Legislature(2009 - 2010)CAPITOL 106
01/27/2009 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Overview: Department of Health & Social Services | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
January 27, 2009
3:02 p.m.
MEMBERS PRESENT
Representative Bob Herron, Co-Chair
Representative Wes Keller, Co-Chair
Representative John Coghill
Representative Bob Lynn
Representative Paul Seaton
Representative Sharon Cissna
Representative Lindsey Holmes
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
OVERVIEW: DEPARTMENT OF HEALTH & SOCIAL SERVICES
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
BILL HOGAN, Commissioner
Office of the Commissioner
Department of Health and Social Services (DHHS)
Juneau, Alaska
POSITION STATEMENT: Presented an overview of the Department of
Health and Social Services.
ALISON ELGEE, Assistant Commissioner
Central Office
Finance and Management Services
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified during the department overview.
JAY BUTLER, M.D.
Chief Medical Officer
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified during the department overview.
STEVE McCOMB, Director
Division of Juvenile Justice (DJJ)
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Testified during the department overview.
ELLIE FITZJARRALD, Director
Director's Office
Division of Public Assistance
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified during the department overview.
ACTION NARRATIVE
3:02:33 PM
CO-CHAIR WES KELLER called the House Health and Social Services
Standing Committee meeting to order at 3:02 p.m.
Representatives Keller, Herron, Coghill, Lynn, Seaton, and
Holmes were present at the call to order. Representative Cissna
arrived as the meeting was in progress.
^Overview: Department of Health & Social Services
3:03:39 PM
CO-CHAIR KELLER announced that the only order of business would
be an overview of the Department of Health and Social Services.
He noted that Representative Cissna had arrived. He gave a
quick overview of the department, stating that the main intent
of the overview was to build dialogue with this department.
3:05:07 PM
CO-CHAIR KELLER offered some background information on
Commissioner Hogan.
3:05:39 PM
BILL HOGAN, Commissioner, Office of the Commissioner, Department
of Health and Social Services (DHHS), announced that he was
speaking via teleconference and apologized for not being there
personally. He explained that this would be a high level Power
Point overview. He noted that Assistant Director Elgee was
present in Juneau and was also available for questions. He
described some of his work background.
3:09:14 PM
COMMISSIONER HOGAN said that he was actively involved with
Health Care providers to help determine the best health care
service delivery system for behavioral and physical health
problems.
3:09: 58 PM
COMMISSIONER HOGAN introduced his Power Point presentation,
[Included in the members' packets were copies of the Power Point
presentation titled "Alaska Department of Health and Social
Services, Department Overview."] and commented on the second
slide, titled "Alaska Department of Health and Social Services
Organization Chart." He noted that the department had 3,600
employees, though many of the provided services were made
available through outside agencies. He gave brief backgrounds
for Jay Butler, Chief Medical Officer; Bill Streuer, Deputy
Commissioner for Medicaid and Health Care Policy; and Pat
Hefley, Deputy Commissioner for Family, Community, and
Integrated Services.
3:11:50 PM
COMMISSIONER HOGAN introduced Alison Elgee, Assistant
Commissioner for Finance Management Services, and discussed her
background experience.
3:13:00 PM
ALISON ELGEE, Assistant Commissioner, Central Office, Finance
and Management Services, Department of Health and Social
Services (DHSS), introduced the members of the staff who were
present, including Wilda Laughlin, Tammy Sandoval, Ellie
Fitzjarrald, Melissa Witzler-Stone, Steve McComb, Pat Hefley,
Dr. Jay Butler, Beverly Wooley, and Dave Cote.
3:14:24 PM
COMMISSIONER HOGAN referred to slide 3, titled "Health & Social
Services," which was the web home page for Department of Health
and Social Services (DHSS). He pointed out the "Headlines"
banner, which highlighted current DHSS programs including the
Emmonak response, residents' survey about healthy behaviors, the
FosterWear clothing program, and DHSS temporary management of
the Mary Conrad Center. He directed attention to an array of
DHSS services listed on the right side of the webpage.
3:16:37 PM
COMMISSIONER HOGAN called attention to slide 4, titled "Alaska
Pioneer Homes." He informed the committee that there are 6
pioneer homes, with more than a 500 bed capacity, and that only
about 35 beds were still available. He noted that 120 veterans
were living at the Pioneer Homes, with the Palmer Pioneer Home
now a 23 bed Veterans home. He explained that the web page
offered information on each of the Pioneer Homes.
3:17:51 PM
COMMISSIONER HOGAN referred to slide 5, titled "Behavioral
Health," and pointed out the program list on the right side of
the page, which included the Alaska Psychiatric Institute. He
also brought attention to the "Current Events & Announcements"
segment.
3:19:06 PM
COMMISSIONER HOGAN continued on to slide 6, titled "Health Care
Services," and confirmed that this was primarily the state
Medicaid program. He explained that a lot of the division's
work was determined by how to finance services, particularly
through Medicaid. He pointed to the programs listed on the
right side of the page, noting that more detail was available
for each.
3:19:44 PM
COMMISSIONER HOGAN summarized slide 7, titled "Juvenile
Justice," and noted that the division had used a lot of data to
make management decisions. He directed attention to the center
of the page, which listed programs on which the division was
focusing.
3:20:49 PM
COMMISSIONER HOGAN referred to slide 8, titled "Office of
Children's Services," and summed up the mission to be, "safe
kids, strong families." He pointed out that the front line
social workers had to make tough decisions and offered his
belief that these were the toughest jobs in the department.
3:22:05 PM
COMMISSIONER HOGAN reported that slide 9, titled "Public
Assistance," described a broad based division which was
instrumental in determining eligibility for an array of
services, including cash and heating assistance, food stamps,
and senior benefits. He stressed that an important
responsibility for the division was to help people get jobs and
stay employed. He noted that there was a strong partnership
with the Department of Labor.
3:23:28 PM
COMMISSIONER HOGAN identified slide 10, titled "Public Health,"
which enumerated a very broad "laundry list" of
responsibilities. He pointed to the "Announcements & Events,"
which listed current programs including the state Trauma System.
3:24:45 PM
COMMISSIONER HOGAN presented slide 11, titled "Senior &
Disabilities Services," and noted that the division
responsibilities included working with seniors, the
developmentally disabled, physically disabled, as well as
vulnerable adults, in general. He observed that this division
had long-term care responsibilities.
3:25:32 PM
COMMISSIONER HOGAN explained that slide 12, titled "Finance and
Management Services," described the array of support services
for the department. He pointed out the "Sections" heading on
the right side of the page, which included audit, budget, grants
and contracts, and revenue and finance. He directed attention
to the middle of the page, which focused on the Long-term
Forecast of Medicaid.
3:26:40 PM
COMMISSIONER HOGAN concluded the broad overview of the
department and each of the divisions.
3:27:06 PM
CO-CHAIR KELLER noted that there was still a budget overview and
department priorities to be discussed and he thanked the
directors for coming to the presentation.
3:27:44 PM
COMMISSIONER HOGAN remarked on slide 14, titled "Priorities,"
which included a focus on substance abuse, health and wellness,
health-care reform, long-term care, and vulnerable Alaskans.
3:29:09 PM
COMMISSIONER HOGAN then reviewed slide 13, which stated the
theme for the future direction of the DHSS to be "helping
individuals and families create safe and healthy communities."
He said the department could provide resources and facilitate
solutions, but the real solutions would come from individuals
and families. He referred to the handout [contained in the
members' packets], "2009 Priorities," which highlighted each of
the priorities mentioned on slide 14, and he began with the
major strategies for Substance Abuse: Prevention, Early
Intervention, Treatment, and Recovery. He offered his belief
that Alaska does not have a comprehensive, behavioral health
plan. He discussed working with other partners to develop this
plan over the next year.
3:31:50 PM
COMMISSIONER HOGAN addressed health and wellness. He pointed
out the economic impact of reducing obesity, tobacco use,
diabetes, cancer, heart disease, and sexually transmitted
diseases. He allowed that the focus would be on prevention,
access to the health care workforce, expansion of health
insurance coverage, development of a trauma system, emergency
preparedness, and a better understanding of environmental health
impacts from large development projects.
3:34:06 PM
COMMISSIONER HOGAN continued and spoke about health care reform.
He commented on the Obama administration concern for reforming
the health care system. He pointed out that Alaska strategies
included care management, Medicaid reform, establishment of a
Health Care Commission, and partnership with others to increase
the health care workforce.
3:35:06 PM
COMMISSIONER HOGAN reported on long-term care, and noted that
seniors represented the fastest growing population in Alaska.
He remarked that DHSS wanted elders to be able to stay at home,
if at all possible. He revealed that a long-term care plan had
been developed.
3:36:17 PM
COMMISSIONER HOGAN acknowledged the concern for vulnerable
Alaskans: kids in child protective services and the juvenile
justice system, as well as kids and adults who were
developmentally disabled. He promoted a safety net for out-of-
work Alaskans who needed temporary assistance. He mentioned the
Families First program, designed to help those who were losing
their temporary assistance.
3:38:28 PM
COMMISSIONER HOGAN concluded that these priorities captured
everything that DHSS was doing or would like to do as it moves
forward.
3:39:03 PM
REPRESENTATIVE CISSNA said that she had noticed a problem of
state relationships with partner providers and that good
communications would be a factor toward good services.
COMMISSIONER HOGAN responded that communication was an ongoing
challenge for departments and for providers. He mentioned
efforts which had shown some progress. He noted that DHSS did
have a regulatory role, and that it was sometimes not clear
whether DHSS was there to help or to check on the providers.
3:42:27 PM
CO-CHAIR HERRON noted the 2009 priorities and asked what grade
DHSS would give itself.
COMMISSIONER HOGAN said that DHSS deserved a C+ or B-. He
questioned the impact DHSS had made and noted that there were
areas for improvement.
3:44:14 PM
CO-CHAIR HERRON asked what would be the most prominent role of
DHSS to the new health care commission.
COMMISSIONER HOGAN advised that the greatest need was a health
plan, with a focus on access for the uninsured and a quality
workforce.
3:45:45 PM
JAY BUTLER, M.D., Chief Medical Officer, Office of the
Commissioner, Department of Health and Social Services (DHSS),
offered his belief that there were four pillars to health care
reform: cost, quality, access, and prevention. He said that the
first three addressed the demand side of health care, but that
prevention could not be separated. He identified that the
primary problem was to prioritize what to do first. He also
observed the need for an overall health care strategy.
3:47:17 PM
REPRESENTATIVE SEATON commented on the first listed priority,
substance abuse, but that he noticed a lack of co-ordination
with other departments and divisions. He pointed out the high
recidivism rate.
COMMISSIONER HOGAN replied that DHSS was part of the criminal
justice working group, which was working to prevent the return
of people to corrections and the justice system. He reported
the need for an array of community based programs. He spoke
about a pilot program that entailed visits with inmates before
their release.
REPRESENTATIVE SEATON offered his belief that this should be
identified in the priorities.
3:51:08 PM
REPRESENTATIVE COGHILL asked how the health care planning
process might dovetail with the conclusion of the budget.
COMMISSIONER HOGAN expressed hope that the legislature would
support the budget, especially understanding that the world
economy continued to change. He revealed that the DHSS budget
increase was only .2 percent. He allowed that it would be hard
to predict until after the health care commission meeting, but
that he envisioned opportunities after the legislative session
to provide updates to the legislature.
3:54:42 PM
REPRESENTATIVE COGHILL asked if a policy or an economic
direction could be "made on the run."
3:55:41 PM
REPRESENTATIVE LYNN commented that juvenile justice was under
DHSS, and asked if that was a standard organizational set-up in
other states.
3:56:37 PM
STEVE McCOMB, Director, Division of Juvenile Justice (DJJ),
Department of Health and Social Services (DHSS), replied that it
was common for juvenile justice to be within the DHSS as these
were often the same families as from the Office of Children's
Services (OCS).
3:57:54 PM
REPRESENTATIVE CISSNA asked that DHSS listen and work as a
partner with the public and the providers, all of whom wanted to
be a part of the solution.
COMMISSIONER HOGAN noted that the solutions did come from
individuals and families, not from state government.
4:00:40 PM
REPRESENTATIVE SEATON commented that about 50 senior citizens
were being kicked off Medicaid because of social security
adjustments and he asked if the Office of Legal Services was
working with these seniors to retain their eligibility for
Medicaid.
COMMISSIONER HOGAN deferred this question to Ms. Fitzjarrald,
and commented that this was most likely the "law of unintended
consequences."
4:02:21 PM
ELLIE FITZJARRALD, Director, Director's Office, Division of
Public Assistance, Department of Health and Social Services
(DHSS), agreed that this was an important issue that no one
anticipated. She allowed that there was an option to create a
Medicaid Qualifying Trust. She explained that DHSS was working
with the Alaska Legal Services Corporation (ALCS) and other
legal groups on an outreach program for seniors to ensure they
knew of the legal services available to regain eligibility.
4:03:41 PM
REPRESENTATIVE SEATON noted that seniors needed to know who to
call for help.
MS. FITZJARRALD agreed that seniors should call her office at
DHSS.
4:04:59 PM
REPRESENTATIVE HOLMES expressed her pleasure that access is a
priority issue under health and wellness.
COMMISSIONER HOGAN pointed out that currently there was funding
for health care providers throughout the municipality of
Anchorage to work with individuals who did not have access to
health care, Medicaid, or Medicare. He offered his belief that
unfortunately this was not included in the FY 2010 budget. He
offered his support for the program and acknowledged the
challenge for funding.
4:07:56 PM
COMMISSIONER HOGAN discussed slide 15, "Budget Highlights,"
which detailed the actual expenditures by division for FY 2008.
He referred to the high percentage of funds depicted within
Health Care Services, and explained that this was for Medicaid
to hospitals, nursing homes, and pharmacies. He noted that the
pie graph was a good illustration of the distribution of the
funds.
4:09:36 PM
COMMISSIONER HOGAN referred to slide 16, also titled "Budget
Highlights," which listed some of the DHSS programs. He
summarized "Medicaid," and noted that although there was a $46
million FY 2009 budget reduction, there were reasons for a
projected budget excess. These included more accurate
expenditure projections through a new DHSS budget methodology; a
five percent reduction in Medicaid enrollment; and some cost
containment initiatives, among them preferred drug lists.
4:12:19 PM
COMMISSIONER HOGAN discussed technical assistance for the
Medicaid providers to reduce the compliance problems often
revealed during audits.
4:13:31 PM
COMMISSIONER HOGAN talked about FY 2010. He noted a $14 million
net increase in the Medicaid budget. He offered his belief that
the federal stimulus package could bring substantial benefit to
Alaska.
4:15:12 PM
COMMISSIONER HOGAN referred to slide 16 and talked about "Denali
KidCare." He disclosed that the governor proposed to increase
the qualifying poverty level percentage. He observed that there
were competing bills and he offered to work with the Alaska
State Legislature to ensure legislation that was best for
Alaskan families. He offered his belief that people valued
something more when they paid something, and hence he would
support a co-pay program, with exceptions for those families
which could not afford it.
COMMISSIONER HOGAN continued with slide 16 and discussed "Child
Care." He observed that there was an increase in the funding.
He advised that there was no longer a pool of bonus money which
had helped fund child care. He asked the committee for
suggestions of ways to pay for child care.
4:19:29 PM
COMMISSIONER HOGAN directed attention to "Heating Assistance" on
slide 16. He announced that the Alaska State Legislature had
funded the program with $10 million for FY 2009 and had
projected $5 million for FY 2010. He reported that DHSS had
staff in the rural villages to help with applications for both
the federal and state program.
4:21:16 PM
COMMISSIONER HOGAN referenced the "Governor's Health Initiative"
on slide 16, which focused on, among others, reducing obesity,
tobacco prevention, and screening for autism.
4:22:02 PM
COMMISSIONER HOGAN directed attention to the "Bring the Kids
Home" initiative. He summarized that in four years this program
had reduced the number of Alaskan kids residing at out-of-state
residential treatment centers from more than 500 to only 168
kids. He applauded the help of the Alaska State Legislature to
develop in-state facilities.
4:23:37 PM
COMMISSIONER HOGAN conveyed that there had been incremental rate
increases for many providers. He mentioned that DHSS had hired
a contractor to develop a methodology to determine the actual
costs of providers. He offered his belief that the methodology
was too sophisticated and posed a challenge for the smaller
providers. He suggested further study to determine actual
costs, before he would recommend incremental rate increases that
would help small providers to stay in business.
4:25:30 PM
COMMISSIONER HOGAN continued with slide 16 and addressed
"Capital Projects." He mentioned the renovations at the Johnson
Youth Center in Juneau. He conveyed that the "Capital Projects"
budget was $21 million.
4:26:27 PM
COMMISSIONER HOGAN indicated slide 17, titled "Other," and
referred to the three items listed. He first addressed
"Measuring Performance," and listed provider performance
expectation and quality client outcomes as the most important
criteria. He referred to the Alaska Scorecard [included in the
members' packets] which presented a succinct review of Health,
Safety, Living with Dignity, and Economic Security. He
instructed that even greater detail was available online.
4:29:18 PM
COMMISSIONER HOGAN directed attention to the areas that needed
improvement on the Alaska Scorecard. He allowed that the
scorecard showed some progress, but more important, it gave a
solid baseline to measure future performance.
4:30:34 PM
COMMISSIONER HOGAN spoke about community partners. He referred
to the Alaska Native Tribal Health Consortium (ANTHC), Rasmussen
Foundation, Alaska Mental Health Trust Authority (AMHTA),
providers, grantees, boards, the courts, other departments,
Alaska native partners, and the Alaska State Legislature as all
very important partners both for funding and for policy. He
emphasized the need for DHSS to work with all of these partners.
4:31:59 PM
COMMISSIONER HOGAN referred to money contained within the
economic stimulus package, which could support women, infant,
and children programs; expand food stamp eligibility; increase
the low income energy assistance program; and fund senior
nutrition and community health centers, along with many other
health and social programs. He declared that DHSS often asked
the faith based partners for support.
4:34:44 PM
CO-CHAIR HERRON asked if Medicaid audits were possible when not
enough money was requested.
COMMISSIONER HOGAN said that he believed an audit review was
possible, especially with regard to under billing or not
requesting services that were allowed.
4:36:17 PM
CO-CHAIR HERRON asked whether there was a formula for general
fund reductions relative to federal receipt reductions.
MS. ELGEE replied that there was not a single answer, as the
federal programs had different match requirements.
4:38:24 PM
CO-CHAIR HERRON asked that if there were a general fund
decrease, would there be a federal receipt decrease.
MS. ELGEE replied that this was program dependent.
4:39:34 PM
REPRESENTATIVE LYNN asked for an update of the heating oil
assistance program from Venezuela.
COMMISSIONER HOGAN offered his belief that Venezuela was going
to begin the program in Alaska in early February.
4:41:27 PM
REPRESENTATIVE LYNN questioned whether the federal stimulus
package was for capital projects or operating budgets.
COMMISSIONER HOGAN noted that both were included.
4:43:21 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:43 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| DHSS_Overview_1-27-2009.ppt |
HHSS 1/27/2009 3:00:00 PM |