Legislature(2015 - 2016)CAPITOL 106

03/31/2015 03:00 PM HEALTH & SOCIAL SERVICES

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03:03:01 PM Start
03:03:30 PM HB148
04:57:10 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 148 MEDICAL ASSISTANCE COVERAGE; REFORM TELECONFERENCED
-- Testimony <Invitation Only> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         March 31, 2015                                                                                         
                           3:03 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Paul Seaton, Chair                                                                                               
Representative Liz Vazquez, Vice Chair                                                                                          
Representative Neal Foster                                                                                                      
Representative Louise Stutes                                                                                                    
Representative David Talerico                                                                                                   
Representative Geran Tarr                                                                                                       
Representative Adam Wool                                                                                                        
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 148                                                                                                              
"An Act relating to medical  assistance reform measures; relating                                                               
to  eligibility  for  medical assistance  coverage;  relating  to                                                               
medical assistance  cost containment  measures by  the Department                                                               
of Health  and Social  Services; and  providing for  an effective                                                               
date."                                                                                                                          
                                                                                                                                
     - HEARD AND HELD                                                                                                           
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 148                                                                                                                  
SHORT TITLE: MEDICAL ASSISTANCE COVERAGE; REFORM                                                                                
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
                                                                                                                                
03/18/15       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/18/15       (H)       HSS, FIN                                                                                               
03/24/15       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/24/15       (H)       Heard & Held                                                                                           
03/24/15       (H)       MINUTE(HSS)                                                                                            
03/26/15       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/26/15       (H)       Heard & Held                                                                                           
03/26/15       (H)       MINUTE(HSS)                                                                                            
03/28/15       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/28/15       (H)       Heard & Held                                                                                           
03/28/15       (H)       MINUTE(HSS)                                                                                            
03/31/15       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
JON SHERWOOD, Deputy Commissioner                                                                                               
Medicaid and Health Care Policy                                                                                                 
Office of the Commissioner                                                                                                      
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions  during the discussion of                                                             
HB 148.                                                                                                                         
                                                                                                                                
VALERIE DAVIDSON, Commissioner Designee                                                                                         
Office of the Commissioner                                                                                                      
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions  during the discussion of                                                             
HB 148.                                                                                                                         
                                                                                                                                
MARGARET BRODIE, Director                                                                                                       
Director's Office                                                                                                               
Division of Health Care Services                                                                                                
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Answered questions during  discussion of HB
148.                                                                                                                            
                                                                                                                                
STACIE KRALY, Chief Assistant Attorney General                                                                                  
Statewide Section Supervisor                                                                                                    
Human Services Section                                                                                                          
Civil Division (Juneau)                                                                                                         
Department of Law                                                                                                               
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Answered questions during  discussion of HB
148.                                                                                                                            
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:03:01 PM                                                                                                                    
                                                                                                                                
CHAIR PAUL  SEATON called  the House  Health and  Social Services                                                             
Standing   Committee    meeting   to    order   at    3:03   p.m.                                                               
Representatives  Seaton,  Vazquez,  Tarr, Stutes,  Talerico,  and                                                               
Wool were  present at the  call to order.   Representative Foster                                                               
arrived as the meeting was in progress.                                                                                         
                                                                                                                                
           HB 148-MEDICAL ASSISTANCE COVERAGE; REFORM                                                                       
                                                                                                                                
3:03:30 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced  that the only order of  business would be                                                               
HOUSE  BILL  NO. 148,  "An  Act  relating to  medical  assistance                                                               
reform measures;  relating to eligibility for  medical assistance                                                               
coverage;  relating   to  medical  assistance   cost  containment                                                               
measures by  the Department  of Health  and Social  Services; and                                                               
providing for an effective date."                                                                                               
                                                                                                                                
3:06:40 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON moved to adopt Amendment 1, labeled 29-GH1055\A.2,                                                                 
Glover, 3/24/15, which read:                                                                                                    
                                                                                                                                
     Page 7, following line 15:                                                                                                 
     Insert a new bill section to read:                                                                                         
        "* Sec. 9. AS 47.07.030(d) is amended to read:                                                                      
          (d) The department shall [MAY] establish [AS                                                                      
     OPTIONAL  SERVICES]  a  primary  care  case  management                                                                    
     system  or  a  managed care  organization  contract  in                                                                    
     which  certain eligible  individuals, including  super-                                                                
     utilizers   as  identified   by  the   department,  are                                                                
     required  to  enroll  and seek  approval  from  a  case                                                                    
     manager  or   the  managed  care   organization  before                                                                    
     receiving  certain   services.  The   department  shall                                                                    
     establish    enrollment    criteria    and    determine                                                                    
     eligibility  for services  consistent with  federal and                                                                    
     state law."                                                                                                                
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 9, following line 3:                                                                                                  
     Insert a new bill section to read:                                                                                         
        *  Sec.  14. The  uncodified  law  of the  State  of                                                                  
     Alaska is amended by adding a new section to read:                                                                         
          MEDICAID MANAGED CARE FOR SUPER-UTILIZERS. On or                                                                      
     before January 1,  2017, the  Department of  Health and                                                                    
     Social Services shall                                                                                                      
               (1)  establish a primary care case                                                                               
     management  system  or   a  managed  care  organization                                                                    
     contract under  AS 47.07.030(d), as  amended by  sec. 9                                                                    
     of this Act, for  super-utilizers, as identified by the                                                                    
     department; and                                                                                                            
               (2)  deliver a report on the system or                                                                           
      contract to the senate secretary and the chief clerk                                                                      
         of the house of representatives and notify the                                                                         
     legislature that the report is available."                                                                                 
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 9, line 12:                                                                                                           
          Delete "sec. 10"                                                                                                      
          Insert "sec. 11"                                                                                                      
                                                                                                                                
     Page 9, line 17:                                                                                                           
          Delete "10"                                                                                                           
          Insert "11"                                                                                                           
                                                                                                                                
     Page 9, line 23:                                                                                                           
          Delete "Sections 13 and 14"                                                                                           
          Insert "Sections 15 and 16"                                                                                           
                                                                                                                                
     Page 9, line 24:                                                                                                           
          Delete "by sec. 16"                                                                                                   
          Insert "in sec. 18"                                                                                                   
                                                                                                                                
CHAIR  SEATON  explained  that  this amended  Section  9  of  the                                                               
proposed  bill,   the  establishment  of  a   primary  care  case                                                               
management  system  or  managed  care  organization  for  certain                                                               
individuals,  changing  "may" to  "shall"  and  adding the  phase                                                               
"including super-utilizers as identified  by the department."  He                                                               
reported that  the proposed amendment  also added a  new section,                                                               
Section 14, to the proposed bill.   He stated that the genesis of                                                               
this amendment was  to address super-utilizers, as  they had been                                                               
identified as a source of a large potential savings.                                                                            
                                                                                                                                
REPRESENTATIVE TARR objected, and  asked for clarification of the                                                               
intention,  as she  had understood  that this  proposed amendment                                                               
had been withdrawn during the previous meeting.                                                                                 
                                                                                                                                
CHAIR SEATON  explained that he had  only taken it off  the table                                                               
during  the previous  meeting, and  that this  proposed amendment                                                               
would require  that Department of  Health and Social  Services do                                                               
what was in statute.                                                                                                            
                                                                                                                                
REPRESENTATIVE  TARR  expressed  her concern  whether  there  was                                                               
capacity to  meet the proposed  amendment, noting that  almost 25                                                               
percent  of  the  super-utilizers  were her  constituents.    She                                                               
acknowledged  that  there  had  been  a  program  implemented  to                                                               
address this  problem, which had  saved several  million dollars.                                                               
She reported that Medicaid Expansion  would provide an additional                                                               
opportunity to  address this, although she  expressed her concern                                                               
for the  availability of  capacity to meet  this directive.   She                                                               
asked  how  the proposed  amendment  differed  from the  existing                                                               
reform measures.                                                                                                                
                                                                                                                                
3:08:35 PM                                                                                                                    
                                                                                                                                
JON  SHERWOOD,  Deputy  Commissioner, Medicaid  and  Health  Care                                                               
Policy,  Office of  the Commissioner,  Department  of Health  and                                                               
Social Services,  in response, said that  the department believed                                                               
that  it had  the  capacity  to expand  for  more  use by  super-                                                               
utilizers under the current case management system.                                                                             
                                                                                                                                
CHAIR SEATON reiterated that the  amendment allowed the committee                                                               
to  identify reforms  which it  required  to be  in the  proposed                                                               
bill,  and for  the  legislature  to receive  a  report that  the                                                               
reforms were being addressed.                                                                                                   
                                                                                                                                
3:09:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  asked  how  this  was  different  than  the                                                               
current program addressing the super-utilizer problem.                                                                          
                                                                                                                                
VALERIE   DAVIDSON,   Commissioner   Designee,  Office   of   the                                                               
Commissioner, Department  of Health  and Social  Services (DHSS),                                                               
replied  that  there  were   about  2000  Medicaid  beneficiaries                                                               
currently  enrolled in  the super-utilizer  contract.   She  said                                                               
that,  as  the  program  was voluntary,  this  provision  of  the                                                               
proposed amendment  would require  the department  to set  up the                                                               
system, reiterating  that it would  become compulsory  instead of                                                               
optional,  and  would  reinforce   the  ongoing  efforts  by  the                                                               
department.   She  pointed out  that it  allowed flexibility  for                                                               
this to be  accomplished either through the  existing contract or                                                               
another mechanism.                                                                                                              
                                                                                                                                
REPRESENTATIVE TARR pointed out that,  as the required report was                                                               
one of  three that came  due on January  1, this would  allow for                                                               
the  possibility  of  consolidation  or  coordination  of  report                                                               
requirements.                                                                                                                   
                                                                                                                                
CHAIR SEATON  said that  the committee would  be in  contact with                                                               
the department to  work toward a practical  solution, although he                                                               
expressed  concern that  the  reform  reports may  be  lost in  a                                                               
larger report.                                                                                                                  
                                                                                                                                
3:11:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ asked which  database or software was used                                                               
to identify super-utilizers.                                                                                                    
                                                                                                                                
MR.  SHERWOOD said  that the  information was  obtained from  the                                                               
claims  payment  system,   the  Medicaid  Management  Information                                                               
Systems (MMIS), although he was  not sure which specific software                                                               
was used.                                                                                                                       
                                                                                                                                
REPRESENTATIVE VAZQUEZ asked whether  MMIS was the predecessor of                                                               
the Alaska Health Enterprise System.                                                                                            
                                                                                                                                
MR. SHERWOOD replied that he had  used MMIS as a generic term for                                                               
the claims processing and related  software system.  He expressed                                                               
agreement  that   the  current  system  was   called  Enterprise,                                                               
although he was unsure for when the data had been extracted.                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  asked whether accuracy in  the Enterprise                                                               
was important.                                                                                                                  
                                                                                                                                
MR. SHERWOOD replied that DHSS  did strive for an accurate claims                                                               
payment system.                                                                                                                 
                                                                                                                                
CHAIR  SEATON  asked if  these  questions  were directed  to  the                                                               
proposed amendment.                                                                                                             
                                                                                                                                
REPRESENTATIVE  VAZQUEZ explained  that, as  it was  necessary to                                                               
identify  super-utilizers through  the Enterprise  claims payment                                                               
system,  she  was  going  to  ask  questions  pertaining  to  the                                                               
effectiveness  of  the  claims  payment  system.    She  directed                                                               
attention to the statewide single audit for Fiscal Year 2014.                                                                   
                                                                                                                                
MR. SHERWOOD replied that he was familiar with the audit.                                                                       
                                                                                                                                
REPRESENTATIVE VAZQUEZ pointed to  a recommendation that the DHSS                                                               
commissioner should  take action to implement  effective controls                                                               
to ensure  Medicaid claims were processed  accurately and timely.                                                               
She  said  that there  were  many  defects identified,  and  this                                                               
"resulted in  a material weakness  in internal controls  over the                                                               
Medicaid  and CHIP  programs."   She  asked how  DHSS planned  to                                                               
identify more super  utilizers, if the claims  payment system was                                                               
not functioning properly.                                                                                                       
                                                                                                                                
3:15:00 PM                                                                                                                    
                                                                                                                                
MARGARET BRODIE, Director, Director's  Office, Division of Health                                                               
Care  Services,   Department  of  Health  and   Social  Services,                                                               
explained that the super utilizer  information was taken from the                                                               
decision  support  system,  not  the  claims  payment  processing                                                               
system.                                                                                                                         
                                                                                                                                
REPRESENTATIVE VAZQUEZ  asked for an explanation  to the decision                                                               
support  system,  questioning  whether   it  was  a  surveillance                                                               
utilization and review system.                                                                                                  
                                                                                                                                
MS.  BRODIE replied  that it  was similar,  although a  different                                                               
tool.                                                                                                                           
                                                                                                                                
CHAIR  SEATON  asked to  return  to  the proposed  amendment  for                                                               
establishment of a  case management system, and  not be concerned                                                               
with the exact technology used to identify super-utilizers.                                                                     
                                                                                                                                
3:16:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  removed  her  objection.   There  being  no                                                               
further,  Amendment 1,  labeled  29-GH1055\A.2, Glover,  3/24/15,                                                               
was adopted.                                                                                                                    
                                                                                                                                
3:16:35 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON  moved to adopt Amendment  3, labeled 29-GH1055\A.1,                                                               
Glover, 3/24/15, which read:                                                                                                    
                                                                                                                                
     Page 9, line 24:                                                                                                           
          Delete "July"                                                                                                         
          Insert "August"                                                                                                       
                                                                                                                                
CHAIR SEATON explained that this  changed the effective date from                                                               
July  1 to  August 1,  in order  to avoid  overlap and  potential                                                               
coding  issues created  by the  rollout of  the new  state fiscal                                                               
system which  would begin on July  1.  There being  no objection,                                                               
Amendment   3,  labeled   29-GH1055\A.1,  Glover,   3/24/15,  was                                                               
adopted.                                                                                                                        
                                                                                                                                
3:17:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  moved to  adopt Amendment 4,  labeled 29-                                                               
GH1055\A.9, Glover, 3/24/15, which read:                                                                                        
                                                                                                                                
     Page 6, line 17:                                                                                                           
          Delete "203 [175]"                                                                                                
          Insert "175"                                                                                                          
                                                                                                                                
     Page 6, line 21:                                                                                                           
          Delete "200 [175]"                                                                                                
          Insert "175"                                                                                                          
                                                                                                                                
CHAIR SEATON objected for discussion.                                                                                           
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  explained  that the  proposed  amendment                                                               
would  decrease the  percentage relative  to the  federal poverty                                                               
level back to its original level of 175 percent.                                                                                
                                                                                                                                
3:19:02 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  offered her  understanding that  the current                                                               
calculations  were set  at  175 percent  of  the federal  poverty                                                               
level, but were  then adjusted, which brought  the percentages to                                                               
the  proposed  levels  of  203  percent and  200  percent.    She                                                               
declared that  it would  be necessary to  continue to  make these                                                               
modified adjusted  gross income (MAGI) adjustments.   She offered                                                               
her  understanding  that  placing  the  figures  in  the  statute                                                               
offered more  transparency to  the actual  amount of  income, and                                                               
did not make it necessary to make the adjustments.                                                                              
                                                                                                                                
3:20:01 PM                                                                                                                    
                                                                                                                                
MR.  SHERWOOD confirmed  the explanation  by Representative  Tarr                                                               
that this reflected  the required conversion of  income levels to                                                               
the MAGI standards.                                                                                                             
                                                                                                                                
CHAIR  SEATON  asked  for  clarification that  the  MAGI  of  203                                                               
percent  and 200  percent  was a  federal  requirement, and  that                                                               
maintenance of the 175 percent would  not be adhered to as it was                                                               
in violation of federal law.                                                                                                    
                                                                                                                                
MR. SHERWOOD said  that the amendment would not  have any effect,                                                               
as  it  was  necessary  to   include  the  MAGI  conversion  when                                                               
calculating income eligibility.                                                                                                 
                                                                                                                                
3:21:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  asked for clarification that  the present                                                               
standard  for  175  percent  of federal  poverty  level  was  not                                                               
federally allowed.                                                                                                              
                                                                                                                                
MR. SHERWOOD explained  that it was a requirement  to convert the                                                               
pre-MAGI standard,  which included the use  of income disregards,                                                               
to a post-MAGI  standard which was the  equivalent amount without                                                               
the use of income disregards.                                                                                                   
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  reiterated   her  question  whether  175                                                               
percent of the  federal poverty level was not  allowed by federal                                                               
statute.                                                                                                                        
                                                                                                                                
MR.  SHERWOOD explained  that federal  law dictated  the ways  to                                                               
apply  the  standard,  as  there  was  a  maintenance  of  effort                                                               
requirement for covering  children.  He declared  that DHSS could                                                               
not reduce the standard for children  and make a MAGI standard at                                                               
175  percent of  federal poverty  level.   He offered  his belief                                                               
that the  pregnant woman  standard could be  amended.   He stated                                                               
that  removal of  the  proposed language  change  would have  the                                                               
effect of allowing the pre-MAGI  standard in statute to remain in                                                               
statute,  and  federal  law  required  that  these  standards  be                                                               
converted.                                                                                                                      
                                                                                                                                
3:23:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  pointed  out  that  the  first  part  of                                                               
proposed  Amendment  4  pertained  to Denali  Kid  Care,  with  a                                                               
present standard  of 175  percent of  the federal  poverty level;                                                               
whereas the  second part of  the proposed amendment  pertained to                                                               
pregnant ladies,  which was  also at 175  percent of  the federal                                                               
poverty level.   She  asked if  this was  not in  compliance with                                                               
federal law.                                                                                                                    
                                                                                                                                
3:24:09 PM                                                                                                                    
                                                                                                                                
COMMISSIONER DAVIDSON  asserted that testimony in  every previous                                                               
hearing for  proposed HB  148 had explained  that this  change of                                                               
the proposed  bill endeavored to  be open and transparent  to the                                                               
public for the new percentages  [to federal poverty levels] after                                                               
they were converted to the newly required MAGI standards.                                                                       
                                                                                                                                
CHAIR  SEATON stated  that the  175 percent  with disregards  for                                                               
certain amounts  equaled 203 percent [of  federal poverty levels]                                                               
in one  section, and it  equaled 200 percent [of  federal poverty                                                               
levels] in the other section.                                                                                                   
                                                                                                                                
COMMISSIONER DAVIDSON offered her agreement.                                                                                    
                                                                                                                                
CHAIR SEATON  maintained his objection  so that the  statutes did                                                               
not reflect a figure no longer allowed by Medicaid.                                                                             
                                                                                                                                
3:25:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  asked if the  present statute was  not in                                                               
compliance with federal law.                                                                                                    
                                                                                                                                
CHAIR  SEATON emphasized  that 175  percent  with disregards  was                                                               
equal  to  203  percent,  pointing  out  that,  as  the  proposed                                                               
amendment did not address the  disregards, it did not address the                                                               
complete law.   He reiterated that  the complete law was  for 175                                                               
percent with  disregards, which equaled  203 percent of  the MAGI                                                               
standards.  He  said that the 175 percent with  disregards was no                                                               
longer acceptable to Medicaid and Medicare Services.                                                                            
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  said  she   had  not  seen  any  federal                                                               
regulations  that Alaska  statute  was not  in  compliance.   She                                                               
acknowledged the  MAGI formula,  but that  an argument  was being                                                               
made that the  current Alaska statute was not  in compliance with                                                               
federal  law.   She  said that  this was  a  separate issue  than                                                               
taking  into consideration  the MAGI  formula.   She demanded  an                                                               
answer to the  legal issue by someone who had  a juris doctor and                                                               
knew  something   about  federal   statutes  that   affected  our                                                               
programs.                                                                                                                       
                                                                                                                                
CHAIR  SEATON declared  that there  was a  proposed amendment  in                                                               
front of  the committee,  that there had  been discussion  and it                                                               
was understood  that there  were differences  in opinion,  and he                                                               
was now calling for a vote.                                                                                                     
                                                                                                                                
A  roll  call  vote  was  taken.    Representatives  Vazquez  and                                                               
Talerico voted in favor of  Amendment 4.  Representatives Stutes,                                                               
Wool,  Tarr, Foster,  and Seaton  voted against  it.   Therefore,                                                               
Amendment 4, labeled 29-GH1055\A.9,  Glover, 3/24/15, failed by a                                                               
vote of 2 yeas - 5 nays.                                                                                                        
                                                                                                                                
3:28:42 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON moved to adopt  Amendment 5, labeled 29-GH1055\A.14,                                                               
Nauman/Glover, 3/25/15, which read:                                                                                             
                                                                                                                                
     Page 2, line 13, following "program":                                                                                      
          Insert "; and the Department of Health and Social                                                                     
       Services shall contract with an independent third                                                                        
     party to advise the department during the development                                                                      
     of the tax proposal under this paragraph."                                                                                 
                                                                                                                                
REPRESENTATIVE TALERICO objected for discussion.                                                                                
                                                                                                                                
CHAIR SEATON explained  that the proposed amendment  added to the                                                               
governor's intent language  on page 2 [of the  proposed bill] for                                                               
a provider tax  with a requirement that Department  of Health and                                                               
Social  Services  contract with  an  independent  third party  to                                                               
advise  in the  development  of  the tax.    He  reported that  a                                                               
provider tax  was a good  mechanism for support toward  the state                                                               
deficit  in health  care, as  every state  with the  exception of                                                               
Alaska had some sort of provider  tax.  He allowed that, as these                                                               
taxes  were complicated  and complex,  a  third party  contractor                                                               
would offer advice.                                                                                                             
                                                                                                                                
REPRESENTATIVE TALERICO  withdrew his objection.   There being no                                                               
further   objection,   Amendment   5,   labeled   29-GH1055\A.14,                                                               
Nauman/Glover, 3/25/15, was adopted.                                                                                            
                                                                                                                                
3:30:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TALERICO withdrew  proposed Amendment  6, labeled                                                               
29-GH1055\A.17, Mischel/Glover, 3/25/15.                                                                                        
                                                                                                                                
3:31:02 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON moved to adopt  Amendment 7, labeled 29-GH1055\A.19,                                                               
Nauman/Glover, 3/25/15, which read:                                                                                             
                                                                                                                                
     Page 9, following line 3:                                                                                                  
     Insert a new bill section to read:                                                                                         
        "*  Sec. 13.  The  uncodified law  of  the State  of                                                                
     Alaska is amended by adding a new section to read:                                                                         
          COST-SHARING;    REPORT   TO    LEGISLATURE.   The                                                                    
     Department of Health and  Social Services shall prepare                                                                    
     a report summarizing  cost-sharing measures implemented                                                                    
     before March 1,  2015, by the Department  of Health and                                                                    
     Social Services  under AS 47.07.042 and  describing the                                                                    
     effect of  those measures  on the  state budget.  On or                                                                    
     before  March 1, 2016,  the  Department  of Health  and                                                                    
     Social Services shall  deliver a copy of  the report to                                                                    
     the senate  secretary and chief  clerk of the  house of                                                                    
     representatives  and notify  the  legislature that  the                                                                    
     report is available."                                                                                                      
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 9, line 23:                                                                                                           
          Delete "Sections 13 and 14"                                                                                           
          Insert "Sections 14 and 15"                                                                                           
                                                                                                                                
     Page 9, line 24:                                                                                                           
          Delete "sec. 16"                                                                                                      
          Insert "sec. 17"                                                                                                      
                                                                                                                                
                                                                                                                                
REPRESENTATIVE TALERICO objected for discussion.                                                                                
                                                                                                                                
CHAIR  SEATON explained  that this  added to  the uncodified  law                                                               
requirements that  the Department  of Health and  Social Services                                                               
prepare   a  report   describing   the   current  cost   measures                                                               
implemented under  AS 47.07.042 prior  to March [1, 2015]  with a                                                               
report due  [describing the effects  of those measures]  on March                                                               
1,  2016.    He  offered   conceptual  Amendment  1  to  proposed                                                               
Amendment 7,  changing March 1,  2015 on  line 7 of  the proposed                                                               
amendment to October 1, 2015, as  it would then correspond to the                                                               
due date for federal changes.                                                                                                   
                                                                                                                                
REPRESENTATIVE TARR  asked for clarification that  the report was                                                               
due on March 1, 2016.                                                                                                           
                                                                                                                                
CHAIR  SEATON expressed  his agreement,  and reiterated  that the                                                               
conceptual amendment would change the  date on line 7 of proposed                                                               
Amendment 7  from March 1,  2015 to October  1, 2015 so  it could                                                               
include  the  implemented changes  required  by  the Centers  for                                                               
Medicare and  Medicaid Services  (CMS) related  to this  as these                                                               
needed to be completed prior to October.                                                                                        
                                                                                                                                
CHAIR SEATON asked  if there was further  objection to conceptual                                                               
Amendment  1   to  proposed   Amendment  7.     In   response  to                                                               
Representative Wool,  he explained that  the report would  be due                                                               
on  March  1, 2016,  which  would  summarize information  through                                                               
October  1, 2015.   He  explained  that there  were cost  savings                                                               
measures which had been already  been implemented, and that there                                                               
could possibly be more before  the federal deadline of October 1,                                                               
2015.   He stated that this  would require a report  from DHSS to                                                               
the legislature on the effects  of these cost savings measures by                                                               
March 1, 2016.                                                                                                                  
                                                                                                                                
3:34:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL expressed his  concern that October would not                                                               
allow  enough time,  and that  he  wanted to  ensure that  report                                                               
reform was not necessary.                                                                                                       
                                                                                                                                
CHAIR SEATON  directed attention back to  the proposed conceptual                                                               
Amendment 1  which proposed  a change  to the  date for  the cost                                                               
sharing measures  to be implemented  as it would  then correspond                                                               
to the  federal deadline  for changes prior  to October  1, 2015.                                                               
He  added  that  the  report  to the  legislature  for  the  DHSS                                                               
implemented cost sharing  measures would then be due  by March 1,                                                               
2016.                                                                                                                           
                                                                                                                                
3:36:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ asked how cost sharing was defined.                                                                      
                                                                                                                                
CHAIR SEATON read from the  cost sharing mechanism handout titled                                                               
"Medicare Cost  Sharing" [Included  in members'  packets], noting                                                               
that the  department was  currently soliciting  federal technical                                                               
assistance  for implementing  the  new federal  rules which  were                                                               
income based  formulaic and  aggregate caps.   He  explained that                                                               
the amendment  would request  that a report  be submitted  to the                                                               
legislature from DHSS to list what had been implemented.                                                                        
                                                                                                                                
REPRESENTATIVE VAZQUEZ asked if this  was a working document from                                                               
DHSS,  a proposed  regulation,  or a  conceptual  document.   She                                                               
stated that the source had not been indicated on the document.                                                                  
                                                                                                                                
3:38:28 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON, in response, said  that the document was a synopsis                                                               
of existing cost sharing measures,  that it came from the statute                                                               
in regulations, 7AAC.105.610(b), which were  required to be done.                                                               
He pointed out  that the impending required  cost sharing charges                                                               
were  at the  bottom.   He reiterated  that proposed  Amendment 7                                                               
required  a report  on the  cost sharing  measures to  the Alaska                                                               
State Legislature.                                                                                                              
                                                                                                                                
3:39:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ asked for  the department to confirm these                                                               
regulations.                                                                                                                    
                                                                                                                                
MR. SHERWOOD stated  that this document was prepared  by DHSS and                                                               
provided  to  the  House  Health  and  Social  Services  Standing                                                               
Committee,  and that  it summarized  the current  regulations and                                                               
described   the  impending   changes  in   federal  statute   and                                                               
regulations.                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ asked if this  was required by the Patient                                                               
Protection and Affordable Care Act as of January 1, 2014.                                                                       
                                                                                                                                
MR.  SHERWOOD said  that the  Patient  Protection and  Affordable                                                               
Care Act  did require changes  to cost  sharing, and that  it was                                                               
accompanied  by  changes  to   federal  regulations  around  cost                                                               
sharing.                                                                                                                        
                                                                                                                                
3:40:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  expressed concern that March  1, 2015 was                                                               
rather late  in the legislative  session, and she  suggested that                                                               
this be moved to an earlier date.                                                                                               
                                                                                                                                
CHAIR SEATON asked  if she was objecting  to conceptual Amendment                                                               
1,  which  changed the  report  date  from  March 1,  2015  until                                                               
October 1,  2015.  He pointed  out that October was  the date for                                                               
federal guidelines to be implemented  and that DHSS had requested                                                               
technical assistance for those changes.   Without the date change                                                               
there would  only be  a report  for what had  been done  prior to                                                               
March  1,  2015, which  would  not  include any  additional  cost                                                               
sharing  measures  implemented  prior  to  the  required  federal                                                               
timeline.                                                                                                                       
                                                                                                                                
REPRESENTATIVE  VAZQUEZ said  that she  wanted to  know what  was                                                               
being done in the future, next January or February [2016].                                                                      
                                                                                                                                
CHAIR  SEATON  declared that  this  the  intention of  conceptual                                                               
Amendment 1.   He reiterated that the date change  for the report                                                               
would  allow inclusion  of all  the cost  sharing elements  which                                                               
were changed and implemented.                                                                                                   
                                                                                                                                
3:42:25 PM                                                                                                                    
                                                                                                                                
There  being no  objection,  conceptual Amendment  1 to  proposed                                                               
Amendment 7 was adopted.                                                                                                        
                                                                                                                                
3:43:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TALERICO   removed  his  objection   to  proposed                                                               
Amendment  7,  and  then reinserted  his  objection  for  further                                                               
discussion.                                                                                                                     
                                                                                                                                
REPRESENTATIVE  TARR  asked whether  the  dates  could be  better                                                               
aligned  to fiscal  year reports  in order  to better  assess the                                                               
success of the programs.                                                                                                        
                                                                                                                                
CHAIR   SEATON  clarified   that  the   proposed  amendment   was                                                               
summarizing  the cost  sharing measures  and not  necessarily the                                                               
exact money saved by these measures.                                                                                            
                                                                                                                                
3:44:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TALERICO  removed his  objection.  There  being no                                                               
further  objection,   Amendment  7,   as  amended,   labeled  29-                                                               
GH1055\A.19, Nauman/Glover, 3/25/15, was adopted.                                                                               
                                                                                                                                
3:45:11 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON moved to adopt  Amendment 8, labeled 29-GH1055\A.20,                                                               
Glover, 3/25/15,  which read:   [Amendment 8  is provided  at the                                                               
end of these minutes]                                                                                                           
                                                                                                                                
REPRESENTATIVE TALERICO objected for discussion.                                                                                
                                                                                                                                
CHAIR SEATON  explained that proposed  Amendment 8  required that                                                               
DHSS would establish prevention of  disease as a primary model of                                                               
health  care,  which  had  been   unanimously  requested  by  the                                                               
legislature in 2011 in Legislative  Resolve 16.  He declared that                                                               
the  proposed  amendment added  the  duty  to DHSS  to  establish                                                               
guidelines  for medical  assistance providers  to develop  health                                                               
care  delivery  models  that  encourage  adequate  nutrition  and                                                               
disease prevention.                                                                                                             
                                                                                                                                
3:46:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TALERICO asked for any comments by DHSS.                                                                         
                                                                                                                                
MR.  SHERWOOD declared  that DHSS  had no  objection to  proposed                                                               
Amendment 8.                                                                                                                    
                                                                                                                                
REPRESENTATIVE TALERICO  removed his  objection.  There  being no                                                               
further objection,  Amendment 8, labeled  29-GH1055\A.20, Glover,                                                               
3/25/15, was adopted.                                                                                                           
                                                                                                                                
3:46:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  moved to  adopt Amendment 9,  labeled 29-                                                               
GH1055\A.24, Glover, 3/26/15, which read:                                                                                       
                                                                                                                                
     Page 7, following line 1:                                                                                                  
     Insert a new bill section to read:                                                                                         
        "* Sec. 7. AS 47.07.020(d) is amended to read:                                                                      
          (d)  Notwithstanding (a) of this section,                                                                         
     additional [ADDITIONAL] groups,  including groups added                                                        
     on or after March 23, 2010,  to the list of persons for                                                                
     whom   the  Social   Security  Act   requires  Medicaid                                                                
     coverage  under  42 U.S.C.  1396  -  1396p (Title  XIX,                                                                
     Social Security Act), may not  be added unless approved                                                                
     by the legislature."                                                                                                       
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 9, line 12:                                                                                                           
          Delete "sec. 10"                                                                                                      
          Insert "sec. 11"                                                                                                      
                                                                                                                                
     Page 9, line 17:                                                                                                           
          Delete "10"                                                                                                           
          Insert "11"                                                                                                           
                                                                                                                                
     Page 9, line 23:                                                                                                           
          Delete "Sections 13 and 14"                                                                                           
          Insert "Sections 14 and 15"                                                                                           
                                                                                                                                
     Page 9, line 24:                                                                                                           
          Delete "by sec. 16"                                                                                                   
          Insert "in sec. 17"                                                                                                   
                                                                                                                                
                                                                                                                                
CHAIR SEATON objected for discussion.                                                                                           
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  explained   that  proposed  Amendment  9                                                               
required   that  the   legislature  approve   any  expansion   of                                                               
eligibility  categories  and  that  it was  appropriate  for  the                                                               
legislature  to properly  consider  all  issues and  consequences                                                               
intended and unintended  before additional eligibility categories                                                               
or  groups were  added  on  to the  Medicaid  program, given  the                                                               
fiscal situation in  Alaska.  She referenced  a Legislative Audit                                                               
Division  report  which indicated  that  there  were many  issues                                                               
confronting the  Department of Health  and Social Services.   She                                                               
offered her belief that the  addition of populations to a program                                                               
that was  not functioning well was  not in the best  interests of                                                               
the State of Alaska.                                                                                                            
                                                                                                                                
COMMISSIONER DAVIDSON, in response to  Chair Seaton, said that it                                                               
was  unusual  for  a  requirement   asking  permission  from  the                                                               
legislature to comply  with federal law.  She  declared that this                                                               
provision was for  a mandatory covered service and  that DHSS had                                                               
a  concern that  non-compliance  with a  mandatory provision  and                                                               
federal law would put the entire Medicaid program at risk.                                                                      
                                                                                                                                
CHAIR   SEATON  asked   for  examples   for  mandatory   Medicaid                                                               
expansions.                                                                                                                     
                                                                                                                                
MR.  SHERWOOD  replied that  the  most  recent addition  was  the                                                               
Medicaid expansion  population but  that the Supreme  Court ruled                                                               
that  states  could not  be  sanctioned  for non-compliance  with                                                               
Medicaid expansion in the Patient  Protection and Affordable Care                                                               
Act.    He relayed  that  in  the  past  there had  been  special                                                               
coverage  added  to provide  assistance  to  low income  Medicare                                                               
beneficiaries,  which  provided  premium support  to  a  slightly                                                               
broader range of Medicare beneficiaries.                                                                                        
                                                                                                                                
3:51:47 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON   reflected  that  this  amendment   would  require                                                               
legislative approval  of Medicaid expansion  as it was  after the                                                               
March 23, 2010 date in the amendment.                                                                                           
                                                                                                                                
3:52:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  STUTES asked  if there  was any  occasion to  add                                                               
additional groups other than if there was a federal mandate.                                                                    
                                                                                                                                
COMMISSIONER DAVIDSON expressed her agreement.                                                                                  
                                                                                                                                
3:52:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  said  that  there  had  been  discussion                                                               
regarding the  ability of  the executive  branch to  proceed with                                                               
expansion  of  Medicaid  into groups  that  were  not  previously                                                               
covered,  as there  was no  need for  legislative approval.   She                                                               
opined  that  the  proposed amendment  would  ensure  legislative                                                               
approval for  further fiscal responsibilities, and  would require                                                               
that  any  statement  by  DHSS  that  something  was  "absolutely                                                               
required by  federal statute"  would be  "fully vetted  and fully                                                               
examined by  the legislature."  She  declared that it was  a duty                                                               
of the legislature to appropriate money for programs.                                                                           
                                                                                                                                
REPRESENTATIVE STUTES  asked if there  had ever been  an occasion                                                               
that a  group had been  included when  it had not  been federally                                                               
directed.                                                                                                                       
                                                                                                                                
MR. SHERWOOD replied that current  statute required that addition                                                               
of any optional group had to  be approved by the legislature.  He                                                               
reported  that  the proposed  amendment  would  require that  the                                                               
addition of any  groups that were federally  mandated would still                                                               
have to be  approved by the legislature.  He  said that federally                                                               
mandated  groups   had  been  added   without  approval   of  the                                                               
legislature, and he  pointed out that it was  still necessary for                                                               
DHSS to receive budgetary authority from the legislature.                                                                       
                                                                                                                                
CHAIR SEATON  asked if those  mandated groups had been  narrow or                                                               
broad exceptions.                                                                                                               
                                                                                                                                
MR. SHERWOOD  explained that  the most  recent mandates  had been                                                               
narrow,  especially around  Medicare program  changes, which  had                                                               
shifted  coverage,  changed the  premium  and  co-pay costs,  and                                                               
included  protections  in the  Medicaid  program  for low  income                                                               
Medicare  beneficiaries.   He  reported that  there  had been  an                                                               
expansion of  mandatory coverage for children  and pregnant women                                                               
with higher incomes in the 1980s and early 1990s.                                                                               
                                                                                                                                
3:56:25 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  STUTES  asked  whether a  federal  mandate  would                                                               
supersede the  Alaska State Legislature,  as otherwise  a program                                                               
would be in jeopardy.                                                                                                           
                                                                                                                                
COMMISSIONER DAVIDSON expressed her agreement.                                                                                  
                                                                                                                                
3:57:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  said that  there had recently  been state                                                               
challenges  to the  federal government  with  regard to  Medicaid                                                               
expansion, resulting in a U.  S. Supreme Court determination that                                                               
the  federal government  could  not make  the  states expand  the                                                               
program.                                                                                                                        
                                                                                                                                
3:57:55 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  DAVIDSON replied  that she  was very  aware of  the                                                               
provision, and, as  it was not a required  coverage, the proposed                                                               
amendment was not necessary.                                                                                                    
                                                                                                                                
CHAIR SEATON explained that, as  the service was optional for the                                                               
expansion  population,  it  was   not  covered  by  the  proposed                                                               
amendment which only covered mandated  services.  He allowed that                                                               
it was  possible to entirely  drop Medicaid, putting  the program                                                               
at risk by  not accepting a mandatory service,  and he questioned                                                               
whether that was the desired outcome.                                                                                           
                                                                                                                                
REPRESENTATIVE TARR expressed  understanding that the legislature                                                               
should  be involved  in  the  funding, stating  that  it was  her                                                               
responsibility to  be a participant  in the budget  process which                                                               
provided  all  the  necessary  opportunities  to  ask  the  tough                                                               
questions,  delve  into  the budget  details,  and  question  any                                                               
requirements.                                                                                                                   
                                                                                                                                
3:59:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  said that the proposed  amendment did not                                                               
address mandatory  services, but instead addressed  the inclusion                                                               
of additional groups  or categories.  She stated  that there were                                                               
two  concepts,   the  mandatory  Medicaid  services   versus  the                                                               
optional  Medicaid  services,  with   expansion  of  the  program                                                               
through the addition of people,  and that was what this amendment                                                               
addressed.                                                                                                                      
                                                                                                                                
3:59:56 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:59 p.m. to 4:06 p.m.                                                                       
                                                                                                                                
4:06:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  STUTES asked  for  an explanation  to any  change                                                               
resulting from proposed Amendment 9.                                                                                            
                                                                                                                                
STACIE  KRALY,   Chief  Assistant  Attorney   General,  Statewide                                                               
Section  Supervisor,  Human   Services  Section,  Civil  Division                                                               
(Juneau), Department of Law, explained  that proposed Amendment 9                                                               
required  the Department  of Health  and Social  Services to  get                                                               
legislative  approval   to  add  additional   mandatory  eligible                                                               
individuals to the Medicaid program.   It was still necessary for                                                               
the department  to come  to the legislature  to add  any optional                                                               
eligible individuals to the Medicaid program.                                                                                   
                                                                                                                                
REPRESENTATIVE  STUTES   asked  if   this  requirement   was  for                                                               
federally mandated individuals.                                                                                                 
                                                                                                                                
4:07:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WOOL  asked  for clarification  that  these  were                                                               
people already covered under the expansion.                                                                                     
                                                                                                                                
COMMISSIONER  DAVIDSON explained  that this  would be  for groups                                                               
added after  March [March 23,  2010], and offered an  example for                                                               
an  addition  by  the  federal   Medicaid  program  of  mandatory                                                               
coverage for  a certain population.   As this  proposed amendment                                                               
would require  the Department of  Health and Social  Services, in                                                               
order to comply with federal law,  to first go to the legislature                                                               
for permission,  she opined that  the department would be  out of                                                               
compliance with federal law before the approval was granted.                                                                    
                                                                                                                                
4:08:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ said  that the  attorney [Ms.  Kraly] did                                                               
not answer the question.   She stated that the legislature should                                                               
know when  an additional  eligibility category  was added  to the                                                               
Medicaid program.                                                                                                               
                                                                                                                                
4:09:57 PM                                                                                                                    
                                                                                                                                
A  roll call  vote was  taken.   Representative Vazquez  voted in                                                               
favor of  Amendment 9,  labeled 29-GH1055\A.24,  Glover, 3/26/15.                                                               
Representatives  Foster, Stutes,  Wool,  Tarr,  and Seaton  voted                                                               
against it.  Therefore,  Amendment 9 failed by a vote  of 1 yea -                                                               
5 nays.                                                                                                                         
                                                                                                                                
4:10:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  moved to adopt Amendment  10, labeled 29-                                                               
GH1055\A.25, Nauman/Glover,  3/28/15, which read:   [Amendment 10                                                               
is provided at the end of these minutes]                                                                                        
                                                                                                                                
CHAIR SEATON objected for discussion.                                                                                           
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  explained  that the  proposed  amendment                                                               
created  a Medicaid  Task Force  to include  four representatives                                                               
appointed by  the Speaker of  the House of  Representatives, four                                                               
senators appointed  by the President  of the Senate,  four public                                                               
members selected by the governor  based on their knowledge of the                                                               
health care  systems of  the state, Medicaid,  and the  budget of                                                               
the state, and  the commissioner of the Department  of Health and                                                               
Social Services.   She said that the Task Force  was charged with                                                               
delivering  a report  to the  legislature  which included  policy                                                               
options and  recommendations to reduce costs  related to Medicaid                                                               
use   in  the   state;  and   recommendations,  including   draft                                                               
legislation,  to achieve  the policy  objective  proposed by  the                                                               
task  force.    She  said  that the  task  force  would  meet  as                                                               
frequently as  necessary, and  that it would  expire on  April 1,                                                               
2017.   She noted that  there would also be  a fiscal note.   She                                                               
opined that it was more critical  than ever to resurrect the idea                                                               
of a task force.                                                                                                                
                                                                                                                                
4:12:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE STUTES said that, although  she was not opposed to                                                               
a task force, 13 people was too  many as it would be difficult to                                                               
get them  all together.   She stated  that she could  not support                                                               
the proposed amendment as written.                                                                                              
                                                                                                                                
REPRESENTATIVE  FOSTER  offered  his belief  that  previous  task                                                               
forces had been created in separate, stand-alone bills.                                                                         
                                                                                                                                
4:13:19 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON  asked if  DHSS had  had success  with a  task force                                                               
studying Medicaid.                                                                                                              
                                                                                                                                
COMMISSIONER DAVIDSON  replied that  there had  been a  number of                                                               
Medicaid task forces or working  groups.  She referenced one that                                                               
had  met between  the  fall of  2010 and  spring  of 2011,  which                                                               
consisted of 12 members, including  8 legislators.  She said that                                                               
the final report  had identified about $20 million  in savings at                                                               
that time.   She said  that the number  of reform efforts  in the                                                               
current  proposed  bill  and the  subsequent  savings  identified                                                               
would  exceed those  task force  recommendations.   She  declared                                                               
that DHSS  welcomed all opportunities  to review  reform efforts.                                                               
She  reiterated  that  DHSS was  continually  building  upon  the                                                               
reforms  that  it had  already  undertaken.   She  reported  that                                                               
another  Medicaid  reform  advisory group  had  been  established                                                               
during the prior administration and  she listed the ten committee                                                               
members which  included two legislators, the  commissioner, and a                                                               
former  commissioner.   She relayed  that  the recommendation  of                                                               
that advisory  group had been  to forward the  recommendations to                                                               
the winner  of the RFP  that had  been issued, who  would include                                                               
the  national  reform efforts  and  engage  with stakeholders  to                                                               
bring the recommendations back to  DHSS and the legislature.  She                                                               
declared that further  reform efforts had been  undertaken by the                                                               
Alaska  Healthcare  Commission,  a  14  member  group  originally                                                               
established  by  executive  order   of  then  Governor  Palin  in                                                               
December, 2008,  and subsequently through  Senate Bill 172.   She                                                               
listed  some of  the  areas  for review  to  include health  care                                                               
delivery, reform, and  payment reform.  She  reiterated that DHSS                                                               
welcomed  any  and all  opportunities  to  reform, and  that  the                                                               
department  recommended for  this task  force to  be proposed  in                                                               
stand-alone legislation.                                                                                                        
                                                                                                                                
4:16:48 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL concurred with  the current reforms, reports,                                                               
and outside groups which had  already offered recommendations and                                                               
stated  that the  creation of  an additional  task force  was not                                                               
necessary at this time.                                                                                                         
                                                                                                                                
CHAIR SEATON  directed attention  to the already  existing Alaska                                                               
Healthcare  Commission, with  a similar  mission and  membership.                                                               
He questioned the cost for  an additional task force, and pointed                                                               
out that  the legislature would be  reviewing the recommendations                                                               
contained in the  proposed bill.  He maintained  his objection to                                                               
proposed Amendment 10.                                                                                                          
                                                                                                                                
4:18:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  said that  the report on  the possibility                                                               
of a  tax on state providers  for Medicaid was a  separate issue.                                                               
She offered  her belief that  the current task force  had expired                                                               
and that  this proposed amendment  would resurrect a  task force.                                                               
She declared  that it was now  even more critical in  the face of                                                               
the approaching $3.5 billion deficit.   She directed attention to                                                               
the 25  page single statewide  audit report dated June  30, 2014,                                                               
indicating  prior problems  which  had not  been  remedied.   She                                                               
offered her belief that it was  time for the department to "allow                                                               
some more fiscal accountability."                                                                                               
                                                                                                                                
4:19:54 PM                                                                                                                    
                                                                                                                                
A  roll call  vote was  taken.   Representative Vazquez  voted in                                                               
favor  of Amendment  10,  labeled 29-GH1055\A.25,  Nauman/Glover,                                                               
3/28/15.  Representatives Tarr,  Foster, Stutes, Wool, and Seaton                                                               
voted against it.  Therefore, Amendment  10 failed by a vote of 1                                                               
yea - 5 nays.                                                                                                                   
                                                                                                                                
4:21:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  moved to adopt Amendment  11, labeled 29-                                                               
GH1055\A.29, Gardner/Glover, 3/27/15, which read:                                                                               
                                                                                                                                
     Page 1, line 5, through page 2, line 13:                                                                                   
          Delete all material and insert:                                                                                       
        "* Section 1. The uncodified law of the State of                                                                    
     Alaska is amended by adding a new section to read:                                                                         
          MEDICAL ASSISTANCE REFORM: LEGISLATIVE FINDINGS                                                                       
     AND INTENT. (a) The legislature finds that                                                                                 
               (1)  the current Medicaid program is not                                                                         
     sustainable;                                                                                                               
               (2)  improving the delivery of health care                                                                       
     services to Alaskans  requires state government, health                                                                    
     care  providers, patient  advocates, and  other parties                                                                    
     interested in  high-quality, affordable health  care to                                                                    
     collaborate to                                                                                                             
               (A)  increase the availability of high-                                                                          
     quality health care to Alaskans;                                                                                           
               (B)  provide greater value for state general                                                                     
       fund dollars spent on the state medical assistance                                                                       
     program;                                                                                                                   
               (C)  reduce health care costs;                                                                                   
               (D)      provide  incentives   to   encourage                                                                    
     Alaskans  to  take  greater  responsibility  for  their                                                                    
     personal health;                                                                                                           
               (E)    reduce  or minimize  the  shifting  of                                                                    
     payment for unreimbursed health  care costs to patients                                                                    
     with health insurance;                                                                                                     
               (3)  providing greater  value for the general                                                                    
     fund  dollars spent  on  the  state medical  assistance                                                                    
     program  requires  considering options  for  delivering                                                                    
     services  in   a  more  efficient   and  cost-effective                                                                    
     manner, including, but not limited to,                                                                                     
               (A)  offering  incentives to encourage health                                                                    
     care  providers   to  achieve   measurable  performance                                                                    
     outcomes;                                                                                                                  
               (B)    improving  the  coordination  of  care                                                                    
     among  health care  providers  who  participate in  the                                                                    
     medical assistance program;                                                                                                
               (C)        reducing   preventable    hospital                                                                    
     readmissions; and                                                                                                          
               (D)  exploring  methods of medical assistance                                                                    
     reimbursement   that  promote   quality  of   care  and                                                                    
     efficiencies;                                                                                                              
               (4)  it is  important to implement additional                                                                    
     fraud,  waste,  and  abuse safeguards  to  protect  and                                                                    
     preserve  the  integrity   and  sustainability  of  the                                                                    
     medical assistance program;                                                                                                
               (5)   state policymakers have an  interest in                                                                    
     testing  the effectiveness  of  wellness incentives  in                                                                    
     order  to collect  and  analyze  information about  the                                                                    
     correlation  between  wellness  incentives  and  health                                                                    
     status;                                                                                                                    
               (6)  the  purposes of this Act  are to modify                                                                    
     and enhance the state's  health care delivery system to                                                                    
     provide access to  high-quality, affordable health care                                                                    
     for all citizens of the state.                                                                                             
          (b)  It is the intent of the legislature that the                                                                     
     Department of  Health and Social Services  maximize the                                                                    
     use of  existing resources  in administering  the state                                                                    
     medical assistance program."                                                                                               
                                                                                                                                
                                                                                                                                
CHAIR SEATON objected for discussion.                                                                                           
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  explained  that the  proposed  amendment                                                               
changed Section 1  of the proposed bill,  "removing statements of                                                               
reduced  annual growth  from 6.45  to 4.8  percent, also  removes                                                               
governor  from the  section and  emphasizing minimizing  wasteful                                                               
spending, fraud,  and best utilization of  general fund dollars."                                                               
It   "changes  legislative   intent  language   to  ensure   more                                                               
meaningful  reform efforts  are  stressed and  undertaken."   She                                                               
declared  that  the  proposed  amendment  was  "more  definitive,                                                               
especially in the reform side."                                                                                                 
                                                                                                                                
COMMISSIONER DAVIDSON offered a  recommendation that the language                                                               
of the  proposed amendment be  added to the existing  language in                                                               
the intent  so that all  of the  intent language in  the existing                                                               
bill would  capture the  successes of the  department as  well as                                                               
the vision for reform efforts.   She expressed a concern that the                                                               
proposed amendment would delete  existing language which directed                                                               
DHSS  to consult  with  stakeholders and  provide  a proposal  to                                                               
authorize  a  provider  tax,   recommending  that  the  provision                                                               
regarding the provider tax remain in the proposed bill.                                                                         
                                                                                                                                
4:24:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ,  in response  to Chair Seaton,  said that                                                               
she would  entertain an amendment  to include cost  sharing plans                                                               
and  utilization  in  the  intent  language of  Section  1.    In                                                               
response to Chair Seaton's question  for inclusion of the section                                                               
regarding a provider  tax, as recommended by DHSS,  she said that                                                               
she would object to that.   She reiterated that she would support                                                               
[an amendment]  for cost sharing,  but she would  oppose addition                                                               
of  a provision  for  DHSS  to submit  a  proposal authorizing  a                                                               
provider tax.                                                                                                                   
                                                                                                                                
4:25:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  relayed that  she was very  comfortable with                                                               
the original legislative intent  language, which she declared was                                                               
more  specific   to  the  reforms   that  were   currently  being                                                               
undertaken by  DHSS.  She  pointed out that an  amendment related                                                               
to the provider tax proposal had  just been adopted.  She offered                                                               
her  belief that  it seemed  inconsistent  to remove  it from  an                                                               
earlier part of the proposed bill.                                                                                              
                                                                                                                                
CHAIR  SEATON  explained his  objection  that,  as reforms  could                                                               
include a Medicaid  provider tax, or at the  least the initiation                                                               
of a  discussion for this  tax, discussion of  cost differentials                                                               
could  not ignore  revenue sources.   He  expressed concern  that                                                               
page  2,  lines  5  -  9,   of  the  proposed  bill  discussed  a                                                               
requirement  to  evaluate  options  for waivers,  which  was  not                                                               
included  in   the  proposed  amendment.     He   maintained  his                                                               
objection.                                                                                                                      
                                                                                                                                
REPRESENTATIVE VAZQUEZ said that she would not object to the                                                                    
inclusion, specifically, of waivers.                                                                                            
                                                                                                                                
CHAIR SEATON maintained his objection.                                                                                          
                                                                                                                                
4:27:55 PM                                                                                                                    
                                                                                                                                
A  roll call  vote was  taken.   Representative Vazquez  voted in                                                               
favor  of Amendment  11, labeled  29-GH1055\A.29, Gardner/Glover,                                                               
3/27/15.  Representatives Wool,  Tarr, Foster, Stutes, and Seaton                                                               
voted against it.  Therefore, Amendment  11 failed by a vote of 1                                                               
yea - 5 nays.                                                                                                                   
                                                                                                                                
4:29:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ moved to adopt Amendment 12, labeled 29-                                                                 
GH1055\A.33, Strasbaugh/Glover, 3/28/15, which read:                                                                            
                                                                                                                                
     Page 7, following line 9:                                                                                                  
     Insert a new bill section to read:                                                                                         
        "* Sec. 8. AS 47.07.020(l) is amended to read:                                                                      
          (l) Notwithstanding the eligibility provisions                                                                        
     under (a)  and (b)  of this section,  a person  may not                                                                    
     receive  medical assistance  under this  section unless                                                                    
     the person first enrolls in  the Medicare program under                                                                    
     42 U.S.C.  1395 and any other  federally funded program                                                                
     providing  medical assistance  to the  extent that  the                                                                
     person  is eligible  to receive  benefits and  services                                                                    
     under   the  program.   The   department  shall   adopt                                                                
     regulations    establishing    civil   penalties    for                                                                
     individuals   who   receive   medical   assistance   in                                                                
     violation of this subsection."                                                                                         
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 9, line 12:                                                                                                           
          Delete "sec. 10"                                                                                                      
          Insert "sec. 11"                                                                                                      
                                                                                                                                
     Page 9, line 17:                                                                                                           
          Delete "10"                                                                                                           
          Insert "11"                                                                                                           
                                                                                                                                
     Page 9, line 23:                                                                                                           
          Delete "Sections 13 and 14"                                                                                           
          Insert "Sections 14 and 15"                                                                                           
                                                                                                                                
     Page 9, line 24:                                                                                                           
          Delete "by sec. 16"                                                                                                   
          Insert "in sec. 17"                                                                                                   
                                                                                                                                
                                                                                                                                
CHAIR SEATON objected for discussion.                                                                                           
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  explained  that the  proposed  amendment                                                               
clarified  that  the  Medicaid  program was  the  payer  of  last                                                               
resort, and directing attention to lines 5 - 10, she read:                                                                      
                                                                                                                                
     unless  the  person  first   enrolls  in  the  Medicare                                                                    
     program under  42 U.S.C. 1395  and any  other federally                                                                    
     funded  program  providing  medical assistance  to  the                                                                    
     extent that the person  is eligible to receive benefits                                                                    
     and services  under the program.   The department shall                                                                    
     adopt  regulations  establishing  civil  penalties  for                                                                    
     individuals   who   receive   medical   assistance   in                                                                    
     violation of this subsection.                                                                                              
                                                                                                                                
REPRESENTATIVE  VAZQUEZ explained  that any  individual qualified                                                               
to receive  Medicare program  benefits needed  to first  apply to                                                               
the Medicare program.   She stated that the  department needed to                                                               
establish  regulations and  civil penalties  for individuals  who                                                               
did not comply.                                                                                                                 
                                                                                                                                
4:31:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  said that  Alaska was  currently spending                                                               
$1.6  billion  on Medicaid,  reiterating  that  Medicaid was  the                                                               
payer  of last  resort.   She stated  that, as  this was  "a very                                                               
fiscally  minded, responsible  type of  amendment," it  should be                                                               
adopted.                                                                                                                        
                                                                                                                                
COMMISSIONER DAVIDSON relayed  that, as it was  already a federal                                                               
requirement  that Medicaid  was  the payer  of  last resort,  the                                                               
department  did  not  feel  that   this  proposed  amendment  was                                                               
necessary.    She explained  that,  in  Alaska, individuals  were                                                               
required to  pursue other coverage.   She stated that  fines were                                                               
not   necessary,  as   DHSS  had   the  authority   to  terminate                                                               
individuals from  the Medicaid program  if the individual  was in                                                               
violation.   She  expressed  concern with  the  statement in  the                                                               
proposed  amendment  for  "any  other  federally  funded  program                                                               
providing  medical assistance"  receiving benefits  and services,                                                               
pointing  out  that  there were  individuals  who  were  Medicaid                                                               
beneficiaries  who had  access to  clinics [funded  under Section                                                               
330 of the  Public Health Service Act] which  were not considered                                                               
coverage,  as well  as individuals  eligible to  receive services                                                               
from a  Veterans' Administration (VA) facility,  an Indian Health                                                               
Service  (IHS)   facility,  or  other  federal   programs.    She                                                               
reiterated  that Medicaid  was already  federally required  to be                                                               
the payer of last resort.                                                                                                       
                                                                                                                                
CHAIR  SEATON  asked if  people  were  required  to sign  up  for                                                               
Medicare prior to receiving Medicaid.                                                                                           
                                                                                                                                
MR. SHERWOOD stated  that anyone eligible for  Medicare needed to                                                               
first apply for  it, as a condition of  eligibility for Medicaid.                                                               
If an individual was otherwise  eligible for Medicaid, they would                                                               
receive it as they were  in the application process for Medicare,                                                               
and  anyone  receiving  Medicaid  who  aged  into  Medicare  were                                                               
required to enroll in it.                                                                                                       
                                                                                                                                
REPRESENTATIVE TARR expressed her  concern for the recommendation                                                               
of civil  penalties in the  proposed amendment.  She  offered her                                                               
understanding  that an  individual who  knowingly had  fraudulent                                                               
action was prohibited from enrolling in Medicaid.                                                                               
                                                                                                                                
COMMISSIONER DAVIDSON expressed her agreement.                                                                                  
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  declared  that termination  of  Medicaid                                                               
benefits  was  "probably more  draconian  than  imposing a  civil                                                               
penalty."   She  stated that  Medicare  would often  not pay  for                                                               
something,  whereas  Medicaid would  pay.    She asked  that  the                                                               
regulations for this be cited.                                                                                                  
                                                                                                                                
MR. SHERWOOD  reported that it was  under 7 AAC 160.200,  and the                                                               
cooperation with third party liability was 7 AAC 100.034.                                                                       
                                                                                                                                
REPRESENTATIVE   VAZQUEZ  asked   for   clarification  that   the                                                               
regulation stated that an individual shall be terminated.                                                                       
                                                                                                                                
4:37:51 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON asked  if there was a problem  with elderly veterans                                                               
not receiving veterans' benefits.                                                                                               
                                                                                                                                
COMMISSIONER DAVIDSON  replied that  this was a  possibility with                                                               
the proposed amendment,  as an individual who did  not pursue the                                                               
coverage   as  required   and  then   enrolled   as  a   Medicaid                                                               
beneficiary, could face civil penalties.   She reported that many                                                               
veterans  in  rural  communities  had not  applied  for  veterans                                                               
benefits,  and she  noted that  the Veterans'  Administration was                                                               
working to enroll veterans.                                                                                                     
                                                                                                                                
4:39:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE STUTES  asked if there was  a questionnaire during                                                               
enrollment for  Medicaid that would reveal  eligibility for other                                                               
benefits.  She offered her belief  that, as a civil penalty would                                                               
go  unpaid by  the majority  of people  eligible for  Medicaid, a                                                               
"larger hammer" was for the loss of benefits.                                                                                   
                                                                                                                                
MR.  SHERWOOD   expressed  his  agreement,  and   clarified  that                                                               
cooperation with third party resources  was a federal requirement                                                               
and a condition of eligibility.   He shared that 7 AAC 100.034(d)                                                               
was the  statute containing the  aforementioned language  to deny                                                               
or  terminate,   although  it  did  provide   certain  exceptions                                                               
consistent with federal law for when there was not enforcement.                                                                 
                                                                                                                                
4:41:06 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON maintained his objection.                                                                                          
                                                                                                                                
REPRESENTATIVE VAZQUEZ  said that  regulations can be  changed or                                                               
deleted by  the department  after certain  procedures.   She said                                                               
that she  would entertain  a conceptual  amendment to  delete the                                                               
civil  penalty provision.   She  offered her  belief that  it was                                                               
especially  critical in  these fiscal  times to  ensure that  the                                                               
state was the payer of last resort.                                                                                             
                                                                                                                                
4:42:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  STUTES  asked  for   clarification  that  it  was                                                               
federally required that the department  exhaust all other sources                                                               
and that Medicaid was the payer of last resort.                                                                                 
                                                                                                                                
COMMISSIONER DAVIDSON expressed her agreement.                                                                                  
                                                                                                                                
REPRESENTATIVE  VAZQUEZ   asked  if  this  was   simply  a  state                                                               
regulation and not a statute.                                                                                                   
                                                                                                                                
COMMISSIONER DAVIDSON replied  that it was a  state regulation in                                                               
compliance with federal law.                                                                                                    
                                                                                                                                
REPRESENTATIVE   VAZQUEZ   asked  who   "promulgates   department                                                               
regulations."                                                                                                                   
                                                                                                                                
COMMISSIONER  DAVIDSON replied  that  the department  promulgated                                                               
regulations   by  publishing   them,   receiving  feedback   from                                                               
individual stakeholders, and then making a final determination.                                                                 
                                                                                                                                
CHAIR  SEATON declared  that every  regulation would  not be  put                                                               
into statute.   He pointed out that there were  two processes and                                                               
that both were effective.                                                                                                       
                                                                                                                                
4:43:38 PM                                                                                                                    
                                                                                                                                
A  roll call  vote was  taken.   Representative Vazquez  voted in                                                               
favor     of     Amendment    12,     labeled     29-GH1055\A.33,                                                               
Strasbaugh/Glover, 3/28/15.   Representatives Wool, Tarr, Foster,                                                               
Stutes, and  Seaton voted  against it.   Therefore,  Amendment 12                                                               
failed by a vote of 1 yea - 5 nays.                                                                                             
                                                                                                                                
4:44:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  explained  that  proposed  Amendment  13                                                               
restricted services  for the [Medicaid]  expansion group  to only                                                               
the nine  mandatory services,  and not  the 27  optional Medicaid                                                               
services,  which included  transportation and  chiropractic care.                                                               
It also required a report describing  the state costs for each of                                                               
the optional services.                                                                                                          
                                                                                                                                
4:45:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  moved to adopt Amendment  13, labeled 29-                                                               
GH1055\A.34, Strasbaugh/Glover, 3/28/15, which read:                                                                            
                                                                                                                                
     Page 7, following line 15:                                                                                                 
     Insert a new bill section to read:                                                                                         
        "*  Sec. 9.  AS 47.07.030 is  amended by  adding new                                                                
     subsections to read:                                                                                                       
          (g)  Notwithstanding (b) - (e) of this section,                                                                       
     for  individuals  described under  AS 47.07.020(b)(16),                                                                    
     the  department  shall  offer only  mandatory  services                                                                    
     required   under  42   U.S.C.   1396a(k)  and   federal                                                                    
     regulations implementing that section.                                                                                     
          (h)  The department shall annually prepare a                                                                          
     report  describing   state  costs  for   each  optional                                                                    
     service  provided under  this  section. The  department                                                                    
     shall deliver  the report to  the senate  secretary and                                                                    
     the clerk  of the  house of representatives  and notify                                                                    
     the legislature that the report is available."                                                                             
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 9, line 12:                                                                                                           
          Delete "sec. 10"                                                                                                      
          Insert "sec. 11"                                                                                                      
                                                                                                                                
     Page 9, line 17:                                                                                                           
          Delete "10"                                                                                                           
          Insert "11"                                                                                                           
                                                                                                                                
     Page 9, line 23:                                                                                                           
          Delete "Sections 13 and 14"                                                                                           
          Insert "Sections 14 and 15"                                                                                           
                                                                                                                                
     Page 9, line 24:                                                                                                           
          Delete "by sec. 16"                                                                                                   
          Insert "in sec. 17"                                                                                                   
                                                                                                                                
                                                                                                                                
REPRESENTATIVE WOOL objected for discussion.                                                                                    
                                                                                                                                
4:45:25 PM                                                                                                                    
                                                                                                                                
COMMISSIONER   DAVIDSON  offered   her  understanding   that  the                                                               
proposed amendment  would "carve out  a new benefit plan  for the                                                               
[Medicaid]  expansion  population."   She  opined  that it  would                                                               
limit 42 U.S.C.  1396a(k), a benchmark plan, and  would not cover                                                               
dental, vision,  and hearing.   She pointed  out that  these were                                                               
generally  covered as  optional benefits  under Alaska  Medicaid.                                                               
She  explained  that,  as they  were  preventive  services,  they                                                               
prevented more  costly, additional, emergency room  services, and                                                               
they benefited people  seeking employment.  She  declared that it                                                               
was  necessary  to see  and  hear  what employers  and  customers                                                               
asked.   She explained that  optional dental services  were added                                                               
to the Medicaid  program as it was incredibly  challenging to get                                                               
a job  if you had poor  teeth.  She reiterated  that the Medicaid                                                               
expansion population would mirror  the existing Medicaid program,                                                               
so  there  would  be  an immediate  opportunity  to  receive  the                                                               
additional federal revenue of $390,000  each day with 100 percent                                                               
federal match.   She said that  the time to design  a new benefit                                                               
plan  would not  be in  the department's  current capacity.   She                                                               
declared that the expansion group  would follow implementation of                                                               
the reform efforts.                                                                                                             
                                                                                                                                
CHAIR  SEATON asked  if some  of  the optional  services were  in                                                               
place because  it was  cheaper to  provide the  necessary service                                                               
through  optional waivers,  instead  of a  higher  level of  care                                                               
through   the  mandatory   institutional  services   which  would                                                               
increase the cost.                                                                                                              
                                                                                                                                
COMMISSIONER  DAVIDSON  expressed   agreement,  noting  that  in-                                                               
facility  care   was  a  mandatory  service,   whereas  home  and                                                               
community  based services  were  optional  services that  allowed                                                               
individuals to remain at home and  in their communities, and at a                                                               
much lower cost.                                                                                                                
                                                                                                                                
4:48:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL maintained his objection.                                                                                   
                                                                                                                                
A roll call  vote was taken.  Representatives  Stutes and Vazquez                                                               
voted  in   favor  of   Amendment  13,   labeled  29-GH1055\A.34,                                                               
Strasbaugh/Glover, 3/28/15.   Representatives Tarr, Foster, Wool,                                                               
and Seaton voted  against it.  Therefore, Amendment  13 failed by                                                               
a vote of 2 yeas - 4 nays.                                                                                                      
                                                                                                                                
4:49:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  moved to adopt Amendment  14, labeled 29-                                                               
GH1055\A.36, Glover, 3/28/15, which read:                                                                                       
                                                                                                                                
     Page 7, line 9, following "regulations.":                                                                                  
          Insert   "The   department   may   only   consider                                                                
     information  provided   by  a  person   claiming  undue                                                                
     hardship that the department  verifies through a source                                                                
     other than the person's own statement."                                                                                
                                                                                                                                
     Page 7, following line 15:                                                                                                 
          Insert a new bill section to read:                                                                                    
        "* Sec. 9.  AS 47.07.020 is amended by  adding a new                                                                
     subsection to read:                                                                                                        
          (o)  The department shall prepare a report that                                                                       
     describes the  total amount that has  been recovered or                                                                    
     saved by the ineligibility  period imposed under (m) of                                                                    
     this  section  and  the total  amount  excluded  for  a                                                                    
     transfer  of assets  below fair  market  value under  a                                                                    
     hardship  waiver  under (g)  of  this  section for  the                                                                    
     previous calendar year. On or  before January 1 of each                                                                    
     year, the  department shall deliver  the report  to the                                                                    
     senate secretary  and the chief  clerk of the  house of                                                                    
     representatives  and notify  the  legislature that  the                                                                    
     report is available."                                                                                                      
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 9, line 12:                                                                                                           
          Delete "sec. 10"                                                                                                      
          Insert "sec. 11"                                                                                                      
                                                                                                                                
     Page 9, line 17:                                                                                                           
          Delete "10"                                                                                                           
          Insert "11"                                                                                                           
                                                                                                                                
     Page 9, line 23:                                                                                                           
          Delete "Sections 13 and 14"                                                                                           
          Insert "Sections 14 and 15"                                                                                           
                                                                                                                                
     Page 9, line 24:                                                                                                           
          Delete "by sec. 16"                                                                                                   
          Insert "in sec. 17"                                                                                                   
                                                                                                                                
CHAIR SEATON objected for discussion.                                                                                           
                                                                                                                                
REPRESENTATIVE VAZQUEZ  read from  the proposed amendment:   "The                                                               
department  may only  consider information  provided by  a person                                                               
claiming undue  hardship that the  department verifies  through a                                                               
source other  than the  person's own statement."   She  said that                                                               
currently  DHSS could  take a  person's statement  at face  value                                                               
that they would  experience hardship.  She went on  to state that                                                               
the proposed  amendment also required  the department  to prepare                                                               
and submit  a report on  the savings from the  eligibility period                                                               
excluding the transfer  of assets on or before January  1 of each                                                               
year.   She  explained  that this  applied to  the  assets of  an                                                               
individual  who was  receiving Medicaid  benefits  for long  term                                                               
care,  and would  assist the  state in  recovering assets  to pay                                                               
back the Medicaid program.                                                                                                      
                                                                                                                                
4:51:29 PM                                                                                                                    
                                                                                                                                
MR. SHERWOOD directed attention to page  1, lines 2 - 4, which he                                                               
declared was  consistent with department practice,  and, although                                                               
it was not an explicit  requirement, the department generally did                                                               
verify hardship.   He stated that the penalties  applied to cases                                                               
where  individuals  were  seeking   long  term  care,  and  other                                                               
individuals were  familiar with the  situation and the care.   He                                                               
suggested  that a  caveat to  the report  would be  that, as  the                                                               
penalty for a transfer of an  asset was a period of ineligibility                                                               
for  services, there  would  not  be any  billing  or payment  of                                                               
services.   He said that  any savings  would only be  an estimate                                                               
and not an  actual savings, as there was not  necessarily any way                                                               
to determine the actual expenses during the ineligibility.                                                                      
                                                                                                                                
CHAIR SEATON acknowledged  that there were a lot  of reports, and                                                               
he was  not convinced  that there  would be a  gain for  any real                                                               
information  from  the report.    He  moved to  adopt  conceptual                                                               
Amendment 1  to proposed  Amendment 14:   Page  1, delete  line 6                                                               
through Page  2, line 10.   He stated that this  would delete the                                                               
report  which  he   opined  would  be  somewhat   costly  and  an                                                               
administrative  burden   that  would   not  offer   any  valuable                                                               
information.    He  expressed  his agreement  with  the  rest  of                                                               
proposed Amendment 14.                                                                                                          
                                                                                                                                
REPRESENTATIVE VAZQUEZ objected  to proposed conceptual Amendment                                                               
1 of Amendment 14, opining that  "it would be very helpful to the                                                               
legislature to see what endeavors are being made in this arena."                                                                
                                                                                                                                
4:54:26 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON offered  his belief  that there  was nothing  to be                                                               
gained and that it would just cost money for the report.                                                                        
                                                                                                                                
REPRESENTATIVE  TARR  expressed  her  support  for  the  proposed                                                               
amendment with  the conceptual amendment,  noting that  there was                                                               
not a lot  of help to be  gained from a report  of estimated cost                                                               
savings.                                                                                                                        
                                                                                                                                
4:55:27 PM                                                                                                                    
                                                                                                                                
A roll call vote was  taken.  Representatives Wool, Tarr, Foster,                                                               
Stutes, and  Seaton voted in  favor of Conceptual Amendment  1 to                                                               
Amendment  14.     Representative   Vazquez  voted   against  it.                                                               
Therefore, Conceptual  Amendment 1  to Amendment  14 passed  by a                                                               
vote of 5 yeas - 1 nay.                                                                                                         
                                                                                                                                
4:56:13 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON removed  his objection to proposed  Amendment 14, as                                                               
amended.    There  being  no  further  objection,  Amendment  14,                                                               
labeled   29-GH1055\A.36,  Glover,   3/28/15,  as   amended,  was                                                               
adopted.                                                                                                                        
                                                                                                                                
4:56:51 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON said that HB 148 would be held over.                                                                               
                                                                                                                                
                           AMENDMENTS                                                                                         
                                                                                                                                
The  following amendments  to  HB 148  were  either discussed  or                                                               
adopted during the hearing.   [Shorter amendments are provided in                                                               
the main text only.]                                                                                                            
                                                                                                                                
                                                                                                                                
Amendment 8, labeled 29-GH1055\A.20, Glover, 3/25/15, which                                                                     
read:                                                                                                                           
                                                                                                                                
     Page 2, line 13, following "program":                                                                                      
          Insert ";                                                                                                             
               (4)  the  Department  of  Health  and  Social                                                                    
     Services  shall establish  prevention of  disease as  a                                                                    
     primary  model   of  health  care  in   the  state,  as                                                                    
     requested by the legislature  in Legislative Resolve 16                                                                    
     of the Twenty-Seventh Alaska State Legislature"                                                                            
                                                                                                                                
     Page 2, following line 16:                                                                                                 
     Insert a new bill section to read:                                                                                         
        "* Sec. 3. AS 47.05.010 is amended to read:                                                                         
          Sec. 47.05.010. Duties of department. The                                                                           
     Department of Health and Social Services shall                                                                             
               (1)  administer  adult public assistance, the                                                                    
     Alaska  temporary  assistance  program, and  all  other                                                                    
     assistance programs,  and receive and spend  money made                                                                    
     available to it;                                                                                                           
               (2)    adopt  regulations necessary  for  the                                                                    
     conduct of  its business  and for carrying  out federal                                                                    
     and  state  laws   granting  adult  public  assistance,                                                                    
     temporary  cash  assistance,   diversion  payments,  or                                                                    
     self-sufficiency services for  needy families under the                                                                    
     Alaska   temporary   assistance  program,   and   other                                                                    
     assistance;                                                                                                                
               (3)      establish  minimum   standards   for                                                                    
     personnel   employed  by   the  department   and  adopt                                                                    
     necessary regulations to maintain those standards;                                                                         
               (4)   require  those  bonds and  undertakings                                                                    
     from persons employed by it  that, in its judgment, are                                                                    
     necessary, and pay the premiums on them;                                                                                   
               (5)   cooperate  with the  federal government                                                                    
     in  matters  of  mutual  concern  pertaining  to  adult                                                                    
     public  assistance,  the  Alaska  temporary  assistance                                                                    
     program, and other forms of public assistance;                                                                             
               (6)    make  the  reports, in  the  form  and                                                                    
     containing   the   information,    that   the   federal                                                                    
     government from time to time requires;                                                                                     
               (7)   cooperate with the  federal government,                                                                    
     its  agencies,  or instrumentalities  in  establishing,                                                                    
     extending,   and   strengthening   services   for   the                                                                    
     protection  and   care  of  homeless,   dependent,  and                                                                    
     neglected  children in  danger of  becoming delinquent,                                                                    
     and  receive   and  expend   funds  available   to  the                                                                    
     department  by the  federal government,  the state,  or                                                                    
     its political subdivisions for that purpose;                                                                               
               (8)  cooperate with the federal government                                                                       
     in adopting state plans to  make the state eligible for                                                                    
     federal   matching   in   appropriate   categories   of                                                                    
     assistance,  and  in  all matters  of  mutual  concern,                                                                    
     including  adoption of  the  methods of  administration                                                                    
     that  are  found  by  the   federal  government  to  be                                                                    
     necessary  for  the   efficient  operation  of  welfare                                                                    
     programs;                                                                                                                  
               (9)  adopt regulations, not inconsistent                                                                         
     with law, defining need,  prescribing the conditions of                                                                    
     eligibility for assistance,  and establishing standards                                                                    
     for  determining  the  amount  of  assistance  that  an                                                                    
     eligible person  is entitled to receive;  the amount of                                                                    
     the assistance  is sufficient when, added  to all other                                                                    
     income  and resources  available to  an individual,  it                                                                    
     provides the  individual with a  reasonable subsistence                                                                    
     compatible  with health  and well-being;  an individual                                                                    
     who   meets  the   requirements  for   eligibility  for                                                                    
     assistance  shall be  granted  the assistance  promptly                                                                    
     upon application for it;                                                                                                   
               (10)  grant to a person claiming or                                                                              
     receiving assistance  and who  is aggrieved  because of                                                                    
     the department's  action or failure to  act, reasonable                                                                    
     notice and  an opportunity  for a  fair hearing  by the                                                                    
     office of  administrative hearings  (AS 44.64.010), and                                                                    
     the  department  shall  adopt regulations  relative  to                                                                    
     this;                                                                                                                      
               (11)  enter into reciprocal agreements with                                                                      
     other  states relative  to  public assistance,  welfare                                                                    
     services,  and institutional  care that  are considered                                                                    
     advisable;                                                                                                                 
               (12)      establish   the   requirements   of                                                                    
     residence for public  assistance, welfare services, and                                                                    
     institutional  care  that   are  considered  advisable,                                                                    
     subject to the limitations of  other laws of the state,                                                                    
     or law or regulation  imposed as conditions for federal                                                                    
     financial participation;                                                                                                   
               (13)  establish the divisions and local                                                                          
     offices that  are considered necessary or  expedient to                                                                    
     carry  out  a duty  or  authority  assigned to  it  and                                                                    
     appoint and  employ the  assistants and  personnel that                                                                    
     are necessary  to carry  on the  work of  the divisions                                                                    
     and   offices,  and   fix  the   compensation  of   the                                                                    
     assistants or  employees, except that a  person engaged                                                                    
     in business as a  retail vendor of general merchandise,                                                                    
     or a member of the immediate  family of a person who is                                                                    
     so engaged, may  not serve as an  acting, temporary, or                                                                    
     permanent  local agent  of the  department, unless  the                                                                    
     commissioner  of health  and social  services certifies                                                                    
     in  writing  to  the  governor,   with  relation  to  a                                                                    
     particular  community, that  no other  qualified person                                                                    
     is  available  in  the  community  to  serve  as  local                                                                    
     welfare agent;  for the purposes  of this  paragraph, a                                                                    
     "member  of the  immediate family"  includes a  spouse,                                                                    
     child,   parent,    brother,   sister,   parent-in-law,                                                                    
     brother-in-law, or sister-in-law;                                                                                          
               (14)  provide education and health-related                                                                       
     services and  referrals designed  to reduce  the number                                                                    
     of  out-of-wedlock   pregnancies  and  the   number  of                                                                    
     induced pregnancy terminations in the state;                                                                               
               (15)  investigate reports of abuse, neglect,                                                                     
     or  misappropriation  of  property by  certified  nurse                                                                    
     aides in  facilities licensed  by the  department under                                                                    
     AS 47.32;                                                                                                                  
               (16)  establish state policy relating to and                                                                     
     administer  federal programs  subject to  state control                                                                    
     as  provided  under  42 U.S.C.  3001  -  3058ee  (Older                                                                    
     Americans  Act  of  1965),   as  amended,  and  related                                                                    
     federal regulations;                                                                                                       
               (17)  administer the older Alaskans service                                                                      
     grants  under AS 47.65.010  - 47.65.050  and the  adult                                                                    
     day  care   and  family   respite  care   grants  under                                                                    
     AS 47.65.100;                                                                                                          
               (18)   establish   guidelines   for   medical                                                                
     assistance  providers to  develop health  care delivery                                                                
     models  that encourage  adequate nutrition  and disease                                                                
     prevention."                                                                                                           
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 9, line 12:                                                                                                           
          Delete "sec. 10"                                                                                                      
          Insert "sec. 11"                                                                                                      
                                                                                                                                
     Page 9, line 17:                                                                                                           
          Delete "10"                                                                                                           
          Insert "11"                                                                                                           
                                                                                                                                
     Page 9, line 23:                                                                                                           
          Delete "Sections 13 and 14"                                                                                           
          Insert "Sections 14 and 15"                                                                                           
                                                                                                                                
     Page 9, line 24:                                                                                                           
          Delete "by sec. 16"                                                                                                   
          Insert "in sec. 17"                                                                                                   
                                                                                                                                
                                                                                                                                
Amendment 10, labeled 29-GH1055\A.25, Nauman/Glover, 3/28/15,                                                                   
which read:                                                                                                                     
                                                                                                                                
     Page 1, line 3, following "Services;":                                                                                   
          Insert "creating the Medicaid Task Force;"                                                                          
                                                                                                                                
     Page 9, following line 3:                                                                                                  
          Insert a new bill section to read:                                                                                    
        "*  Sec. 13.  The  uncodified law  of  the State  of                                                                
     Alaska is amended by adding a new section to read:                                                                         
          MEDICAID TASK FORCE. (a) The Medicaid Task Force                                                                    
     is  created  in  the  legislature for  the  purpose  of                                                                    
     making  recommendations  for   potential  cost  savings                                                                    
     related to the medical assistance program.                                                                               
          (b) The task force consists of 13 members as                                                                          
     follows:                                                                                                                   
               (1) four senators selected by the president                                                                      
     of  the  senate based  on  their  knowledge of  health,                                                                    
     finance, and budgetary issues;                                                                                             
               (2) four representatives selected by the                                                                         
     speaker  of  the  house of  representatives,  based  on                                                                    
     their  knowledge  of  health,  finance,  and  budgetary                                                                    
     issues;                                                                                                                    
               (3) the commissioner of health and social                                                                        
     services;                                                                                                                  
               (4) four public members selected by the                                                                          
     governor based  on their knowledge  of the  health care                                                                    
     systems of the  state, Medicaid, and the  budget of the                                                                    
     state.                                                                                                                     
          (c) The task force shall, not later than                                                                              
     February 1 each  year, deliver a  report to  the senate                                                                    
     secretary   and   chief   clerk   of   the   house   of                                                                    
     representatives  and notify  the  legislature that  the                                                                    
     report is available. The report must include                                                                               
               (1) policy options and recommendations to                                                                        
     reduce costs related to Medicaid use in the state;                                                                         
               (2)    recommendations,    including    draft                                                                    
     legislation, to achieve  the policy objectives proposed                                                                    
     by the task force.                                                                                                         
          (d)  The task force shall meet as frequently as                                                                       
     necessary  and   may  meet  between  sessions   of  the                                                                    
     legislature to carry out its responsibilities.                                                                             
          (e)  The speaker of the house of representatives                                                                      
     and the  president of the senate  shall jointly appoint                                                                    
     the chair of the task  force from among the legislative                                                                    
     members of  the task force.  The task force  shall meet                                                                    
     at the call of the chair.                                                                                                  
          (f)  A majority of the task force constitutes a                                                                       
     quorum; a vacancy on the  task force shall be filled in                                                                    
     the   same  manner   as  the   original  selection   or                                                                    
     appointment.                                                                                                               
          (g)  The task force may request data and other                                                                        
     information from  the Department  of Health  and Social                                                                    
     Services and other state agencies.                                                                                         
          (h)  The staff of the legislator who chairs the                                                                       
     task  force  shall  provide  administrative  and  other                                                                    
     support to the task force.                                                                                                 
          (i)  Public members of the task force serve                                                                           
     without compensation  but are entitled to  per diem and                                                                    
     travel expenses  authorized for boards  and commissions                                                                    
     under AS 39.20.180.                                                                                                        
          (j)  The task force expires April 1, 2017."                                                                           
                                                                                                                                
4:57:10 PM                                                                                                                    
                                                                                                                                
RECESSED                                                                                                                      
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health and Social Services Standing Committee meeting was                                                                       
recessed to a call of the chair at 4:57 p.m.                                                                                    

Document Name Date/Time Subjects