Legislature(1995 - 1996)
04/26/1996 09:10 AM Senate HES
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* first hearing in first committee of referral
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= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
CSHB 393(FIN) MANAGED CARE PROGRAM FOR MEDICAID
CHAIRMAN GREEN brought CSHB 393(FIN) before the committee.
REPRESENTATIVE ROKEBERG, prime sponsor of HB 393, advised that
after the previous hearing on the legislation, further discussions
with the Department of Health & Social Services resulted in an
agreement by the department to modify their amendment and indicate
their willingness to proceed by developing the program and the
pilot programs almost immediately. One of the issues that remains
to be worked out by the department is the makeup of a pilot program
involving the public, affected consumers, the legislature and the
provider community. He expressed his pleasure that these efforts
have ended up with a modified amended bill, and it is his hope that
it will accelerate the process.
Representative Rokeberg explained that the amended amendment puts
a date on the implementation, as well as adding in the word
"public" into those people that should be involved in the process
of developing a managed care system that will be used in the
projects.
Number 055
SENATOR LEMAN moved the adoption of the following amendment to CSHB
393(FIN):
Amendment No. 1
Delete existing Section 2 and replace with:
*Sec. 2. MANAGED CARE PROGRAM. (a) The Department of
Health and Social Services shall begin development of a managed
care system for recipients of medical assistance under AS 47.07 by
designing and implementing no fewer than two innovative managed
care pilot projects by June 30, 1997. The projects must be in one
or more predominantly urban areas of the state that take into
account the unique features of the project areas and include a
rural element, if feasible. The department shall involve the
public, affected consumers and providers of health care services in
the selected project areas in the development of the managed care
system that will be used in the projects.
(b) Upon developing a system required under (a) of this
section, the Department of Health and Social Services shall submit
through the governor legislation if necessary that would provide
for implementation of the proposed system in two or more pilot
project areas to the legislature on the first day of the First
Regular Session of the Twentieth Alaska State Legislature.
(c) The department under this Act may require that a
recipient of medical assistance under 47.07 must participate in a
managed care system in order to remain eligible for medical
assistance under AS 47.07. This participation requirement may be
based on geographical, financial, social, medical, and other
factors that the Department of Health and Social Services
determines are relevant to the development and efficient management
of the managed care system.
(d) The department under this Act may apply for waivers of
federal law or for other federal approval if federal approval is
required in order to implement the pilot projects for the managed
care system developed under this section.
(e) Nothing in this section precludes the department from
acting to effectively manage costs through case management and
other cost containment measures that are within the department's
statutory authorization in order to assure the operation of the
program within its budget.
Hearing no objection to the motion to adopt the amendment, CHAIRMAN
GREEN stated Amendment No. 1 was adopted.
Number 061
REPRESENTATIVE ROKEBERG said the legislation is important because
it provides statutory authority, clearly for the first time, that
the department should manage care, per se. He added that he
compliments the department because of intent language in the budget
and the implicit need for cost containment while they move forward.
Number 083
BOB LABBE, Director, Division of Medical Assistance, Department of
Health & Social Services, also expressed his pleasure that the
department and the sponsor have been able to work through an
agreement. The department is committed to managing the program
within the constraints that they have and to assure the best
service for the consumers. He said he is looking forward to
challenge, and although there is a bit of anxiety with the date, he
thinks they need to have that to motivate them a bit.
Number 104
SENATOR SALO inquired if the department has selected sites for the
pilot programs. MR. LABBE responded that the department is
currently getting data from the contractor to give them an idea of
utilization patterns, and the contractor will be coming up with
some recommendations. The department will then approach
communities that seem appropriate and see if there is a willingness
for a pilot project. SENATOR SALO noted there is a physician in
her area who has been interested in setting up a managed care
facility, but one of the impediments to doing it has been that he
would like to have a birthing center as part of this clinic, but he
has been told that Medicaid doesn't allow the cost of delivery to
be reimbursed if the birthing center is outside of the hospital.
MR. LABBE said that in true in terms of the facility cost.
Medicaid will pay for the practitioner cost, but not the cost of a
facility.
Number 140
ED HANSEN, representing the Yukon-Kuskokwim Health Care Corporation
and testifying by teleconference from Bethel, said the Yukon-
Kuskokwim Delta Regional Hospital located in Bethel services a
substantially economically depressed population, a large percentage
of which are Medicaid eligible. The hospital is able to address
acute levels of needs and high demand for services in large part
because of Medicaid reimbursement. Any action taken by the
legislature which limits Medicaid reimbursement to their hospital
will directly and adversely impact the actual health status of the
residents of the delta. Any managed care for Alaska Medicaid must
be constructed in a manner that does not limit the capacity of the
Native health care or limit the potential to pass through federal
dollars at 100 percent. He said managed care is something that we
must prepare for as Alaskans, however, care should be taken not to
act in a manner that destabilizes current dynamics which may be to
the advantage of multiple parties.
In his closing remarks, Mr. Hansen said the Yukon-Kuskokwim Health
Care Corporation wants to go on record with their concerns and
their request for thoughtful, strategic implementation. Whatever
the planning process for implementation, it should include focused
consideration of the health and welfare of Alaskan Natives and the
Native health care delivery system.
There being no further testimony on HB 393, CHAIRMAN GREEN asked
for the pleasure of the committee.
Number 226
SENATOR LEMAN moved that SCS CSHB 393(HES) with accompanying fiscal
notes be passed out of committee with individual recommendations.
Hearing no objection, it was so ordered.
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