Legislature(2017 - 2018)SENATE FINANCE 532

04/11/2018 01:30 PM FINANCE

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01:51:52 PM Start
01:52:34 PM HB215
02:33:32 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
<Bill Hearing Canceled>
<Bill Hearing Canceled>
+ Bills Previously Heard/Scheduled: TELECONFERENCED
Heard & Held
<Bill Hearing Rescheduled from 4/13/18 at 9 a.m.>
CS FOR HOUSE BILL NO. 215(FIN)                                                                                                
     "An Act relating to program receipts; and relating to                                                                      
     fees for services provided by the Department of Health                                                                     
     and Social Services."                                                                                                      
1:52:34 PM                                                                                                                    
Co-Chair MacKinnon introduced the bill.                                                                                         
1:53:09 PM                                                                                                                    
AT EASE                                                                                                                         
1:53:32 PM                                                                                                                    
ELIZABETH  DIAMENT,   STAFF,  REPRESENTATIVE   PAUL  SEATON,                                                                    
discussed the bill.  She explained the process  of the bill.                                                                    
She  stated that  during  the  subcommittee process,  Public                                                                    
Health was identified  as a division that  could be charging                                                                    
additional  fees to  help sustain  its  mission. She  shared                                                                    
that  the   constitutional  mission  of  the   division  was                                                                    
protecting  and  promoting  the   health  of  Alaskans.  She                                                                    
announced  that, currently,  the  Department  of Health  and                                                                    
Social  Services  (DHSS)  charged  for  some  public  health                                                                    
services,  however, the  department could  only charge  what                                                                    
was listed  in AS  44.29.022a. She shared  that the  list of                                                                    
duties   that  were   currently  fee-eligible   were  mostly                                                                    
clinical.  The  fees  included  maternal  and  child  health                                                                    
services;  nutrition  services;   and  preventative  medical                                                                    
health services.  The division lacked fee  authority such as                                                                    
administrative  and professional  services.  The bill  would                                                                    
amend AS 44.29.022 to grant  DHSS the authority to establish                                                                    
reasonable fees for the support  of administration of public                                                                    
health programs.  The bill gave statutory  authority to DHSS                                                                    
to charge fees for any  public health related services under                                                                    
AS 18, and tobacco control  programs under AS 44.29.022. The                                                                    
bill  also added  the fees  created to  the list  of program                                                                    
receipts separately accounted under  AS 37.05.146c. The bill                                                                    
allowed DHSS to decide what  fees it would establish through                                                                    
regulation and  a public process.  The fees already  must be                                                                    
in  the   public  interest  and  economically   feasible  to                                                                    
collect;  and could  not undermine  the division's  mission.                                                                    
The fees  were limited to  the actual cost of  services, and                                                                    
any regulation would be required for each new fee.                                                                              
Co-Chair MacKinnon  wondered whether the fees  would be used                                                                    
for public  health, and not  the Medicaid program.  She felt                                                                    
that  public  health  was  sometimes  shadowed  by  Medicaid                                                                    
Ms. Diament replied  that the intent of  the legislation was                                                                    
that  the fees  would pay  for public  health services.  She                                                                    
deferred to Ms. Lewis for more information.                                                                                     
JILL  LEWIS, DEPUTY  DIRECTOR,  DIVISION  OF PUBLIC  HEALTH,                                                                    
agreed with  Ms. Diament.  She stated  that the  listed fees                                                                    
would  be in  the  list of  designated  program receipts  in                                                                    
statute, which would clarify the  intent of the legislature.                                                                    
The fees  would support the specific  program that generated                                                                    
the fees.                                                                                                                       
Co-Chair MacKinnon  asked if there was  anything to consider                                                                    
inside the bill language that  would bolster the intent. She                                                                    
felt that the bill should  support the areas which the funds                                                                    
were generated and overall public health.                                                                                       
Vice-Chair Bishop  asked if the committee  would discuss the                                                                    
fiscal note.                                                                                                                    
Co-Chair  MacKinnon replied  that the  fiscal note  would be                                                                    
covered by DHSS.                                                                                                                
Vice-Chair  Bishop thought  the  fiscal  note answered  many                                                                    
questions regarding the designation of the receipts.                                                                            
2:00:01 PM                                                                                                                    
Ms. Diament  addressed the Sectional  Analysis for  the bill                                                                    
(copy on file):                                                                                                                 
     Section 1                                                                                                                  
     (page 1, line 4)                                                                                                           
     Adds  a   new  paragraph  (90)   to  the  list   in  AS                                                                    
     37.05.146(c)   of  designated   general  fund   program                                                                    
     receipts  and non-general  fund  program receipts  that                                                                    
     are accounted  for separately, and  appropriations from                                                                    
     these   program  receipts   are  not   made  from   the                                                                    
     unrestricted general fund.                                                                                                 
     Paragraph (90) does 2 things:                                                                                              
     1) Consolidates  all current public health  fees listed                                                                    
     in   AS  37.05.146(c)   that  are   collected  by   the                                                                    
     Department  of  Health  and Social  Services  into  one                                                                    
     Note: It was determined that  the statute could be made                                                                    
     clearer  by  consolidating   other  DHSS  programs  and                                                                    
     services along with public health  under (90). From the                                                                    
     current list of 89  program receipts in AS 37.05.146(c)                                                                    
     the following would move under (90):                                                                                       
     Current AS 37.05.146 (c) 42 becomes (90) (A)                                                                               
     59 - (B)                                                                                                                   
     60 - (C)                                                                                                                   
     61 - (90) (D)                                                                                                              
     62,63,65,66  (E)                                                                                                           
     64  (F)                                                                                                                    
     67  (90) (G)                                                                                                               
     71  (H)                                                                                                                    
     88  ( I)                                                                                                                   
     2)  Adds language  in  subsection  90(e), other  public                                                                    
     health programs and services                                                                                               
     Note: The specific public  health programs and services                                                                    
     for which DHSS may establish fees are                                                                                      
     specified under AS 44.29.022(a),  which is explained in                                                                    
     the next section.                                                                                                          
     Section 2                                                                                                                  
     (page 2, line 14)                                                                                                          
     Adds  AS  44.29.020(a)  (14) tobacco  control  programs                                                                    
     administered by the Department and public health                                                                           
     programs the  department administers under AS18  to the                                                                    
     list of services in AS 44.29.022(a) for which the                                                                          
     Commissioner  of  the  Department of  Health  &  Social                                                                    
     Services can establish reasonable fees.                                                                                    
     Note:  While there  are other  departments also  listed                                                                    
    within AS 18, language under AS 44.29.022(a) states                                                                         
     that the  commissioner of DHSS may  only establish fees                                                                    
     for  services  listed  under   this  statute  that  are                                                                    
     provided by DHSS.                                                                                                          
     Section 3                                                                                                                  
     (page 2, line 26)                                                                                                          
     Adds a  new sub section  to AS 44.29.022  requiring the                                                                    
     commissioner of  health and social services  to consult                                                                    
     with  stakeholders,  including   at  least  one  public                                                                    
     meeting,  before a  notice of  proposed action  is made                                                                    
     regarding  the   development  of  new  fees   under  AS                                                                    
     44.29.020(a) (14) or AS 18.                                                                                                
     Section 4                                                                                                                  
     (page 3, line 5)                                                                                                           
     Repeals  statutes  that  have been  consolidated  under                                                                    
     subsection (90) in section 1 of this bill.                                                                                 
Co-Chair MacKinnon asked if there was a reason there was no                                                                     
effective date for the bill.                                                                                                    
Ms. Diament replied  that there was no fiscal  impact for FY                                                                    
19, because  it would  take time for  the regulations  to go                                                                    
into effect.                                                                                                                    
Senator von  Imhof noted that  there was a  presentation, so                                                                    
she would aske a question during the presentation.                                                                              
Ms. Lewis  discussed the presentation  "HB 215  DHSS: Public                                                                    
Health Fees," (copy on file).                                                                                                   
Ms. Lewis showed slide 2, "HB215 DHSS: Public Health Fees":                                                                     
     ? Public Health is able to charge fees for certain                                                                         
     clinical services:                                                                                                         
     ? Maternal and child health services                                                                                       
     ? Nutrition services                                                                                                       
     ? Preventive medical services                                                                                              
     ? Health education                                                                                                         
     ? Public health nursing services                                                                                           
     ? Laboratories                                                                                                             
Ms.  Lewis turned  to slide  3, "HB215  DHSS: Public  Health                                                                    
Fees,"  which  showed  a pie  chart  entitled  'Division  of                                                                    
Public Health  Funding Sources - FY2019  Governor's Budget."                                                                    
She  remarked that  the FY  16  and FY  17 budgets  included                                                                    
intent language that the Division  of Public Health evaluate                                                                    
and implement strategies to  maximize billable services. She                                                                    
recalled that the Legislative  Audit's performance review of                                                                    
the department included  similar recommendations. She stated                                                                    
that  the  graph showed  that  the  budget already  included                                                                    
nearly $7  million in general  fund program  receipts, which                                                                    
made up approximately  6 percent of the  total receipts. The                                                                    
receipts  came from  individuals who  paid for  the clinical                                                                    
services listed on slide 2.                                                                                                     
Ms. Lewis showed slide 4, "HB215 DHSS: Public Health Fees":                                                                     
     ? Public health lacks fee authority for other services                                                                     
     and functions:                                                                                                             
          o Professional services                                                                                               
              o Data extraction and analysis                                                                                    
               o Training and expert consultation                                                                               
          o Administrative functions                                                                                            
          o Inspections and                                                                                                     
          o Program administration                                                                                              
2:06:54 PM                                                                                                                    
Ms.  Lewis displayed  slide 5,  "HB215  DHSS: Public  Health                                                                    
     ? Fees waived if                                                                                                           
          ? not in the public interest                                                                                          
          ? not economically feasible to collect                                                                                
          ? the public health is best served by the waiver                                                                      
          of the fee                                                                                                            
     ? Services not denied because of inability to pay                                                                          
     ? Sliding fee schedules                                                                                                    
     ? Fees limited to the actual cost                                                                                          
     ? Regulations required for each new fee                                                                                    
Ms. Lewis spoke to slide 6, "HB215 DHSS: Public Health Fees                                                                     
     ? Fees for public health services will                                                                                     
          o Keep us safe                                                                                                        
          o Help communities be healthy                                                                                         
          o Provide access to primary care                                                                                      
          o Inform decision makers where resources are most                                                                     
Co-Chair   MacKinnon  stated   that  the   presentation  was                                                                    
available online.                                                                                                               
Senator  Micciche asked  about  the success  of sliding  fee                                                                    
schedules,  and   wondered  if   there  was   a  significant                                                                    
administrative burden.                                                                                                          
Ms. Lewis  replied that  the slide  fee schedule  was mostly                                                                    
used  the public  health nursing  centers.  She stated  that                                                                    
each  client filled  out information  about their  income to                                                                    
determine  where they  fit  in the  sliding  fee scale.  She                                                                    
remarked that  the burden  was minimized,  because it  was a                                                                    
standardized process.  She emphasized that it  was, however,                                                                    
a manual process.                                                                                                               
Senator Micciche  asked if there was  documentation required                                                                    
or if the process relied on the honor system.                                                                                   
Ms. Lewis stated that it was mostly the honor system.                                                                           
2:12:10 PM                                                                                                                    
Senator von  Imhof asked if  the data being referred  to was                                                                    
already collected or if it was a new data set.                                                                                  
Ms. Lewis stated  that the data sets were  made available as                                                                    
was  reasonable  under  state  privacy  and  confidentiality                                                                    
Senator  von Imhof  wondered about  a  potential charge  for                                                                    
providing raw data.                                                                                                             
Ms. Lewis  stated that the  fee structure for every  type of                                                                    
service provided  varied. In general,  most likely  raw data                                                                    
would be based on the record count or the size of the file.                                                                     
Co-Chair MacKinnon OPENED public testimony.                                                                                     
Co-Chair MacKinnon CLOSED public testimony.                                                                                     
Ms. Lewis discussed the fiscal note.                                                                                            
Co-Chair MacKinnon  asked whether the regulation  cost would                                                                    
be absorbed.                                                                                                                    
Ms. Lewis replied in the affirmative.                                                                                           
2:18:53 PM                                                                                                                    
Ms. Lewis addressed page 2 of  FN 2. She noted that the fees                                                                    
would  be   used  to  support  public   operations.  In  the                                                                    
narrative  portion  there  were   four  examples  given  for                                                                    
different types of fees:                                                                                                        
     *  Registration,   certification,  and   inspection  of                                                                    
     radiological  device  fees  are  needed  to  support  a                                                                    
     second  radiological  health   physicist  for  magnetic                                                                    
     resonance  imaging  (MRI),  computed  tomography  (CT),                                                                    
     mammography, and ultraviolet devices.                                                                                      
     Currently only  fees for  X-ray devices  are authorized                                                                    
     and only  X-ray devices  are registered,  certified and                                                                    
     inspected.  No new  position are  needed; the  division                                                                    
     will utilize an existing vacant position. ($100.0 DGF)                                                                     
     *   An   administration    fee   for   the   healthcare                                                                    
     practitioner   loan   repayment   program,   Supporting                                                                    
     Healthcare Access through                                                                                                  
     Loan Repayment  Program (SHARP),  would cover  the cost                                                                    
     of operating the program,  which is currently supported                                                                    
     with   unrestricted   general   funds.   Similar   loan                                                                    
     repayment  programs   charge  an   administrative  fee.                                                                    
     ($200.0 DGF/-200.0 UGF)                                                                                                    
     * Allowing a reasonable  fee for custom statistical and                                                                    
     epidemiological  analyses on  public  health data  sets                                                                    
     would greatly  enhance the usefulness of  the datasets.                                                                    
     The division  is frequently asked for  ad hoc analyses;                                                                    
     however, our  resources are consumed in  collecting the                                                                    
     data,  leaving  little  capacity  for  analysis.  Other                                                                    
     states charge  annual or  per-hour fees  for analytical                                                                    
     work. ($175.0 DGF)                                                                                                         
     * The division has turned  away requests to assist with                                                                    
     community health assessments  and community action plan                                                                    
     development. The  division lost  the capacity  for this                                                                    
     service  when  the  position funded  with  unrestricted                                                                    
     general  funds was  eliminated in  recent budget  cuts.                                                                    
     The  ability to  charge fees  would enable  us to  once                                                                    
     again support local  efforts for healthier communities.                                                                    
     No new positions are needed;  the division will utilize                                                                    
     existing positions. ($125.0 DGF)                                                                                           
Vice-Chair   Bishop  asked   for  clarification   about  the                                                                    
inspection of radiological devices.                                                                                             
Ms.  Lewis  replied  that  the   division  visited  all  the                                                                    
different  facilities to  inspect the  radiological devices.                                                                    
She  remarked  that  the  current focus  was  on  the  x-ray                                                                    
Vice-Chair  Bishop   wondered  if   there  was   a  timeline                                                                    
associated  with  the inspection,  or  if  a major  hospital                                                                    
would  bring   on  a  contractor.  He   wondered  about  the                                                                    
liability associated with inspection.                                                                                           
Ms.  Lewis thought  the matter  was a  gap in  public health                                                                    
coverage.  She  remarked  that   there  were  stories  about                                                                    
diagnostic machines  that were not properly  calibrated. She                                                                    
stressed that  facilities were making their  best efforts to                                                                    
ensure that the machines  and procedures were good practice.                                                                    
She  stated that  there  was  no one  to  ensure that  those                                                                    
efforts were happening for the public safety.                                                                                   
Vice-Chair  Bishop  felt  that examining  the  machines  was                                                                    
important to save money downstream.                                                                                             
Senator   Micciche   asked   whether  the   department   was                                                                    
certifying x-ray machines.                                                                                                      
Ms. Lewis replied in the affirmative.                                                                                           
Senator Micciche wondered  whether there was a  fee for each                                                                    
Ms. Lewis  thought the fee would  be similar to that  of the                                                                    
x-ray fee, which was a per  unit fee. She noted that the fee                                                                    
was $80 per x-ray tube.                                                                                                         
2:25:01 PM                                                                                                                    
Co-Chair MacKinnon  observed that  the fiscal  note provided                                                                    
funding for an existing vacant position.                                                                                        
Ms. Lewis stated that the  department was asking the funding                                                                    
to  be applied  to the  personal services  line. She  stated                                                                    
that the existing vacant position would be repurposed.                                                                          
Co-Chair  MacKinnon   felt  that   there  was  a   focus  on                                                                    
eliminating all positions.  She noted that there  was a cost                                                                    
to putting positions in the  system. She remarked that there                                                                    
were  positions  that  were   unfilled  in  the  books.  She                                                                    
wondered whether the fee would be  used to cover the cost of                                                                    
the position.                                                                                                                   
Ms.  Lewis stated  that the  Division of  Public Health  had                                                                    
approximately  430 employees,  and there  was turnover  that                                                                    
generated  30   to  40   current  vacant   positions.  Those                                                                    
vacancies  were  evaluated  and  prioritized  based  on  the                                                                    
highest need at the time.                                                                                                       
Vice-Chair Bishop  remarked that there was  not a criticism,                                                                    
but there was an examination of the turnover of employees.                                                                      
Co-Chair  MacKinnon  shared  her gratitude  for  those  that                                                                    
worked in public health.                                                                                                        
Co-Chair  MacKinnon  referenced  x-rays and  technology  and                                                                    
asked  how it  related to  scans in  airports. She  wondered                                                                    
whether  there was  a verification  of the  output on  those                                                                    
Ms.  Lewis  stated  that  DHSS had  no  authority  over  the                                                                    
devices used in airports by the federal government.                                                                             
Co-Chair MacKinnon asked if there  was a way for Division of                                                                    
Public Health to make an  inquiry related to the possibility                                                                    
of unhealthy output of the machines.                                                                                            
Ms. Lewis stated she would look into the matter.                                                                                
Co-Chair  MacKinnon  stated  she  was willing  to  cosign  a                                                                    
letter related to that concern.                                                                                                 
Co-Chair  MacKinnon  asked  for   an  update  on  the  SHARP                                                                    
supportive care access repayment program.                                                                                       
CSHB  215  was  HEARD  and HELD  in  committee  for  further                                                                    
Co-Chair MacKinnon  discussed the  agenda for  the following                                                                    
2:32:00 PM                                                                                                                    
AT EASE                                                                                                                         
2:32:11 PM                                                                                                                    
Co-Chair MacKinnon clarified items  about the agenda for the                                                                    
following day.                                                                                                                  

Document Name Date/Time Subjects
HB 215 Additional Documents-Public Health Briefing Paper 2.20.2018.pdf SFIN 4/11/2018 1:30:00 PM
HB 215
HB 215 Explanation of changes Ver D to Ver O.pdf SFIN 4/11/2018 1:30:00 PM
HB 215
HB 215 DHSS Slide Presentation 2-20-2018.pdf SFIN 4/11/2018 1:30:00 PM
HB 215
HB 215 Letters of Support 3.27.18.pdf SFIN 4/11/2018 1:30:00 PM
HB 215
HB215 Sectional Analysis ver O 2.20.18.pdf SFIN 4/11/2018 1:30:00 PM
HB 215
HB215 Sponsor Statement ver O 3.27.18.pdf SFIN 4/11/2018 1:30:00 PM
HB 215