Legislature(2019 - 2020)DAVIS 106

03/21/2020 09:00 AM House HEALTH & SOCIAL SERVICES

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Audio Topic
09:03:42 AM Start
09:04:18 AM Overview: Public Assistance & Medicaid Services Covid-19 Response
10:07:04 AM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Uniform Rule 23(a) Waived
+ Overview: Public Assistance & Medicaid Services TELECONFERENCED
COVID-19 Response by
- Deputy Commissioner Al Wall, Dept. of Health
& Social Services
- Shawnda O'Brien, Director, Div. of Public
-- Testimony <Invitation Only> --
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         March 21, 2020                                                                                         
                           9:03 a.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Representative Tiffany Zulkosky, Chair                                                                                          
Representative Ivy Spohnholz, Vice Chair                                                                                        
Representative Matt Claman                                                                                                      
Representative Harriet Drummond                                                                                                 
Representative Geran Tarr                                                                                                       
Representative Sharon Jackson (via teleconference)                                                                              
MEMBERS ABSENT                                                                                                                
Representative Lance Pruitt                                                                                                     
OTHER LEGISLATORS PRESENT                                                                                                     
Representative Louise Stutes                                                                                                    
COMMITTEE CALENDAR                                                                                                            
OVERVIEW: PUBLIC ASSISTANCE & MEDICAID SERVICES COVID-19                                                                        
     - HEARD                                                                                                                    
PREVIOUS COMMITTEE ACTION                                                                                                     
No previous action to record                                                                                                    
WITNESS REGISTER                                                                                                              
ALBERT WALL, Deputy Commissioner                                                                                                
Office of the Commissioner                                                                                                      
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during the informational                                                              
hearing on Medicaid Services and Public Assistance programs.                                                                    
SHAWNDA O'BRIEN, Director                                                                                                       
Director's Office                                                                                                               
Division of Public Assistance                                                                                                   
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered  questions during the informational                                                             
hearing on Medicaid services and public assistance programs.                                                                    
ACTION NARRATIVE                                                                                                              
9:03:42 AM                                                                                                                  
CHAIR  TIFFANY  ZULKOSKY  called  the  House  Health  and  Social                                                             
Services  Standing  Committee  meeting  to  order  at  9:03  a.m.                                                               
Representatives Zulkosky and  Claman were present at  the call to                                                               
order.   Representatives Drummond,  Tarr, Spohnholz,  and Jackson                                                               
(via  teleconference) arrived  as  the meeting  was in  progress.                                                               
Also in attendance was Representative Stutes.                                                                                   
^OVERVIEW:  Public   Assistance  &  Medicaid   Services  COVID-19                                                               
    OVERVIEW: Public Assistance & Medicaid Services COVID-19                                                                
9:04:18 AM                                                                                                                    
CHAIR ZULKOSKY  announced that the  only order of  business would                                                               
be an Overview on Public  Assistance & Medicaid Services COVID-19                                                               
Response by the Department of Health and Social Services.                                                                       
9:05:01 AM                                                                                                                    
ALBERT  WALL, Deputy  Commissioner, Office  of the  Commissioner,                                                               
Department  of  Health  and Social  Services  (DHSS),  began  the                                                               
overview  on  Public  Assistance  &  Medicaid  Services  COVID-19                                                               
Response.    He  said  simultaneous  efforts  were  taking  place                                                               
regarding  safety and  modification  of  systems while  providing                                                               
access to  health care during  [the pandemic].   The department's                                                               
Emergency  Operations Center  (EOC)  efforts  were ongoing,  with                                                               
twice-daily meetings  headed by  Chief Medical Officer  Anne Zink                                                               
and Director of  the Division of Public Health  within DHSS Heidi                                                               
Hedberg.   He said  EOC put  out alerts  and advisories  from the                                                               
Office  of the  Governor.   Mr.  Wall spoke  to the  department's                                                               
relaxation of those policies which  impeded quality of care, such                                                               
as  requirements  around  background   checks  in  licensure  for                                                               
certified nursing assistants (CNAs),  for the purpose of speeding                                                               
up the  licensure process  and ensuring a  supply of  health care                                                               
providers.  While  people are in isolation, telehealth  is also a                                                               
priority, he  related:  efforts  by the director of  the Division                                                               
of  Health Care  Services and  the  director of  the Division  of                                                               
Behavioral Health to determine from  where health care originated                                                               
would  relax  the  medium  through   which  healthcare  could  be                                                               
provided, adding  audio and visual  components that had  not been                                                               
tested to  this extent.  The  third policy change focused  on the                                                               
elderly population on Medicaid.                                                                                                 
9:09:49 AM                                                                                                                    
MR. WALL said  the effort was being led by  John Lee, Director of                                                               
Senior  and Disabilities  Services.   In order  to implement  the                                                               
federal requirements  for change,  Mr. Wall stated,  an appendix,                                                               
or emergency  response, to the waiver  must be put together.   He                                                               
said an application  for the waiver had been made  at the time of                                                               
his  testimony  and  DHSS  was  waiting to  hear  back  from  the                                                               
[federal] Centers  for Medicare  & Medicaid  Services (CMS).   He                                                               
said he  would provide changes  to the committee when  the waiver                                                               
was  accepted by  CMS.    The final  policy  change  was an  1135                                                               
waiver, under  a section of  Medicaid that allowed  for emergency                                                               
regulatory change  during times of  pandemics and disaster.   The                                                               
1135  was last  activated during  the earthquake,  he said.   The                                                               
waiver  was still  being  drafted,  he stated,  and  it would  be                                                               
submitted to the committee as well.                                                                                             
9:13:13 AM                                                                                                                    
REPRESENTATIVE SPOHNHOLZ asked about the 1915K waiver.                                                                          
MR. WALL replied it was an appendix  to a C waiver, which is what                                                               
all senior  disability services  were provided  through Medicaid,                                                               
and the K  appendix is the emergency appendix that  went to the C                                                               
9:14:08 AM                                                                                                                    
REPRESENTATIVE TARR asked how the  emergency regulatory change on                                                               
the 1135 waiver would be used.                                                                                                  
MR. WALL  replied that  every area of  service would  be covered,                                                               
such as  allowing the use  of tents  in parking lots  rather than                                                               
requiring people  receive care in a  building.  In response  to a                                                               
request  for more  information on  the 1135  waiver services,  he                                                               
offered to send a summary sheet.                                                                                                
9:17:05 AM                                                                                                                    
CHAIR  ZULKOSKY  reviewed   considerations  regarding  bolstering                                                               
provider  workforce   when  looking   at  the   federal  Medicaid                                                               
guidelines regarding public health  crisis response:  temporarily                                                               
waiving   screening  requirements   including   the  payment   of                                                               
application  fees, background  checks, and  site visits;  ceasing                                                               
revalidation of providers located  in state or otherwise directly                                                               
impacted;  temporarily  waiving   requirements  for  out-of-state                                                               
providers  to be  licensed in-state;  and allowing  facilities to                                                               
provide  services  in  an  alternate setting.    She  then  asked                                                               
whether the considerations were being  made in Alaska because the                                                               
state   foresaw   a   possible  increase   in   Medicaid-eligible                                                               
MR. WALL confirmed  that a comprehensive letter  had been written                                                               
including   the  four   considerations,   and   a  response   was                                                               
anticipated presently.  He reiterated  that "pretty much anything                                                               
having  to do  with  access to  care" was  included  in the  1135                                                               
CHAIR ZULKOSKY  asked about the  intersection of Mr.  Wall's work                                                               
with DHSS and EOC.                                                                                                              
MR.  WALL replied  that until  an  actual state  of emergency  is                                                               
declared,  EOC is  somewhat dormant  and runs  training missions.                                                               
He added that  EOC had footholds in the Department  of Military &                                                               
Veterans' Affairs (DMVA) as well  as "homeland security," so when                                                               
emergency  was declared  EOC worked  with  DHSS to  respond.   He                                                               
added  that  EOC was  also  connected  to the  Federal  Emergency                                                               
Management Agency (FEMA) to provide  protective equipment and, in                                                               
some cases, personnel.                                                                                                          
9:20:39 AM                                                                                                                    
CHAIR ZULKOSKY asked  Mr. Wall about his work in  relation to the                                                               
efforts  of  the  EOC  regarding   Medicaid  services  in  Alaska                                                               
considering COVID-19.                                                                                                           
MR.  WALL  said  they  met  at  least  twice  daily  to  exchange                                                               
information and contacts.                                                                                                       
CHAIR  ZULKOSKY  asked  Mr.  Wall  to  speak  to  DHSS's  efforts                                                               
regarding additional  benefits currently  not in the  state plan,                                                               
such as waiving prior authorization requirements.                                                                               
MR. WALL  said DHSS had  asked to waive various  specific ongoing                                                               
monthly   checks  so   that  administrative   burdens  could   be                                                               
alleviated and the focus remain on actual care.                                                                                 
CHAIR  ZULKOSKY  asked  for  updates  regarding  availability  of                                                               
personal protective equipment (PPE) in Alaska.                                                                                  
MR. WALL replied  that many PPE manufacturers were  in China, but                                                               
EOC and DHSS were working on the issue.                                                                                         
9:24:57 AM                                                                                                                    
REPRESENTATIVE TARR opined that  something more aggressive should                                                               
be  done  regarding  travel, especially  regarding  International                                                               
travelers  and   passengers  transiting   through  Seattle-Tacoma                                                               
International Airport, and she asked  Mr. Wall whether he had any                                                               
MR. WALL  responded that  the issue  was discussed  by DHSS  on a                                                               
daily, if not  hourly, basis, and he would  provide the committee                                                               
with a specific statement from Dr. Anne Zink on the matter.                                                                     
REPRESENTATIVE TARR  suggested that the American  Red Cross could                                                               
be  passing out  information or  doing temperature  screenings at                                                               
airports.   She offered more  suggestions on  getting information                                                               
to the public.                                                                                                                  
MR. WALL offered to supply a  specific writeup of all the efforts                                                               
in  that  area,  including  "the   public  messaging  piece"  and                                                               
9:27:49 AM                                                                                                                    
CHAIR ZULKOSKY  expressed her agreement with  Representative Tarr                                                               
and implored Mr.  Wall to continue to advocate within  DHSS.  She                                                               
also mentioned  recent epidemiology  studies which  showed Alaska                                                               
had  less than  eight  days to  shut down  the  state before  the                                                               
possibility of becoming overwhelmed with hospitalizations.                                                                      
9:29:08 AM                                                                                                                    
REPRESENTATIVE DRUMMOND  referenced a radio interview  with Rorie                                                               
Watt,  City Manager  for the  City and  Borough of  Juneau (CBJ),                                                               
during  which  Mr.  Watt  stated  he  was  setting  up  volunteer                                                               
screening at  the Juneau International  Airport, which is  run by                                                               
CBJ.    Representative  Drummond  opined  there  also  should  be                                                               
screening at the Ted Stevens  Anchorage International Airport and                                                               
at additional  voluntary screening checkpoints.   She said Alaska                                                               
must take swifter action.                                                                                                       
9:30:28 AM                                                                                                                    
CHAIR ZULKOSKY said HB 206 had  allocated $13 million to DHSS for                                                               
response  and  mitigation  efforts  related  to  COVID-19.    She                                                               
related  that the  committee was  aware some  of these  funds had                                                               
been  spent   on  public  health  nurses,   epidemiologists,  and                                                               
microbiologists, and she  asked Mr. Wall whether he  knew how the                                                               
remainder would be spent.                                                                                                       
MR. WALL replied that organizations  that typically operated in a                                                               
congregate setting were  basically unfunded and would  have to be                                                               
modified.  He said PPE would  be ordered and more emergency staff                                                               
would be hired.   He remarked that the money would  be used "in a                                                               
variety of ways," and he said he  would supply a list of what the                                                               
expenditures would be.   He added that a small  amount would be a                                                               
contingency fund.                                                                                                               
9:32:50 AM                                                                                                                    
REPRESENTATIVE TARR asked what additional  resources needed to be                                                               
provided  in  terms of  public  health  education and  screening,                                                               
because there was still funding available.                                                                                      
MR. WALL said he would defer to Dr. Anne Zink for the response.                                                                 
9:34:00 AM                                                                                                                    
REPRESENTATIVE  JACKSON  asked  for confirmation  that  Mr.  Wall                                                               
would provide  the committee with  the list of  important numbers                                                               
he had mentioned.                                                                                                               
MR. WALL confirmed he would supply the list.                                                                                    
REPRESENTATIVE  JACKSON  asked  for  reconfirmation  that  nurses                                                               
licensed in other states would  have their licensure requirements                                                               
MR.  WALL replied  that it  must be  determined whether  services                                                               
would be able to  be provided in Alaska and how  to pay for them.                                                               
Mr. Wall  said DHSS  was working  with Occupational  Licensing on                                                               
the issue.  He added this was all in the 1135 waiver.                                                                           
REPRESENTATIVE  JACKSON asked  whether the  information available                                                               
at airports had been translated.                                                                                                
MR. WALL said  Dr. Anne Zink was the appropriate  person to field                                                               
this question as well, and he would provide her answer.                                                                         
9:36:22 AM                                                                                                                    
REPRESENTATIVE  TARR  said  she  had  not  seen  the  information                                                               
translated but  had personally sent  materials to the  Center for                                                               
Disease Control (CDC)  to be translated.   She agreed translating                                                               
information should be a high priority.                                                                                          
9:37:31 AM                                                                                                                    
REPRESENTATIVE DRUMMOND  said the  Anchorage School  District had                                                               
language experts who may be able to help translate.                                                                             
MR. WALL  said he  called in to  answer questions  about Medicaid                                                               
services, but DHSS  may be able to provide  a representative from                                                               
EOC to answer questions on screening and the like.                                                                              
CHAIR ZULKOSKY  replied that the  committee did not wish  to take                                                               
those in emergency  operations away from their  efforts to answer                                                               
legislative questions, but if needed they would circle back.                                                                    
9:39:30 AM                                                                                                                    
SHAWNDA O'BRIEN,  Director, Division of Public  Assistance (DPA),                                                               
Department  of  Health and  Social  Services,  shared a  list  of                                                               
implementation efforts.   Relaxing DHSS  eligibility requirements                                                               
and allowing  clients to  give information  over the  phone, thus                                                               
avoiding  in-person  contact, were  two  major  ones.   She  said                                                               
Medicaid   cases  would   not  be   closed  due   to  eligibility                                                               
requirements.    She  related that  state  regulations  would  be                                                               
relaxed around  recertification of  eligible programs;  if people                                                               
were  required to  recertify or  renew in  March, April,  May, or                                                               
June,  those  periods would  be  extended  for  a period  of  six                                                               
months.   She added  that DPA was  working to  balance employees'                                                               
work and childcare needs.                                                                                                       
9:44:17 AM                                                                                                                    
REPRESENTATIVE TARR  asked about payment for  testing and whether                                                               
folks were being charged.                                                                                                       
MR. WALL replied testing was covered under Medicaid.                                                                            
9:45:45 AM                                                                                                                    
CHAIR ZULKOSKY asked Ms. O'Brien for a list of the suspensions.                                                                 
MS. O'BRIEN  said DPA  had more approvals  pending, and  she said                                                               
she  would provide  a  list  that would  be  updated  daily.   In                                                               
response to a follow-up question, she  said there had been no end                                                               
date for  the relaxation of  work requirements; however,  DPA was                                                               
monitoring the situation.                                                                                                       
9:48:40 AM                                                                                                                    
CHAIR ZULKOSKY  asked whether  DPA was  prepared for  a sustained                                                               
increase  in  demand  on  public  assistance  programs  and  what                                                               
preparations had been put in place.                                                                                             
MS.  O'BRIEN replied  there was  enough funding  for meeting  the                                                               
most immediate  needs, and  it had not  been indicated  DPA would                                                               
lose federal funding.                                                                                                           
CHAIR  ZULKOSKY  asked  whether   there  had  been  telecommuting                                                               
mandates  put forward  to the  teams handling  the processes  and                                                               
steps  taken  to  address  a   possible  bottleneck  in  managing                                                               
applications and eligibilities.                                                                                                 
MS.  O'BRIEN  replied  that  certain  levels  of  leadership  had                                                               
telework agreements, especially those with health- or childcare-                                                                
related issues.   She added a  certain number of staff  needed to                                                               
work  from the  office and  the department  was working  daily to                                                               
find the right balance.                                                                                                         
9:52:16 AM                                                                                                                    
CHAIR ZULKOSKY asked whether, while  DHSS has considered relaxing                                                               
eligibility requirements,  there had been evaluation  or guidance                                                               
to increase the  permitted amount of countable  assets that would                                                               
allow Alaska to expand eligibility to various programs.                                                                         
MS.  O'BRIEN replied  there had  not been  a lot  of conversation                                                               
with federal partners on the topic at the time of her testimony.                                                                
9:54:02 AM                                                                                                                    
REPRESENTATIVE  TARR asked  whether a  federal government  payout                                                               
would be under  a similar provision as the  hold harmless portion                                                               
of the state permanent fund dividend (PFD).                                                                                     
MS. O'BRIEN replied she was not  aware of anything at the federal                                                               
level  which would  impact  program recipients.    The focus  was                                                               
trying  to keep  folks eligible  and to  relax as  many rules  as                                                               
possible to keep folks enrolled in programs.                                                                                    
REPRESENTATIVE TARR  said that  if the  federal government  did a                                                               
payout,  then  some folks  could  be  kicked off  their  programs                                                               
because of money  received, and she said this  should be avoided.                                                               
She  asked whether  DHSS was  doing anything  for those  seasonal                                                               
workers whose  work is reduced  in the summer  months, especially                                                               
regarding  the Alaska  Temporary  Assistance  Program (ATAP)  and                                                               
Temporary Assistance for Needy Families (TANF).                                                                                 
9:58:58 AM                                                                                                                    
MS. O'BRIEN  answered that  DHSS was  prioritizing what  was more                                                               
urgently needed, such as preventing any loss of benefits.                                                                       
REPRESENTATIVE TARR  said she feared  disruption in  income could                                                               
lead to more homelessness.                                                                                                      
MS.  O'BRIEN said  external communications  were still  being put                                                               
9:59:42 AM                                                                                                                    
REPRESENTATIVE JACKSON  related a question  from a dentist  as to                                                               
whether  medical  professionals could  help  in  terms of  public                                                               
health screenings.                                                                                                              
MR.  WALL replied  that DHSS  would  gladly accept  a network  of                                                               
professionals interested  in helping.   He added  that interested                                                               
parties were welcome to contact  him directly via his cell phone.                                                               
In response  to Chair Zulkosky,  he said anyone calling  would be                                                               
directed to the appropriate person for assistance.                                                                              
REPRESENTATIVE  JACKSON asked  whether a  direct number  could be                                                               
MR. WALL replied his cell phone number was (907)465-1610.                                                                       
10:03:47 AM                                                                                                                   
REPRESENTATIVE  SPOHNHOLZ  remarked   that  taking  advantage  of                                                               
medical professionals'  expertise would  be in the  best interest                                                               
of the public.                                                                                                                  
10:04:59 AM                                                                                                                   
MS. O'BRIEN, in response to  a question from Chair Zulkosky about                                                               
the status  of the  hold harmless provision,  said DHSS  had full                                                               
funding and no programs had been reduced.                                                                                       
CHAIR  ZULKOSKY asked,  in the  absence of  legislation providing                                                               
statutory authority to  DHSS for hold harmless, and  if a federal                                                               
stimulus check were to be  provided to Alaskans, whether DHSS had                                                               
considered  being proactive  in  holding  Alaskans harmless  from                                                               
that as a countable asset.                                                                                                      
MS. O'BRIEN replied that DHSS had  not been given guidance on how                                                               
to handle  funds, but traditionally  the department would  not be                                                               
considered hold  harmless-eligible, because it was  not under the                                                               
PFD for Alaska.                                                                                                                 
10:07:04 AM                                                                                                                   
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 10:07 a.m.                                                                                                         

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