Legislature(2013 - 2014)CAPITOL 106
01/22/2013 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Department of Health and Social Services | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
January 22, 2013
3:03 p.m.
MEMBERS PRESENT
Representative Pete Higgins, Chair
Representative Wes Keller, Vice Chair
Representative Benjamin Nageak
Representative Lora Reinbold
Representative Paul Seaton
Representative Geran Tarr
MEMBERS ABSENT
Representative Lance Pruitt
COMMITTEE CALENDAR
PRESENTATION: DEPARTMENT OF HEALTH AND SOCIAL SERVICES
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
WILLIAM STREUR, Commissioner
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented a PowerPoint overview of the
Department of Health and Social Services.
ACTION NARRATIVE
3:03:09 PM
CHAIR PETE HIGGINS called the House Health and Social Services
Standing Committee meeting to order at 3:03 p.m.
Representatives Higgins, Seaton, Reinbold, Nageak, Keller, and
Tarr were present at the call to order.
^Presentation: Department of Health and Social Services
Presentation: Department of Health and Social Services
3:04:49 PM
CHAIR HIGGINS announced that the only order of business would be
a presentation by the Department of Health and Social Services.
3:06:10 PM
WILLIAM STREUR, Commissioner, Office of the Commissioner,
Department of Health and Social Services (DHSS), introduced
members of the Department of Health and Social Services who were
present, including Wilda Laughlin, Ree Sailors, Melissa Stone,
Duane Mayes, Dave Cote, and Ron Kreher.
3:07:33 PM
COMMISSIONER STREUR introduced a PowerPoint, titled "Innovation
& Change," and directed attention to slide 1, an organizational
chart of the Department of Health and Social Services (DHSS).
He reported that there were 3600 employees, with a budget of
$2.6 billion. He pointed out that the search to fill the
vacancies of both the Deputy Commissioner for Medicaid and
Health Care Policy, and the Assistant Commissioner for Finance
Management Services were moving along. He shared his
philosophy: "I'm going to hire right, I'm not going to hire to
fill the position and put a body in place."
3:08:56 PM
COMMISSIONER STREUR moved on to slide 2, "Priorities," and
commented that this priority system would be responsive to the
needs and expectations of the state residents. Noting that each
priority had equal weighting, he listed the first of three
priorities: Health & Wellness across the Lifespan, pointing out
that, although there was an aging population in Alaska, it was
necessary to provide for the next generation, as well. He
reported that 80 percent of our health care expenditures
occurred in the last 10 years of our lives. He directed
attention to the second priority: Health Care Access, Delivery
and Value. He declared that it was necessary to reach out, and
ensure that quality, cost efficient services were available to
everyone in the state. He noted that the third priority, Safe
and Responsible Individuals, Families, & Communities, included
Medicaid, children's services, and public health.
3:11:19 PM
COMMISSIONER STREUR addressed slide 3, "Priority 1: Health &
Wellness Across the Lifespan," and noted that it was necessary
to promote and protect the health of Alaskans, while providing
quality of life in a safe living environment.
COMMISSIONER STREUR, commenting on slide 4, "Priority 2: Health
Care Access, Delivery and Value," said that it was necessary to
manage health care coverage for Alaskans in need, and to
facilitate access to affordable health care for Alaskans.
COMMISSIONER STREUR continued on with slide 5, "Priority 3:
Safe and Responsible Individuals, Families, and Communities,"
listing these core services: Strengthen Alaskan families,
protect vulnerable Alaskans, and promote personal responsibility
and accountable decisions by Alaskans. He clarified that it was
necessary to include the residents of Alaska in health care
discussions with the payers and the providers.
3:12:22 PM
COMMISSIONER STREUR emphasized his "Service Philosophy," slide
6, stating: "Deliver the right care to the right person at the
right time for the right price." He shared an anecdote of
hearing his philosophy stated at a national meeting.
3:12:59 PM
COMMISSIONER STREUR moved on to slide 7, "Chart in millions of
dollars," and reported that there were health expenditures not
only for Medicaid, but also for Corrections, Workers
Compensation, and Alaska Care. He declared that it was
necessary to maximize the more than $2 billion spent on health
care by working with the providers for more efficient, cost
effective care. He reflected on his aforementioned priorities,
stating that these were now measured by the effectiveness and
efficiency of each division. He revealed that measurement had
previously been reflected in "138 pages of deliverables, where
we report a whole bunch of numbers and don't really say
anything."
3:14:43 PM
COMMISSIONER STREUR indicated slide 8, "Alaska Pioneer Homes,"
and called them "one of the greatest experiments that Alaska has
done." He noted the services, the home environment, and the
protection for its residents and declared these to be a great
resource for Alaskans. He shared that Alaskans always voiced
support for the Pioneer Homes during budget discussions.
3:16:17 PM
COMMISSIONER STREUR discussed slide 9, "Division of Behavioral
Health," stating that behavioral health issues affected
everyone, whether it was substance abuse, mental health
services, suicide, or fetal alcohol syndrome. He noted that
innovation was going to be a major aspect for moving forward
with these issues.
3:17:21 PM
COMMISSIONER STREUR moved on to slide 10, "Office of Children's
Services," declaring that its director, Christy Lawton, had "the
toughest job in the department and that includes my job." He
shared that often almost any course of action the division
pursued would be called into question. He allowed that a major
challenge was to protect the social workers, as even the Alaska
State Troopers would not go alone into homes with the potential
situation for domestic violence. He declared that there would
be a push to better equip the social workers, the children, and
the families for their own protection and safety. He announced
that "safe children, strong families" would be the theme.
3:19:03 PM
COMMISSIONER STREUR directed attention to slide 11, "Division of
Juvenile Justice," and established that the juvenile facilities
throughout Alaska were treatment centers for juveniles. He
reported that the centers were investigating the trauma
experiences of the juveniles, in order to better address their
needs. He shared that this informed care had led to major
reductions in negative incidences within the facilities. He
endorsed the two focuses: rehabilitation and return to a home
environment.
3:20:49 PM
COMMISSIONER STREUR introduced slide 12, "Division of Health
Care Services," reporting that the majority of hospital
services, physician services, and Medicaid were paid through
this division. He noted the importance of work with the tribal
partners and access from the communities.
3:21:40 PM
COMMISSIONER STREUR directed attention to slide 13, "Division of
Public Assistance," and explained that this division managed a
wide range of programs, including Adult Public Assistance, Child
Care, Chronic and Acute Medical Assistance, Denali Kid Care, and
Food Stamps.
3:22:27 PM
COMMISSIONER STREUR, addressing slide 14, "Division of Public
Health," stated that Chief Medical Officer Dr. Ward Hurlburt and
Acting Director Kerre Fisher were administering the division.
He noted that this division ensured that immunizations were
being provided.
3:24:18 PM
COMMISSIONER STREUR reviewed slide 15, "Senior and Disabilities
Services," and stated that this was the fastest growing
population in Alaska, having grown by more than 70 percent
according to the most recent census, compared to the national
increase of 15 percent. He declared that this significantly
aging population contributed to the cost increases, the
complexities, and the challenges encountered in dealing with
seniors, disabled, and personal care attendant operations, and
that it could eclipse the Medicaid budget.
3:25:44 PM
COMMISSIONER STREUR affirmed that the vision of the Department
of Health and Social Services was for Alaskan individuals,
families and communities to be safe and healthy (slide 16).
3:26:22 PM
COMMISSIONER STREUR, in response to Representative Tarr, said
that DHSS was unclear as to the direction of many federal
programs. He stated that indications in some areas such as
adoption, children's services, and foster care were that funding
was decreasing.
3:27:14 PM
REPRESENTATIVE NAGEAK, referring to the Pioneer Homes, suggested
that there needed to be a partnership for senior support among
areas of the state, as space to care for the elderly was
limited. He declared that there were not enough beds in his
district to care for all the elders, and that it became
necessary to send them to other areas. He shared that his
personal platform was to encourage intervention for potential
suicides. He urged people to "butt in," "be rude," and "talk to
them" if they encountered someone who was despondent. He
emphasized the necessity to talk and to confront this issue,
especially with the young people, and to tell them "they are
wanted; they are needed; especially in Bush Alaska."
3:31:35 PM
REPRESENTATIVE REINBOLD asked about any effects of the Patient
Protection and Affordable Care Act on the Department of Health
and Social Services.
3:31:56 PM
COMMISSIONER STREUR, in response, said that Medicaid expansion
in Alaska would add at least 40,000 people to the program, and,
although the federal government would pick up the cost of care,
the State of Alaska would incur the associated infrastructure
cost. He noted that a new eligibility information system was
being implemented for enrollment. He expressed his desire for
more time to allow completion of the new enrollment system. He
reported that the current system would continue to enroll
individuals, but this 30 percent increase to Medicaid enrollees
would add significant costs. He estimated annual operating
costs of $5-$8 million with an increased expense to $33-$40
million in 2019, when the state would assume responsibility for
10 percent of the cost of care. Directing attention to the
federal health care exchange, he confirmed that the State of
Alaska had decided to pursue the federal option, as the state
option would have included $5-$8 million in operating expenses
for "a relatively small number of lives to enroll;" whereas, the
federal option would be paid by the federal government. He
declared that DHSS was presently evaluating Medicaid expansion.
He affirmed that although federal support would be 100 percent
in 2014-15, and would decline to 90 percent in 2019, it was
unclear what the payments would be beyond this date. He
compared this to the current federal Medicaid expense support of
50 percent.
3:36:22 PM
REPRESENTATIVE REINBOLD asked how many people were currently
enrolled in Medicaid in Alaska.
COMMISSIONER STREUR, in response, said that 135,000 individuals
were currently enrolled in Medicaid, with an estimated 40,000
more to be added. He assessed that the "woodwork effect," those
individuals who were eligible for Medicaid but had not signed
up, included an estimated 7700 individuals.
REPRESENTATIVE REINBOLD asked if this included Denali KidCare.
COMMISSIONER STREUR explained that Denali KidCare was a part of
the Medicaid program.
3:37:31 PM
REPRESENTATIVE SEATON reflected on a State of Alaska resolution,
House Concurrent Resolution 5, unanimously adopted in 2011,
which had declared that prevention of disease would be the
primary model for health care. He pointed out that this
resolution also recognized the potential of Vitamin D as an aid
in the prevention of disease. He announced that the Department
of Administration had recognized the cost savings and now
offered free Vitamin D testing. He asked what the Department of
Health and Social Services had done to promote the prevention of
disease model for health care, as well as to create awareness
for the value of Vitamin D, as determined in House Concurrent
Resolution 5.
COMMISSIONER STREUR offered his belief that this had been
previously discussed with Dr. Hurlburt, who, as the Director of
the Division of Public Health, would be in charge. He stated
that awareness bulletins had been issued immediately after
passage of the resolution, and he opined that there had been a
subsequent follow up. He reported that neither active
promotion, prescription, nor testing had occurred.
3:39:35 PM
REPRESENTATIVE SEATON, referring to a recent US military study
on suicide of veterans, reported that veterans with the lowest
levels of vitamin D were twice as likely as those with higher
levels to successfully commit suicide. He asked if the suicide
prevention methods in Alaska included reviews of Vitamin D.
3:40:46 PM
COMMISSIONER STREUR replied that he was not aware of this
military study. He offered to get back to the committee with an
answer.
3:41:06 PM
CHAIR HIGGINS, referring to the Division of Seniors and
Disabilities Services, asked if the increase in cost was a
result of the cost of service, or the number of people served.
COMMISSIONER STREUR, in response, said that there had been an
increase to both the cost of services and those accessing the
services. He offered his belief that this upward trend had been
occurring for the past five years.
3:42:07 PM
REPRESENTATIVE REINBOLD asked to compare the difficulty for
enrollment between the State of Alaska programs and those of
other states. She also asked who was the director for the
Medicaid programs.
COMMISSIONER STREUR asked for clarification for what to compare.
REPRESENTATIVE REINBOLD asked to compare the eligibility and the
length of the programs. She opined that the number of Medicaid
enrollees seemed excessive given the size of the general
population. She asked if the Medicaid enrollment was the result
of lack of jobs, or lack of employee health insurance.
COMMISSIONER STREUR clarified that the Medicaid enrollment in
Alaska was "about average." He stated that Alaska Medicaid
enrollment ranged from 18-20 percent of the population, whereas
the national average was 16-24 percent. He pointed out that
enrollment in Alaska had "a bit of an uptick the last couple of
years," which he attributed to "the recession in the Lower 48."
He reported that enrollment had "flattened out now again," and
he expressed his hope that the enrollment would remain
"flattened out." He offered to provide the statistics over the
previous five years.
3:44:11 PM
REPRESENTATIVE NAGEAK, referring to the earlier discussion
regarding the effectiveness and efficiency of each division,
asked if there had been an assessment for each division within
DHSS.
COMMISSIONER STREUR reported that there had been an assessment,
stating "that's a continuing, unfolding thing." He explained
that the aforementioned 138 pages of performance measures were
now used in conjunction with the earlier discussed three
priorities for evaluation of each division.
REPRESENTATIVE NAGEAK asked if these studies had reflected
effectiveness, and were there any resulting changes to the
programs.
COMMISSIONER STREUR replied that "the intent of the entire
program is to do just that; to begin to take a look at, is it
effective and is it efficient." He expressed the desire to
review all the DHSS programs for value and quality, and to
measure each for effectiveness. He opined that it was necessary
for the division directors to embrace and support these studies.
3:46:44 PM
REPRESENTATIVE TARR asked to clarify that the federal government
reimbursement for Medicaid was 50 percent. She also asked for
the income guidelines for Medicaid.
COMMISSIONER STREUR offered to provide the guidelines, noting
that it was based on a variety of factors.
REPRESENTATIVE TARR asked if the Medicaid rate in Alaska was
based on the federal poverty rate.
COMMISSIONER STREUR replied that he did not know.
3:47:44 PM
CHAIR HIGGINS, recounting his work as a health care
professional, expressed his appreciation for the efforts of the
Department of Health and Social Services. He opined that this
department "was one of the best in the nation, and I'd like to
see it kept that way." He suggested that there were some
bureaucracy issues to be addressed.
3:48:32 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 3:48 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| House HSS 1-22 follow up - A.pdf |
HHSS 1/22/2013 3:00:00 PM |
HSS Overview |
| House HSS 1-22 follow up B.pdf |
HHSS 1/22/2013 3:00:00 PM |
HSS Overview |