Legislature(2009 - 2010)BELTZ 211

02/02/2009 01:30 PM HEALTH & SOCIAL SERVICES


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01:32:32 PM Start
01:34:02 PM SB65|| SB82
02:02:18 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ SB 65 MEDICAID FOR ADULT DENTAL SERVICES TELECONFERENCED
Heard & Held
*+ SB 82 MEDICAID FOR ADULT DENTAL SERVICES TELECONFERENCED
Moved SB 82 Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
           SB  65-MEDICAID FOR ADULT DENTAL SERVICES                                                                        
           SB  82-MEDICAID FOR ADULT DENTAL SERVICES                                                                        
                                                                                                                                
1:34:02 PM                                                                                                                    
CHAIR DAVIS announced consideration of SB 65 and SB 82.                                                                         
                                                                                                                                
LYNNE  KORAL, intern  to Senator  Davis, presented  the sponsor's                                                               
statement for SB 65.                                                                                                            
                                                                                                                                
     SB 65  is an Act  repealing the repeal  of preventative                                                                    
     and  restorative  adult dental  services  reimbursement                                                                    
     under  Medicaid; providing  for  an  effective date  by                                                                    
     repealing the  effective date  of sec.  3, ch.  52, SLA                                                                    
     2006; and providing for an effective date.                                                                                 
                                                                                                                                
The purpose  of this bill  is to  repeal the termination  date on                                                               
June 30, 2009 of coverage  for adult restorative and preventative                                                               
dental services under Medicaid.  Without the repeal, the coverage                                                               
for adult dental  services would revert to  minimal treatment for                                                               
the  immediate  relief  of  pain  or  to  reduce  the  spread  of                                                               
infection, as  it was before the  bill went into effect  in April                                                               
2007. The  coverage under Medicaid  began with the passage  of HB
105.                                                                                                                            
                                                                                                                                
It  has  been  demonstrated  that across  the  continuum  of  the                                                               
average  life span,  good preventative  and restorative  oral and                                                               
dental  health is  very  important.  It is  a  necessity in  part                                                               
because  poor   oral  and   dental  health   can  be   linked  to                                                               
cardiovascular  problems,  diabetes  and  other  life-threatening                                                               
illnesses. It can also contribute to low birth-weight babies.                                                                   
                                                                                                                                
She pointed out that the  federal government contributes at least                                                               
50 percent of the funding for this program.                                                                                     
                                                                                                                                
1:36:57 PM                                                                                                                    
TOM OBERMEYER, aid  to Senator Davis, noted that  the fiscal note                                                               
points out  that 7600 people  were beneficiaries of  this program                                                               
in the last  year and over half  of the cost was paid  for by the                                                               
federal government.                                                                                                             
                                                                                                                                
This bill repeals the sunset  provisions of the previous bill and                                                               
differs from  SB 82  in that  SB 82 contains  a five  year sunset                                                               
provision.  The   fiscal  note  extends  through   2015  with  an                                                               
anticipated  total  cost  and  appropriate  increases,  with  the                                                               
greater portion again being covered by federal receipts.                                                                        
                                                                                                                                
1:38:50 PM                                                                                                                    
SENATOR DYSON questioned  why Senator Davis's bill  does not have                                                               
a sunset date.                                                                                                                  
                                                                                                                                
CHAIR  DAVIS affirmed  that  is the  difference  between the  two                                                               
bills before the committee.                                                                                                     
                                                                                                                                
SENATOR DYSON asked  if Senator Davis or her  staff would explain                                                               
her reasoning.                                                                                                                  
                                                                                                                                
MR. OBERMEYER  said it  appears that there  will be  a continuing                                                               
need for  adult restorative  and preventative  care and  that, as                                                               
this will be  an ongoing program, it will save  time and money if                                                               
it doesn't have to be reauthorized regularly.                                                                                   
                                                                                                                                
CHAIR DAVIS  added that everyone  agrees with the need  for these                                                               
services and  the people who  have contacted her have  asked that                                                               
it be an ongoing program.                                                                                                       
                                                                                                                                
1:41:04 PM                                                                                                                    
PAT LUBY, Advocacy  Director, AARP, Anchorage, AK,  said AARP has                                                               
heard from  older consumers  that this  program is  working well.                                                               
Oral health  is critical to  overall health. Dental  problems can                                                               
result in  diseases varying from  malnutrition to  heart disease.                                                               
Medicare  did  not provide  any  funding  for dental  care;  it's                                                               
critical  that  Alaska  continue  to provide  this  provision  on                                                               
dental care  and oral health  to adults  who are on  the Medicaid                                                               
program. AARP strongly supports it.                                                                                             
                                                                                                                                
1:41:51 PM                                                                                                                    
CHAIR DAVIS announced  that John Sherwood is  available to answer                                                               
questions.                                                                                                                      
                                                                                                                                
1:42:09 PM                                                                                                                    
SENATOR DYSON  said he would appreciate  hearing the department's                                                               
position regarding a sunset date.                                                                                               
                                                                                                                                
JOHN SHERWOOD,  Long Term Care Coordinator,  Department of Health                                                               
and Social  Services (DHSS), Juneau,  AK, answered that,  at this                                                               
time the department would support  a date to give them additional                                                               
time to  collect information and evaluate  the cost-effectiveness                                                               
and adequacy of the enhanced adult dental coverage.                                                                             
                                                                                                                                
CHAIR DAVIS  pointed out that the  department has had 2  years or                                                               
more [to gather information].                                                                                                   
                                                                                                                                
MR. SHERWOOD  responded that the  program is going on  its second                                                               
full year of operation. The  department has data for one complete                                                               
year and part of an earlier  year; they don't have their data for                                                               
this year  yet, so they  are not  comfortable with the  data they                                                               
have  in terms  of making  a conclusive  determination about  the                                                               
overall effect.  Also, in  many places  during the  first partial                                                               
year,  there were  long waiting  periods to  get appointments  so                                                               
even though they began offering it  in 2007, very few people were                                                               
able to access it.                                                                                                              
                                                                                                                                
1:43:51 PM                                                                                                                    
SENATOR THOMAS  asked Mr.  Sherwood if  the department  has other                                                               
objections to removing the sunset date.                                                                                         
                                                                                                                                
MR.  SHERWOOD  answered that  the  department  supports a  sunset                                                               
date; they would not oppose not having one.                                                                                     
                                                                                                                                
1:45:15 PM                                                                                                                    
DR.  BRAD  WHISTLER, Dental  Officer,  Department  of Health  and                                                               
Social Services (DHSS), said he is  primarily here to speak to SB
82.                                                                                                                             
                                                                                                                                
CHAIR  DAVIS  suggested  that  he   wait  to  testify  until  the                                                               
committee has finished discussing SB 65.                                                                                        
                                                                                                                                
DELISA CULPEPPER,  Chief Operating Officer, Alaska  Mental Health                                                               
Trust   Authority   (AMHTA);,Co-Chair,   Alaska   Dental   Action                                                               
Coalition, Anchorage,  AK, said  AMHTA is very  much in  favor of                                                               
repealing the  sunset date; they  would not oppose having  a five                                                               
year sunset,  but want  to be  sure that  this program  for adult                                                               
dental  Medicaid  moves  forward.  Many  of  their  clients  have                                                               
benefited from  this in the  past two  and a half  years. They've                                                               
worked with the  department and others to look at  the effects of                                                               
this [program] and  it really makes a difference in  the lives of                                                               
vulnerable  adults  who have  no  other  way  to pay  for  dental                                                               
treatment.                                                                                                                      
                                                                                                                                
MS.  CULPEPPER  said  AMHTA  has been  working  with  the  dental                                                               
society and the  department regarding whether or not  a sunset is                                                               
needed  and, until  now, the  discussion was  leaning toward  not                                                               
having one.  They felt that  budgeting and other issues  could be                                                               
handled  through   regulation  and  through  the   annual  budget                                                               
process. In  all of  the bills  addressing adult  dental Medicaid                                                               
however,  they would  like to  address repeal  of the  three year                                                               
sunset and  address the cap,  which is  set in statute  at $1150.                                                               
The  statute  allows that  cap  to  be  reduced,  but not  to  be                                                               
increased  in any  way; both  the dental  society and  AMHTA fear                                                               
that will limit access to the program in the future.                                                                            
                                                                                                                                
She  closed  by  saying  she hopes  the  committee  will  support                                                               
reauthorization of adult dental Medicaid.                                                                                       
                                                                                                                                
CHAIR  DAVIS  closed public  testimony  on  SB 65  and  announced                                                               
consideration of SB 82.                                                                                                         
                                                                                                                                
1:48:24 PM                                                                                                                    
DR.  BRAD  WHISTLER, Dental  Officer,  Department  of Health  and                                                               
Social  Services (DHSS)  said he  is in  favor of  the governor's                                                               
bill SB82  to reauthorize the  adult preventive  dental services.                                                               
SB  82  provides for  an  extension  of adult  dental  preventive                                                               
services through  June 30, 2014,  or five years past  the current                                                               
sunset date.                                                                                                                    
                                                                                                                                
He continued  that good oral  health is a  quality-of-life issue.                                                               
Pain from  dental infections  can result  in missed  work; adults                                                               
with missing  or decayed front  teeth have problems  getting jobs                                                               
or  job  enhancement,  especially in  Alaska's  customer  service                                                               
sector,  where it  is  part  of the  image  one  presents to  the                                                               
public. For Alaska  seniors and adults, lack of  dentures or ill-                                                               
fitting  dentures   can  contribute  to  food   choices  such  as                                                               
nutritional choices  of fresh fruits and  vegetables. Coverage of                                                               
preventive and  routine dental  services reduces  the progression                                                               
of  dental  decay to  the  point  that  the pulp  doesn't  become                                                               
involved and it isn't necessary  to extract permanent teeth. Once                                                               
that happens, all other alternatives are more expensive.                                                                        
                                                                                                                                
Finally,  adult  dental services  are  important  in terms  of  a                                                               
comprehensive  approach  to  reducing dental  decay  in  Alaska's                                                               
children.  The  bacteria  that cause  dental  decay  are  usually                                                               
passed from  caregiver to child;  if the  caregiver has a  lot of                                                               
decay, he  or she can transmit  those organisms to the  infant by                                                               
means of  sampling bottles  or tasting foods  and once  the teeth                                                               
erupt it creates a risk  factor for developing early dental decay                                                               
in the  child. He stressed  that Department of Health  and Social                                                               
Services  (DHSS)  is trying  to  convince  people, especially  in                                                               
rural  areas  where  there  are  high  rates  of  decay,  of  the                                                               
importance of keeping teeth through  proper oral hygiene and good                                                               
nutrition. That  was a hard  message to  sell when the  state was                                                               
only offering emergency services.                                                                                               
                                                                                                                                
DR.  WHISTLER reiterated  that the  department is  supporting the                                                               
passage of SB  82 with the sunset extension to  June 30, 2014. As                                                               
John Sherwood  indicated, by the  time they had  received federal                                                               
approval to  proceed with  this program, they  were able  to give                                                               
only  very  short  notice  and  few  people  were  able  to  make                                                               
appointments during that  first quarter of FY07, so  FY08 was the                                                               
first full  year of  information. They would  like to  extend the                                                               
sunset  date to  give them  time to  discuss whether  the program                                                               
actually results  in fewer  extracted teeth  or other  things the                                                               
legislature  was  concerned about  when  this  pilot program  was                                                               
passed.                                                                                                                         
                                                                                                                                
1:53:22 PM                                                                                                                    
CHAIR DAVIS commented  that she has received  emails from several                                                               
people who state  that the current cap does not  cover a full set                                                               
of dentures. There  are other issues related to the  cap as well,                                                               
but she does not particularly want to take them up in this bill.                                                                
                                                                                                                                
She pointed  out that no one  here has denied the  need for these                                                               
services and  all of the  testimony supports it. Even  though the                                                               
department feels  it needs  time to  establish its  database, she                                                               
does  not understand  why  they  need five  years  to gather  the                                                               
information to prove this is a much-needed service.                                                                             
                                                                                                                                
1:54:54 PM                                                                                                                    
DR.  WHISTLER said  he can  only  echo John's  comments that  the                                                               
department would prefer to respond  to the directive it was given                                                               
by  the  legislature  when they  authorized  these  services,  to                                                               
report back  on whether the  services were effective  in reducing                                                               
emergency services and to answer  other questions that came up at                                                               
that time.                                                                                                                      
                                                                                                                                
He  clarified  that,  when  he spoke  about  annual  limit  being                                                               
adequate to  cover an upper  or lower  denture, he based  that on                                                               
what the state pays for reimbursement on the Medicaid program.                                                                  
                                                                                                                                
1:55:52 PM                                                                                                                    
SENATOR PASKVAN asked if there  has been any thought of including                                                               
a medical or dental escalator to the $1150 limit.                                                                               
                                                                                                                                
DR. WHISTLER answered that the  department has not looked at that                                                               
issue; they've  just been  looking at  this as  a reauthorization                                                               
with the $1150.                                                                                                                 
                                                                                                                                
1:56:51 PM                                                                                                                    
SENATOR DYSON  said he is  generally in favor of  showing respect                                                               
for the department;  if they want a sunset, that's  fine. He also                                                               
thinks there will be significant changes  in the next two to four                                                               
years in the way health care  issues are dealt with and financed,                                                               
so there is some wisdom to retaining the sunset.                                                                                
                                                                                                                                
CHAIR DAVIS  said she wants  this to  be an ongoing  program. She                                                               
knows there  will probably be  significant changes in  our health                                                               
care  system under  the new  federal administration  and it  will                                                               
probably be  safe to leave the  sunset in the bill;  she does not                                                               
see the necessity  for it, but has no problem  leaving it if that                                                               
is the  consensus. She  agreed to withdraw  her bill  and proceed                                                               
with SB 82 if the vice-chair would be willing to make a motion.                                                                 
                                                                                                                                
SENATOR PASKVAN moved  to withdraw SB65 and to  place SB82 before                                                               
the committee  for consideration.  There being no  objection, the                                                               
motion carried.                                                                                                                 
                                                                                                                                
SENATOR  DYSON  moved  to  report   SB  82  from  committee  with                                                               
individual  recommendations and  attached  fiscal note(s).  There                                                               
being no objection, the motion carried.                                                                                         
                                                                                                                                
2:02:18 PM                                                                                                                    
There  being  no further  business  before  the committee,  CHAIR                                                               
DAVIS adjourned the meeting at 2:02 PM.                                                                                         
                                                                                                                                

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