Legislature(2003 - 2004)

03/03/2003 09:03 AM FIN

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
     SENATE BILL NO. 78                                                                                                         
     "An Act relating  to an optional group of persons  eligible for                                                            
     medical  assistance   who  require  treatment  for  breast  and                                                            
     cervical  cancer; relating to cost sharing by  those recipients                                                            
     under  the medical  assistance  program; and  providing for  an                                                            
     effective date."                                                                                                           
This  was the first  hearing  for this  bill in  the Senate  Finance                                                            
Co-Chair Wilken stated  that this bill continues the optional breast                                                            
and  cervical cancer  Medicaid  coverage due  to  terminate in  June                                                            
2003. He  stated that this  bill would authorize  the Department  of                                                            
Health  and  Social  Services  to  impose  recipient   cost  sharing                                                            
procedures as allowed by federal regulations.                                                                                   
Co-Chair Green, the bill's  sponsor, stated that the purpose of this                                                            
bill  is to  extend  the  termination  date for  this  program.  She                                                            
reminded  the  Committee  that  those  individuals  who  have  begun                                                            
treatment would continue  to receive Medicaid coverage as previously                                                            
mandated by separate Legislation.  Additionally, she noted, the bill                                                            
would allow the  Department of Health and Social Services  to impose                                                            
allowable  cost sharing between  the State  and program recipients.                                                             
She furthered  that the bill's language is consistent  with language                                                            
of the Denali  KidCare program. She noted that the  bill would allow                                                            
the  State the  flexibility  required  to  align with  any  upcoming                                                            
federal  "re-workings"  of  the program.  She  noted that  were  the                                                            
existing legislation  to include this  flexibility, the State  would                                                            
have been eligible for additional federal funding.                                                                              
ELMER  LINDSTROM, Special  Assistant,  Office of  the Commissioner,                                                             
Department  of Health and  Social Services  voiced the Department's                                                             
support of  this legislation.  He specified  that the Office  of the                                                            
Governor  would   welcome  legislation  that  would   make  Medicaid                                                            
coverage of  breast and cervical cancer  treatment "permanent,"  and                                                            
he  noted that  the bill's  fiscal  note would  be  included in  the                                                            
Governor's amended FY 04  budget. He affirmed that the bill's fiscal                                                            
note is consistent  with the Department's  projections as  there has                                                            
been no unexpected growth in the program.                                                                                       
Senator Olson,  a medical doctor,  thanked the sponsor on  behalf of                                                            
the  individuals  provided  coverage  by this  bill.  He  questioned                                                            
whether the  State is charging  patients  the maximum co-pay  amount                                                            
allowable under federal law.                                                                                                    
Mr.  Lindstrom specified  that,  "the language  in  the proposal  is                                                            
consistent with current  practice relative to co-pays." He continued                                                            
that  the  issue  of  the  co-payment  amount  "is  something  worth                                                            
reiterating"  as  this program  provides  coverage  to people  whose                                                            
income is  "significantly"  above the typical  qualifying level.  He                                                            
stated  that  the  Murkowski  Administration  is  committed  to  the                                                            
broader   qualification  coverage.   Furthermore,   he  noted,   the                                                            
Administration supports  a co-payment "cost sharing" contribution by                                                            
the beneficiaries  of the program.  He noted that further  expansion                                                            
of qualifications into  the program would require changes in federal                                                            
Senator Olson  asked whether the State is charging  participants the                                                            
maximum co-payment amount.                                                                                                      
Mr. Lindstrom  responded that the Department would  collect the same                                                            
level of  co-payments under  the proposed  legislation as  collected                                                            
under the current legislation.                                                                                                  
Senator  Olson asked  whether  the State  collects  the maximum  co-                                                            
payment amount allowed under federal law.                                                                                       
Mr. Lindstrom replied that is correct.                                                                                          
Senator  Olson asked  whether  the proposed  bill  would change  the                                                            
amount of money  that the State would either pay or  collect through                                                            
the program.                                                                                                                    
Co-Chair Green clarified  that, rather than the State collecting the                                                            
co-payments,  the co-payments  would be paid  to service  providers.                                                            
She shared  some the  co-payment  amounts. She  reiterated that  the                                                            
State's broadened  "asset eligibility"  requirements allow  Medicaid                                                            
coverage for individuals  earning significantly higher  incomes than                                                            
normally allowed.                                                                                                               
Senator Olson  surmised that  this legislation  would not result  in                                                            
cost savings to the State.                                                                                                      
Mr. Lindstrom agreed.                                                                                                           
SFC 03 # 13, Side A 10:41 AM                                                                                                    
AT EASE 10:41 AM / 10:41 AM                                                                                                     
Senator  Hoffman  asked the  reason  the legislation  includes  cost                                                            
sharing language  if there  is no related  reduction in the  cost to                                                            
the State.                                                                                                                      
Mr. Lindstrom  responded that language  is included in the  proposed                                                            
legislation  to allow the  State to pursue  higher cost-sharing  co-                                                            
payment  levels  with   program-eligible  women  in  "significantly                                                             
higher"  income brackets,  provided that future  changes in  federal                                                            
regulations allow for that option.                                                                                              
Senator Hoffman asked whether  the State has attempted to expand the                                                            
existing cost-sharing language  in the Denali KidCare program, which                                                            
also provides benefits  to those with incomes higher than the normal                                                            
qualifying amounts.                                                                                                             
Mr. Lindstrom  responded that, as  a result of a State inquiry,  the                                                            
federal government  ruled against including additional  cost sharing                                                            
language  in the  Denali KidCare  program  "barring  some change  in                                                            
federal law."                                                                                                                   
Senator  Hoffman   asked  whether   the  Department  anticipates   a                                                            
different federal  ruling pertaining to the additional  cost sharing                                                            
language included  in this breast  and cervical cancer legislation.                                                             
Mr.  Lindstrom responded  that  the  Department does  not  currently                                                            
anticipate a different  ruling; however, he reiterated, the language                                                            
is included  in this legislation in  anticipation of future  federal                                                            
changes regarding cost-sharing allowances.                                                                                      
Co-Chair Wilken  asked the testifier  to clarify information  in the                                                            
fiscal note regarding  whether Alaska Native women,  who receive 100                                                            
percent  medical  coverage  through   Indian  Health  Services,  are                                                            
eligible for this program.                                                                                                      
Mr. Lindstrom  responded that the federal government  has determined                                                            
that Native  women  could participate  in this  program. He  stated,                                                            
however,  that  the reason  for  there being  "fewer  billings  than                                                            
anticipated" for Native women is unclear.                                                                                       
Co-Chair Green  informed the Committee that a financial  arrangement                                                            
has  been established   whereby the  Indian  Health  Services  would                                                            
reimburse  the State for  the breast and  cervical cancer  treatment                                                            
provided to Native women.  She continued that Native women could not                                                            
be denied this program.                                                                                                         
Mr. Lindstom concurred with Co-chair Green's comments.                                                                          
Senator  Hoffman   specified  that,  while  many  health   providers                                                            
contract  with  the federal  government  to  provide  services,  the                                                            
provider and the client  have the option to determine whether or not                                                            
to bill Indian Health Services,  an insurance company, or the State.                                                            
Co-Chair Wilken  asked for further clarification regarding  language                                                            
in the fiscal note regarding  the expected growth rate; specifically                                                            
whether the growth rate would be five or ten percent.                                                                           
Mr. Lindstrom  clarified that, while  there has been a five  percent                                                            
increase  in the number of  program participants,  there has  been a                                                            
ten percent increase  in program expenses due to the  rising cost of                                                            
health care.                                                                                                                    
Co-Chair Wilken  summarized that program  expenditures are  expected                                                            
to increase at  twice the rate of the number of program  recipients.                                                            
Mr. Lindstrom agreed.                                                                                                           
Senator Taylor moved to  report SB 78 from Committee with individual                                                            
recommendations and the accompanying fiscal note.                                                                               
There being  no objections,  SB 78  reported from  Committee  with a                                                            
$970.0 fiscal  note, dated February 24, 2003 from  the Department of                                                            
Health and Social Services.                                                                                                     

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