Legislature(2017 - 2018)BUTROVICH 205
03/21/2018 01:30 PM Senate HEALTH & SOCIAL SERVICES
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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.