                                                                                                
3:52:25 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON  said that one of  the reasons many of  the dentists                                                               
complained  about   Medicaid  patients   was  due   to  cancelled                                                               
appointments, and the department should address that issue.                                                                     
                                                                                                                                
3:52:50 PM                                                                                                                    
                                                                                                                                
COMMISSIONER GILBERTSON noted  that he would not speak  as to the                                                               
motivations  of dentists  to treat  Medicaid patients,  but there                                                               
are a  variety of reasons.   He noted  that the U.S.  Senator Ted                                                               
Stevens  is very  concerned about  this problem  and he  has been                                                               
"approping money"  to support  the dental  health care  system by                                                               
developing dental health aides.                                                                                                 
                                                                                                                                
3:53:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  McGUIRE  said that  she  would  be interested  in                                                               
analyzing  the provider  agreement because  it could  be impacted                                                               
legislatively.     She  related  her  belief   that  the  federal                                                               
government should  consider tax write-offs for  the providers who                                                               
treat Medicaid  patients, thus creating more  incentive for those                                                               
providers.                                                                                                                      
                                                                                                                                
3:55:34 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  GILBERTSON  related  that  he  would  explore  that                                                               
option, but warned  that tax credit issues  and their interaction                                                               
with  other  aspects  of   reimbursement  policies  are  complex.                                                               
During the  twenty-third legislative session, Senate  Bill 41 was                                                               
signed into law and mandated  that the department must contract a                                                               
third party  to conduct audits  under all Medicaid services.   He                                                               
noted  that  while the  provider  agreement  may  be a  topic  to                                                               
discuss, the  real issue is what  is the agency doing  to support                                                               
providers and what are the providers  doing to make sure they are                                                               
increasing   access  to   health   care.     He  concluded   that                                                               
reimbursement  issues  should  be responsive  to  providers;  the                                                               
supply  and  demand  of  health   care  should  be  assessed  and                                                               
addressed.                                                                                                                      
                                                                                                                                
3:57:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER  said that  Alaskan rural health  care has                                                               
practitioners that  provide cleaning, exams, and  basic fillings.                                                               
She asked  if the rural  health care providers would  be eligible                                                               
to participate in the Medicaid program.                                                                                         
                                                                                                                                
3:57:40 PM                                                                                                                    
                                                                                                                                
COMMISSIONER GILBERTSON said "yes,"  adding that the rural health                                                               
care  is  a federal  initiative  through  Indian Health  Services                                                               
(IHS) and the  Alaska Native corporations, and  the proposal plan                                                               
is  to use  more extender  services.   The  Alaska Native  Tribal                                                               
Health Consortium (ANTHC), alongside  the Native corporations, is                                                               
in  the process  of utilizing  more mid-level  professionals, who                                                               
are  the crux  of  the health  care system  in  rural Alaska,  he                                                               
noted.                                                                                                                          
                                                                                                                                
4:00:37 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  GILBERTSON, in  response to  Representative Seaton,                                                               
said  that  the  DHSS  is currently  providing  the  service  for                                                               
children,  but there  is no  coverage for  adults.   The proposal                                                               
would  give  adults  the increased  coverage  that  the  children                                                               
already receive, he noted.                                                                                                      
                                                                                                                                
4:01:45 PM                                                                                                                    
                                                                                                                                
MR. SHERWOOD,  in response to Representative  Seaton, related his                                                               
belief that  the DHSS fiscal note  did not "factor in  an unusual                                                               
amount for transportation."                                                                                                     
                                                                                                                                
4:02:43 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  GILBERTSON added  that the  fiscal note  should not                                                               
have  to   factor  in  additional  transportation   costs,  since                                                               
Medicaid is  the largest transportation  purchaser in  Alaska and                                                               
any reimbursement of transportation  services is done through the                                                               
Medicaid program, so it is a larger leverage of federal dollars.                                                                
                                                                                                                                
4:03:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  related the  dentists who  accept Medicaid                                                               
patients would continue  to service the ones they  have, but will                                                               
not take any  new Medicaid patients.   Under these circumstances,                                                               
would  any  patient  under  the   proposed  program  have  to  be                                                               
transported out  of the area?   He asked the DHSS  to report back                                                               
to the committee with a response.                                                                                               
                                                                                                                                
[HB 105, Version G, was held over.]                                                                                             
                                                                                                                                

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