Legislature(2017 - 2018)BUTROVICH 205

03/21/2018 01:30 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ HB 215 DHSS: PUBLIC HEALTH FEES TELECONFERENCED
Heard & Held
-- Testimony <Invited and Public> --
+ Bills Previously Heard/Scheduled: TELECONFERENCED
+= HB 151 DHSS;CINA; FOSTER CARE; CHILD PROTECTION TELECONFERENCED
Heard & Held
-- Public Testimony --
                HB 215-DHSS: PUBLIC HEALTH FEES                                                                             
                                                                                                                                
2:10:05 PM                                                                                                                    
CHAIR   WILSON  reconvened   the   meeting   and  announced   the                                                               
consideration  of   HB  215.  [CSHB   215(FIN)  was   before  the                                                               
committee.]                                                                                                                     
                                                                                                                                
2:11:11 PM                                                                                                                    
ELIZABETH  DIAMENT,  Staff,  Representative Paul  Seaton,  Alaska                                                               
State Legislature, presented  HB 215. She said HB 215  is a House                                                               
Finance  Committee-sponsored bill.  During the  DHSS subcommittee                                                               
process last  year, Public  Health was  identified as  a division                                                               
that   could  be   charging  additional   fees  to   sustain  its                                                               
constitutional  mission, which  is protecting  and promoting  the                                                               
health of all  Alaskans. DHSS does charge for  some Public Health                                                               
services but  can only charge for  what is listed in  statute, AS                                                               
44.29.022. The duties that are  currently fee-eligible are mostly                                                               
clinical in  nature, and they  include maternal and  child health                                                               
services,  nutrition   services,  preventive   medical  services,                                                               
public   health   nursing   services,   health   education,   and                                                               
laboratories. The  Division of Public Health  lacks fee authority                                                               
for other  services and functions, such  as professional services                                                               
and administrative functions. HB 215  would amend AS 44.29.022 to                                                               
grant  DHSS the  authority  to establish  and collect  reasonable                                                               
fees to support the administration  of public health programs. HB
215 allows  DHSS to  decide what fees  it will  establish through                                                               
regulation and a public process.                                                                                                
                                                                                                                                
She  explained  that fees  are  limited  to  the actual  cost  of                                                               
services and that regulation would  be required for each new fee.                                                               
In the  current fiscal  environment, it  is important  that every                                                               
agency looks for efficiencies and  ways to decrease dependence on                                                               
unrestricted general funds.                                                                                                     
                                                                                                                                
2:13:38 PM                                                                                                                    
JILL  LEWIS,   Deputy  Director,   Division  of   Public  Health,                                                               
Department of Health and Social  Services (DHSS), testified on HB
215. She said  the Division of Public Health  focuses on services                                                               
that  protect  and improve  the  public's  health status.  Public                                                               
health  services  control  infectious diseases,  prevent  chronic                                                               
diseases  and  injuries,   promote  healthy  lifestyles,  protect                                                               
maternal and  child health, as  well as respond to  disasters. HB
215 is  needed to  allow the division  to increase  and diversify                                                               
its revenue opportunities, so it  has the means to support health                                                               
operations  and reduce  reliance on  general funds.  The widening                                                               
gap  between public  health costs  and general  funds jeopardizes                                                               
their ability  to provide  services that  keep Alaskans  safe and                                                               
healthy. One of the obstacles is  they cannot charge fees for all                                                               
services they provide.                                                                                                          
                                                                                                                                
She said  the DPS  budget includes nearly  $7 million  in general                                                               
fund  program  receipts  or  about six  percent  of  their  total                                                               
revenue.  These  receipts come  from  clinical  services such  as                                                               
laboratory tests and  well-child exams. The new fees  will not be                                                               
substantial enough to  fund all operations, but  they will reduce                                                               
dependence on  other funds.  DPS lacks  fee authority  for things                                                               
such  as  data  extraction  and  analysis,  training  and  expert                                                               
consultation,   inspections  and   certifications,  and   program                                                               
administration.  This is  where their  opportunities lie.  Budget                                                               
cuts  have forced  some cuts  to services  that industry  and the                                                               
public are asking for. The bill  makes it possible, when it makes                                                               
sense, to recoup costs and  do these services. Generally the fees                                                               
are optional. If services are not used, then there is no fee.                                                                   
                                                                                                                                
2:16:55 PM                                                                                                                    
MS. LEWIS explained  that to implement the fees,  DPS would reach                                                               
out to  stakeholders in  a series of  public meetings  leading to                                                               
separate regulations for each fee.  Collaborating with the public                                                               
and stakeholders  will help  determine what  is a  reasonable fee                                                               
and  how to  balance  the  burden on  the  stakeholders with  the                                                               
reality that  public health doesn't  mean free health.  Rates are                                                               
limited to actual  costs of providing the services,  not making a                                                               
profit.  Fees will  only  be  implemented when  they  are in  the                                                               
public  interest,   it  is  economical   to  do  so,   and,  most                                                               
importantly, doesn't  undermine the  public health  mission. They                                                               
don't  deny services  because of  an  inability to  pay and  they                                                               
employ a  system of sliding  fee schedules and waivers  to ensure                                                               
the fee is applied fairly.                                                                                                      
                                                                                                                                
She said  DPS understands no  one wants to  pay fees, but  in the                                                               
current  fiscal  environment,  the widening  gap  between  public                                                               
health costs  and state general  funds jeopardizes  their ability                                                               
to  provide  services  that  protect  Alaskans  from  preventable                                                               
causes of illness, injury, and death.                                                                                           
                                                                                                                                
SENATOR  VON  IMHOF  observed  that  the  slides  are  high-level                                                               
example  of what  type of  data is  collected. She  asked for  an                                                               
example  of   an  actual  entity,   a  hospital,  a   clinic,  an                                                               
organization that would ask for data.                                                                                           
                                                                                                                                
MS.  LEWIS said  an example  of data  analysis is  a survey  done                                                               
every  other  year with  school  districts  of risk  factors  for                                                               
adolescents. They do a statewide  report and school districts ask                                                               
for a  special analysis  to target their  students, but  DPS does                                                               
not have  the capacity for that  analysis. They might be  able to                                                               
build that capacity if they could charge a fee for it.                                                                          
                                                                                                                                
SENATOR VON  IMHOF noted that  the committee heard that  DHSS was                                                               
contracting  services with  Evergreen  for  certain reports.  She                                                               
asked if they would provide  the underlying data from an existing                                                               
report if an entity asked for it,  and if there would be a charge                                                               
for the information.                                                                                                            
                                                                                                                                
2:21:01 PM                                                                                                                    
MS. LEWIS  said there  is no  straight yes  or no  answer because                                                               
each individual  data set has individual  concerns about privacy,                                                               
who is asking for the data,  and why. The department has standard                                                               
agreements with  entities that are  interested in  the underlying                                                               
data.  Much  of  what  they  produce  in  data  and  reports  are                                                               
published on  the Internet or  available in aggregate  form. DHSS                                                               
collects a lot of data from  entities that are required to report                                                               
and those entities should be able  to get something in return for                                                               
providing the  information. But if  someone wants to  look deeper                                                               
or have  a special analysis  that takes extra time,  collecting a                                                               
fee would be appropriate.                                                                                                       
                                                                                                                                
SENATOR  VON  IMHOF  said  she   understands  that  is  true  for                                                               
specialized data.  Her concern is  that if there is  data already                                                               
collected, she hopes they make  it available to people asking for                                                               
it. DHSS  is a data  trove and she would  hope that it  makes the                                                               
data  it  is  already  collecting   readily  available  to  other                                                               
entities.                                                                                                                       
                                                                                                                                
SENATOR  GIESSEL  said she  commends  the  department for  coming                                                               
forward with this  bill, in collaboration with  the House Finance                                                               
Committee.  It is  long overdue.  This not  unlike what  the Park                                                               
Division in  the Department of  Natural Resources is  doing. They                                                               
are raising  fees and  selling logo gear  to make  their division                                                               
more self-sustaining.  The Public  Health Division  provides such                                                               
great services  to Alaska and  should charge for them.  She asked                                                               
if there was any opposition to this bill in the other body.                                                                     
                                                                                                                                
MS. LEWIS  said in the  initial hearing  in the House  Health and                                                               
Social  Services  Committee, they  did  hear  some concern  about                                                               
whether  the regulatory  process  allowed  for sufficient  public                                                               
input.  Rather than  just commit  to  doing preliminary  meetings                                                               
with  stakeholders, it  was  put  into the  bill.  That's a  good                                                               
practice  and  essential.  They   need  to  understand  what  fee                                                               
structure will work for the people who will be paying the fees.                                                                 
                                                                                                                                
2:25:47 PM                                                                                                                    
SENATOR  GIESSEL said  that when  a regulation  packet goes  out,                                                               
there  is always  a public  comment period.  Ms. Lewis  is saying                                                               
that  they are  putting in  statute a  pre-public comment  period                                                               
where  stakeholders  would  give   feedback  before  DHSS  writes                                                               
regulations. She  said it  is similar to  what the  Department of                                                               
Revenue often  does with oil  and gas tax regulations.  She asked                                                               
if her interpretation was correct.                                                                                              
                                                                                                                                
MS. LEWIS said yes and it  is helpful to work with partners ahead                                                               
of time to scope out what a  program or rule might look like. The                                                               
Department  of   Law  has  guidelines   on  how  to   have  these                                                               
preliminary meetings without getting  crossways with the official                                                               
regulatory process. She agreed that  many departments already use                                                               
that process.                                                                                                                   
                                                                                                                                
2:27:15 PM                                                                                                                    
CHAIR WILSON asked for a list of the current fees                                                                               
                                                                                                                                
MS. LEWIS  said the  list of fees  is in regulation  7 AAC  80. A                                                               
more comprehensive detailed  list is in a  fee schedule published                                                               
by the  Office of Management  and Budget every year,  where every                                                               
fee in the  state is listed individually. She agreed  to send the                                                               
extract of their fees.                                                                                                          
                                                                                                                                
CHAIR WILSON  said she could  provide the links and  page numbers                                                               
to his office.  He asked if the fees collected  would go into the                                                               
general fund or be designated.                                                                                                  
                                                                                                                                
2:29:27 PM                                                                                                                    
MS. LEWIS  said these  would be  designated general  fund program                                                               
receipts. In  Section 1 of the  bill, they are added  to the list                                                               
of  fees already  in statute.  It helps  make it  clear that  the                                                               
intent of fees is to be  used for those programs. The legislature                                                               
always has  the power  to appropriate funds,  but that  makes the                                                               
intent clear.                                                                                                                   
                                                                                                                                
CHAIR WILSON asked what the guesstimate is for revenue.                                                                         
                                                                                                                                
MS.  LEWIS said  the fiscal  note is  for $600,000  in new  fees,                                                               
which is  a comparatively  small amount.  The division  budget is                                                               
roughly $117 million from all fund  sources, but now there are no                                                               
funds for those  particular services. This is the  way forward to                                                               
provide those services.                                                                                                         
                                                                                                                                
2:31:37 PM                                                                                                                    
CHAIR WILSON  said he is  a huge  supporter of public  health. He                                                               
has been  disappointed that a  lot of the education  services and                                                               
other items  key for  communities have been  cut. He  agrees with                                                               
Senator Giessel  that the administration  is trying to  solve the                                                               
problem in providing services.                                                                                                  
                                                                                                                                
SENATOR MICCICHE  said he is excited  to see this bill.  There is                                                               
already  a  section in  the  Fiscal  Procedures Act  that  covers                                                               
monetary recoveries  by DHSS and  Medicaid expenditures  and from                                                               
recipients and  third-party providers  under AS  47. He  asked if                                                               
there are any further discussions  on offsetting costs from those                                                               
who can afford something.                                                                                                       
                                                                                                                                
MS.  LEWIS said  the  department  is always  looking  at its  fee                                                               
structure. [AS  44.29.022] has a  list of  what kind of  fees the                                                               
department  may charge  for,  and specific  fee  authority is  in                                                               
other  statutes. That  particular  list includes  a fairly  broad                                                               
authority for  things such as  child welfare,  public assistance,                                                               
and juvenile  justice, but the  public health pieces of  that are                                                               
very  specific. Instead  of saying  the department  has authority                                                               
for  public  health  services, it  says  maternal  child  health,                                                               
health  education,  public  health nursing.  Essentially  nothing                                                               
else is  allowed. Public  Health is  different in  the way  it is                                                               
listed and  that is  why the  bill focuses  on that  division and                                                               
doesn't go broader than that.                                                                                                   
                                                                                                                                
2:34:37 PM                                                                                                                    
CHAIR WILSON opened public testimony.                                                                                           
                                                                                                                                
2:35:09 PM                                                                                                                    
ALISON  KULAS, Executive  Director, Alaska  Mental Health  Board,                                                               
Advisory Board  on Alcoholism and  Drug Abuse, supported  HB 215.                                                               
She said  during this budget  crisis it  is necessary to  look at                                                               
other income sources.  This won't be a huge revenue  gain, but it                                                               
is a  piece of what they  are allowed to do.  Reasonable fees and                                                               
requiring public  input to  determine those fees  are the  key to                                                               
the bill.  Her board will  be one of the  voices at the  table as                                                               
they   go  through   this  process.   These   boards  take   into                                                               
consideration  what   their  community   needs  and   what  their                                                               
providers  need  to promote  the  health  and well-being  of  all                                                               
Alaskans.  They believe  in  the mission  of  public health.  All                                                               
Alaskans  are consumers  of what  the Division  of Public  Health                                                               
provide.                                                                                                                        
                                                                                                                                
2:36:52 PM                                                                                                                    
SENATOR  BEGICH asked  if both  of her  boards have  analyzed the                                                               
impact of  this bill and are  confident that it will  not have an                                                               
adverse impact on  their beneficiaries, many of whom  do not have                                                               
the ability to represent themselves.                                                                                            
                                                                                                                                
MS. KULAS  responded that that is  why they are impressed  by the                                                               
intent  for  the public  process  to  establish fees.  They  look                                                               
comprehensively at  how to  promote the health and  well-being of                                                               
all  Alaskans.  They will  always  keep  an  eye to  ensure  that                                                               
beneficiaries are  protected and  that they are  not overburdened                                                               
by any sort of legislation.                                                                                                     
                                                                                                                                
SENATOR  MICCICHE opined  that the  state should  be prioritizing                                                               
need. Those who can afford  to pay allows additional services for                                                               
people who can't.  The state has not had to  worry about that and                                                               
has grown its  ability to spend money faster than  its ability to                                                               
manage money.  That puts services  to everyone at  absolute risk.                                                               
He  said if  we  get to  the  point where  a  broad-based tax  is                                                               
necessary  to  pay the  bills,  there  will  be a  revolution  of                                                               
opposition  to  the services  the  state  provides. He  suggested                                                               
bringing  it down  to the  beneficiary  level for  those who  can                                                               
afford to pay,  so the state can guarantee services  to those who                                                               
can't pay. He asked Ms. Kulas for her thoughts.                                                                                 
                                                                                                                                
2:39:35 PM                                                                                                                    
MS. KULAS  said that when  she says beneficiaries,  she's looking                                                               
at  the Mental  Health  Trust beneficiaries,  those consumers  of                                                               
behavioral health services. When looking  at models, if people or                                                               
agencies  can  pay,  the  Trust   do  want  to  ensure  they  are                                                               
contributing. But  they want to  look full picture, so  those who                                                               
aren't  able  to pay  but  really  need  the services  to  better                                                               
contribute   back   to   society    are   also   afforded   those                                                               
opportunities.  That's why  it's great  that reasonable  fees are                                                               
based on the actual service rather than flat fees.                                                                              
                                                                                                                                
SENATOR MICCICHE said  his theory is that every  dollar the state                                                               
collects from  someone who can  contribute is a  service provided                                                               
to someone who  can't. The last 15 years the  state hasn't had to                                                               
consider that,  but now it is  either cutting out key  or in some                                                               
cases  borderline constitutionally  required services  because it                                                               
can't  afford  them.  He  is  very supportive  of  the  bill  and                                                               
appreciates  the department  bringing it  forward. Hopefully  the                                                               
concept becomes contagious.                                                                                                     
                                                                                                                                
CHAIR  WILSON  said  he  is supportive  but  also  worried  about                                                               
potential harm  by setting fee  schedules. He oversaw  a domestic                                                               
violence  sexual assault  shelter  and the  Mat-Su public  health                                                               
office would  come once  a month to  provide services.  They were                                                               
actively  involved  in  their community  domestic  violence  task                                                               
force.  He doesn't  want those  services to  stop because  of fee                                                               
schedules, but he is supportive of the legislation overall.                                                                     
                                                                                                                                
2:42:27 PM                                                                                                                    
SENATOR MICCICHE  asked by what percentage  public health nursing                                                               
has been reduced over the past four years.                                                                                      
                                                                                                                                
2:42:39 PM                                                                                                                    
MS. LEWIS  said she didn't have  numbers in front of  her. Public                                                               
health  nursing is  about  half  of their  general  fund and  the                                                               
largest section  within the Division  of Public Health.  They are                                                               
mostly  general fund  supported. Because  of that,  public health                                                               
nursing has  absorbed a disproportionate share  in their division                                                               
because  they had  nowhere  else  to take  cuts.  They have  been                                                               
reduced 20 percent since 2015.  They lost 40 positions. More than                                                               
20 were filled at the time and resulted in layoffs.                                                                             
                                                                                                                                
SENATOR MICCICHE said  he just wanted to point that  out. That is                                                               
why this bill is so important.  It's a concept to evaluate. Along                                                               
with those  positions and that  funding, some services  went away                                                               
that Alaskans count on.  He said he's not a bad  guy who wants to                                                               
rub his hands  and see services go away. The  more they put their                                                               
heads together  on similar solutions,  the less services  will be                                                               
cut in the future.                                                                                                              
                                                                                                                                
CHAIR WILSON thanked  Ms. Lewis for the presentation.  He held HB
215 in committee.                                                                                                               

Document Name Date/Time Subjects
HB 215 CSHB215(FIN) Ver O.PDF SHSS 3/21/2018 1:30:00 PM
HB 215
HB215 Sponsor Statement ver O 2.20.18.pdf SHSS 3/21/2018 1:30:00 PM
HB 215
HB215 Sectional Analysis ver O 2.20.18.pdf SHSS 3/21/2018 1:30:00 PM
HB 215
HB 215 Explanation of changes Ver D to Ver O.PDF SHSS 3/21/2018 1:30:00 PM
HB 215
HB 215 FN 1_26_18.pdf SHSS 3/21/2018 1:30:00 PM
HB 215
HB 215 DHSS Slide Presentation 2-20-2018.pdf SHSS 3/21/2018 1:30:00 PM
HB 215
HB 215 Additional Documents-Public Health Briefing Paper 2.20.2018.pdf SHSS 3/21/2018 1:30:00 PM
HB 215
HB 215 Letters of Support.pdf SHSS 3/21/2018 1:30:00 PM
HB 215
CSHB 215 Comm on Aging Support.pdf SHSS 3/21/2018 1:30:00 PM
HB 215
HB151 Support Mark Lackey.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
Conference Committee Action 6-21 on OCS funding increase.pdf SHSS 3/21/2018 1:30:00 PM
HB 151 Alaska Caseloads FY 17 and 18.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Additional letters of support (Trust, AMHB, ARC, Access Alaska, FFCA).pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Applying the Science of Child Development in Child Welfare Systems excerpt.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Article - High caseloads hinder face-to-face visits with foster kids.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Article - Iowa's social workers see growing foster care loads.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 article High Caseloads Hinder Face-to-Face Visists with Foster Kids.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Article High Turnover, Caseloads in Louisiana Foster Care System.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Article Indiana Foster Care System is in Crisis.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 article Opioid Crisis Strains Indiana Foster Care System.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Caseload and Workload Management.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Facts about Child Abuse in Alaska.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Family Reunification, What the Evidence Shows.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 FN Dept Admin Ofc Public Advocacy.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 FN DHSS Children's Services Training.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 FN DHSS Front Line Social Workers.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Foster Care PowerPoint for SEN HSS.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 How Heroin is Hitting the Foster Care System.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 National Child Welfare Workforce Institute Brief on the Importance of Manageable Caseloads.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 New Jersey DCF Work Force Report excerpt.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 New Jersey's Child Welfare Outcomes Report 2017.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Reunification, Bringing Your Child Home from Foster Care.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Sectional analysis version L.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Sponsor Statement Senate HSS.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Supporting Document 1. OCS Office by Office Caseloads.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Supporting Document 2. High Caseloads How Do They Impact Health and Human Services 3.1.17.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Supporting Document 3. Children Waiting to be Adopted 2014.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Supporting Document 10. Relevant Statistics.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Supporting Document 14. Letters of Support.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Supporting Document 15. Casey Family Programs Testimony.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Syummary of New Jersey Settlement Agreement.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 version L.PDF SHSS 3/21/2018 1:30:00 PM
HB 151
HB151 Support Mark Lackey.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
LetterOfSupport-R.O.C.K.MatSu-HB151.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
MSHF Letter of Support HB151.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
Screened Out Reports 30-LS0451 L.2 to HB 151.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151 Reunification, Bringing Your Child Home from Foster Care.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB 151Letter of Support_kristina andrew.pdf SHSS 3/21/2018 1:30:00 PM
HB 151
HB151 LOS All Alaska Pediatric Partnership.pdf SHSS 3/21/2018 1:30:00 PM
HB 151