02/29/2024 03:00 PM House HEALTH & SOCIAL SERVICES

           HB 343-SCHOOL DISTRICT MEDICAL ASSISTANCE                                                                        
                                                                                                                                
3:30:57 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX  announced that  the next order  of business  would be                                                               
HOUSE  BILL  NO. 343,  "An  Act  relating to  medical  assistance                                                               
coverage  for rehabilitative,  mandatory,  and optional  services                                                               
furnished or paid  for by a school district on  behalf of certain                                                               
children."                                                                                                                      
                                                                                                                                
3:31:39 PM                                                                                                                    
                                                                                                                                
HEIDI HEDBERG,  Commissioner, Department of Health,  on behalf of                                                               
the  bill  sponsor,  House  Rules by  request  of  the  governor,                                                               
introduced  HB 343.    She said  the  proposed legislation  would                                                               
improve  access  to  school-based   services  "for  all  eligible                                                               
Medicaid children."   It would  remove statutory  [language] that                                                               
limits access to  those services.  She said HB  343 would provide                                                               
more  convenient  choices  for  parents seeking  care  for  their                                                               
children and  increase flexibility  for schools  seeking Medicaid                                                               
reimbursement for eligible  children.  She turned  to Emily Ricci                                                               
and Leah Van Kirk to offer a presentation.                                                                                      
                                                                                                                                
3:32:45 PM                                                                                                                    
                                                                                                                                
EMILY  RICCI,  Deputy  Commissioner,  Department  of  Health,  on                                                               
behalf  of  the bill  sponsor,  House  Rules  by request  of  the                                                               
governor,  co-offered   a  PowerPoint  presentation   [hard  copy                                                               
included in the  committee packet] during the hearing  on HB 343.                                                               
She  began   on  slide  3,   which  read  as   follows  [original                                                               
punctuation provided, with some formatting changes]:                                                                            
                                                                                                                                
     Medicaid can  only reimburse for  school-based services                                                                    
     if  the child  has a  disability and  the services  are                                                                    
     included  in  the  student's  individualized  education                                                                    
     plan (IEP).                                                                                                                
                                                                                                                                
       Only 6 out of 54 school districts currently submit                                                                       
     claims for Medicaid reimbursement.                                                                                         
                                                                                                                                
     Speech, Occupational, and Physical Therapy make up 96                                                                      
     percent of reimbursed services.                                                                                            
                                                                                                                                
MS. RICCI explained  that within the federal  umbrella are state-                                                               
supported services for  children in a school-based  setting.  She                                                               
noted that the  services that districts can bill  Medicaid for to                                                               
receive  reimbursement  are limited  within  the  smaller set  of                                                               
services  outlined  in the  state  plan.    They are  limited  to                                                               
services   available    through   a    student's   individualized                                                               
educational plan  (IEP).   She said  this creates  challenges for                                                               
school districts.   She said HB 343  addresses one administrative                                                               
barrier;  others  are  being addressed  by  the  department  with                                                               
stakeholders.    She  named the  districts  currently  submitting                                                               
claims  for  Medicaid  reimbursement:   Anchorage,  Delta/Greely,                                                               
Fairbanks, Juneau, Ketchikan, and Matanuska-Susitna (Mat-Su).                                                                   
                                                                                                                                
MS. RICCI turned to slide  4, "Healthy Families Initiative" - the                                                               
governor's initiative  - which  focuses on  "Healthy Beginnings,"                                                               
"Health Care  Access," and "Health  Care Communities."   She said                                                               
HB 343  focuses on  improving and increasing  access to  care for                                                               
students.  She turned the presentation over to Leah Van Kirk.                                                                   
                                                                                                                                
3:36:49 PM                                                                                                                    
                                                                                                                                
LEAH VAN  KIRK, Healthcare Policy Advisor,  Department of Health,                                                               
on behalf  of the  bill sponsor,  House Rules  by request  of the                                                               
governor,  co-offered   a  PowerPoint  presentation   [hard  copy                                                               
included in the  committee packet] during the hearing  on HB 343.                                                               
She touched  upon slide 5,  regarding what  HB 343 would  do, and                                                               
she echoed  that it  would improve access  for students  that can                                                               
receive school-based  services.  It  would allow schools  to bill                                                               
for Medicaid  services without having those  services included in                                                               
the  IEP.   She  said  the  bill  would create  opportunities  to                                                               
provide services to children that may  not need an IEP.  Further,                                                               
HB 343  would provide an  option, not a mandate.   She said  if a                                                               
parent cannot  find services in  the community, they may  be able                                                               
to access those services in the school.                                                                                         
                                                                                                                                
3:39:38 PM                                                                                                                    
                                                                                                                                
MS. RICCI  continued with  slide 8,  "Benefits to  Alaskans," and                                                               
talked  about  early  intervention and  prevention  and  avoiding                                                               
emergency  room visits  or acute  level of  care.   She said  the                                                               
department  sees HB  343 as  reducing  administrative burden  and                                                               
maximizing the federal Medicaid match.                                                                                          
                                                                                                                                
MS. VAN  KIRK drew  attention to  slide 9,  "Why now?,"  and said                                                               
that  by  reducing the  administrative  burden  on schools,  they                                                               
would be more likely to  deliver school-based services.  She said                                                               
25 states  thus far  have "reduced  the requirement"  and provide                                                               
services to  those who do not  have a disability or  have an IEP.                                                               
She indicated that after removing  statutory barriers via HB 343,                                                               
the  next  step would  be  to  engage stakeholders  and  identify                                                               
methodologies that work  for school districts.  She  made note of                                                               
letters of support  that had been received.  She  stated that DOH                                                               
is applying for a grant to support efforts.                                                                                     
                                                                                                                                
MS. RICCI  added that the  process of speaking  with stakeholders                                                               
is beginning,  and removing the statutory  provision is essential                                                               
to that process.                                                                                                                
                                                                                                                                
3:45:00 PM                                                                                                                    
                                                                                                                                
MS. RICCI,  in response to a  question from Chair Prax,  said she                                                               
is  not certain  how  many of  the  six aforementioned  districts                                                               
utilize school staff  to provide services, but she  has seen them                                                               
contract with  outside providers "to  come in and  offer services                                                               
in the school setting."                                                                                                         
                                                                                                                                
3:47:49 PM                                                                                                                    
                                                                                                                                
MS. RICCI,  in response  to a  question from  Representative Mina                                                               
about the  second paragraph of  one of the fiscal  notes, offered                                                               
her  understanding  that  the  reference to  an  increase  of  50                                                               
percent  refers to  current participation.   She  added that  the                                                               
department sees this  as a long process  with incremental growth.                                                               
In  response to  Representative  Saddler,  she further  clarified                                                               
that  50 percent  pertains to  the number  of children  in school                                                               
districts.                                                                                                                      
                                                                                                                                
3:49:35 PM                                                                                                                    
                                                                                                                                
MS.  RICCI, in  response to  Chair  Prax, indicated  that a  work                                                               
group would figure out a  flexible system that includes the needs                                                               
of smaller school districts.                                                                                                    
                                                                                                                                
3:50:28 PM                                                                                                                    
                                                                                                                                
MS.  RICCI next  covered the  sectional  analysis of  HB 343,  on                                                               
slide 11, which read as follows [original punctuation provided]:                                                                
                                                                                                                                
     Sectional Analysis                                                                                                         
     Section 1                                                                                                                  
       This section removes the requirement that Medicaid                                                                       
     services provided  in a school  setting are  limited to                                                                    
     those covered under an Individual Education Plan (IEP)                                                                     
                                                                                                                                
3:51:10 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX open public testimony on HB 343.                                                                                     
                                                                                                                                
3:51:35 PM                                                                                                                    
                                                                                                                                
TREVOR STORRS,  President & CEO,  Alaska Children's  Trust (ACT),                                                               
testified in support of HB 343.   He thanked the governor and DOH                                                               
leadership for  taking this step  to increase health  care access                                                               
for  children.   He  explained that  ACT  supports policies  that                                                               
promote  the  health and  wellbeing  of  Alaska's children.    He                                                               
talked  about  the  importance of  ensuring  that  families  have                                                               
access  to  the  knowledge,  skill,  support,  and  resources  to                                                               
thrive.   He echoed  the statements of  the presenters  about the                                                               
current  status for  reimbursement and  said HB  343 would  allow                                                               
schools to  be reimbursed for  services provided to  all students                                                               
eligible  for Medicaid.    He emphasized  that  the expansion  of                                                               
school-based   Medicaid  services   would  support   families  by                                                               
providing  opportunities for  parents to  access health  services                                                               
for  their children,  increase the  convenience for  the families                                                               
seeking that  care, and  promote parent-directed  services within                                                               
the school setting.  Further,  he echoed that increasing services                                                               
would  encourage early  intervention  and prevention.   He  spoke                                                               
about  the flexibility  and support  for Alaska  communities that                                                               
would result from HB 343.                                                                                                       
                                                                                                                                
3:54:17 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX, after  ascertaining there was no one  else who wished                                                               
to testify, close public testimony on HB 343.                                                                                   
                                                                                                                                
3:55:22 PM                                                                                                                    
                                                                                                                                
MS. RICCI, in response to  a question from Representative Saddler                                                               
regarding whether  there would be  an increase in  positions such                                                               
as therapists  in each school  rather than one that  travels from                                                               
school to  school indicated that  would be  up to each  school to                                                               
decide based on the needs of  students and what the community can                                                               
support.   In response to  follow-up question regarding  the cost                                                               
to the state,  she said the services will be  built up over time,                                                               
and  she  noted   these  are  not  additional   services  but  an                                                               
additional setting  in which existing  services can  be provided.                                                               
Overall, she  said, the department  does not believe that  HB 343                                                               
would result in  additional cost to the Medicaid  component.  She                                                               
explained that  the department  thinks of this  as a  cost shift,                                                               
not an expansion of services.                                                                                                   
                                                                                                                                
3:58:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   FIELDS   gave    his   interpretation   of   the                                                               
presentation that  instead of  a parent taking  their child  to a                                                               
Medicaid covered  appointment after school, they  could take them                                                               
to  the appointment  at  the school,  and this  could  be a  more                                                               
efficient system but is not necessarily "more care."                                                                            
                                                                                                                                
CHAIR PRAX announced that HB 343 was held over.