Legislature(2015 - 2016)CAPITOL 106

03/31/2015 06:00 PM HEALTH & SOCIAL SERVICES

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Audio Topic
06:03:08 PM Start
06:03:14 PM HB148
08:24:20 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Continuation of 3:00 pm Meeting --
+= HB 148 MEDICAL ASSISTANCE COVERAGE; REFORM TELECONFERENCED
Moved CSHB 148(HSS) Out of Committee
-- Public Testimony --
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         March 31, 2015                                                                                         
                           6:03 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."                                                                                                                          
                                                                                                                                
     - MOVED CSHB 148(HSS) OUT OF COMMITTEE                                                                                     
                                                                                                                                
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                                                                             
03/31/15       (H)       HSS AT 6:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
JOSHUA BANKS, Staff                                                                                                             
Representative Dave Talerico                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented Amendment 15 to HB 148, on behalf                                                              
of Representative Talerico.                                                                                                     
                                                                                                                                
JON SHERWOOD, Deputy Commissioner                                                                                               
Medicaid and Health Care Policy                                                                                                 
Office of the Commissioner                                                                                                      
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during the hearing on HB
148.                                                                                                                            
                                                                                                                                
VALERIE DAVIDSON, Commissioner Designee                                                                                         
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Responded to questions during the hearing                                                                
on HB 148.                                                                                                                      
                                                                                                                                
STACIE KRALY, Chief Assistant Attorney General                                                                                  
Human Services Section                                                                                                          
Civil Division                                                                                                                  
Department of Law (DOL)                                                                                                         
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Offered information during the hearing on                                                                
HB 148.                                                                                                                         
                                                                                                                                
SHELLY VENDETTI-VUCKOVICH                                                                                                       
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 148.                                                                          
                                                                                                                                
MARY TONSMIERE                                                                                                                  
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 148.                                                                          
                                                                                                                                
ILONA FARR, MD                                                                                                                  
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in opposition to HB 148.                                                                       
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
6:03:08 PM                                                                                                                    
                                                                                                                                
CHAIR PAUL  SEATON called  the House  Health and  Social Services                                                             
Standing   Committee  meeting   back  to   order  at   6:03  p.m.                                                               
Representatives  Stutes,  Talerico,   Wool,  Tarr,  Vazquez,  and                                                               
Seaton were present at the  call to order.  Representative Foster                                                               
arrived as the meeting was in progress.                                                                                         
                                                                                                                                
           HB 148-MEDICAL ASSISTANCE COVERAGE; REFORM                                                                       
                                                                                                                                
6:03:14 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."                                                                                               
                                                                                                                                
6:03:30 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON announced  that the  committee  would complete  its                                                               
consideration  of  the  remaining  amendments  in  the  committee                                                               
packet before continuing on to public testimony.                                                                                
                                                                                                                                
REPRESENTATIVE  TALERICO moved  to  adopt  Amendment 15,  labeled                                                               
29GH1055\A.37,  Glover, 3/30/15.   [Amendment  15 is  provided at                                                               
the end of the minutes on HB 148.]                                                                                              
                                                                                                                                
CHAIR SEATON objected for discussion.                                                                                           
                                                                                                                                
6:04:36 PM                                                                                                                    
                                                                                                                                
JOSHUA BANKS,  Staff, Representative Dave Talerico,  Alaska State                                                               
Legislature, presented  Amendment 15 on behalf  of Representative                                                               
Talerico.   He said the  amendment would  create a July  1, 2018,                                                               
sunset for each  section of HB 148, by "creating  new sections in                                                               
the bill  to restore  the original language  in statute  that the                                                               
bill  changes."   He said  Amendment 15  would provide  a way  to                                                               
"test  the  waters  of  Medicaid expansion"  and  make  sure  the                                                               
federal government  upholds its  promise of 90  percent coverage.                                                               
He indicated that  under Amendment 15, the State  of Alaska could                                                               
withdraw  for  various  reasons,   for  example  if  the  federal                                                               
government dropped coverage  below 90 percent or  if an increased                                                               
number  of applicants  ended up  costing the  state more  than it                                                               
anticipated.                                                                                                                    
                                                                                                                                
6:06:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TALERICO  said Amendment  15  was  a concept  for                                                               
consideration, and he  said he would like to  hear the Department                                                               
of Health and Social Services' opinion of it.                                                                                   
                                                                                                                                
CHAIR  SEATON  noted  that  the committee  had  held  an  earlier                                                               
meeting that day.                                                                                                               
                                                                                                                                
CHAIR SEATON said there were  an anticipated 20,000 to 30,000 new                                                               
enrollees, for which there would  need to be additional services.                                                               
He expressed fear  that even with federal funding  at 95 percent,                                                               
it would  be difficult to  get private businesses to  invest when                                                               
they know "a bill would terminate in three years."                                                                              
                                                                                                                                
6:08:41 PM                                                                                                                    
                                                                                                                                
JON  SHERWOOD,  Deputy  Commissioner, Medicaid  and  Health  Care                                                               
Policy,  Office of  the Commissioner,  Department  of Health  and                                                               
Social  Services, stated  that  the department  did  not think  a                                                               
sunset provision  on Medicaid expansion  was necessary.   He said                                                               
some of the impacts of "this"  were more in line with reform than                                                               
expansion.  He  indicated that the department  views some issues,                                                               
such   as  clarification   of  income   levels  and   deprivation                                                               
requirements, as  "clean-up," and  it did  not see  a need  for a                                                               
2018 sunset, as proposed under Amendment 15.                                                                                    
                                                                                                                                
6:10:14 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON noted  that reports  would be  made after  the 2018                                                               
sunset date,  while some  of the reforms  would not  have "kicked                                                               
in" or have good analysis before that date.                                                                                     
                                                                                                                                
6:10:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   TALERICO  said   Mr.  Sherwood's   response  had                                                               
provided clarification.                                                                                                         
                                                                                                                                
REPRESENTATIVE TALERICO  withdrew his  motion to  adopt Amendment                                                               
15.                                                                                                                             
                                                                                                                                
6:12:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  moved to adopt Amendment  16, labeled 29-                                                               
GH1055\A.40,  Glover, 3/30/15,  which read  as follows  [original                                                               
punctuation provided]:                                                                                                          
                                                                                                                                
     Page 7, following line 15:                                                                                                 
     Insert a new bill section to read:                                                                                         
       "* Sec. 9. AS 47.07.030 is amended by adding a new                                                                   
     subsection to read:                                                                                                        
          (g)  The department shall annually prepare a                                                                          
     report, separately describing  state costs for optional                                                                    
     and mandatory services provided  under this section. On                                                                    
     or before  March 1 of each  year, 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"                                                                                                   
                                                                                                                                
CHAIR SEATON objected for discussion.                                                                                           
                                                                                                                                
6:12:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  spoke to  Amendment 16.   She  said there                                                               
were nine mandatory  services and 27 optional  services under the                                                               
Medicaid program.   She opined that  it would be helpful  to have                                                               
the  information required  under  Amendment 16  as  the State  of                                                               
Alaska faced upcoming  fiscal challenges.  She noted  that the 27                                                               
optional services  were not  mandated by  federal law,  and other                                                               
states did  not have all  of them.   She listed some  examples of                                                               
optional   services,    including:       optician,   optometrist,                                                               
chiropractic, occupational therapy, vision, and transportation.                                                                 
                                                                                                                                
CHAIR  SEATON questioned  how the  state  would be  served by  an                                                               
annual  report  on  "state  costs   for  optional  and  mandatory                                                               
services".     He  said  optional  services   were  sometimes  "a                                                               
replacement for  mandatory services, which cost  the state less."                                                               
He  said, "It's  not like  optional means  they're not  needed or                                                               
they are  insignificant to the  Medicaid beneficiary."   He asked                                                               
if the department had a position [on Amendment 16].                                                                             
                                                                                                                                
6:14:47 PM                                                                                                                    
                                                                                                                                
MR.  SHERWOOD answered  no.   He  said, "This  is information  we                                                               
reproduce relatively routinely."                                                                                                
                                                                                                                                
CHAIR SEATON asked if the  department did each service separately                                                               
or if all mandatory services were  "lumped as one."  He said that                                                               
was the way he was reading  Amendment 16.  He clarified he wanted                                                               
to  know  how the  department  reported  the services  that  were                                                               
provided under both the optional and mandatory categories.                                                                      
                                                                                                                                
MR. SHERWOOD  responded that typically  the department  created a                                                               
list  of  all  services  and  divided it  into  adult  and  child                                                               
services.     He  said  essentially   all  child   services  were                                                               
mandatory.   He said the  department showed, service  by service,                                                               
which was mandatory,  which was optional, and how  much was spent                                                               
on  each.   In  response to  a follow-up  question,  he said  the                                                               
department typically  did not  post the report  on its  web site,                                                               
but  did  get  requests  for  it and  could  produce  the  report                                                               
readily.   He said he  did not know the  exact date by  which the                                                               
department produced the report, but  said it tried to complete it                                                               
at  least three  to four  months after  the close  of the  fiscal                                                               
year,  so that  the department  would  know it  had "good,  solid                                                               
numbers."  Nevertheless, he said  he did not think the department                                                               
would  have difficulty  producing a  fiscal year  report for  one                                                               
year by March 1 of the following year.                                                                                          
                                                                                                                                
6:17:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL  indicated that  he viewed [Amendment  16] as                                                               
being in  the category of report  reform, and he was  hesitant to                                                               
add another  report "just for  the sake  of reports."   He stated                                                               
his preference  to "get  good reports,  at a  good time  that are                                                               
beneficial to everybody."                                                                                                       
                                                                                                                                
CHAIR  SEATON asked  Representative Vazquez  whether the  March 1                                                               
date in Amendment 16 was critical  or whether the report could be                                                               
required to coincide with the department's annual report.                                                                       
                                                                                                                                
REPRESENTATIVE VAZQUEZ  asked what  the date  was for  the annual                                                               
report.                                                                                                                         
                                                                                                                                
MR.  SHERWOOD  said  he  did  not know  the  date  on  which  the                                                               
department was  required to report  to the legislature,  but said                                                               
he could check.                                                                                                                 
                                                                                                                                
CHAIR  SEATON ventured  that "if  it turns  out on  consideration                                                               
that  it would  work  into a  different date,"  he  was sure  the                                                               
committee would  be [amenable] to  "make that date change  in the                                                               
amendment."                                                                                                                     
                                                                                                                                
6:19:06 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON  withdrew his  objection  to  the motion  to  adopt                                                               
Amendment 16.  He asked if there was any further objection.                                                                     
                                                                                                                                
REPRESENTATIVE  VAZQUEZ stated  that she  would like  [the report                                                               
required under Amendment  16] to be included  in the department's                                                               
annual report.                                                                                                                  
                                                                                                                                
6:19:37 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON moved  to adopt Conceptual Amendment  1 to Amendment                                                               
16, to change the  date from [on or before] March  1 of each year                                                               
and  require the  report  to be  included  with the  department's                                                               
annual  report.   He asked  whether  there was  any objection  to                                                               
Conceptual Amendment 1 to Amendment 16.                                                                                         
                                                                                                                                
6:20:25 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WOOL asked  for clarification  that the  proposed                                                               
Conceptual  Amendment 1  to  Amendment 16  would  not require  an                                                               
additional  report,  but  incorporate  the  information  required                                                               
under Amendment 16 within the department's annual report.                                                                       
                                                                                                                                
CHAIR  SEATON  responded  that  was  correct.    He  offered  his                                                               
understanding that  "we" had  made a change  so that  the reports                                                               
could  be  delivered  to  the  legislature  electronically.    He                                                               
recalled that Mr.  Sherwood had said the  services were itemized,                                                               
and  he posited  that that  would help  in determining  over time                                                               
which services may be increasing or decreasing.                                                                                 
                                                                                                                                
REPRESENTATIVE   WOOL   offered   his  understanding   that   the                                                               
department was  already providing  what it  would be  required to                                                               
provide  under  Amendment  16;  therefore,  he  opined  that  the                                                               
proposed amendment would be redundant.                                                                                          
                                                                                                                                
CHAIR SEATON  responded that according to  the previous statement                                                               
by Mr. Sherwood, the department  could "pull this" if it received                                                               
a request,  but "it is not  included as a category  in the annual                                                               
report";  therefore,  he  concurred with  Representative  Vazquez                                                               
that  [Amendment 16]  would require  additional information  that                                                               
could  be valuable  to and  easily accessed  by all  legislators,                                                               
rather than to just a specific  legislator that made a request to                                                               
the department.                                                                                                                 
                                                                                                                                
6:22:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  announced that  there being  no objection,                                                               
Conceptual Amendment 1 to Amendment 16 was adopted.                                                                             
                                                                                                                                
CHAIR SEATON removed  his objection to Amendment  16, as amended.                                                               
There being no  further objection, Amendment 16,  as amended, was                                                               
adopted.                                                                                                                        
                                                                                                                                
6:23:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  moved to adopt Amendment  17, labeled 29-                                                               
GH1055\A.42,  Mischel/Glover,  3/30/15,  which  read  as  follows                                                               
[original punctuation provided]:                                                                                                
                                                                                                                                
     Page 8, lines 4 - 6:                                                                                                       
          Delete all material.                                                                                                  
                                                                                                                                
     Renumber the following paragraphs accordingly.                                                                             
                                                                                                                                
CHAIR SEATON objected for discussion.                                                                                           
                                                                                                                                
REPRESENTATIVE VAZQUEZ spoke to Amendment  17.  She said it would                                                               
remove the [section]  1915(i) option.  She stated  that there was                                                               
not sufficient vetting  of this option.  She said  if the reforms                                                               
were implementing,  improvement was seen, and  all issues related                                                               
to  the audit  report  were  addressed, then  she  could see  the                                                               
possibility   of   the   department  coming   back   before   the                                                               
legislature,  with specific  information  regarding benefits  and                                                               
costs, to consider the option.                                                                                                  
                                                                                                                                
6:25:18 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON spoke  to his objection.  He  said current community                                                               
services that  qualify were funded through  general relief, which                                                               
was 100 percent  state dollars, and "this is a  switch, if we get                                                               
the waiver, to  a 50-50 match of federal funds."   He opined that                                                               
applying for a  waiver that would reduce costs by  50 percent was                                                               
a good  decision, in  terms of  the state's  fiscal balance.   He                                                               
said "the  K waiver" increased  the federal  match from 50  to 56                                                               
percent.   He  observed  that  Amendment 17  seemed  to say  that                                                               
instead of  taking a  higher federal match,  the State  of Alaska                                                               
would pay  more state  dollars, which was  going in  the opposite                                                               
direction of "what we thought of as Medicaid reform."                                                                           
                                                                                                                                
6:26:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ   said  Amendment  17  applied   only  to                                                               
1915(i).  She  asked Mr. Sherwood what the federal  match was for                                                               
that option.                                                                                                                    
                                                                                                                                
MR. SHERWOOD answered that in  most cases the anticipated federal                                                               
match would be the federal default  rate of 50 percent.  However,                                                               
he  noted  that  if  an   individual  was  eligible  through  the                                                               
Children's Health Insurance Program (CHIP),  the rate would be 65                                                               
percent and if  services were provided through  a tribal facility                                                               
to an Indian  Health Services (IHS) beneficiary, it  would be 100                                                               
percent.    He  confirmed  Chair   Seaton's  remark  that  "these                                                               
services  are  now  being paid  for  through  other  state-funded                                                               
programs," including general relief,  assisted living, senior and                                                               
disabilities   grant  programs,   and  behavioral   health  grant                                                               
programs.                                                                                                                       
                                                                                                                                
6:28:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  stated her objection  to Amendment 17.   She                                                               
said, "This  has been  identified as one  of the  reform measures                                                               
that could really bring about  significant savings for the state,                                                               
and  I  don't  want  the  department to  delay  in  getting  that                                                               
application in and moving forward with that effort."                                                                            
                                                                                                                                
6:28:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   VAZQUEZ  asked   what  empirical   evidence  the                                                               
department had to show that  the aforementioned option would save                                                               
the state money.                                                                                                                
                                                                                                                                
6:28:46 PM                                                                                                                    
                                                                                                                                
VALERIE  DAVIDSON, Commissioner  Designee,  Department of  Health                                                               
and  Social Services  (DHSS), responded  that the  1915(i) option                                                               
would  allow   the  department  to   receive  a   federal  match;                                                               
currently,  because of  the way  the program  was structured,  it                                                               
received  no federal  money for  these services.   She  said this                                                               
option  had  been available  since  2010,  but unfortunately  the                                                               
department,  through  prior  administration, had  not  taken  the                                                               
opportunity  to  save  the  50  percent  in  state  general  fund                                                               
dollars.   She said  the department  thought that  considering it                                                               
was  now   2015,  the  state   should  take  advantage   of  this                                                               
opportunity.     In  response  to   a  follow-up   question  from                                                               
Representative Vazquez, she stated,  "We have no prospective data                                                               
on a  guaranteed way to  be able to  save the state  general fund                                                               
savings  of 50  percent, just  as we  have no  guaranteed way  of                                                               
demonstrating that we wouldn't be able to do that."                                                                             
                                                                                                                                
6:30:35 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON  drew  attention   to  reference  material  in  the                                                               
committee  packet, from  the Corporation  for Supportive  Housing                                                               
(CSH),  which contained  a summary  of improved  1915(i) Medicaid                                                               
home- and community-based state options from September 2010.                                                                    
                                                                                                                                
6:31:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  asked  under what  circumstances  people                                                               
were currently  qualifying to  receive behavioral  health program                                                               
benefits from the general fund.                                                                                                 
                                                                                                                                
6:31:30 PM                                                                                                                    
                                                                                                                                
MR. SHERWOOD  answered that a  number of grant  programs provided                                                               
behavioral  health  services   to  individuals  whose  behavioral                                                               
health needs were  not currently covered by Medicaid  or who were                                                               
not  currently eligible  for  Medicaid.   He  said  the home  and                                                               
community-based   waiver   program    served   individuals   with                                                               
disabilities,  when  those  individuals  "meet  an  institutional                                                               
level  of care  for very  similar services."   He  explained that                                                               
under  law,  Medicaid  did  not   cover  institutional  care  for                                                               
individuals between  the ages of  21 and 64 with  mental disease;                                                               
therefore, some of  the services the department  could provide to                                                               
people with  other disabilities through  its waiver  program were                                                               
not available to the behavioral health institution.                                                                             
                                                                                                                                
6:32:58 PM                                                                                                                    
                                                                                                                                
A  roll call  vote was  taken.   Representative Vazquez  voted in                                                               
favor of  Amendment 17.  Representatives  Stutes, Talerico, Wool,                                                               
Tarr, Foster, and Seaton voted  against it.  Therefore, Amendment                                                               
17 failed by a vote of 1-6.                                                                                                     
                                                                                                                                
6:33:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  moved to adopt Amendment  18, labeled 29-                                                               
GH1055\A.43,  Mischel/Glover,  3/30/15,  which  read  as  follows                                                               
[original punctuation provided]:                                                                                                
                                                                                                                                
     Page 8, lines 7 - 9:                                                                                                       
          Delete all material.                                                                                                  
                                                                                                                                
     Renumber the following paragraphs accordingly.                                                                             
                                                                                                                                
CHAIR SEATON objected for discussion.                                                                                           
                                                                                                                                
REPRESENTATIVE  VAZQUEZ spoke  to  Amendment 18,  which she  said                                                               
focused on  the [section]  1915(k) option.   She said  that there                                                               
appeared  to  be  no  evidence  showing  that  the  option  would                                                               
actually save the state money.  She continued as follows:                                                                       
                                                                                                                                
     And  should  the  department clean  up  ...  the  audit                                                                    
     findings and  want to  then expand  additional services                                                                    
     because  this option  basically  is  like the  1915(c),                                                                    
     which  are currently  in  existence,  except that  this                                                                    
     provides  even  more  services, so  ...  what  I  would                                                                    
     expect is  that it  will actually  cost the  state more                                                                    
     money getting into this option.                                                                                            
                                                                                                                                
REPRESENTATIVE  VAZQUEZ indicated  that it  was unclear  whether,                                                               
once [1915(k)] was provided, it  could, under the Affordable Care                                                               
Act, be withdrawn.   She said the same comment  could be made for                                                               
the other options.                                                                                                              
                                                                                                                                
6:35:20 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON asked the department's position on Amendment 18.                                                                   
                                                                                                                                
6:35:29 PM                                                                                                                    
                                                                                                                                
COMMISSIONER DAVIDSON answered that  the department's position on                                                               
Amendment 18 was similar to that  on Amendment 17, which was that                                                               
[1915(k)]  was  an  opportunity  for the  state  to  enhance  the                                                               
federal  match from  50  percent to  56 percent.    She said  the                                                               
legislature had  made the department  aware that  any opportunity                                                               
to  save  the state's  general  fund  dollars by  increasing  the                                                               
federal  match dollars  was  an opportunity  that  should not  be                                                               
declined.   She said these  services were already  being provided                                                               
today,  but they  would  be refinanced  for  an enhanced  federal                                                               
match.    Regarding  the  ability  to "opt  out,"  she  said  the                                                               
department had not been made aware  of any federal law that would                                                               
prohibit the  state from doing so.   She said the  department had                                                               
been working  with the Centers  for Medicare &  Medicaid Services                                                               
(CMS), who  had made it clear  that Alaska had the  right to drop                                                               
its  participation if  the  match dropped  below  the 90  percent                                                               
mark, for example.                                                                                                              
                                                                                                                                
6:37:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ said she believed  the letter to which she                                                               
said Ms. Davidson  made reference did not  specify which program;                                                               
therefore,  she said  she would  not assume  it referred  to this                                                               
option.                                                                                                                         
                                                                                                                                
6:37:46 PM                                                                                                                    
                                                                                                                                
COMMISSIONER DAVIDSON  said she  did not mean  to imply  that the                                                               
letter stated the  department was not allowed to  change its mind                                                               
regarding 1915(k) or (i); it  was specific to Medicaid expansion.                                                               
She  offered  her  understanding  that   a  copy  of  the  letter                                                               
previously  had  been  provided  to  the  committee.    She  said                                                               
Congress  could change  a  law;  however, in  order  to make  the                                                               
change,  Congress would  have to  pass new  legislation to  limit                                                               
these kinds  of options, and  the legislation would have  to have                                                               
the consent  of the  President.   She said  she thought  this was                                                               
unlikely to happen, and she was not worried about it.                                                                           
                                                                                                                                
6:38:47 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON maintained his objection.                                                                                          
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  asked  if Commissioner  Davidson  had  a                                                               
legal  opinion showing  that the  state could  withdraw from  the                                                               
aforementioned options.                                                                                                         
                                                                                                                                
COMMISSIONER DAVIDSON answered no.                                                                                              
                                                                                                                                
6:39:20 PM                                                                                                                    
                                                                                                                                
A  roll call  vote was  taken.   Representative Vazquez  voted in                                                               
favor  of   Amendment  18.     Representatives   Foster,  Stutes,                                                               
Talerico, Wool,  Tarr, and Seaton  voted against it.   Therefore,                                                               
Amendment 18 failed by a vote of 1-6.                                                                                           
                                                                                                                                
6:40:28 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
6:41:48 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON moved to adopt Amendment 19, labeled 29-                                                                           
GH1055\A.60, Glover, 3/30/15, which read as follows [original                                                                   
punctuation provided]:                                                                                                          
                                                                                                                                
     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 WAIVERS; REPORT TO LEGISLATURE. On or                                                                        
     before February 1,  2019, the Department of  Health and                                                                    
     Social Services  shall complete a report  informing the                                                                    
     legislature  of the  results  of  the applications  for                                                                    
     waivers  and options  under  AS 47.07.036(d)(1) -  (3),                                                                    
     enacted by sec.  10 of this Act, and  shall deliver the                                                                    
     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)  information explaining whether the                                                                          
     department's  applications for  a  section 1115  waiver                                                                    
     under  42  U.S.C.  1315(a), a  section  1915(i)  option                                                                    
     under  42 U.S.C.  1396n, and  a section  1915(k) option                                                                    
     under  42  U.S.C. 1396n  were  approved  by the  United                                                                    
     States Department of Health and Human Services;                                                                            
               (2)  a description of cost savings to the                                                                        
     state  resulting from  the  programs implemented  under                                                                    
     the waivers, including                                                                                                     
               (A)  the extent to which the programs                                                                            
     implemented  under the  section  1115  waiver under  42                                                                    
     U.S.C. 1315(a)  achieved the  savings estimated  by the                                                                    
     department;                                                                                                                
               (B)  the extent to which the programs                                                                            
     implemented under  the section 1915(i) and  (k) options                                                                    
     under 42  U.S.C. 1396n  achieved the  savings estimated                                                                    
     by the department."                                                                                                        
                                                                                                                                
     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 "by sec. 16"                                                                                                   
     Insert "in sec. 17"                                                                                                        
                                                                                                                                
REPRESENTATIVE STUTES objected for discussion.                                                                                  
                                                                                                                                
CHAIR  SEATON  spoke  to  Amendment  19, and  he  read  from  the                                                               
amendment  language.   He  said  the  intent  was to  ensure  the                                                               
legislature  was informed  of  the progress,  and  he stated  his                                                               
belief that  the 2019 date  was necessary, because it  would take                                                               
until the 2018 fiscal year to  fully analyze the effects of these                                                               
waivers.                                                                                                                        
                                                                                                                                
6:43:45 PM                                                                                                                    
                                                                                                                                
COMMISSIONER DAVIDSON,  in response to Chair  Seaton, said, "This                                                               
is something  we were planning to  report on anyway, so  we would                                                               
have no objection to this reporting."                                                                                           
                                                                                                                                
REPRESENTATIVE  STUTES removed  her  objection to  the motion  to                                                               
adopt Amendment 19.  There  being no further objection, Amendment                                                               
19 was adopted.                                                                                                                 
                                                                                                                                
6:44:23 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 6:44 p.m. to 6:47 p.m.                                                                       
                                                                                                                                
6:47:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  moved to adopt Amendment  20, labeled 29-                                                               
GH1055\A.26,  Strasbaugh/Glover,  3/28/15.     [Amendment  20  is                                                               
provided at the end of the minutes on HB 148.]                                                                                  
                                                                                                                                
CHAIR SEATON objected for discussion.                                                                                           
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  spoke to  Amendment  20.   She  said  it                                                               
concerned  verification  of  eligibility  for  public  assistance                                                               
programs  administered  by  the  department.   It  would  require                                                               
verification  of  income,  assets,   and  identity,  as  well  as                                                               
resolution  of  discrepancy.   Further,  the  proposed  amendment                                                               
would   require   the  department   to   follow   up  on   fraud,                                                               
misrepresentation,  and inadequate  documentation in  other state                                                               
agencies.                                                                                                                       
                                                                                                                                
CHAIR SEATON  noted that HB  148 addressed Medicaid  and Medicaid                                                               
expansion, and public  assistance programs, although administered                                                               
by  the  department,  were  really  not the  main  topic  of  the                                                               
proposed legislation.                                                                                                           
                                                                                                                                
REPRESENTATIVE VAZQUEZ  said the  term "public  assistance" would                                                               
be used in  a broad sense and replace "medical  assistance."  She                                                               
said the thrust  of Amendment 20 was within the  realm of HB 148,                                                               
because the proposed legislation had  been presented as a package                                                               
including reform and expansion,  and [Amendment 20] would address                                                               
critical components  of what  a reform  system should  look like.                                                               
She reiterated  those issues, which the  proposed amendment would                                                               
target.                                                                                                                         
                                                                                                                                
CHAIR  SEATON  clarified his  prior  comment  by specifying  that                                                               
[Amendment 20] would  modify AS 47.05, and  Medicaid and Medicaid                                                               
expansion was under AS 47.07.                                                                                                   
                                                                                                                                
CHAIR SEATON maintained his objection.                                                                                          
                                                                                                                                
REPRESENTATIVE WOOL [called] for the question.                                                                                  
                                                                                                                                
A  roll  call  vote  was  taken.    Representatives  Vazquez  and                                                               
Talerico voted in  favor of Amendment 20.   Representatives Tarr,                                                               
Foster, Stutes,  Wool, and Seaton  voted against it.   Therefore,                                                               
Amendment 20 failed by a vote of 2-5.                                                                                           
                                                                                                                                
6:50:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  moved to adopt Amendment  21, labeled 29-                                                               
GH1055\A.57,  Mischel/Glover,  3/30/15,  which  read  as  follows                                                               
[original punctuation provided]:                                                                                                
                                                                                                                                
     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)  Notwithstanding the eligibility provisions                                                                       
     under (a) and  (b) of this section, a  provider may not                                                                    
     receive  reimbursement  for   services  provided  to  a                                                                    
     recipient  of  medical  assistance under  this  section                                                                    
     unless  the provider  requires the  recipient first  to                                                                    
     enroll  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                                                                    
     knowingly   seek   medical   assistance   payments   in                                                                    
     violation  of  this  subsection. The  department  shall                                                                    
     prepare an  annual report that describes  the types and                                                                    
     amounts  of penalties  assessed under  this subsection.                                                                    
     By  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 spoke to Amendment  21.  She said it would                                                               
require  providers  to  pursue other  federally  funded  programs                                                               
before  billing  Medicaid,  which  aligned  with  "the  idea  and                                                               
requirement  that   Medicaid  is  the  payor   of  last  resort."                                                               
Further, the  proposed amendment would require  the department to                                                               
regulate an imposed civil penalty and  to provide a report to the                                                               
legislature regarding this effort.                                                                                              
                                                                                                                                
CHAIR SEATON asked for the opinion of the department.                                                                           
                                                                                                                                
6:51:43 PM                                                                                                                    
                                                                                                                                
COMMISSIONER DAVIDSON observed that  Amendment 21 was "remarkably                                                               
familiar to"  Amendment 12.  She  said as with Amendment  12, the                                                               
department already  had "the  authority to be  able to  do this."                                                               
She said Medicaid as payor of  last resort is outlined in federal                                                               
law.  Regarding  the civil penalty, she said  the department does                                                               
not think fines are necessary when  it already had the ability to                                                               
terminate  people from  the program  when they  did not  meet the                                                               
requirements.                                                                                                                   
                                                                                                                                
REPRESENTATIVE VAZQUEZ asked, "Do you  have a regulation in place                                                               
requiring this of providers?"                                                                                                   
                                                                                                                                
MR. SHERWOOD  answered no.   He said currently the  state assumed                                                               
the responsibility  for ensuring  people "cooperate with  any and                                                               
all third-party resources  to the providers," and that  was not a                                                               
burden the department would want to shift from the state.                                                                       
                                                                                                                                
REPRESENTATIVE WOOL [called] for the question.                                                                                  
                                                                                                                                
6:53:27 PM                                                                                                                    
                                                                                                                                
A  roll  call  vote  was  taken.    Representatives  Vazquez  and                                                               
Talerico voted in  favor of Amendment 21.   Representatives Wool,                                                               
Tarr, Foster,  Stutes, and Seaton  voted against it.   Therefore,                                                               
Amendment 21 failed by a vote of 2-5.                                                                                           
                                                                                                                                
6:54:02 PM                                                                                                                    
                                                                                                                                
CHAIR   SEATON  moved   to  adopt   Amendment  22,   labeled  29-                                                               
GH1055\A.58,  Glover, 3/30/15,  which read  as follows  [original                                                               
punctuation provided]:                                                                                                          
                                                                                                                                
     Page 8, following line 16:                                                                                                 
     Insert new subsections to read:                                                                                            
          "(e) Notwithstanding (a) - (c) of this section                                                                        
     and in addition to  the projects and services described                                                                    
     under (d)  of this section, the  department shall apply                                                                    
     for a  section 1115 waiver  under 42 U.S.C.  1315(a) to                                                                    
     establish  one or  more demonstration  projects focused                                                                    
     on innovative payment models for  one or more groups of                                                                    
     medical assistance  recipients in one or  more specific                                                                    
     geographic   areas.   The  demonstration   project   or                                                                    
     projects may include                                                                                                       
               (1)  managed care organizations as described                                                                     
     under 42 U.S.C. 1396u-2;                                                                                                   
               (2)  community care organizations;                                                                               
               (3)  patient-centered medical homes as                                                                           
     described under 42 U.S.C. 256a-1; or                                                                                       
               (4)  other innovative payment models that                                                                        
     ensure  access  to  health care  without  reducing  the                                                                    
     quality of care.                                                                                                           
          (f) The department shall design and implement at                                                                      
     least  one  demonstration  project under  (e)  of  this                                                                    
     section  that  is   a  coordinated  care  demonstration                                                                    
     project  using  a  global payment  fee  structure.  The                                                                    
     demonstration  project  must  include  a  managed  care                                                                    
     system that  operates within a  fixed budget  to reduce                                                                    
     medical cost inflation, improves  the quality of health                                                                    
     care  for  recipients,  and   results  in  a  healthier                                                                    
     population.  The department  shall  design the  managed                                                                    
     care system to reduce  the growth in medical assistance                                                                    
     expenditures  with a  goal of  reducing the  per capita                                                                    
     growth rate  for medical assistance expenditures  by at                                                                    
     least two  percentage points.  The managed  care system                                                                    
     must  implement alternative  payment methodologies  and                                                                    
     create  a  network  of  patient-centered  primary  care                                                                    
     homes,  and  will  be measured  based  on  quality  and                                                                    
     performance  outcomes. The  department shall  prepare a                                                                    
     report  regarding the  progress  of this  demonstration                                                                    
     project  and  shall,  on or  before  February 1,  2019,                                                                    
     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."                                                                             
                                                                                                                                
     Reletter the following subsection accordingly.                                                                             
                                                                                                                                
REPRESENTATIVE STUTES objected for discussion.                                                                                  
                                                                                                                                
CHAIR SEATON  spoke to Amendment  22.  He stated  that innovative                                                               
payment models  were a  great opportunity for  reform.   He said,                                                               
"The  department   has  placed  this  in   their  broader  intent                                                               
language, but  this language  is more specific."   He  said there                                                               
was  a hospital  in Alaska  already pursuing  this global  budget                                                               
option, but it  needed coordination with the state.   He said the                                                               
state could save money with  this reform, and under Amendment 22,                                                               
there  would be  a  report  to the  legislature  at the  earliest                                                               
possible  date that  it would  be possible  to show  the progress                                                               
made.                                                                                                                           
                                                                                                                                
6:56:17 PM                                                                                                                    
                                                                                                                                
MS  DAVIDSON,  in  response  to Chair  Seaton,  stated  that  the                                                               
department had no objection to Amendment 22.                                                                                    
                                                                                                                                
6:56:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ questioned why  there would be a four-year                                                               
wait for a  report on the progress of the  project.  She observed                                                               
that under Amendment  22, the report would be due  by February 1,                                                               
2019,  and she  said there  would  be no  opportunity to  monitor                                                               
progression.                                                                                                                    
                                                                                                                                
CHAIR SEATON explained the reason  for the February 1, 2019, date                                                               
was in order to  allow for a full fiscal year.   He said it would                                                               
probably take that much time  to integrate the full payment model                                                               
into an entire community organization for a geographic region.                                                                  
                                                                                                                                
6:57:42 PM                                                                                                                    
                                                                                                                                
COMMISSIONER DAVIDSON concurred with Chair Seaton's explanation.                                                                
                                                                                                                                
6:57:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  STUTES removed  her  objection to  the motion  to                                                               
adopt Amendment 22.                                                                                                             
                                                                                                                                
REPRESENTATIVE  VAZQUEZ   asked  what   other  states   may  have                                                               
"implemented this particular waiver."                                                                                           
                                                                                                                                
MR.  SHERWOOD answered  that [Amendment  22] described  a project                                                               
similar to one  currently in Oregon.  He said  there may be other                                                               
states, as well, but the project  in Oregon was one with which he                                                               
is  familiar.     In  response  to  a   follow-up  question  from                                                               
Representative Vazquez, he said he  did not remember the specific                                                               
timing of  Oregon's project, but  offered his  understanding that                                                               
they phased  it in throughout various  regions in the state.   He                                                               
said he thought Oregon had  been successful in "at least reducing                                                               
the  growth  in  cost,"  but   said  he  did  not  have  specific                                                               
information with him.                                                                                                           
                                                                                                                                
CHAIR SEATON pointed out that  Amendment 22 was not brought forth                                                               
by the administration, but was  one brought by the legislature to                                                               
ensure there was  a reform model exercised in Alaska  in a region                                                               
that  would like  to participate.   He  indicated there  would be                                                               
some risk involved,  because the model would put  money aside for                                                               
all  the participants,  and the  hospitals would  be required  to                                                               
maintain the  health of the  communities they served, but  if the                                                               
participants  needed  additional  services, it  would  cost  them                                                               
extra,  and they  would  not get  additional  reimbursement.   He                                                               
said, "If  we want  to have  demonstrations, if  we want  to have                                                               
reform, we're  going to  have to figure  out how to  do it."   He                                                               
concluded that Amendment 22 was a legislative reform model.                                                                     
                                                                                                                                
REPRESENTATIVE VAZQUEZ  said it  troubled her  that there  was no                                                               
information related to Oregon's  result, and, under Amendment 22,                                                               
Alaska would  not have any  reports for  four years.   She opined                                                               
that  the state  had a  fiduciary duty,  in light  of its  fiscal                                                               
crisis, to  monitor how  and when it  entered into  programs with                                                               
financial obligations.   She added,  "We're not even sure  we can                                                               
withdraw from  this project."   She  indicated that  [adoption of                                                               
Amendment 22] would be fiscally irresponsible.                                                                                  
                                                                                                                                
7:01:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL  stated his  understanding that  Amendment 22                                                               
would bring about a pilot  project related to managed care, which                                                               
could be  tested in  a small  geographical area.   He  stated his                                                               
belief  that  there was  currently  "some  kind of  managed  care                                                               
thing"  in  all  but  ten states,  and  perhaps  a  demonstration                                                               
project  in Alaska  - one  of the  ten exception  states -  would                                                               
allow the  state time  to see if  it would work.   He  said there                                                               
were  many other  reforms and  projects  going on  that had  many                                                               
report dates, and he did not  see the state as doing this without                                                               
keen oversight.  He stated his support of Amendment 22.                                                                         
                                                                                                                                
REPRESENTATIVE STUTES restated that she removed her objection.                                                                  
                                                                                                                                
7:02:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  stated  that conceptually  Amendment  22                                                               
might be a  good idea, but posited that waiting  four years for a                                                               
report was ludicrous.                                                                                                           
                                                                                                                                
CHAIR  SEATON announced  that there  being no  further objection,                                                               
Amendment 22 was adopted.                                                                                                       
                                                                                                                                
7:03:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TALERICO moved to  adopt Amendment 23, labeled 29-                                                               
GH1055\A.50,  Glover, 3/30/15,  which read  as follows  [original                                                               
punctuation provided]:                                                                                                          
                                                                                                                                
     Page 1, line 1, following "Act":                                                                                         
          Insert "relating to certificates of need;"                                                                          
                                                                                                                                
     Page 2, following line 13:                                                                                                 
     Insert a new bill section to read:                                                                                         
         "* Sec. 2. AS 18.07 is amended by adding a new                                                                       
     section to read:                                                                                                           
          Sec. 18.07.103. Exemption. Nothing in this                                                                        
     chapter applies to an existing  or proposed health care                                                                    
     facility  that  is located  or  will  be located  in  a                                                                    
     municipality  with  a  population of  more  than  5,000                                                                    
     according  to  the  most recent  United  States  census                                                                    
     before  initiation of  the  construction or  alteration                                                                    
     of, or addition to, the health care facility."                                                                             
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 9, following line 8:                                                                                                  
     Insert a new bill section to read:                                                                                         
        "*  Sec. 15.  The  uncodified law  of  the State  of                                                                  
     Alaska is amended by adding a new section to read:                                                                         
          APPLICABILITY. AS 18.07.103, enacted by sec. 2 of                                                                     
     this  Act, applies  to the  construction or  alteration                                                                    
     of, or addition to, a  health care facility begun on or                                                                    
     after the effective  date of sec. 2 of this  Act. For a                                                                    
     health care facility that is  located in a municipality                                                                    
     with a population  of more than 5,000  according to the                                                                    
     most  recent  United  States census  and  that  has  an                                                                    
     existing certificate  of need issued by  the department                                                                    
     under  AS 18.07.031  or   modified  under  AS 18.07.061                                                                    
     before the  effective date of  sec. 2 of this  Act, the                                                                    
     department  may  not  take any  action  to  enforce  or                                                                    
     modify the terms of the certificate."                                                                                      
                                                                                                                                
     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 16"                                                                                           
                                                                                                                                
     Page 9, line 24:                                                                                                           
          Delete "by sec. 16"                                                                                                   
     Insert "in sec. 18"                                                                                                        
                                                                                                                                
CHAIR SEATON objected for discussion.                                                                                           
                                                                                                                                
REPRESENTATIVE   TALERICO  explained   that   Amendment  23   was                                                               
generated by  constituents from a  neighboring district,  who did                                                               
not have representation  on the House Health  and Social Services                                                               
Standing Committee.   He said  after speaking with  Chair Seaton,                                                               
he realized that there was  probably a more appropriate venue for                                                               
the issue that  could be brought up in the  future, outside of HB
148.                                                                                                                            
                                                                                                                                
REPRESENTATIVE TALERICO withdrew his motion to adopt Amendment                                                                  
23.                                                                                                                             
                                                                                                                                
7:04:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TALERICO moved to adopt Amendment 24, labeled 29-                                                                
GH1055\A.51, Glover, 3/30/15, which read as follows [original                                                                   
punctuation provided]:                                                                                                          
                                                                                                                                
     Page 1, line 1, following "Act":                                                                                         
          Insert "relating to certificates of need;"                                                                          
                                                                                                                                
     Page 2, following line 13:                                                                                                 
     Insert a new bill section to read:                                                                                         
        "* Sec. 2. AS 18.07.031(e) is amended to read:                                                                      
          (e) In (a) of this section, "expenditure"                                                                             
     includes the purchase of [PROPERTY  OCCUPIED BY OR THE]                                                                    
     equipment required  for the  health care  facility [AND                                                                    
     THE NET PRESENT VALUE OF  A LEASE FOR SPACE OCCUPIED BY                                                                    
     OR  THE   EQUIPMENT  REQUIRED   FOR  THE   HEALTH  CARE                                                                    
     FACILITY];   "expenditure"  does   not  include   costs                                                                    
     associated with routine  maintenance and replacement of                                                                    
     equipment  at an  existing  health  care facility,  the                                                                
     purchase of  property occupied by the  facility, or the                                                                
     net present value  of a lease for space  occupied by or                                                                
     equipment required for the facility."                                                                                  
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 9, following line 8:                                                                                                  
     Insert a new bill section to read:                                                                                         
        "*  Sec. 15.  The  uncodified law  of  the State  of                                                                
     Alaska is amended by adding a new section to read:                                                                         
          APPLICABILITY. Section 2 of this Act applies to                                                                       
     the construction or  alteration of or an  addition to a                                                                    
     health  care   facility  initiated  on  or   after  the                                                                    
     effective  date   of  sec.  2   of  this  Act   and  to                                                                    
     applications pending under AS 18.07.031."                                                                                  
                                                                                                                                
     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 16"                                                                                           
                                                                                                                                
     Page 9, line 24:                                                                                                           
          Delete "by sec. 16"                                                                                                   
     Insert "in sec. 18"                                                                                                        
                                                                                                                                
CHAIR SEATON objected for discussion.                                                                                           
                                                                                                                                
REPRESENTATIVE TALERICO  stated that as with  Amendment 23, there                                                               
would  be  a  more  appropriate  way  to  address  the  issue  in                                                               
Amendment  24  through  future  legislation.    Nevertheless,  he                                                               
stated  that a  lease was  currently qualified  as a  capitalized                                                               
investment, but he  thought a lease without an option  to buy was                                                               
an expense under General Accounting Principles.                                                                                 
                                                                                                                                
7:05:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TALERICO  withdrew his  motion to  adopt Amendment                                                               
24.                                                                                                                             
                                                                                                                                
CHAIR  SEATON explained  for the  record  that there  had been  a                                                               
number of amendments addressing  large and complex certificate of                                                               
need  issues, and  Representative Talerico  was choosing  to take                                                               
them up  in another piece  of legislation in the  future, because                                                               
to bring them up within HB 148 would muddy the waters.                                                                          
                                                                                                                                
7:06:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TALERICO moved to  adopt Amendment 25, labeled 29-                                                               
GH1055\A.53,  Shutts/Glover,  3/30/15,   which  read  as  follows                                                               
[original punctuation provided]:                                                                                                
                                                                                                                                
     Page 9, lines 9 - 17:                                                                                                      
          Delete all material.                                                                                                  
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 9, line 23:                                                                                                           
          Delete "Sections 13 and 14 of this Act take"                                                                          
          Insert "Section 13 of this Act takes"                                                                                 
                                                                                                                                
     Page 9, line 24:                                                                                                           
          Delete "by sec. 16"                                                                                                   
     Insert "in sec. 15"                                                                                                        
                                                                                                                                
7:06:57 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON objected for discussion.                                                                                           
                                                                                                                                
REPRESENTATIVE  TALERICO spoke  to  Amendment 25.   He  explained                                                               
that under  Amendment 25, the  department would have  the ability                                                               
to  create  emergency  regulations   to  implement  the  proposed                                                               
legislation.   He  stated  concern that  if  the legislature  was                                                               
going to create  statutory provisions under HB 148,  there may be                                                               
emergency  regulations "that  don't appear  to have  sideboards."                                                               
He  said those  currently  in the  department  were trusted,  but                                                               
there could be rapid changes within state government.                                                                           
                                                                                                                                
CHAIR SEATON  noted that the language  on page 9, lines  9-17, of                                                               
HB  148, which  would be  deleted under  Amendment 25,  addressed                                                               
emergency regulations.  Section 14,  he said, was uncodified law;                                                               
therefore, it  was generally  considered as  short-term duration.                                                               
He said, "This is in uncodified law.   I'm not sure quite why and                                                               
how that effects ... this."                                                                                                     
                                                                                                                                
7:09:41 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
7:10:24 PM                                                                                                                    
                                                                                                                                
STACIE  KRALY,  Chief  Assistant  Attorney  General  -  Statewide                                                               
Section  Supervisor,  Human   Services  Section,  Civil  Division                                                               
(Juneau),  Department of  Law (DOL),  addressed  points that  had                                                               
been  raised  by  Representative   Talerico.    First,  she  said                                                               
emergency   regulatory  authority   was   generally  drafted   as                                                               
uncodified law,  which explained why it  was done that way  in HB
148.  Second,  she said the emergency regulation  authority in HB
148 applied  to only  two sections:   the  intent language  and a                                                               
section relating  to reforms.   It  was designed  specifically to                                                               
allow the  department to  have "a jumpstart"  on getting  some of                                                               
the  reforms in  progress.   She said  the regulatory  process to                                                               
"get  a   project  through"  could  take   between  6-24  months;                                                               
therefore,  an  emergency regulation  would  give  the option  to                                                               
achieve  a  reform  quickly.   She  suggested  to  Representative                                                               
Talerico that  one way  to address  his concern  about sideboards                                                               
would  be to  sunset  the emergency  regulation provision,  which                                                               
would create a  date in the future when  reauthorization from the                                                               
legislature would be required, in  the event that all the desired                                                               
savings had not been achieved.   She said the intent was never to                                                               
do everything  through emergency  regulation, but rather  to have                                                               
the opportunity to get done what needed to be done quickly.                                                                     
                                                                                                                                
7:12:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   TALERICO   said   he    thought   it   was   the                                                               
responsibility  of  the  legislature   to  "put  the  appropriate                                                               
information  out there"  and for  the  department to  be able  to                                                               
utilize  it.   He indicated  he would  like to  know whether  the                                                               
department felt it was "going out on a limb."                                                                                   
                                                                                                                                
7:14:07 PM                                                                                                                    
                                                                                                                                
MR.   SHERWOOD   offered   his   understanding   that   emergency                                                               
regulations took  effect immediately  and lasted  120 days.   The                                                               
department noticed the regulations,  took public comment, decided                                                               
whether it needed  to make amendments to  those regulations, then                                                               
adopted the  regulation by  the end  of the  120-day period.   He                                                               
said  he  thought  a  lot  of the  public  protections  that  the                                                               
regulatory  process was  intended to  provide were  there in  the                                                               
emergency   regulation   process,    which,   allowed   immediate                                                               
implementation  and  possible  instant savings,  which,  in  turn                                                               
allowed the department from having to  cut deeper.  He echoed Ms.                                                               
Kraly's comment that  the department never expected  it would use                                                               
emergency   regulations   for   every   provision.      He   said                                                               
[Representative  Talerico's]  point  was   well  taken  that  the                                                               
department would  have to be  judicious in its use  [of emergency                                                               
regulations].                                                                                                                   
                                                                                                                                
7:16:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked  what an appropriate date  for such a                                                               
sunset might be.                                                                                                                
                                                                                                                                
MR. SHERWOOD suggested June 30, 2017.                                                                                           
                                                                                                                                
COMMISSIONER DAVIDSON,  in response  to Chair Seaton,  stated her                                                               
belief that two years would be long enough.                                                                                     
                                                                                                                                
7:17:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TALERICO,  in response to Chair  Seaton, indicated                                                               
that  he would  be  comfortable  with a  compromise  of having  a                                                               
sunset in two years.                                                                                                            
                                                                                                                                
7:17:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  expressed her discomfort with  this.  She                                                               
said, "I'm very curious, because this  will also apply to the tax                                                               
on providers,  which is within Section  2, so that's going  to be                                                               
on fast track."  She said the  tax would apply to all 19 provider                                                               
types, whether  or not  they accepted  Medicaid.   She referenced                                                               
Section  1 of  HB 148,  and  offered her  understanding that  the                                                               
department   already   practiced   "utilization   control,"   and                                                               
questioned why  the department would "need  emergency regulations                                                               
for that."                                                                                                                      
                                                                                                                                
7:19:11 PM                                                                                                                    
                                                                                                                                
MR.  SHERWOOD responded  that although  the department  had cost-                                                               
sharing and  utilization control  provisions, in order  to change                                                               
its  provisions, it  would need  to change  its regulations.   He                                                               
clarified  that  HB 148  would  not  give the  department  taxing                                                               
authority;  before  it  could  ever  levy  a  provider  tax,  the                                                               
department would  have to request  legislation that gave  it that                                                               
authority.                                                                                                                      
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  offered  her understanding  that  before                                                               
offering  an  option or  waiver,  the  department would  have  to                                                               
obtain permission  from CMS, which would  take months; therefore,                                                               
she questioned [how the department  would benefit from] emergency                                                               
regulations.                                                                                                                    
                                                                                                                                
MR. SHERWOOD explained  that a state plan  amendment could become                                                               
effective as  early as the first  day of the quarter  in which it                                                               
is submitted.   He said  the department often consulted  with CMS                                                               
prior to  submitting state  plan amendments, so  it would  have a                                                               
good  idea  whether  or  not  there  would  a  significant  issue                                                               
regarding the plan's approval.                                                                                                  
                                                                                                                                
7:21:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL  asked whether  the department  had emergency                                                               
regulation authority in the past.                                                                                               
                                                                                                                                
MR. SHERWOOD  answered that every  department had the  ability to                                                               
issue  emergency regulations,  if the  regulations met  statutory                                                               
criteria.    He stated,  "This  language  essentially provides  a                                                               
legislative finding that these  circumstances meet that criteria,                                                               
which  would   probably  give  us   some  degree   of  additional                                                               
protection were  somebody challenge  our ability to  do emergency                                                               
regulations."                                                                                                                   
                                                                                                                                
REPRESENTATIVE   WOOL   offered   his  understanding   that   the                                                               
department  was  tasked  with initiating  reforms  and  had  used                                                               
emergency  regulations to  do  so in  the past  for  the sake  of                                                               
efficiency.   He asked,  "This is pretty  standard stuff,  all in                                                               
all, correct?"                                                                                                                  
                                                                                                                                
MR.  SHERWOOD   said  he  would   not  characterize   giving  the                                                               
department the specific authority  to do emergency regulations as                                                               
standard.   He added that it  was not highly unusual,  but it was                                                               
probably not common practice.                                                                                                   
                                                                                                                                
7:23:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TALERICO  asked what  the required number  of days                                                               
was for posting notice [for public comment].                                                                                    
                                                                                                                                
7:23:24 PM                                                                                                                    
                                                                                                                                
MR.  SHERWOOD answered  30  days was  the minimum.    He said  an                                                               
emergency  regulation  would  be effective  immediately,  and  he                                                               
offered  his understanding  that  public comment  would be  taken                                                               
immediately.                                                                                                                    
                                                                                                                                
7:23:47 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON moved  to adopt Conceptual Amendment  1 to Amendment                                                               
25, to add a sunset date of June 30, 2017, to Section 14.                                                                       
                                                                                                                                
REPRESENTATIVE STUTES  objected.  She indicated  that she planned                                                               
to  support Amendment  25, as  it was;  therefore, she  would not                                                               
support Conceptual Amendment 1.                                                                                                 
                                                                                                                                
                                                                                                                                
7:24:39 PM                                                                                                                    
                                                                                                                                
A  roll call  vote was  taken.   Representatives Talerico,  Wool,                                                               
Tarr, Foster,  Vazquez, and Seaton  voted in favor  of Conceptual                                                               
Amendment  1  to  Amendment  25.    Representative  Stutes  voted                                                               
against it.   Therefore, Conceptual  Amendment 1 to  Amendment 25                                                               
was adopted by a vote of 6-1.                                                                                                   
                                                                                                                                
7:25:15 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 7:25 p.m. to 7:27 p.m.                                                                       
                                                                                                                                
7:27:02 PM                                                                                                                    
                                                                                                                                
There was discussion  as to the effect of  Conceptual Amendment 1                                                               
to  Amendment 25  and  the  need for  Conceptual  Amendment 2  to                                                               
Amendment 25.                                                                                                                   
                                                                                                                                
7:28:03 PM                                                                                                                    
                                                                                                                                
The committee took a brief at-ease.                                                                                             
                                                                                                                                
7:29:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TALERICO moved to  adopt Conceptual Amendment 2 to                                                               
Amendment  25,  which  would  delete  the  language  embodied  in                                                               
Amendment 25,  as amended, such  that Section 14 would  remain in                                                               
HB 148.                                                                                                                         
                                                                                                                                
REPRESENTATIVE STUTES objected.                                                                                                 
                                                                                                                                
7:30:22 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON  explained that  with  the  adoption of  Conceptual                                                               
Amendment 2 to Amendment 25, Section  14 would remain in the bill                                                               
and due  to the adoption  of Conceptual Amendment 1  to Amendment                                                               
25, Section 14 would include a sunset date of June 30, 2017.                                                                    
                                                                                                                                
A  roll call  vote was  taken.   Representatives Talerico,  Wool,                                                               
Tarr, Foster, and  Seaton voted in favor  of Conceptual Amendment                                                               
2  to  Amendment 25,  as  amended.   Representatives  Stutes  and                                                               
Vazquez voted against  it.  Therefore, Conceptual  Amendment 2 to                                                               
Amendment 25, as amended, was adopted by a vote of 5-2.                                                                         
                                                                                                                                
CHAIR SEATON restated the effect  of the adopted Amendment 25, as                                                               
amended.                                                                                                                        
                                                                                                                                
7:32:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  asked whether  there was a  legal opinion                                                               
that set forth  the parameters around which  the department could                                                               
utilize  emergency   regulations,  which  she   characterized  as                                                               
unusual and extraordinary.                                                                                                      
                                                                                                                                
7:33:07 PM                                                                                                                    
                                                                                                                                
MS. KRALY  responded that the standard  for emergency regulations                                                               
was  already established  through  [the Administrative  Procedure                                                               
Act].   She  said because  of  the current  circumstances of  the                                                               
state  regarding its  fiscal  crisis and  the  need for  Medicaid                                                               
reform, the  legislature made the  finding that the needs  of the                                                               
agency were such  that they track the language  already set forth                                                               
in  statute.   She stated  her belief,  based on  the information                                                               
that would be  provided in the notices and  process going forward                                                               
through  emergency  regulations,  that  the  standards  had  been                                                               
established.   She said she  could not guarantee there  would not                                                               
be  a legal  challenge to  an  emergency regulation  that may  be                                                               
adopted;  however, she  said she  felt comfortable  and confident                                                               
that  the  provisions  were  legally  sufficient,  based  on  the                                                               
current information showing the  urgent need for Medicaid reform.                                                               
She stated  that the health,  safety, and welfare  of individuals                                                               
would be at risk if the state did not achieve reform.                                                                           
                                                                                                                                
REPRESENTATIVE   VAZQUEZ  asked   whether   that  would   include                                                               
addressing  audit  findings,  "especially the  lack  of  criminal                                                               
background checks on providers."                                                                                                
                                                                                                                                
MS. KRALY said  she had not read the  legislative audit findings;                                                               
therefore, she had no comment.                                                                                                  
                                                                                                                                
7:34:53 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON  asked  whether  there was  any  objection  to  the                                                               
adoption of Amendment 25, as amended.                                                                                           
                                                                                                                                
REPRESENTATIVE STUTES  objected to the motion  to adopt Amendment                                                               
25, as amended.                                                                                                                 
                                                                                                                                
7:35:24 PM                                                                                                                    
                                                                                                                                
A  roll call  vote was  taken.   Representatives Talerico,  Wool,                                                               
Tarr,  Foster, and  Seaton voted  in  favor of  Amendment 25,  as                                                               
amended.   Representatives Vazquez  and Stutes voted  against it.                                                               
Therefore, Amendment 25, as amended, was adopted by a vote of 5-                                                                
2.                                                                                                                              
                                                                                                                                
7:35:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ stated that  she would not offer Amendment                                                               
26,  labeled 29-GH1055\A.45,  Glover, 3/30/15,  [included in  the                                                               
committee packet].                                                                                                              
                                                                                                                                
7:37:04 PM                                                                                                                    
                                                                                                                                
CHAIR   SEATON  moved   to  adopt   Amendment  27,   labeled  29-                                                               
GH1055\A.63,  Glover, 3/31/15,  which read  as follows  [original                                                               
punctuation provided]:                                                                                                          
                                                                                                                                
     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:                                                                         
          DEMONSTRATION PROJECT: REDUCING PRE-TERM BIRTHS.                                                                      
     The  Department of  Health  and  Social Services  shall                                                                    
     design and  implement a  demonstration project  for the                                                                    
     purpose of  reducing pre-term birth rates  in the state                                                                    
     from   the   current   rate  of   10.3   percent.   The                                                                    
     demonstration project  shall provide for  the voluntary                                                                    
     enrollment  of  approximately  500 recipients  who  are                                                                    
     eligible      for     medical      assistance     under                                                                    
     AS 47.07.020(b)(14).  The  Department   of  Health  and                                                                    
     Social  Services  shall  offer  pregnancy  counselling,                                                                    
     nutritional counselling,  and, as necessary,  vitamin D                                                                    
     supplementation to maintain levels  of 40 ng/ml vitamin                                                                    
     D   during   pregnancy    for   participants   in   the                                                                    
     demonstration  project. The  demonstration project  may                                                                    
     be modeled after the Protect  Our Children NOW! project                                                                    
     implemented  as  a  cooperative project  of  the  South                                                                    
     Carolina Department  of Health  and Human  Services and                                                                    
     private   health  organizations.   The   goal  of   the                                                                    
     demonstration  project  is  to  achieve  a  50  percent                                                                    
     reduction in  pre-term births in the  state, consistent                                                                    
     with the  results of  the following  published studies:                                                                    
     Wagner, C. L.,  et al., "A Randomized  Trial of Vitamin                                                                    
     D  Supplementation  in   Two  Community  Health  Center                                                                    
     Networks  in  South   Carolina,"  American  Journal  of                                                                    
     Obstetrics and Gynecology  208 (February 2013); Bodnar,                                                                    
     L.  M.,  et  al.,  "Maternal  25-Hydroxyvitamin  D  and                                                                    
     Preterm  Birth  in  Twin  Gestations,"  Obstetrics  and                                                                    
     Gynecology 122 (July 2013)."                                                                                               
                                                                                                                                
     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 "by sec. 16"                                                                                                   
     Insert "in sec. 17"                                                                                                        
                                                                                                                                
REPRESENTATIVE STUTES objected.                                                                                                 
                                                                                                                                
CHAIR SEATON initiated a summary of the language of Amendment                                                                   
27.                                                                                                                             
                                                                                                                                
7:37:42 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 7:37 p.m. to 7:39 p.m.                                                                       
                                                                                                                                
7:39:06 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON withdrew his motion to adopt Amendment 27.                                                                         
                                                                                                                                
7:39:29 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON moved to adopt Amendment 28, labeled 29-                                                                           
GH1055\A.64, Glover, 3/31/15, which read as follows [original                                                                   
punctuation provided]:                                                                                                          
                                                                                                                                
     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:                                                                         
          DEMONSTRATION PROJECT: REDUCING PRE-TERM BIRTHS.                                                                      
     Before January 1,  2018, the  Department of  Health and                                                                    
     Social   Services  shall   investigate  and   design  a                                                                    
     demonstration project for the  purpose of reducing pre-                                                                    
     term birth rates in the  state from the current rate of                                                                    
     10.3 percent.  The demonstration project  shall provide                                                                    
     for  the  voluntary  enrollment  of  approximately  500                                                                    
     recipients  who  are  eligible for  medical  assistance                                                                    
     under  AS 47.07.020(b)(14).  The Department  of  Health                                                                    
     and Social Services  shall offer pregnancy counselling,                                                                    
     nutritional counselling,  and, as necessary,  vitamin D                                                                    
     supplementation to maintain levels  of 40 ng/ml vitamin                                                                    
     D   during   pregnancy    for   participants   in   the                                                                    
     demonstration  project. The  demonstration project  may                                                                    
     be modeled after the Protect  Our Children NOW! project                                                                    
     implemented  as  a  cooperative project  of  the  South                                                                    
     Carolina Department  of Health  and Human  Services and                                                                    
     private   health  organizations.   The   goal  of   the                                                                    
     demonstration  project is  to  achieve  a reduction  in                                                                    
     pre-term  births  in  the state,  consistent  with  the                                                                    
     results of the following  published studies: Wagner, C.                                                                    
     L.,  et   al.,  "A   Randomized  Trial  of   Vitamin  D                                                                    
     Supplementation   in   Two  Community   Health   Center                                                                    
     Networks  in  South   Carolina,"  American  Journal  of                                                                    
     Obstetrics and Gynecology  208 (February 2013); Bodnar,                                                                    
     L.  M.,  et  al.,  "Maternal  25-Hydroxyvitamin  D  and                                                                    
     Preterm  Birth  in  Twin  Gestations,"  Obstetrics  and                                                                    
     Gynecology 122 (July 2013)."                                                                                               
                                                                                                                                
     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 "by sec. 16"                                                                                                   
     Insert "in sec. 17"                                                                                                        
                                                                                                                                
REPRESENTATIVE STUTES objected for discussion.                                                                                  
                                                                                                                                
CHAIR SEATON paraphrased Amendment 28.                                                                                          
                                                                                                                                
7:42:14 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON moved  to adopt Conceptual Amendment  1 to Amendment                                                               
28, following  "investigate", to delete "and",  and insert "the",                                                               
and following "design"  insert "of".  He explained  that with the                                                               
change the  language would read:   "shall investigate  the design                                                               
of  a   demonstration  project".    There   being  no  objection,                                                               
Conceptual Amendment 1 to Amendment 28 was adopted.                                                                             
                                                                                                                                
7:43:44 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  DAVIDSON, in  response  to Chair  Seaton, said  the                                                               
department had no objection to Amendment 28, [as amended].                                                                      
                                                                                                                                
7:43:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL asked for  clarification regarding the length                                                               
of the  [demonstration project] proposed  under Amendment  28, as                                                               
amended.                                                                                                                        
                                                                                                                                
CHAIR SEATON indicated that if  the demonstration project results                                                               
were similar to  those of South Carolina,  then Alaska's pre-term                                                               
birth  rates  could  be  reduced  by half;  however,  he  said  a                                                               
reduction of just  25 percent would still be a  huge cost savings                                                               
for Alaska's medical  system.  He said Amendment  28, as amended,                                                               
would  give  the department  the  authority  to discover  whether                                                               
there was  a project  that it  could undertake.   He  opined that                                                               
this  authority  should  be  given  to  the  department,  because                                                               
preterm births should  be addressed.  He said  the studies listed                                                               
within  the proposed  amendment were  the only  ones he  had seen                                                               
that  directly  related  to  high  success  of  reducing  preterm                                                               
births,  which was  why he  offered  it.   He said  approximately                                                               
5,000  children  were born  under  the  state's Denali  Kid  Care                                                               
Program; therefore, it  would be great to find  success through a                                                               
demonstration project.                                                                                                          
                                                                                                                                
7:46:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR said she had  worked in health research for a                                                               
long time and knew about  the restrictions and requirements.  She                                                               
said she thought  there would be a great  opportunity through the                                                               
demonstration  projects   to  involve  students   throughout  the                                                               
University of Alaska system.                                                                                                    
                                                                                                                                
REPRESENTATIVE  STUTES removed  her  objection to  the motion  to                                                               
adopt  Amendment  28  [as  amended].    There  being  no  further                                                               
objection, Amendment 28, as amended, was adopted.                                                                               
                                                                                                                                
7:47:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TALERICO, in  response  to  Chair Seaton,  stated                                                               
that  due to  the  lack  of support,  he  would  not be  offering                                                               
Amendment  29,   labeled  29-GH1055\A.52,   Strasbaugh,  3/31/15,                                                               
[Included in the committee packet].                                                                                             
                                                                                                                                
7:48:17 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON,  after ascertaining  that  there  were no  further                                                               
amendments to consider, returned to public testimony on HB 148.                                                                 
                                                                                                                                
7:49:04 PM                                                                                                                    
                                                                                                                                
SHELLY VENDETTI-VUCKOVICH  said HB  148 was  a critical  piece of                                                               
legislation for  "all of those close  to me."  She  said Alaskans                                                               
should  be able  to utilize  a  program funded  by their  federal                                                               
taxes.  She  relayed there were those who  believed that Medicaid                                                               
should not be used as a safety  net, but rather as a motivator to                                                               
beneficiaries  to  improve   their  circumstances;  however,  she                                                               
pointed out one group that  would be helped by Medicaid expansion                                                               
was adults with a mental  illness diagnosis, whose coverage ended                                                               
at  the age  of 21  years,  and many  of them  would not  receive                                                               
ongoing  care.    She  said many  in  this  group  self-medicated                                                               
through alcohol  and substance abuse,  could not hold a  job, and                                                               
would  be  in  more  difficult circumstances  without  access  to                                                               
mental health  medication.  Many were  in jail or homeless.   She                                                               
stated that Alaskans were already  paying the cost to incarcerate                                                               
many of the people in this group.   For many, it was difficult to                                                               
continue with an  education, get a better job,  and improve their                                                               
circumstances  when they  did  not have  access  to their  mental                                                               
health  medications just  to  function.   Ms.  Vendetti-Vuckovich                                                               
related her  personal experience was  that members of  this group                                                               
did  not want  to go  to jail  and did  want treatment,  but were                                                               
discouraged  by   the  paperwork,   delays,  and   waitlists  for                                                               
appointments, and  just gave up.   Medication and  some treatment                                                               
was available  to those in  jail, but aftercare  was short-lived.                                                               
Some in  this group received  services paid for by  state general                                                               
funds, and  expansion would augment state  programs with matching                                                               
funds.    She  described  the  delays  and  problems  related  to                                                               
obtaining  medical care  through community  clinics, even  though                                                               
state grants paid for these services.                                                                                           
                                                                                                                                
MS. VENDETTI-VUCKOVICH told  the story of a  family that suffered                                                               
terribly because  psychiatric treatment  was not available.   She                                                               
opined  that  Medicaid  reform should  include  suggestions  from                                                               
those receiving  assistance to  identify inefficiencies,  and she                                                               
offered  to  participate  in  finding  remedies  and  cost-saving                                                               
procedures,  because  administration   procedures  needed  to  be                                                               
examined  to ensure  accuracy  of reporting  and  tracking.   She                                                               
expressed  her  belief  that reform  and  expansion  must  happen                                                               
concurrently in  a professional  manner, without  rancor, because                                                               
the issue was about people, their health, and their lives.                                                                      
                                                                                                                                
7:55:39 PM                                                                                                                    
                                                                                                                                
MARY TONSMIERE  informed the committee  she had been a  nurse for                                                               
47  years, 37  in Alaska.   She  said she  established the  first                                                               
Hospice in the  state in 1980, and in 1994  established the first                                                               
school-based health  center in Alaska.   She said  her experience                                                               
in providing  services to  the working  poor and  the underserved                                                               
had shown her  that it is appreciated and important.   She opined                                                               
it was  appalling that  the proposed  legislation was  being held                                                               
up.   She further related  her experience in listening  to budget                                                               
hearings as one safety net  after another was taken from citizens                                                               
of the state.   She said the state had  an opportunity to provide                                                               
health care that  was vital to life, liberty, and  the pursuit of                                                               
happiness, and  she could not  understand why this was  not going                                                               
forward.                                                                                                                        
                                                                                                                                
7:57:42 PM                                                                                                                    
                                                                                                                                
ILONA FARR, MD, asked why  Medicaid expansion would be done under                                                               
emergency regulations before  public comment.  She  stated that a                                                               
6 percent  tax would  be devastating  for sole  practitioners and                                                               
people  in   small  businesses,   and  she  related   that  every                                                               
physician, dentist, pharmacist,  and nurse she had  talked to did                                                               
not  know [about  the tax].   Dr.  Farr said  HB 148  proposed to                                                               
authorize  a provider  tax up  to the  maximum extent  allowed by                                                               
federal law, and  she was unaware of any other  tax the state had                                                               
put  in place  without  consulting  the people  it  was going  to                                                               
impact.  She  expressed concern that no studies had  been done as                                                               
to the impact such a tax  would have, and she cautioned that such                                                               
a tax  would drive out the  very providers the state  would need,                                                               
in  order  to provide  care  to  these  Medicaid patients.    She                                                               
related that  38 percent of  physicians nationwide had  opted out                                                               
of Medicaid, 70  percent in California, and in  2014, Alaska went                                                               
from 4,500 providers  to 3,500.  More providers would  be lost as                                                               
more tried to stay solvent, she maintained.                                                                                     
                                                                                                                                
DR. FARR  stated that  under HB 148,  people would  be underpaid,                                                               
over-regulated, and  over-audited, as  well as taxed  for serving                                                               
[Medicaid recipients].   She said  no analysis had  been included                                                               
about  how  state  and  federal  taxes  paid  by  Alaskans  might                                                               
increase.   She  said currently  $80  million was  being paid  so                                                               
these Medicaid  patients could get their  permanent fund dividend                                                               
(PFD), but she had not seen how  much more the state was going to                                                               
pay  for this  expansion  to allow  them to  keep  their PFDs  or                                                               
whether  these patients  would "have  to  interrupt their  cancer                                                               
treatment for  the month of ...  October to be able  to get their                                                               
cancer treatment."   Additionally,  for Medicaid patients  at the                                                               
end of  life, the state could  come against their estates  to try                                                               
to recoup  some of the cost.   Dr. Farr asked  whether that would                                                               
happen  with  this  expansion  population if  they  died  or  got                                                               
cancer.     She  expressed   her  concern   that  there   was  no                                                               
verification of the  assets of people, whether  for the exchanges                                                               
or Medicaid.   She  said she  was afraid HB  148 would  cause the                                                               
collapse of the  private sector of medicine,  especially those in                                                               
small businesses, and the state would  end up with a worse health                                                               
care  system and  people unable  to get  the care  they deserved.                                                               
She urged that parts of the bill be reconsidered.                                                                               
                                                                                                                                
8:01:03 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON  closed public testimony  after ascertaining  no one                                                               
further wished to tesify.                                                                                                       
                                                                                                                                
CHAIR SEATON  said the Department  of Health and  Social Services                                                               
had the ability to design a  proposal for a provider tax, but the                                                               
legislature would have to enact  that tax, and the governor would                                                               
have  to sign  it, which  would provide  lots of  opportunity for                                                               
discussion and public input.                                                                                                    
                                                                                                                                
CHAIR SEATON opened committee discussion on HB 148, as amended.                                                                 
                                                                                                                                
8:02:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ said the  proposed legislation went beyond                                                               
the  Medicaid expansion  often spoken  about  by the  press.   It                                                               
would  cover  the  population, generally  speaking,  aged  19-64,                                                               
able-bodied, working age, no children,  and at 138 percent income                                                               
of  federal poverty  level.   She said  presently, [the  state's]                                                               
Medicaid  covered  the most  vulnerable:    the disabled,  blind,                                                               
elderly,  and low-income  families  with children.   [The  state]                                                               
also  offered  a  very generous  Medicaid  package  of  mandatory                                                               
Medicaid services,  plus 27 optional  services that  other states                                                               
did not necessarily provide.   Representative Vazquez warned that                                                               
expanding  Medicaid   without  looking   at  the   numbers  could                                                               
jeopardize the  state's fiscal  situation, especially  in today's                                                               
situation.  She opined that  without sufficient vetting, the bill                                                               
was  fiscally irresponsible,  and  she expressed  shame that  the                                                               
committee  had  not  received  expert  data  to  consider.    She                                                               
characterized  the legislation  as an  octopus, and  said it  was                                                               
unknown whether these options would  really save the state money,                                                               
because there  were no  empirical studies.   She referred  to the                                                               
aforementioned experimental  waiver done by the  State of Oregon,                                                               
and  remarked  that  the  committee had  not  seen  the  results,                                                               
because the department had not obtained  them.  She said at least                                                               
one study in Oregon showed that  emergency room visits shot up by                                                               
41  percent after  Medicaid expansion,  yet the  driving argument                                                               
being  heard by  the  committee  was that  [HB  148] would  lower                                                               
emergency room and other health costs.                                                                                          
                                                                                                                                
8:04:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  said the  same  Oregon  study of  20,000                                                               
patients  found that  expanding  Medicaid did  almost nothing  to                                                               
control  high  blood  pressure,   high  blood  sugar,  and  other                                                               
conditions.   The study found  an improvement in  depression, but                                                               
she  questioned whether  that much  needed to  be spent  to treat                                                               
depression.    This was  the  tip  of  the iceberg,  she  opined,                                                               
because it  was not  known with  confidence how  many individuals                                                               
would  be enrolled.   The  Lewin Group  report, commissioned  and                                                               
paid  for  by  the  Department of  Health  and  Social  Services,                                                               
predicts slightly  over 40,000 enrollees,  whereas a  report from                                                               
Evergreen  Economics put  the  number of  enrollees  at 26,000  -                                                               
about a 52 percent discrepancy.   She remarked that the committee                                                               
had  yet to  hear  any facts  to show  what  the real  enrollment                                                               
number would  be.  She said  in seven states where  expansion had                                                               
occurred   under   the   Affordable   Care   Act,   the   average                                                               
underestimated enrollment  was a whopping 88  percent; therefore,                                                               
she reiterated that the enrollment  number was unknown, but could                                                               
be 26,000 to 40,000 or even double that.                                                                                        
                                                                                                                                
8:07:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ noted  HB  148 proposed  a provider  tax.                                                               
She said  she was troubled  by the depth  and the breadth  of the                                                               
possibility of this  tax.  She said there were  19 provider types                                                               
upon  which the  state could  impose taxes,  whether or  not they                                                               
accepted  Medicaid,  and  that  money would  be  used  to  offset                                                               
Medicaid costs.   The department  had enough  containment efforts                                                               
that should  be undertaken  in this  25-page report,  she argued,                                                               
and then the  department should come back to  [the committee] and                                                               
ask for  what it  wanted to  do in order  to expand  the Medicaid                                                               
program.  Citing from an audit  report issued last week, she said                                                               
Recommendation 2014-07  stated there should be  background checks                                                               
for criminal activity; that in fiscal  year 2014, 15 of 30 tested                                                               
Medicaid  provider  certification  files  were  missing  complete                                                               
criminal   history   background   checks,   and   each   provider                                                               
certification  file  may  include  multiple  employees  requiring                                                               
background checks.   She said the audit also  stated that testing                                                               
of the  15 provider files  disclosed that:   for 4  providers, no                                                               
background  clearances  were  located  for 12  employees,  and  5                                                               
employees were barred, meaning there  was something in their past                                                               
criminal history that  they were not allowed to  participate as a                                                               
provider in the  Medicaid program; for 2  additional providers, 3                                                               
employees  were also  barred; and  for 2  providers, 6  employees                                                               
were in provisional status for a  period of time ranging from 5-8                                                               
months.                                                                                                                         
                                                                                                                                
8:09:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  continued citing  from the  audit report,                                                               
saying it concluded that there  was material weakness in internal                                                               
control,  which  could result  in  material  misstatement to  the                                                               
financial statements.   Before the state proceeded  to expand the                                                               
programs,  she  argued,  the department  should  be  tasked  with                                                               
seriously addressing  these deficiencies.   She noted  that seven                                                               
of the  audit findings were a  repeat of audit findings  from the                                                               
previous  year,   so  those  previous   findings  had   not  been                                                               
corrected.  She  said studies in Oregon  indicated that expanding                                                               
Medicaid  may not  lead  to  results the  state  may  need.   She                                                               
maintained  that expanding  Medicaid could  result in  unintended                                                               
consequences, such  as squeezing out seniors  in Medicare because                                                               
Medicaid provided better benefits  and paid better than Medicare,                                                               
and she  said Alaska's  seniors already had  a hard  time finding                                                               
providers.    She  further  warned   that  benefits  received  by                                                               
Alaska's  existing disabled  blind populations  could potentially                                                               
be squeezed  out, because  - as the  fiscal situation  tightens -                                                               
cuts may  need to  be done  and [the  legislature] would  be more                                                               
tempted to cut  back on the population that was  reimbursed by 50                                                               
percent versus  the new expansion population  that was reimbursed                                                               
at  least 90  percent.   Also,  she said  the federal  government                                                               
could change  the matching  formula, which had  been done  in the                                                               
past;  there was  no guarantee  what the  federal government  may                                                               
contribute  after 2020.   Representative  Vazquez concluded  that                                                               
the state  might be  committing itself to  programs it  could not                                                               
get out of and might be unable to afford in the future.                                                                         
                                                                                                                                
8:12:25 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TALERICO stated  he had no intention  of trying to                                                               
stop the bill  from going to its next committee  of referral, but                                                               
said he  would be unable to  recommend it to the  next committee,                                                               
because several amendments were not  included that he felt should                                                               
have  been.   He  offered  his  appreciation  for the  spirit  of                                                               
cooperation of the committee members and of the department.                                                                     
                                                                                                                                
8:13:26 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON expressed  appreciation  for  the committee's  hard                                                               
work on HB  148.  He said  there were a number  of studies before                                                               
the committee, including ones from  The Lewin Group and Evergreen                                                               
Economics; there was  an investigation of what would  happen.  He                                                               
stated that  approximately $6 million  in savings  was identified                                                               
with the 20,000 estimated participants  and, should 41,000 people                                                               
sign up  the identified savings  was over  $4 million.   He added                                                               
that should 60,000 participants  somehow appeared, it would still                                                               
be a savings of $2 million.  He  relayed that at the low end, the                                                               
fiscal  impact to  the State  of Alaska  was a  positive economic                                                               
impact  of  $145 million  that  would  be spread  throughout  the                                                               
state.   A number of reforms  were included in the  initial bill,                                                               
and this committee added other  reforms, targets, and timetables,                                                               
which would ensure that reform actually took place.                                                                             
                                                                                                                                
8:15:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR urged  that  any frustrations  with how  the                                                               
Medicaid program  was previously administered not  be directed at                                                               
current employees who are new.   She expressed her trust that the                                                               
current employees  would respond  to the  statements made  in the                                                               
audit  and look  for opportunities  to improve.   She  said there                                                               
would  be opportunities  for  input  on the  provider  tax.   She                                                               
stated  that currently,  Alaska was  the only  state not  doing a                                                               
provider tax; therefore, it would not  come as a surprise to some                                                               
of  the  providers that  that  conversation  might happen.    She                                                               
stated disagreement  that her actions  in the future would  be to                                                               
squeeze out  other individuals from this  important social safety                                                               
net  program, including  seniors.   She also  said she  disagreed                                                               
that the  state would be  committing itself to programs  it could                                                               
not  get  out of  or  could  not  afford,  saying this  had  been                                                               
substantiated by a letter from "the  secretary, that we do have a                                                               
process of  getting out  of this."   Responding to  the statement                                                               
that the  state could not  afford what  was being done  here, she                                                               
emphasized that  the state could not  afford to do nothing.   She                                                               
said the  responsibility was on  legislators, and there  had been                                                               
opportunity to obtain information from the department.                                                                          
                                                                                                                                
REPRESENTATIVE  TARR  indicated  there  was  overwhelming  public                                                               
support  [for HB  148], and  legislators worked  for the  people.                                                               
She added that of the individuals  who weighed in on this matter,                                                               
90  percent  were  in  support.   She  remarked  upon  the  great                                                               
opportunity for very detailed discussions  that had been afforded                                                               
the  committee, and  she  noted that  on  several occasions,  the                                                               
department had  responded to lengthy questions  the committee had                                                               
posed.  She said she  was sorry Representative Vazquez had missed                                                               
the committee  meeting that  covered all  16 fiscal  notes, which                                                               
was  the opportunity  to delve  into  the financial  information.                                                               
She stated  that she was  not ashamed  of the work  the committee                                                               
had done and would not  characterize the committee's work in that                                                               
way.                                                                                                                            
                                                                                                                                
8:18:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WOOL   said  committee  members  had   heard  the                                                               
arguments in  support of Medicaid  expansion, such that  it would                                                               
be good for  the state economy, would help bring  in money to the                                                               
state,  would help  people, and  would  help create  jobs in  the                                                               
medical  industry  and spinoff  jobs  in  other industries.    He                                                               
stated  that those  arguments seemed  compelling.   He said  that                                                               
while  reports were  conflicting, the  data  as a  whole was  all                                                               
positive.    He drew  attention  to  a Kaiser  Family  Foundation                                                               
article that looked at data up  to March 2015 for states that had                                                               
adopted  the  expansion.   He  said  30  states had  adopted  the                                                               
expansion,  so   Alaska  would  not  be   experimenting  in  some                                                               
uncharted  territory.   He  shared  that  someone he  spoke  with                                                               
talked about  the empowerment  of being  insured, the  security a                                                               
person  receives  from having  insurance.    He related  his  own                                                               
experience  of   having  been  self-employed   and  under-insured                                                               
because of the  cost of insurance, but under  the Affordable Care                                                               
Act was  able to get a  good family plan, which  had provided him                                                               
an  immeasurable ease  of  mind.   He said  [HB  148] would  give                                                               
Alaskans  peace  of  mind  and let  them  know  legislators  were                                                               
looking out for  their health, productivity, and  ability to stay                                                               
in the state.  He opined that  expansion was a good thing and was                                                               
an overall net positive thing that had to be done.                                                                              
                                                                                                                                
8:21:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE STUTES said she concurred  with her colleagues and                                                               
appreciated Chair Seaton's efforts  in the presentations provided                                                               
to the committee and his handling of this controversial subject.                                                                
                                                                                                                                
8:22:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  FOSTER recognized  the  work done,  and said  his                                                               
constituents  and  the  constituents of  other  legislators  were                                                               
happy with it.                                                                                                                  
                                                                                                                                
8:22:57 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FOSTER moved to report  HB 148, as amended, out of                                                               
committee  with individual  recommendations and  the accompanying                                                               
fiscal notes.                                                                                                                   
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  objected,   referring  to  her  previous                                                               
statement   and   adding   that  other   states   were   pursuing                                                               
alternatives to  provide more access  and more  affordable health                                                               
care.   The  health care  and  fiscal consequences  had not  been                                                               
fully vetted, she maintained.                                                                                                   
                                                                                                                                
8:23:42 PM                                                                                                                    
                                                                                                                                
A  roll call  vote was  taken.   Representatives Foster,  Stutes,                                                               
Talerico, Wool,  Tarr, and Seaton  voted in  favor of HB  148, as                                                               
amended.   Representative Vazquez  voted against it.   Therefore,                                                               
CSHB 148(HSS)  was reported  out of the  House Health  and Social                                                               
Services Standing Committee by a vote of 6-1.                                                                                   
                                                                                                                                
                           AMENDMENTS                                                                                         
                                                                                                                                
The  following amendments  to  HB 148  were  either discussed  or                                                               
adopted  during the  hearing.   [Shorter amendments  are provided                                                               
within the main text only.]                                                                                                     
                                                                                                                                
Amendment 15 [29GH1055\A.37, Glover, 3/30/15] (withdrawn):                                                                    
                                                                                                                                
     Page 3, following line 6:                                                                                                  
     Insert a new bill section to read:                                                                                         
        "* Sec. 4. AS 47.05.200(a), as  amended by sec. 3 of                                                                
     this Act, is amended to read:                                                                                              
          (a) The department shall annually contract for                                                                        
     independent  audits  of  a   statewide  sample  of  all                                                                    
     medical  assistance  providers  in  order  to  identify                                                                    
     overpayments and  violations of criminal  statutes. The                                                                    
     audits  conducted   under  this  section  may   not  be                                                                    
     conducted  by  the  department   or  employees  of  the                                                                    
     department.  The number  of audits  under this  section                                                                    
     [MAY NOT  BE LESS THAN  50] each  year, as a  total for                                                                
     the  medical  assistance  programs under  AS 47.07  and                                                                
     AS 47.08,  shall  be  0.75   percent  of  all  enrolled                                                                
     providers  under  the  programs, adjusted  annually  on                                                                
     July 1, as  determined by  the department,  except that                                                                
     the  number of  audits under  this section  may not  be                                                                
     less  than  75.  The  audits under  this  section  must                                                                
     include both  on-site audits and  desk audits  and must                                                                    
     be of a  variety of provider types.  The department may                                                                    
     not  award  a  contract  under this  subsection  to  an                                                                    
     organization  that  does  not  retain  persons  with  a                                                                    
     significant level of  expertise and recent professional                                                                    
     practice in  the general  areas of  standard accounting                                                                    
     principles and  financial auditing and in  the specific                                                                    
     areas   of   medical  records   review,   investigative                                                                    
     research,  and Alaska  health  care  criminal law.  The                                                                    
     contractor,  in  consultation  with  the  commissioner,                                                                    
     shall  select the  providers to  be audited  and decide                                                                    
     the  ratio of  desk audits  and on-site  audits to  the                                                                    
     total  number selected.  [IN IDENTIFYING  PROVIDERS WHO                                                                    
     ARE  SUBJECT  TO  AN  AUDIT  UNDER  THIS  CHAPTER,  THE                                                                    
     DEPARTMENT SHALL  ATTEMPT TO MINIMIZE  CONCURRENT STATE                                                                    
     OR FEDERAL AUDITS.]"                                                                                                       
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 3, following line 20:                                                                                                 
     Insert a new bill section to read:                                                                                         
        "* Sec. 6. AS 47.05.200(b), as  amended by sec. 5 of                                                                
     this Act, is amended to read:                                                                                              
          (b)  Within 90 days after receiving each audit                                                                        
     report from an audit  conducted under this section, the                                                                    
     department  shall  begin administrative  procedures  to                                                                    
     recoup overpayments identified in  the audits and shall                                                                    
     allocate  the reasonable  and  necessary financial  and                                                                    
     human   resources   to   ensure  prompt   recovery   of                                                                    
     overpayments  unless the  attorney general  has advised                                                                    
     the   commissioner   in   writing   that   a   criminal                                                                    
     investigation  of an  audited provider  has been  or is                                                                    
     about   to   be   undertaken,  in   which   case,   the                                                                    
     commissioner  shall hold  the administrative  procedure                                                                    
     in  abeyance until  a final  charging  decision by  the                                                                    
     attorney general has been  made. The commissioner shall                                                                    
     provide  copies of  all audit  reports to  the attorney                                                                    
     general so  that the  reports can  be screened  for the                                                                    
     purpose of  bringing criminal charges.  [THE DEPARTMENT                                                                    
     MAY  ASSESS   INTEREST  PENALTIES  ON   ANY  IDENTIFIED                                                                    
     OVERPAYMENT.  INTEREST  UNDER  THIS  SECTION  SHALL  BE                                                                    
     CALCULATED USING THE  STATUTORY RATES FOR POST-JUDGMENT                                                                    
     INTEREST ACCRUING FROM THE DATE  OF THE ISSUANCE OF THE                                                                    
     FINAL AUDIT.]"                                                                                                             
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 7, following line 1:                                                                                                  
     Insert a new bill section to read:                                                                                         
        "* Sec. 9. AS 47.07.020(b), as  amended by sec. 8 of                                                                
     this Act, is amended to read:                                                                                              
          (b) In addition to the persons specified in (a)                                                                       
     of  this  section,  the following  optional  groups  of                                                                    
     persons for whom the state  may claim federal financial                                                                    
     participation are eligible for medical assistance:                                                                         
               (1) persons eligible for but not receiving                                                                       
     assistance under  any plan of the  state approved under                                                                    
     42  U.S.C. 1381  -  1383c (Title  XVI, Social  Security                                                                    
     Act,  Supplemental   Security  Income)  or   a  federal                                                                    
     program  designated  as the  successor  to  the aid  to                                                                    
     families with dependent children program;                                                                                  
               (2) persons in a general hospital, skilled                                                                       
     nursing facility,  or intermediate care  facility, who,                                                                    
     if  they  left  the  facility, would  be  eligible  for                                                                    
     assistance under one of  the federal programs specified                                                                    
     in (1) of this subsection;                                                                                                 
               (3) persons under 21 years of age who are                                                                        
     under   supervision  of   the   department,  for   whom                                                                    
     maintenance  is being  paid in  whole or  in part  from                                                                    
     public funds,  and who are  in foster homes  or private                                                                    
     child-care institutions;                                                                                                   
               (4) aged, blind, or disabled persons, who,                                                                       
     because  they   do  not   meet  income   and  resources                                                                    
     requirements,  do  not  receive  supplemental  security                                                                    
     income under 42 U.S.C. 1381  - 1383c (Title XVI, Social                                                                    
     Security  Act),  and who  do  not  receive a  mandatory                                                                    
     state  supplement, but  who are  eligible, or  would be                                                                    
     eligible  if  they  were  not   in  a  skilled  nursing                                                                    
     facility or  intermediate care  facility to  receive an                                                                    
     optional state supplementary payment;                                                                                      
               (5) persons under 21 years  of age who are in                                                                    
     an  institution  designated  as  an  intermediate  care                                                                    
     facility    for   persons    with   intellectual    and                                                                    
     developmental  disabilities  and  who  are  financially                                                                    
     eligible as determined by the  standards of the federal                                                                    
     program  designated  as the  successor  to  the aid  to                                                                    
     families with dependent children program;                                                                                  
               (6)  persons  in  a medical  or  intermediate                                                                    
     care facility  whose income while in  the facility does                                                                    
     not  exceed 300  percent of  the supplemental  security                                                                    
     income  benefit  rate  under 42  U.S.C.  1381  -  1383c                                                                    
     (Title XVI, Social  Security Act) but who  would not be                                                                    
     eligible  for an  optional state  supplementary payment                                                                    
     if they left the hospital or other facility;                                                                               
               (7)  persons under  21 years  of age  who are                                                                    
     receiving  active treatment  in a  psychiatric hospital                                                                    
     and who  are financially eligible as  determined by the                                                                    
     standards  of the  federal  program  designated as  the                                                                    
     successor  to  the  aid   to  families  with  dependent                                                                    
     children program;                                                                                                          
               (8)  persons under  21 years  of age  and not                                                                    
     covered  under  (a)  of  this  section,  who  would  be                                                                    
     eligible  for   benefits  under  the   federal  program                                                                    
     designated  as the  successor to  the  aid to  families                                                                    
     with dependent children program,  except that they have                                                                
     the  care  and  support   of  both  their  natural  and                                                                
     adoptive parents [DO NOT  MEET THE DEPRIVATION CRITERIA                                                                
     UNDER 42 U.S.C. 1396u-1(b)(1)(A)(II)];                                                                                     
               (9) pregnant  women not covered under  (a) of                                                                    
     this  section  and who  meet  the  income and  resource                                                                    
     requirements of  the federal program designated  as the                                                                    
     successor  to  the  aid   to  families  with  dependent                                                                    
     children program;                                                                                                          
               (10)  persons  under  21  years  of  age  not                                                                    
     covered under  (a) of this  section who  the department                                                                    
     has determined  cannot be  placed for  adoption without                                                                    
     medical  assistance  because  of  a  special  need  for                                                                    
     medical or  rehabilitative care and who  the department                                                                    
     has determined are  hard-to-place children eligible for                                                                    
     subsidy under AS 25.23.190 - 25.23.210;                                                                                    
               (11) persons  who can be considered  under 42                                                                    
     U.S.C.  1396a(e)(3) (Title  XIX,  Social Security  Act,                                                                    
     Medical Assistance)  to be individuals with  respect to                                                                    
     whom  a  supplemental  security income  is  being  paid                                                                    
     under  42  U.S.C.  1381  -  1383c  (Title  XVI,  Social                                                                    
     Security Act)  because they meet  all of  the following                                                                    
     criteria:                                                                                                                  
               (A) they are  18 years of age  or younger and                                                                    
     qualify  as   disabled  individuals  under   42  U.S.C.                                                                    
     1382c(a) (Title XVI, Social Security Act);                                                                                 
               (B) the department has determined that                                                                           
               (i) they require a level  of care provided in                                                                    
     a  hospital,  nursing  facility, or  intermediate  care                                                                    
     facility    for   persons    with   intellectual    and                                                                    
     developmental disabilities;                                                                                                
               (ii) it is appropriate  to provide their care                                                                    
     outside of an institution; and                                                                                             
               (iii)  the  estimated  amount that  would  be                                                                    
     spent for medical assistance  for their individual care                                                                    
     outside  an   institution  is  not  greater   than  the                                                                    
     estimated  amount  that  would  otherwise  be  expended                                                                    
     individually   for   medical   assistance   within   an                                                                    
     appropriate institution;                                                                                                   
               (C) if  they were  in a  medical institution,                                                                    
     they  would be  eligible for  medical assistance  under                                                                    
     other provisions of this chapter; and                                                                                      
               (D) home  and community-based  services under                                                                    
     a waiver approved by the  federal government are either                                                                    
     not available  to them under  this chapter or  would be                                                                    
     inappropriate for them;                                                                                                    
               (12)  disabled persons,  as  described in  42                                                                    
     U.S.C. 1396a(a)(10)(A)(ii)(XIII),  who are  in families                                                                    
     whose  income, as  determined under  applicable federal                                                                    
     regulations or guidelines, is less  than 250 percent of                                                                    
     the  official poverty  line applicable  to a  family of                                                                    
     that size according to the  United States Department of                                                                    
     Health and  Human Services, and  who, but  for earnings                                                                    
     in  excess of  the  limit established  under 42  U.S.C.                                                                    
     1396d(q)(2)(B), would  be considered to  be individuals                                                                    
     with respect to whom  a supplemental security income is                                                                    
     being  paid under  42  U.S.C. 1381  -  1383c; a  person                                                                    
     eligible  for assistance  under this  paragraph who  is                                                                    
     not eligible  under another  provision of  this section                                                                    
     shall  pay  a  premium or  other  cost-sharing  charges                                                                    
     according  to a  sliding  fee scale  that  is based  on                                                                    
     income   as   established    by   the   department   in                                                                    
     regulations;                                                                                                               
               (13) persons  under 19 years  of age  who are                                                                    
     not  covered  under  (a)  of  this  section  and  whose                                                                    
     household income  does not exceed 175  [203] percent of                                                                
     the  federal  poverty line  as  defined  by the  United                                                                    
     States  Department of  Health  and  Human Services  and                                                                    
     revised under 42 U.S.C. 9902(2);                                                                                           
               (14) pregnant women who are not covered                                                                          
     under (a)  of this  section and whose  household income                                                                    
     does  not  exceed  175 [200]  percent  of  the  federal                                                                
     poverty   line  as   defined  by   the  United   States                                                                    
     Department  of Health  and Human  Services and  revised                                                                    
     under 42 U.S.C. 9902(2);                                                                                                   
               (15) persons who have been diagnosed with                                                                        
     breast  or cervical  cancer and  who  are eligible  for                                                                    
     coverage under 42 U.S.C. 1396a(a)(10)(A)(ii)(XVIII) [;                                                                     
               (16) PERSONS WHO ARE UNDER 65 YEARS OF AGE,                                                                      
     WHO ARE  NOT PREGNANT, WHOSE HOUSEHOLD  INCOME DOES NOT                                                                    
     EXCEED  138  PERCENT  OF   THE  FEDERAL  POVERTY  LINE,                                                                    
     INCLUDING  THE   FIVE  PERCENT  INCOME   DISREGARD,  AS                                                                    
     DEFINED BY  THE UNITED STATES DEPARTMENT  OF HEALTH AND                                                                    
     HUMAN  SERVICES AND  REVISED UNDER  42 U.S.C.  9902(2),                                                                    
     AND    WHO    ARE     ELIGIBLE    UNDER    42    U.S.C.                                                                    
     1396A(a)(10)(A)(i)(VIII),   IF   THE  FEDERAL   MEDICAL                                                                    
     ASSISTANCE  PERCENTAGE  PAID  TO   THE  STATE  FOR  THE                                                                    
     COVERAGE IS NOT LESS THAN 90 PERCENT]."                                                                                    
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 7, following line 9:                                                                                                  
     Insert a new bill section to read:                                                                                         
        "* Sec.  11. AS 47.07.020(g), as amended  by sec. 10                                                                
     of this Act, is amended to read:                                                                                           
          (g) A person's [FOR THOSE PERSONS WHOSE MEDICAID                                                                  
     ELIGIBILITY  IS  NOT   CALCULATED  USING  THE  MODIFIED                                                                    
     ADJUSTED  GROSS INCOME  STANDARD SET  OUT IN  42 U.S.C.                                                                    
     1396A(e)(14), THOSE  PERSONS'] eligibility  for medical                                                                    
     assistance  under this  chapter  may not  be denied  or                                                                    
     delayed on the  basis of a transfer of  assets for less                                                                    
     than  fair market  value if  the person  establishes to                                                                    
     the satisfaction  of the department that  the denial or                                                                    
     delay would  work an  undue hardship  on the  person as                                                                    
     determined  on  the  basis of  criteria  in  applicable                                                                    
     federal regulations."                                                                                                      
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 7, following line 15:                                                                                                 
     Insert a new bill section to read:                                                                                         
        "* Sec.  13. AS 47.07.020(m), as amended  by sec. 12                                                                
     of this Act, is amended to read:                                                                                           
          (m) Except [FOR THOSE PERSONS WHOSE MEDICAID                                                                      
     ELIGIBILITY  IS  NOT   CALCULATED  USING  THE  MODIFIED                                                                    
     ADJUSTED  GROSS INCOME  STANDARD SET  OUT IN  42 U.S.C.                                                                    
     1396A(e)(14), AND,  EXCEPT] as provided in  (g) of this                                                                    
     section, the  department shall impose a  penalty period                                                                    
     of ineligibility for the transfer  of an asset for less                                                                    
     than  fair   market  value  by   an  applicant   or  an                                                                    
     applicant's   spouse   consistent    with   42   U.S.C.                                                                    
     1396p(c)(1)."                                                                                                              
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 7, following line 28:                                                                                                 
     Insert a new bill section to read:                                                                                         
        "* Sec.  15. AS 47.07.036(b), as amended  by sec. 14                                                                
     of this Act, is amended to read:                                                                                           
          (b) The department, in implementing this section,                                                                     
     shall  take  all  reasonable steps  to  implement  cost                                                                    
     containment  measures  that  do not  eliminate  program                                                                    
     eligibility  or  the  scope  of  services  required  or                                                                    
     authorized  under  AS 47.07.020  and  47.07.030  before                                                                    
     implementing  cost containment  measures  under (c)  of                                                                    
     this section  that directly affect  program eligibility                                                                    
     or coverage of services.  The cost containment measures                                                                    
     taken   under   this   subsection   may   include   new                                                                    
     utilization  review  procedures,  changes  in  provider                                                                    
     payment rates, [AND]  precertification requirements for                                                                    
     coverage  of  services,  and  agreements  with  federal                                                                
     officials  under  which  the  federal  government  will                                                                
     assume responsibility for  coverage of some individuals                                                                
     or some  services for some individuals  through federal                                                                
     programs,  including  the   Indian  Health  Service  or                                                                
     Medicare."                                                                                                             
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 8, following line 26:                                                                                                 
     Insert a new bill section to read:                                                                                         
        "* Sec.  18. AS 47.07.900(4), as amended  by sec. 17                                                                
     of this Act, is amended to read:                                                                                           
               (4)   "clinic    services"   means   services                                                                    
     provided by state-approved  outpatient community mental                                                                    
     health clinics  that receive grants  under AS 47.30.520                                                                
     -  47.30.620,  state-operated community  mental  health                                                                
     clinics,   outpatient   surgical  care   centers,   and                                                                    
     physician clinics;"                                                                                                        
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 9, following line 3:                                                                                                  
     Insert new bill sections to read:                                                                                          
        "* Sec. 20. AS 47.07.900(17),  as amended by sec. 19                                                                
     of this Act, is amended to read:                                                                                           
               (17)    "rehabilitative    services"    means                                                                    
     services   for   substance  abusers   and   emotionally                                                                    
     disturbed or  chronically mentally ill  adults provided                                                                    
     by                                                                                                                         
               (A) a drug or alcohol treatment center that                                                                  
     is funded with a grant under AS 47.30.475; or                                                                          
               (B) an outpatient community mental health                                                                        
     clinic that has a  contract to provide community mental                                                                
     health services under AS 47.30.520 - 47.30.620;                                                                        
        *    Sec.    21.   AS 43.23.075(d);    AS 47.05.250;                                                                  
     AS 47.07.036(d), and 47.07.036(e)  are repealed July 1,                                                                    
     2018."                                                                                                                     
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 9, line 12:                                                                                                           
          Delete "sec. 10"                                                                                                      
          Insert "sec. 16"                                                                                                      
                                                                                                                                
     Page 9, line 17:                                                                                                           
          Delete "10"                                                                                                           
          Insert "16"                                                                                                           
                                                                                                                                
     Page 9, following line 17:                                                                                                 
     Insert a new bill section to read:                                                                                         
        "*  Sec.  24. Section  1  of  this Act  is  repealed                                                                
     July 1, 2018."                                                                                                             
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 9, line 23:                                                                                                           
          Delete "Sections 13 and 14"                                                                                           
          Insert "Sections 21 - 23"                                                                                             
                                                                                                                                
     Page 9, line 24:                                                                                                           
          Delete all material and insert:                                                                                       
        "* Sec.  27. Sections 1  - 3, 5,  7, 8, 10,  12, 14,                                                                
     16, 17, and 19 of this Act take effect July 1, 2015.                                                                       
        * Sec. 28. Sections 4, 6,  9, 11, 13, 15, 18, and 20                                                                  
     of this Act take effect July 1, 2018."                                                                                     
                                                                                                                                
Amendment   20   [29-GH1055\A.26,   Strasbaugh/Glover,   3/28/15]                                                             
(failed 2-5):                                                                                                                   
                                                                                                                                
     Page 1, line 1, following "measures;":                                                                                   
          Insert "relating to verification of eligibility                                                                     
     for  public  assistance  programs administered  by  the                                                                  
     Department of Health and Social Services;"                                                                               
                                                                                                                                
     Page 2, following line 16:                                                                                                 
          Insert a new bill section to read:                                                                                    
        "*  Sec.  3.  AS 47.05  is  amended  by  adding  new                                                                
     sections to article 1 to read:                                                                                             
          Sec.    47.05.105.     Computerized    eligibility                                                                  
     verification   system.   (a)   The   department   shall                                                                  
     establish  a computerized  income, asset,  and identity                                                                    
     eligibility  verification system  for  the purposes  of                                                                    
     verifying   eligibility,  eliminating   duplication  of                                                                    
     public  assistance payments,  and  deterring waste  and                                                                    
     fraud  in public  assistance  programs administered  by                                                                    
     the department under AS 47.05.010.                                                                                         
          (b)   The   department    shall   enter   into   a                                                                    
     competitively  bid contract  with a  third-party vendor                                                                    
     for  the  purpose of  developing  a  system under  this                                                                    
     section  for verifying  an applicant's  eligibility for                                                                    
     public assistance  before the  payment of  benefits and                                                                    
     for   periodically    verifying   eligibility   between                                                                    
     eligibility  redeterminations  and  during  eligibility                                                                    
     redeterminations and reviews  under AS 47.05.110 - 120.                                                                    
     The  department may  also contract  with a  third-party                                                                    
     vendor to provide information  to facilitate reviews of                                                                    
     recipient eligibility conducted by the department.                                                                         
         (c) A contract awarded under this section must                                                                         
               (1) require the vendor to ensure that                                                                            
     annualized savings realized  from implementation of the                                                                    
     verification  system exceed  the total  yearly cost  to                                                                    
     the state for implementing the verification system;                                                                        
               (2) provide a payment structure based on a                                                                       
     per applicant rate and provide  a performance bonus for                                                                    
     achieving a  rate of success in  accurately identifying                                                                    
     waste  and fraud  that is  higher than  a predetermined                                                                    
     rate established by the department;                                                                                        
               (3) require the vendor to include in its                                                                         
     system the databases identified in AS 47.05.110.                                                                           
          (d) The third-party vendor selected under this                                                                        
     section may not hold, bid  on, or be awarded a contract                                                                    
     to  provide enrollment  services  to an  agency of  the                                                                    
     state.                                                                                                                     
          Sec. 47.05.110. Income and asset eligibility                                                                        
     verification.  (a)  Before awarding  public  assistance                                                                  
     and  on a  quarterly  basis thereafter,  to the  extent                                                                    
     permitted  by   federal  or  state  law,   and  if  the                                                                    
     information  is   available  to  the   department,  the                                                                    
     department shall  compare the financial  information of                                                                    
     an  applicant  for  and recipient  of  assistance  with                                                                    
     information from the following sources:                                                                                    
               (1)  earned and  unearned income  information                                                                    
     maintained  by  the   United  States  Internal  Revenue                                                                    
     Service;                                                                                                                   
               (2)  employer weekly,  monthly, or  quarterly                                                                    
     reports  of income  and unemployment  insurance payment                                                                    
     information maintained  by the Department of  Labor and                                                                    
     Workforce Development;                                                                                                     
               (3) earned  income information  maintained by                                                                    
     the United States Social Security Administration;                                                                          
               (4) a  nationwide public records  data source                                                                    
     of  physical asset  ownership  such  as real  property,                                                                    
     automobiles,    watercraft,   aircraft,    and   luxury                                                                    
     vehicles, or  any other vehicle owned  by the applicant                                                                    
     for or recipient of public assistance;                                                                                     
               (5)    national     and    local    financial                                                                    
     institutions;                                                                                                              
               (6)  public  housing and  housing  assistance                                                                    
     payment  information maintained  by  the United  States                                                                    
     Department of Housing and Urban Development;                                                                               
               (7)  wage reporting  and similar  information                                                                    
     maintained by states contiguous to this state;                                                                             
               (8)   beneficiary   records,  earnings,   and                                                                    
     pension  information maintained  by  the United  States                                                                    
     Social Security Administration;                                                                                            
               (9) employment information  maintained by the                                                                    
     Department of Labor and Workforce Development;                                                                             
               (10)     veterans'    benefit     information                                                                    
     maintained by  the United  States Department  of Health                                                                    
     and   Human   Services,   in  coordination   with   the                                                                    
     department   and  the   Department   of  Military   and                                                                    
     Veterans' Affairs;                                                                                                         
               (11) child care  services payment information                                                                    
     maintained by the department;                                                                                              
               (12)  income, employment,  and child  support                                                                    
     information  maintained by  the  Department of  Revenue                                                                    
     under AS 25.27;                                                                                                            
               (13)  income, employment,  and child  support                                                                    
     information maintained by  the United States Department                                                                    
     of  Health and  Human Services  under 42  U.S.C. 652  -                                                                    
     669b;                                                                                                                      
               (14) utility payment information maintained                                                                      
     by  the department  for the  Alaska affordable  heating                                                                    
     program under  AS 47.25.621 - 47.25.626 or  the federal                                                                    
     low-income  home  energy  assistance program  under  42                                                                    
     U.S.C. 8621 - 8629;                                                                                                        
               (15) emergency utility payment information                                                                       
     maintained by the state or a municipality;                                                                                 
               (16) information maintained by the state                                                                         
     concerning a license, permit,  or certificate issued by                                                                    
     a  state agency  if  the cost  of  the license  exceeds                                                                    
     $500;                                                                                                                      
               (17)    information    maintained   by    the                                                                    
     Department   of   Administration   concerning   pension                                                                    
     payments   made   under    AS 14.25,   AS 26.05.222   -                                                                    
     26.05.229, AS 39.35, and former AS 39.37;                                                                                  
               (18) a database of individuals receiving                                                                         
     public assistance or other benefits in another state;                                                                      
               (19) any other database or other source that                                                                     
     provides  current and  accurate information  concerning                                                                    
     the income and assets  of applicants for and recipients                                                                    
     of public assistance.                                                                                                      
          (b) Notwithstanding the requirements of this                                                                          
     section, an application for  public assistance shall be                                                                    
     processed  before a  deadline set  by federal  or state                                                                    
     law or regulation.                                                                                                         
          Sec. 47.05.115. Identity verification process.                                                                      
     (a) Before  awarding public assistance,  the department                                                                  
     shall  require an  applicant for  public assistance  to                                                                    
     prove  the   applicant's  identity  by   requiring  the                                                                    
     applicant  to answer  a series  of questions  about the                                                                    
     applicant's  personal  and financial  information  that                                                                    
     the   department   can    verify   independently.   The                                                                    
     department  shall   provide  a  means  to   verify  the                                                                    
     financial history of an  applicant without bank records                                                                    
     or a credit history.                                                                                                       
          (b) The department shall permit an applicant to                                                                       
     provide the  answers to the  questions posed  under (a)                                                                    
     of  this  section  electronically,  in  person,  or  by                                                                    
     telephone.                                                                                                                 
          (c) Before awarding assistance, and on a                                                                              
     quarterly basis,  the department  shall, to  the extent                                                                    
     permitted  by   federal  or  state   law  and   if  the                                                                    
     information  is  available  to  the  department,  match                                                                    
     identity information  of an applicant for  or recipient                                                                    
     of  public  assistance  against,   at  a  minimum,  the                                                                    
     following public records:                                                                                                  
               (1)     immigration    status     information                                                                    
     maintained by the United  States Department of Homeland                                                                    
     Security, Citizenship and Immigration Services;                                                                            
               (2) death register  information maintained by                                                                    
     the United States Social Security Administration;                                                                          
               (3)  prisoner information  maintained by  the                                                                    
     United States Social Security Administration;                                                                              
               (4)   national   fleeing  felon   information                                                                    
     maintained by the Federal Bureau of Investigation;                                                                         
               (5) a  nationwide public records  data source                                                                    
     of incarcerated individuals;                                                                                               
               (6)  a nationwide  best-address and  driver's                                                                    
     license  data source  to  verify  that individuals  are                                                                    
     residents of the state;                                                                                                    
               (7) a  comprehensive public  records database                                                                    
     that  identifies potential  identity fraud  or identity                                                                    
     theft that can closely  associate name, social security                                                                    
     number, date  of birth,  telephone number,  and address                                                                    
     information;                                                                                                               
               (8)   outstanding  default or  arrest warrant                                                                    
     information  maintained  by  the Department  of  Public                                                                    
     Safety under AS 12.62; and                                                                                                 
               (9)  any other database  or other source that                                                                    
     provides  current and  accurate information  concerning                                                                    
     the identification of individuals.                                                                                         
          Sec. 47.05.120. Discrepancies and case review.                                                                      
     (a) If  there is a discrepancy  between the information                                                                    
     received from  an applicant for or  recipient of public                                                                    
     assistance  and the  results  of  the review  conducted                                                                    
     under AS 47.05.110 and 47.05.115, the department shall                                                                     
               (1)   take   no   further   action   if   the                                                                    
     discrepancy  does not  affect  the  eligibility of  the                                                                    
     applicant or recipient;                                                                                                    
               (2) undertake  a further  investigation under                                                                    
     (b) - (e) of this  section if the discrepancy indicates                                                                    
     that  an  applicant  or  recipient  is  or  has  become                                                                    
     ineligible for assistance.                                                                                                 
          (b) The department shall provide written notice                                                                       
     to  an applicant  or recipient  of a  discrepancy under                                                                    
     (a)(2) of  this section.  The notice must  describe the                                                                    
     discrepancy  and set  out the  reasons the  discrepancy                                                                    
     requires a  redetermination of eligibility,  the manner                                                                    
     in which  the applicant  or recipient may  respond, and                                                                    
     the consequences of failing to respond.                                                                                    
          (c) The applicant or recipient shall respond to a                                                                     
     notice  under (b)  of this  section within  10 business                                                                    
     days.  The  applicant  or recipient  shall  respond  in                                                                    
     writing.                                                                                                                   
          (d)   After    receiving   the    applicant's   or                                                                    
     recipient's response, the department                                                                                       
               (1) may request that the applicant or                                                                            
     recipient provide additional information;                                                                                  
               (2) shall, if the applicant or recipient                                                                         
     disputes  the   accuracy  of   the  information   in  a                                                                    
     database,  disputes  the  effect of  a  discrepancy  on                                                                    
     eligibility for assistance,  or provides an explanation                                                                    
     for the discrepancy,  reinvestigate the discrepancy and                                                                    
     its   effect   on   the  applicant's   or   recipient's                                                                    
     eligibility.                                                                                                               
          (e) In reviewing information under this section,                                                                      
     the department  shall independently  verify information                                                                    
     provided solely by the applicant or recipient.                                                                             
          (f) If the department finds that the report of a                                                                      
     discrepancy  is inaccurate,  that  the discrepancy  has                                                                    
     been satisfactorily explained,  or that the discrepancy                                                                    
     does  not affect  the eligibility  of the  applicant or                                                                    
     recipient,  the department  shall  approve or  continue                                                                    
     eligibility   for   the  relevant   public   assistance                                                                    
     program.                                                                                                                   
          (g) If the department finds that the information                                                                      
     provided by  the applicant or recipient  is inaccurate,                                                                    
     and  that   the  inaccurate  information   affects  the                                                                    
     applicant's  or   recipient's  eligibility,   it  shall                                                                    
     promptly  redetermine  eligibility. If  the  department                                                                    
     determines  that  an  applicant  or  recipient  is  not                                                                    
     eligible for  assistance, the department  shall provide                                                                    
     written notice  of the  determination to  the applicant                                                                    
     or recipient,  along with notice of  the applicant's or                                                                    
     recipient's   right    to   a   fair    hearing   under                                                                    
     AS 47.05.010.                                                                                                              
          (h) If the applicant or recipient does not                                                                            
     respond  to the  notice, the  department shall  deny or                                                                    
     discontinue  assistance   for  failure   to  cooperate.                                                                    
     Eligibility for  assistance may  not be  established or                                                                    
     reestablished until the discrepancy  or change has been                                                                    
     resolved. The  department shall provide  written notice                                                                    
     of the  denial or  discontinuation to the  applicant or                                                                    
     recipient,  along with  notice  of  the applicant's  or                                                                    
     recipient's   right    to   a   fair    hearing   under                                                                    
     AS 47.05.010.                                                                                                              
          (i) The department shall adopt regulations to                                                                         
     implement this section.                                                                                                    
          Sec.     47.05.125.    Referrals     for    fraud,                                                                  
     misrepresentation,  or  inadequate  documentation.  (a)                                                                  
     The department  shall refer  suspected cases  of fraud,                                                                    
     including identity  fraud, to the attorney  general for                                                                    
     criminal  prosecution, recovery  of improper  payments,                                                                    
     and collection of civil penalties.                                                                                         
          (b) The department shall refer suspected cases of                                                                     
     fraud,  misrepresentation, or  inadequate documentation                                                                    
     to other state agencies and programs for review.                                                                           
          Sec. 47.05.130. Reporting. The department shall,                                                                    
     on a  quarterly basis, deliver to  the senate secretary                                                                    
     and  the chief  clerk of  the house  of representatives                                                                    
     and  notify the  legislature of  the availability  of a                                                                    
     report   detailing   the  effectiveness   and   general                                                                    
     findings  of   the  eligibility   verification  system,                                                                    
     including the  number of cases reviewed,  the number of                                                                    
     case  closures, the  number of  referrals for  criminal                                                                    
     prosecution,  the  recovery  of improper  payment,  the                                                                    
     outcomes  of cases  referred to  the attorney  general,                                                                    
     and the savings that have resulted from the system.                                                                        
          Sec. 47.05.135. Provider payments. (a) To the                                                                       
     extent  permitted   by  federal  and  state   law,  the                                                                  
     department  shall  make  available  to  the  public  an                                                                  
     annual report of                                                                                                         
               (1) the names, office locations, and                                                                           
     national  provider identifier  under 42  U.S.C. 1396  -                                                                  
     1396p (Title XIX of the  Social Security Act) of health                                                                  
     care  providers  receiving   payments  under  a  public                                                                  
     assistance program administered by the department; and                                                                   
               (2) for each health care provider, the                                                                         
     number and  types of services  provided under  a public                                                                  
     assistance program, average  submitted charges for each                                                                  
     type  of  service,   average  allowed  amount,  average                                                                  
     medical  assistance   payment,  the   common  procedure                                                                  
     coding system compiled by  the United States Department                                                                  
     of Health and Human  Services for the services provided                                                                  
     by  the  physician,  and   whether  the  services  were                                                                  
     performed in a facility or office setting.                                                                               
          (b) Notwithstanding (a) of this section, the                                                                        
     department  may  not  release  information  under  this                                                                  
     section if the information  would disclose, directly or                                                                  
     indirectly,  the identity  and medical  condition of  a                                                                  
     patient  of   the  health   care  provider,   or  could                                                                  
     reasonably  be expected  to  constitute an  unwarranted                                                                  
     invasion of the personal privacy of the patient.                                                                           
          Sec. 47.05.150. Definitions. In AS 47.05.105 -                                                                      
     47.05.150,                                                                                                                 
               (1) "department" means the Department of                                                                         
     Health and Social Services;                                                                                                
               (2) "health care provider" means a person or                                                                     
     facility approved  by the department to  provide health                                                                    
     care  services  to  a recipient  of  public  assistance                                                                    
     administered by the department;                                                                                            
               (3) "identity information" includes the full                                                                     
     name, aliases, date of  birth, address, social security                                                                    
     number, or  other information identifying  an applicant                                                                    
     for or recipient of  an assistance program administered                                                                    
     by the department under AS 47.05.010."                                                                                     
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page  9, line  12,  following the  first occurrence  of                                                                    
     "Act,":                                                                                                                    
          Insert "AS 47.05.105 - 47.05.150, enacted by sec.                                                                     
     3 of this Act,"                                                                                                            
          Delete "sec. 10"                                                                                                      
          Insert "sec. 11"                                                                                                      
                                                                                                                                
     Page 9, lines 16 - 17:                                                                                                     
          Delete "secs. 1 and 10"                                                                                               
          Insert "secs. 1, 3, and 11"                                                                                           
                                                                                                                                
     Page 9, line 23:                                                                                                           
          Delete "Sections 13 and 14"                                                                                           
          Insert "Sections 14 - 16"                                                                                             
                                                                                                                                
     Page 9, following line 23:                                                                                                 
          Insert new bill sections to read:                                                                                     
        "* Sec. 18. AS 47.05.130, enacted  by sec. 3 of this                                                                
     Act, takes effect July 1, 2016.                                                                                            
        * Sec.  19. Except  as provided in  sec. 18  of this                                                                  
     Act, sec. 3 of this Act takes effect January 1, 2016."                                                                     
                                                                                                                                
     Page 9, line 24:                                                                                                           
          Delete "by sec. 16"                                                                                                   
     Insert "in secs. 17 - 19"                                                                                                  
                                                                                                                                
                                                                                                                                
8:24:20 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health, Education and Social Services Standing Committee meeting                                                                
was adjourned at 8:24 p.m.                                                                                                      

Document Name Date/Time Subjects
HB148 - Amendment combined packet number 1- March-30.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Amendment combined packet number 2 - March 31.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.36 - Vazquez.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.34 -Vazquez.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.33 - Vazquez.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.25 - Vazquez.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Propsed Amendment - A.31 - Seaton.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.24 - Vazquez.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.29 - Vazquez.PDF HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.43 Vazquez.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.17 - Talerico.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.37 - Talerico.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Support - Resolutions in support - March 26-30.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Opposition - Emails - 3-30.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Support - Written Testimony - 3-28-2015.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Support - Emails - 3-30.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Opposition - Written testimony - sheila smith - 3-28.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.42 - Vazquez.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.40 - Vazquez.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.1 -Seaton.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.20 - Seaton.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.19 - Seaton.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.26 - Vazqueaz.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.60 - Seaton -.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.58 - Seaton.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.57 -Vazquez.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.50 - Talerico.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.51 - Talerico.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.53 - Talerico.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.52 - Talerico.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.45 - Vazquez.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.63 - Seaton.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Proposed Amendment - A.64 - Seaton.pdf HHSS 3/31/2015 6:00:00 PM
HB 148
HB148 - Support - AFL-CIO - 03-31-2015.pdf HHSS 3/31/2015 6:00:00 PM
HB 148