Legislature(2017 - 2018)BUTROVICH 205
03/26/2018 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB193 | |
| HB215 | |
| HB176 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 176 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 193 | TELECONFERENCED | |
| += | HB 215 | TELECONFERENCED | |
HB 176-EMER. MEDICAL TRANSPORT SERVICE PAYMENTS
1:42:17 PM
CHAIR WILSON announced the consideration of HB 176. [CSHB
176(FIN) was before the committee.]
REPRESENTATIVE ADAM WOOL, Alaska State Legislature, sponsor of
HB 176, said HB 176 is an emergency medical transport bill which
allows the state to collect additional money from federal
Medicaid to more fully reimburse the state for emergency medical
transport, both ambulance and air. Currently fire departments
and emergency medical services are compensated for only a
fraction of the cost associated with transporting Medicaid
beneficiaries. This bill will allow the Department of Health and
Social Services (DHSS) to ask that the federal government amend
Alaska's Medicaid plan to include supplemental reimbursements
for emergency medical transport. The federal government approved
the amended plan; fire departments will be able to get 50
percent of their current uncompensated costs. If it is a tribal
transport, the reimbursement is 100 percent.
1:46:40 PM
REPRESENTATIVE WOOL said the program should take 12 to 18 months
to implement. The bill is cost neutral to the state. California,
Washington, Missouri, Nevada, Texas, and Florida have done this,
and programs are pending in other states. Last year there were
21,000 claims for ground transport in Alaska. On average, $800
was not reimbursed for each of these transports. That total is
$17 million. The state would have netted $8.5 million if this
program had been in place last year. For air transport, there
were 281 claims. Those average $17,000 in unreimbursed Medicaid
costs. That was $5 million in unreimbursed costs. Of that, the
state would get half. Last year the state would have received
$11 million additional dollars from the Medicaid program if this
had been in place. There is a slight administration cost that is
passed on to the transport provider and the federal government,
so the state incurs no cost at all for this program.
1:48:12 PM
ROB EARL, Staff, Representative Adam Wool, Alaska State
Legislature, reviewed the HB 176 flow chart in members' packets.
The flow chart has four circles. The two blue circles represent
DHSS. The left circle, DHSS-Regular State Medicaid, represents
Medicaid as it is reimbursed now. The right blue circle, DHSS-
Supplemental Reimbursement, represents what this bill would
accomplish. The red circle is the medical transport provider,
usually a fire department or a municipality. The green circle is
the Centers for Medicare and Medicaid Services (CMS).
He said the flow chart has six arrows with hypothetical numbers
to show the flow of money noted in the explanation below:
Explanation--Based on Hypothetical $1000 Transport
Cost
The Provider is reimbursed $400 under regular state
Medicaid for a $1000 transport. This leaves a $600
uncompensated cost. Under HB 176, the Provider then
sends $300 to DHSS (Supplemental) and CMS matches with
the $300 federal share. DHSS then sends $600 back to
the Provider. The Provider recoups $700 of the $1000
Transport Cost ($400 Regular State Medicaid + $300
Federal Share). Administrative fees (expected to be
nominal) will be deducted from the reimbursement to
the Provider.
SENATOR VON IMHOF said some of this depends on timing. If $1,000
is spent on the transport, there is a delay getting $400 from
Medicaid. At the same time $300 is going to the state in order
to get the match. The provider could be out $1,300 until the
money comes back. She asked if the bill addresses timing or if
it is up to the cash flow of the provider.
1:51:37 PM
REPRESENTATIVE WOOL said the provider would have some money in
their cash account. As they submit to Medicaid for the $400
reimbursement, they could simultaneously send $300 to DHSS to
start the federal process going. He does not know if they would
wait for Medicaid reimbursement before submitting the $300. He
said Rich Etheridge, the Juneau Fire Chief, might be able to
answer that.
SENATOR VON IMHOF asked what the net savings is to the state vs
the cost to the state. She said she wanted to make sure she was
reading the two fiscal notes correctly. The first one from DHSS
Appropriation: Health Care Services, Allocation: Medical
Assistance Administration, is a person to help administer this
at about $116,000. The next page is DHSS Appropriation: Medicaid
Services, Allocation: Health Care Medicaid Services. She asked
how to read that fiscal note.
1:53:51 PM
MR. EARL said that for the first fiscal note, OMB Component
Number 2077, the $11.1 million under the fund sources is the
federal receipts. That is the amount of money going from the
green circle, the Centers for Medicare and Medicaid Services
(CMS), back to the department. This is the Medicaid supplemental
reimbursement amount the state providers will be receiving. The
$10.7 million is the amount the provider is sending to the
department and then receiving back. That money is pass-through
money. The other fiscal note, OMB Component Number 242, is the
cost for the state to run the program, but the cost is entirely
borne by the provider at 50 percent and the federal government
at 50 percent. That is seen on page 3 of the first fiscal note,
number 2077.
SENATOR VON IMHOF summarized that in FY 2020 the state will
receive $11.167 million from the federal government under this
program. The state will take receipt of $10.73 million from
providers throughout the year and then the state will turn
around and pay providers $21.898 million.
REPRESENTATIVE WOOL said that is correct. The providers pay
$10.7 million and receive $21.8 million. They are paying 10 to
get 20, in a sense. They have to put up half and they get back
the full payment.
CHAIR WILSON said the local municipalities are putting up the
state's 50 percent to get the federal match.
1:57:09 PM
REPRESENTATIVE WOOL said this concept is a little confusing in
that the state portion is paid by the provider, the state holds
on to the half, they bill out the federal government, they get
the other half back, and they give both halves back. He said
it's awkward, but it's how the system works.
SENATOR BEGICH asked if the provider in all cases is the
municipal government or if it will be public and private
providers.
MR. EARL said it is available only to government public
providers.
SENATOR BEGICH said instead of the state paying the $10 million,
the local governments are paying the $10 million and that is how
the Medicaid match is triggered.
REPRESENTATIVE WOOL said that in the past the state never paid
the money and therefore the state was never received the money.
The loss was incurred by the provider, either the fire
department or municipal government. This is trying to recoup
some of these costs. Other states are doing this and Alaska
wants to take advantage of it. The state wasn't losing the
money. The municipal governments were not getting compensated.
SENATOR BEGICH said there are proposals to cut back some of the
federal Medicaid funding. Every time a Medicaid bill has come to
the committee he has asked what the impact would be to the law
if the federal Medicaid was cut back.
REPRESENTATIVE WOOL said if the funding goes away, the program
goes away. There is no liability to the state. It doesn't cost
anything to implement the plan and it doesn't cost any money if
it goes away.
2:00:03 PM
SENATOR GIESSEL said Moose Pass and Cooper Landing both have
volunteer fire departments and emergency responders. She asked
how they would fit into this.
REPRESENTATIVE WOOL said the community of Fairbanks has many of
those as well. The municipality handles the money disbursement.
In the end, the money DHSS gets goes to the municipality.
SENATOR GIESSEL said Senator Micciche pointed out that the Kenai
Peninsula Borough would be the billing mechanism.
SENATOR MICCICHE asked, using the example of the $1,000, instead
of the fire department receiving $400, by going through the
state, they get the federal match billed through the state for
300 additional dollars.
MR. EARL responded yes.
SENATOR MICCICHE added that that is at no additional cost to the
state.
MR. EARL responded yes.
SENATOR VON IMHOF asked if a private carrier like Alaska
Airlines could be compensated under the program.
2:02:13 PM
MR. EARL said contractors can be compensated under the program
if they have no direct relationship with Medicaid.
SENATOR MICCICHE asked if there is any interest in
municipalities sharing the cost of the position that would be
the only cost to the state, the $116,000 the first year and
$109,000 afterwards.
MR. EARL said the bill is zero cost to the state. The providers
will pay half and the federal government will pay the other
half.
SENATOR MICCICHE said so the interagency receipts of $116,000
for the position is paid the same way as the other funding is
paid with the match.
MR. EARL deferred the question to DHSS.
CHAIR WILSON said if the state is taking off a percentage of the
fees coming back that can be more cost neutral for the state.
This is a huge concern for people in the Mat-Su who have asked
about this for a couple of years. He said he likes the concept,
but wants to make sure it is more of a cost neutral to the
state.
SENATOR MICCICHE said if OMB Component Number 242 is correct,
the reason it is interagency is that the fees would be collected
from providers who participate in the program via reimbursable
services agreement.
He asked Ms. Brodie, using the $1,000 example, whether the bill
allows the state to bill Medicaid the $300 that municipalities
cannot bill Medicaid for and then provide that $300 to the
municipalities.
2:05:37 PM
MARGARET BRODIE, Director, Division of Health Care Services,
Department of Health and Social Services (DHSS), said that is
correct. Municipalities would be providing the match for the
state to draw down the federal $300.
SENATOR MICCICHE clarified that in fiscal note OMB Component
Number 242, the cost of the position will be funded from fees
collected from providers, which he assumes is also the
municipalities, through a reimbursable services agreement.
MS. BRODIE said correct, that funding would be provided at the
same time as the other match.
2:06:21 PM
SENATOR VON IMHOF asked if a private carrier can qualify for
reimbursement.
MS. BRODIE said not unless they are associated with a government
entity.
SENATOR VON IMHOF asked if there are private carriers that
provide transport in Alaska.
MS. BRODIE said yes.
SENATOR BEGICH asked if the relationship she is describing is
when a private carrier has a contract with government.
MS. BRODIE said yes, the government entity would have to bill
Medicaid.
SENATOR BEGICH asked for clarification that if the private
carrier had a contract with a local government, the local
government could compensate the private entity.
MS. BRODIE said that would be up to the contract they have with
a municipality.
2:08:24 PM
SENATOR MICCICHE asked if she could give the committee a
hypothetical of the government owned Central Peninsula Hospital
that has a case that has to be airlifted to Anchorage. That
private company could bill through the Kenai Peninsula Borough
to the state and the state would apply for the additional match
at no cost to the state. It's that there is an additional match
available for the local governmental body that has contracted
with that carrier.
MS. BRODIE said if they had a contract with Central Peninsula
Hospital, that is correct.
2:09:24 PM
JEFF TUCKER, President, Alaska Fire Chief's Association, Fire
Chief, supported HB 176. He said this program falls under Title
19 of the Social Security Act. Several states have enacted this
program. It has been available for years, but Alaska has not
taken advantage of it. This bill is the first step for Alaska
emergency medical services (EMS) providers to be eligible for
this federal reimbursement. Providers only get a fraction of the
cost right now for ambulance services for Medicaid transport.
Thirty-one percent of the patients transported by the City of
Kenai are Medicaid patients. The percentages are similar across
the state. There is no cost to the state for this program. The
reimbursement dollars will pay for the program. The program is
optional for each community.
He said the federal dollars are for expenses already incurred.
The local taxpayers are supplementing federal government for the
cost of that transport. They are already paying taxes for that
federal government program. There is no impact to the existing
Medicaid program. These funds come back to the EMS department to
continue to provide care for the patients they transport. HB 176
has a real impact to communities that provide ambulance
services.
He said the City of Kenai is looking at $200,000 in potential
reimbursements for this program, which is not a small sum. One
of the questions was about timing of collections and
submissions. As the program is set up, the municipality can plan
submissions, either yearly or quarterly, for example. It is an
easy way for the communities to budget and plan for the program.
2:13:27 PM
SENATOR VON IMHOF said one of her concerns is that
municipalities may expand their EMS departments with this extra
money. If this program goes away, they will have to go through
the painful process of decreasing the department. Another
thought is whether this additional money will offset local taxes
and provide fiscal relief to local taxpayers.
MR. TUCKER said that would be up to the municipality or agency
collecting funds. The funds collected through this program are
to fund EMS programs. As to the question of whether they will
expand, hopefully municipalities will take into consideration
that the program may not last forever. This is an entitlement
program separate from other programs. There is no sign that it
will go away.
SENATOR MICCICHE asked if his billing agency is the City of
Kenai.
MR. TUCKER said yes.
SENATOR MICCICHE asked whether private insured, non-Medicaid
eligible and non-Medicaid charity care would not become a
liability to the state. That would stay the same as it is. The
state would secure the additional match for Medicaid-eligible
billing for his EMS department.
MR. TUCKER said that is correct.
2:15:53 PM
SENATOR GIESSEL asked, assuming your EMS fire department got
$200,000 back, if that money would be used to upgrade equipment.
MR. TUCKER responded that it would be up to the municipality.
Those grant-funded programs, the Code Blue Project that she is
referring to, are vital to the state, especially smaller EMS
programs. This program will assist in providing services, but it
will not offset the total needs for the community. It helps get
back to square one for their reimbursed costs for providing
those services.
SENATOR MICCICHE asked why it has taken so long to discover this
program.
2:17:45 PM
MR. TUCKER said his understanding is that the program has been
on the books for 30 years. Fire chiefs in California discovered
that the language was in the federal regulation. California was
the first state to enact this legislation and it spread through
the western states. For Alaska to get this reimbursement takes
legislation and then going through the process with the federal
program. He wishes they had known about the program 20 years
ago, but they didn't. Hopefully they can take advantage of a
program they have been paying for as federal taxpayers.
RICH ETHERIDGE, Representative, Alaska Fire Chief's Association,
Fire Chief, supported HB 176. He said the Fire Chief's
Association represents over 100 fire departments from one end of
the state to the other. This is their highest priority. HB 176
provides desperately needed relief to departments. The call for
medical services is climbing drastically. Juneau has had a 26
percent increase in call volume in three years. They don't
receive any additional funds based on that. Twenty-five percent
of their medical transports are Medicaid patients. As in the
example given, for $1,000 in costs they get $400 back. The rest
of the money is borne by taxpayers locally. They will get back
half of the money that taxpayers are already paying. The cost
recovery is not for the entire cost, but it helps quite a bit.
2:20:42 PM
He said Juneau is short staffed for ambulances. This could put
another ambulance on the road to help reduce the wait for
medical care. Regarding the question about private entities
being able to benefit from this program, the local helicopter
companies bill the city, not the patients. Because they bill the
city, that is part of the cost of the city providing services.
It is an amazing program. The fire chief in Sacramento,
California, discovered this in 2011, perhaps. They found this
and have been promoting this to other departments. It has gone
through many other states now. There is no cost to the general
fund. It puts money back into municipal coffers. It can relieve
the tax burden or it can be a supplement to what is already
budgeted. The funds coming back do have to go to the care of
Medicaid patients.
MR. ETHERIDGE said this may help slow requests for equipment. It
doesn't replace the Code Blue Project that many departments
depend on for ambulances and basic medical supplies. The City of
Juneau anticipates that this program could bring in $600,000.
The fire chief in Anchorage estimates that this will cover $4
million of their costs. It is cheaper to do an ambulance run in
Anchorage than in Moose Pass. The previous fire chief of Hoonah
told him his training budget was $1,200 for a year. The influx
of even a few thousand dollars would greatly benefit small
departments.
2:24:10 PM
CHAIR WILSON asked what paperwork is needed to comply because
Medicaid billing is not easy.
MR. ETHERIDGE said they have to get a cost program approved by
the federal government. The Fire Chief's Association's
contractor is willing to help write that. The local departments
have to fill out and submit an annual cost report and submit the
data to DHSS.
SENATOR GIESSEL asked if it takes 12 to 18 months to get the
program approved.
MR. ETHERIDGE said 12 to 18 months can be accurate. The company
his department is working with has done this several times. It
would be on the shorter end of the timeframe.
SENATOR VON IMHOF said the California fire chief created a
consulting firm to let everyone know about the fabulous program.
If everyone takes advantage of this program that has been a
sleeping giant for 30 years, it could put the brakes on this
program.
MR. ETHERIDGE said that is a risk but any money into communities
would help out. Even if it went away after the first payment,
they are not out anything.
2:26:48 PM
SENATOR VON IMHOF said a concern of the Health Care Blueprint
Committee that she is part of is bending the cost of growth of
health care. Simply bringing in new money doesn't necessarily
bend the growth of health care. It generally expands it because
there are new areas to spend it on. She asked if the fire chiefs
have talked about that.
MR. ETHERIDGE responded that it takes good fiscal management
from the department, knowing that the funds could go away at any
time. They need a tax base to support programs that they have
built. Juneau has a desperate need for an additional ambulance.
If they could get the funds for one, it would be easier for
long-term planning. It takes careful fiscal management.
SENATOR GIESSEL said this bill is talking about Medicaid
beneficiaries. To expand the conversation to private businesses,
there is a large business group in Anchorage upset about the
high cost of insurance, health care, and medivacs in particular.
She related that it cost $17,000 to medivac someone from Kenai
to Anchorage. Somebody has to cover the Medicaid costs that are
not fully reimbursed. She asked if those costs are shifted to
private insurance.
2:29:22 PM
MR. ETHERIDGE said they have to set standard ambulance fees,
whether it is medivac or ambulance transport. They bill patients
the same amount. They have to write off as bad debt what is not
covered by Medicaid.
2:30:13 PM
CHAIR WILSON opened public testimony on HB 176.
BRITTANY SMART, Special Assistant to the Mayor, Fairbanks North
Star Borough, supported HB 176. She said in the Fairbanks
Borough, 30 percent of transport patients are Medicaid patients.
In calendar year 2016, the borough had $430,000 in uncompensated
costs that could be reimbursed through this program.
2:31:50 PM
CHAIR WILSON closed public testimony on HB 176.
CHAIR WILSON asked how many states have similar programs.
REPRESENTATIVE WOOL said there are six states that have the
program in place and four pending. Alaska will make that five.
He noted that the bill has support from municipalities and
transportation providers. They didn't hear from any air
transport. They are largely private and contract through
municipalities.
SENATOR GIESSEL hypothesized that Ravn Air transports a Medicaid
beneficiary from Kenai to Anchorage. They are going to bill the
Kenai Peninsula Borough and the borough is only going to get 40
percent reimbursed from Medicaid. She asked who makes up the
rest of the charge.
2:34:03 PM
REPRESENTATIVE WOOL said from Chief Etheridge's testimony, it
sounds like the provider pays the contractor. The municipality
is on the hook for the air transporter's costs.
SENATOR MICCICHE said, to put it another way, it is the EMS
agency with jurisdiction for that particular place. Whoever has
the jurisdiction takes on the cost. Sometimes it is
uncompensated with no one to pay and they are left holding the
bag.
REPRESENTATIVE WOOL said some states have private ambulances,
but most of the ambulances and EMS services in Alaska are run by
municipalities.
CHAIR WILSON said the fiscal notes were changed from "emergency
ground transport" to "emergency transport." At a future time, he
would like to know if taking out "ground" changed the numbers at
all.
2:36:21 PM
CHAIR WILSON stated that he would hold HB 176 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 176 - Legislation - Version U (FIN).PDF |
SHSS 3/26/2018 1:30:00 PM |
HB 176 |
| HB176 Sponsor Statement 3.1.18.pdf |
SHSS 3/26/2018 1:30:00 PM |
HB 176 |
| HB 176 - Explanation of Changes 3.1.18.pdf |
SHSS 3/26/2018 1:30:00 PM |
HB 176 |
| HB 176 Flow Chart - 3.1.18.pdf |
SHSS 3/26/2018 1:30:00 PM |
HB 176 |
| HB 176 -Fiscal Note - HB176CS(HSS)-DHSS-MAA-2-15-18.pdf |
SHSS 3/26/2018 1:30:00 PM |
HB 176 |
| HB 176 - Fiscal Note - HB176CS(HSS)-DHSS-HCMS-2-23-18.pdf |
SHSS 3/26/2018 1:30:00 PM |
HB 176 |
| HB176 Supporting Documents - LTRs of Support 3.1.18.pdf |
SHSS 3/26/2018 1:30:00 PM |
HB 176 |
| HB176 - Letter of Support - FNSB - 3.26.18.pdf |
SHSS 3/26/2018 1:30:00 PM |
HB 176 |
| hb176 Support AML.pdf |
SHSS 3/26/2018 1:30:00 PM |
HB 176 |
| SB 193 Version D.pdf |
SHSS 3/26/2018 1:30:00 PM |
SB 193 |
| SB 193 Version D Sponsor Statement.pdf |
SHSS 3/12/2018 1:30:00 PM SHSS 3/26/2018 1:30:00 PM |
SB 193 |
| SB 193 Version D Sectional.pdf |
SHSS 3/12/2018 1:30:00 PM SHSS 3/26/2018 1:30:00 PM |
SB 193 |
| SB 193 Version D CMS Letter 1.11.18.pdf |
SHSS 3/12/2018 1:30:00 PM SHSS 3/26/2018 1:30:00 PM |
SB 193 |
| SB 193 Fiscal Note DHSS DPA Field Svcs.pdf |
SHSS 3/12/2018 1:30:00 PM SHSS 3/26/2018 1:30:00 PM |
SB 193 |
| SB 193 Fiscal Note Dept Admin - Cent Admin Svcs.pdf |
SHSS 3/12/2018 1:30:00 PM SHSS 3/26/2018 1:30:00 PM |
SB 193 |
| SB 193 Fiscal Note DHSS DPA QC.pdf |
SHSS 3/12/2018 1:30:00 PM SHSS 3/26/2018 1:30:00 PM |
SB 193 |
| SB 193 Fiscal Note DHSS DPA Work Svcs.pdf |
SHSS 3/12/2018 1:30:00 PM SHSS 3/26/2018 1:30:00 PM |
SB 193 |
| SB 193 Fiscal Note DHSS Med Svcs Adult Dental.pdf |
SHSS 3/12/2018 1:30:00 PM SHSS 3/26/2018 1:30:00 PM |
SB 193 |
| SB 193 Fiscal Note DHSS Medicaid Services.pdf |
SHSS 3/12/2018 1:30:00 PM SHSS 3/26/2018 1:30:00 PM |
SB 193 |
| SB 193 Fiscal Note DHSS Medicaid Svcs BH.pdf |
SHSS 3/12/2018 1:30:00 PM SHSS 3/26/2018 1:30:00 PM |
SB 193 |
| SB 193 Fiscal Note DLWD E&TS.pdf |
SHSS 3/12/2018 1:30:00 PM SHSS 3/26/2018 1:30:00 PM |
SB 193 |
| Support Letter for SB 193.pdf |
SHSS 3/12/2018 1:30:00 PM SHSS 3/26/2018 1:30:00 PM |
SB 193 |
| SB 193 Support M Coons.pdf |
SHSS 3/12/2018 1:30:00 PM SHSS 3/26/2018 1:30:00 PM |
SB 193 |
| SB 193 Version D CMS Letter 1.11.18.pdf |
SHSS 3/23/2018 1:30:00 PM SHSS 3/26/2018 1:30:00 PM |
SB 193 |
| SB 193 WORKDRAFT CS 30-LS1349.J.pdf |
SHSS 3/23/2018 1:30:00 PM SHSS 3/26/2018 1:30:00 PM |
SB 193 |
| SB 193 Explanation of Changes.pdf |
SHSS 3/23/2018 1:30:00 PM SHSS 3/26/2018 1:30:00 PM |
SB 193 |
| Support Letter for SB 193 FGA.pdf |
SHSS 3/23/2018 1:30:00 PM SHSS 3/26/2018 1:30:00 PM |
SB 193 |
| HB 215 CSHB215(FIN) Ver O.PDF |
SHSS 3/26/2018 1:30:00 PM |
HB 215 |
| HB 215 DHSS Slide Presentation 2-20-2018.pdf |
SHSS 3/26/2018 1:30:00 PM |
HB 215 |
| HB 215 FN 1_26_18.pdf |
SHSS 3/26/2018 1:30:00 PM |
HB 215 |
| HB 215 Additional Documents-Public Health Briefing Paper 2.20.2018.pdf |
SHSS 3/26/2018 1:30:00 PM |
HB 215 |
| HB 215 Explanation of changes Ver D to Ver O.PDF |
SHSS 3/26/2018 1:30:00 PM |
HB 215 |
| HB215 Sectional Analysis ver O 2.20.18.pdf |
SHSS 3/26/2018 1:30:00 PM |
HB 215 |
| HB 215 Letters of Support.pdf |
SHSS 3/26/2018 1:30:00 PM |
HB 215 |
| CSHB 215 Support - Ak Comm on Aging.pdf |
SHSS 3/26/2018 1:30:00 PM |
HB 215 |
| HB215 Sponsor Statement ver O 2.20.18.pdf |
SHSS 3/26/2018 1:30:00 PM |
HB 215 |