Legislature(2009 - 2010)CAPITOL 106
02/10/2009 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Governor's Council on Disabilities and Special Education -autism | |
| Presentation: Rates-on-going Process on Efforts to Develop Fair and Consistent Rate Methodologies for Service Providers Such as Assisted Living Homes, Foster Care, Etc. | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 10, 2009
3:08 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
MEMBERS ABSENT
Representative Lindsey Holmes
COMMITTEE CALENDAR
PRESENTATION: GOVERNOR'S COUNCIL ON DISABILITIES AND SPECIAL
EDUCATION -AUTISM
- HEARD
PRESENTATION: RATES-ON-GOING PROCESS ON EFFORTS TO DEVELOP FAIR
AND CONSISTENT RATE METHODOLOGIES FOR SERVICE PROVIDERS SUCH AS
ASSISTED LIVING HOMES, FOSTER CARE, ETC.
- HEARD
PREVIOUS COMMITTEE ACTION
No Previous Action to Record
WITNESS REGISTER
MILLIE RYAN, Executive Director
Governor's Council on Disabilities & Special Education
Office of the Commissioner
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Presented a Power Point and answered
questions during the presentation.
PATRICK HEFLEY, Deputy Commissioner
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions regarding
the on-going process to develop fair and consistent rate
increases for service providers.
JON SHERWOOD, Medical Assistance Administrator
Division of Health Care Services
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions on the rate increases
for service providers.
ACTION NARRATIVE
3:08:12 PM
CO-CHAIR WES KELLER called the House Health and Social Services
Standing Committee meeting to order at 3:08 p.m.
Representatives Keller, Herron, Coghill, Lynn, Seaton, and
Cissna were present at the call to order.
^Presentation: Governor's Council On Disabilities And Special
Education -Autism
CO-CHAIR KELLER announced that the first order of business would
be a Power Point presentation from the Governor's Council on
Disabilities and Special Education -Autism.
3:08:50 PM
MILLIE RYAN, Executive Director, Governor's Council on
Disabilities & Special Education, Office of the Commissioner,
Department of Health and Social Services (DHSS), presented a
Power Point titled "Autism Issues and Needs." [Included in the
members' packets.] She offered an overview of the 28 member
Council on Disabilities & Special Education. She stated that
the council had five functions: the state council on
developmental disabilities, the special education advisory
panel, the governing board for the special education service
agency, the representative for people with developmental
disabilities to the Alaska Mental Health Trust Authority
(AMHTA), and the interagency coordinating council for infants
and toddlers with disabilities. She noted that Alaska was the
only state to combine these into one council. She described its
Autism Initiative process.
3:11:39 PM
MS. RYAN pointed to slide 2, "Autism," and defined autism as a
spectrum disorder that affected social skills, communication,
play, and behavior. She allowed that there was a wide range of
autism.
3:12:11 PM
MS. RYAN referred to slide 3, "Prevalence," and observed that
there appeared to be an "epidemic" of autism disorders. She
offered that there was now a better diagnostic system and a
broader definition.
3:13:39 PM
REPRESENTATIVE SEATON asked about the parameters of the
definition for autism.
MS. RYAN explained that it was across the spectrum.
REPRESENTATIVE SEATON asked for Ms. Ryan to define the ends of
the spectrum.
MS. RYAN stated that autism was distinguishable from other
developmental disabilities as it affected social interactions
and behaviors.
3:16:36 PM
CO-CHAIR KELLER asked for a list of the guidelines and
parameters, as they had broadened.
MS. RYAN agreed to supply it.
REPRESENTATIVE SEATON asked if any disruptive play or
communication problem, with a neurological base, was autistic.
MS. RYAN replied that there were diagnostic markers.
REPRESENTATIVE SEATON asked for a written definition of the
autism spectrum.
3:18:13 PM
CO-CHAIR HERRON asked if there were a graph for indicators.
3:18:52 PM
MS. RYAN said that there was more information which included
some early warning signs for children.
CO-CHAIR KELLER commented that there had been quite a change in
diagnostic rates.
MS. RYAN explained that diagnosis was now better. She pointed
to slide 4, "Alaska Information," that showed the rise in Alaska
children receiving special education under the autism category.
3:20:15 PM
MS. RYAN spoke about the cumulative annual cost for autism
listed on slide 5 "Alaska Information."
3:20:53 PM
MS. RYAN presented slide 6, "What Research Tells Us," and
emphasized that early intervention made a significant
difference. She explained how important this early intervention
was for the ability to acquire language skills.
3:22:08 PM
MS. RYAN noted the cost savings for early intervention on slide
7, "If we Obtained Similar Results in Alaska."
3:22:38 PM
MS. RYAN pointed to slide 8, "Previous Activities," which
outlined some of the actions already started for autism issues:
an autism alliance, an autism summit, and funding to establish
the Alaska Autism Resource Center.
3:23:33 PM
MS. RYAN reported that slide 9, "Governor's Council on
Disabilities & Special Education" and slide 10, "Committee's
Report" explained that the ad hoc committee had made 59
recommendations to change policy. She reported that the 59
recommendations were narrowed down to 5 interrelated parts. She
listed these to be universal screening; expanded diagnostic
capacity; enhanced referral and training; workforce training;
and time limited, intensive intervention services. She
explained how each of these was necessary for an effective
package. She elaborated on the universal screening, shown on
slide 11, "5-Part Autism Initiative, Universal screening for
ASD" which included a pilot project with two Anchorage
pediatricians, and an autism grant for rapid response in rural
and remote state areas.
3:27:37 PM
MS. RYAN referred to slide 12, "5-Part Autism Initiative,
Expanded diagnostic capacity," which listed the programs at
Children's Hospital at Providence, and the FY09 funding.
3:28:27 PM
MS. RYAN presented slide 13, "5-Part Autism Initiative Outcomes"
which indicated the increases in referrals and evaluations.
3:29:18 PM
MS. RYAN referred to slide 14, "5-Part Autism Initiative
Enhanced referral and training," and explained about the funding
and the contract to Special Education Service Agency. She also
spoke about the Stone Soup group which offered skills building
classes for the entire family.
3:30:41 PM
MS. RYAN continued on to slide 15, "5-Part Autism Initiative
Outcomes," which listed the training, the informational
material, and the national recognition about autism.
3:31:23 PM
MS. RYAN directed attention to slide 16, "5-Part Autism
Initiative Workforce Training," and spoke about the program and
the funding for the University of Alaska, Center for Human
Development curriculum.
MS. RYAN continued with slide 17, 5-Part Autism Initiative
Workforce Training," and described the bachelor, graduate and
paraprofessional programs which were being developed and offered
to Alaskans for clinical work in the state autism network.
3:34:25 PM
MS. RYAN commented on slide 18, "5-Part Autism Initiative Time-
limited, intensive intervention services," and explained that
DHSS was looking at ways to increase and fund the current
intensive services program for kids less than 10 years. She
stated that this included ways to amend Medicaid regulations to
include more autism services, as well as increasing private
insurance mandates.
3:36:02 PM
MS. RYAN mentioned that the ad hoc committee had reconvened and
reviewed the progress to date, prioritized the remaining
recommendations, and met with the State Board of Education &
Early Development with some recommendations, as listed on slide
19, "Recent Recommendations."
3:37:34 PM
MS. RYAN directed attention to slide 20, "Next Steps," and said
that the council was developing strategies for implementing best
practices across different systems. She explained that the
National Autism Center had almost finished its National
Standards Project.
3:38:17 PM
CO-CHAIR HERRON asked about the pilot program for pooled
funding.
MS. RYAN responded that it was an attempt to coordinate a
comprehensive group of systems, so that no single system was
paying for all the services.
CO-CHAIR HERRON opined that parents were either concerned about
the stigma, or demanded that the school district raise their
child.
3:41:16 PM
MS. RYAN observed that a lot of parents had researched options
for their children and were frustrated when they believed that
the schools did not respond to their needs. She allowed that
the state did not always have the necessary services and
resources. She stated the need for everyone to work together.
3:42:34 PM
REPRESENTATIVE COGHILL reiterated the need to receive the
expanded autism definition. He asked whether an autism
diagnosis by a nurse practitioner was considered preliminary,
but would still initiate the service delivery system.
3:43:35 PM
MS. RYAN, in response to a question from Representative Coghill,
explained that currently there was only one advanced nurse
practitioner, but that an autism diagnosis would require an
additional level of training.
REPRESENTATIVE COGHILL asked about the progress for the
University of Alaska Bachelor level program.
3:44:51 PM
MS. RYAN declared that UAA was working on its details.
REPRESENTATIVE COGHILL asked if there was a curriculum ready
program to import, or if it required accreditation and work with
staff to build-up an existing program.
3:45:37 PM
MS. RYAN replied that it was a mixture, as Dr. Richard Kiefer-
O'Donnell had worked with other universities to put together
curriculums.
3:46:19 PM
REPRESENTATIVE COGHILL opined that most everyone was still
working to fully understand all aspects of the Autism
Initiative.
3:46:33 PM
CO-CHAIR KELLER reaffirmed the need for the committee to
understand how autism was diagnosed.
3:47:33 PM
MS. RYAN offered for professionals from Providence Hospital in
Anchorage to speak with the committee about diagnostic methods
for autism.
REPRESENTATIVE SEATON asked whether [slide 18, "5-Part Autism
Initiative Time-limited, intensive intervention services,"]
"information on private insurance mandates implemented in other
states," was a prelude to proposing a mandate for private
insurance coverage in Alaska. He also asked to know if this
coverage already existed under the state insurance policy, and
what the impact would be on insurance costs.
3:49:18 PM
MS. RYAN reported that autism claims by many families were being
denied by insurance carriers. She described some of the
different approaches the states had taken: some states funded
services through ages 18 - 21; some states had specific autism
interventions that were covered; some covered various therapies;
some treated autism similar to mental health services; and some
states had caps. She added that she was informed that the
increased cost for mandated coverage would be about $1.25 each
month per policy.
REPRESENTATIVE SEATON reflected that broadening the definition
could affect the cost, and he would want to see a fiscal
analysis.
^Presentation: Rates-On-Going Process on Efforts to Develop Fair
and Consistent Rate Methodologies for Service Providers Such as
Assisted Living Homes, Foster Care, etc.
CO-CHAIR KELLER announced that the final order of business would
be a presentation on the Rates-On-Going Process on Efforts to
Develop Fair and Consistent Rate Methodologies for Service
Providers Such as Assisted Living Homes, Foster Care, etc.
3:53:16 PM
PATRICK HEFLEY, Deputy Commissioner, Office of the Commissioner,
Department of Health and Social Services (DHSS), presented an
overview of activities for rate review. He noted the impact on
health policy and health financing issues. He reported that
many less costly service alternatives to hospitals and nursing
homes had evolved in the last 35 years. He noted that many of
these alternatives allowed people to stay in their homes and
their communities. He reported that many of the services were
struggling financially as they had not had any increase in
grants or Medicaid rates since 1992.
3:55:40 PM
MR. HEFLEY stated that these businesses received a modest "bump"
last year. He surmised that the financing for these services
needed to be reviewed. He opined that these services often kept
patients from entering more expensive health care facilities.
CO-CHAIR KELLER asked what about the context of the legislative
intent for fee increases.
JON SHERWOOD, Medical Assistance Administrator, Division of
Health Care Services, Department of Health and Social Services
(DHSS), reported that the department did receive a budget
increment for an increase to provider rates. He was not aware
of the intent language, although he mentioned that there were
discussions with the House Health and Social Services Finance
Subcommittee to develop consistent rational rate processes, as
opposed to annually returning to ask for rate increases.
3:57:59 PM
CO-CHAIR KELLER asked if the process was to set a predetermined
rate of increase.
MR. SHERWOOD offered his belief that it was not that specific.
3:58:25 PM
MR. HEFLEY opined that the objective was to establish a rate
methodology. He explained the factors of the methodology to
include geographic cost; a fixed point in time so the data was
based on a point prevalence review; and the ability to breakdown
the elements into a common field for comparable information. He
admitted that the department had a service with no unified way
for determining costs or how to set those costs. He explained
that the legislature had empowered the department to find a rate
methodology to be used for a health care service that had no
prior rate setting.
3:59:41 PM
REPRESENTATIVE COGHILL agreed that there was a need to raise and
set rates. He offered his belief that there was intent language
for the department to research a methodology. He explained that
part of the design was to raise the service provider rates in
order to draw a larger work force into these work areas.
4:01:07 PM
CO-CHAIR KELLER noted that there were five service provider
areas to review on the handout "Rate Increases for Service
Providers" [included in the members' packets] and he asked if
these providers were in a critical status.
4:01:57 PM
MR. HEFLEY declared that those provider areas needed increases,
but that it was necessary to apply a methodology to these
programs. He acknowledged that a rate review had not yet been
done, except for the Senior and Disabilities Services (SDS).
4:02:30 PM
MR. HEFLEY said that the department looked at each program to
find a methodology to apply to a broad spectrum of programs. He
explained that the SDS program was the first test. He reported
that the difficulty they encountered with this methodology was
finding an individual cost, as many costs were bundled into
packages. He allowed that this accounting methodology was very
challenging for many of the providers.
4:05:14 PM
MR. HEFLEY, in response to a question from Co-Chair Keller,
stated that the methodology objective was to find median price
as a basis for setting rates. He allowed that the difficulty
was in the variability of the factors surrounding each service;
for example, the cost to bathe a person would vary depending
upon that patient's level of function.
4:06:41 PM
CO-CHAIR KELLER reflected on the purported 10-20 percent of
fraudulent billing to Medicaid.
MR. SHERWOOD, in response to Co-Chair Keller, explained that
there was a statutory requirement to audit a specific number and
variety of Medicaid providers.
MR. HEFLEY reported that a national policy required Medicaid
audits. He opined that Alaska had done a good job of educating
providers about Medicaid billing.
4:09:35 PM
MR. HEFLEY continued to explain the methodology. He summarized
one difficulty was the determination of cost per unit of service
as compared with an overall budget. He explained the difficulty
of where to account for an actual cost which was not included in
the basis. He reported that the solution was to develop ten
statistical methodologies which adjusted for the reporting
factors. He disclosed that this allowed a statistical mean to
provide a cost. He noted that there were 356 different types of
providers. He expressed that the difficulty of collecting the
data, verifying the information, factoring in the variables, and
modifying the numbers for many divergences made for a slow,
arduous process. He also noted the necessity of determining the
correct language for intent of use to avoid any legal costs. He
referred to SB 32 [An Act relating to medical assistance
payments for home and community-based services] as being close to
having the correct language for the rate proposal.
4:15:55 PM
REPRESENTATIVE COGHILL acknowledged the daunting task, and asked
if the formulation for adjustment of geographic differences was
available.
MR. HEFLEY said that he did not know where the geographic
difference formula originated.
MR. SHERWOOD responded that geographic differentials for a
limited number of services were developed in 1993.
REPRESENTATIVE COGHILL asked about the significant increase in
the rate for personal care attendants.
4:18:46 PM
MR. HEFLEY identified the quest as a search for the fair price
of doing business. He acknowledged the need for stability and
predictability for the provider.
4:20:19 PM
MR. HEFLEY, in response to Representative Cissna, noted the
difference of a policy decision for health care cost containment
as opposed to the mechanics of cost and allocation for
businesses.
CO-CHAIR HERRON referred to the handout "Rate Increases for
Service Providers," [included in members' packets] and asked if
there was a priority to the bulleted points.
MR. HEFLEY noted that there were a variety of categories that
still needed a methodology assessment and determination of the
necessity for an imminent review.
4:23:51 PM
CO-CHAIR HERRON asked again about the priority to the
aforementioned bullet points.
MR. HEFLEY replied that a priority had not been made and that a
determination might be made within each area as opposed to which
area.
4:25:42 PM
MR. HEFLEY noted that a Medicaid task force had been put
together to make recommendations for the upcoming stimulus
package.
4:26:25 PM
REPRESENTATIVE SEATON commented that policy decisions needed to
be made on "what we want to do," and "not on a comparison of
potential costs... ."
4:28:37 PM
MR. HEFLEY expressed that cost was just one factor. He
reflected that the cost was the topic in the committee arena,
but that the care was the topic among his colleagues.
4:29:25 PM
REPRESENTATIVE COGHILL asked when to anticipate the final
report. He expressed the desire for a management tool to define
expected costs for budget certainty. He allowed it was a
separate question from the source of funding.
4:31:19 PM
MR. HEFLEY expressed his unawareness for an expected report. He
noted that fee setting methodologies were being finalized, and
that this presentation was an update before the final
recommendations.
REPRESENTATIVE COGHILL noted that the budget was now being
finalized.
MR. HEFLEY offered to have a methodology by February 18, for
implementation in the budget. He stressed that this was the
first step and the beginning of the process.
4:34:45 PM
REPRESENTATIVE COGHILL, in response to Representative Seaton,
explained that the intention of the House Health and Social
Services Finance Subcommittee was to incrementally raise the
current rates, and to look at a methodology to ensure they were
on the right track. He stated that the expectation was to
assure the money was being spent in the right places.
REPRESENTATIVE SEATON said that there might be policy choices
that were made by dollars. He commented that the House Health
and Social Services Standing Committee should be looking at
policy choices, and should not leave it to a decision by the
House Health and Social Services Finance Subcommittee.
4:37:47 PM
REPRESENTATIVE COGHILL noted that there were ongoing Medicaid
discussions including quality of care, and the qualification for
billing. He emphasized that a budget was a policy statement.
CO-CHAIR KELLER asked for a comprehensive list of all the
services which rates were being set for, and a comparison of
provider services. He asked to know the dollars spent on each
type of provider.
4:40:08 PM
MR. HEFLEY explained that there was a book that listed the
contractors and grantors.
MR. SHERWOOD said that DHSS would provide summary information
and make suggestions.
CO-CHAIR KELLER asked for an executive summary.
MR. HEFLEY asked for the level and the format that would be most
useful.
4:42:24 PM
MR. HEFLEY noted that the volume and complexity for addressing
the comments received from the provider groups affected the
timeline for the project.
CO-CHAIR HERRON noted that both committees must figure out what
was important for Alaskans.
REPRESENTATIVE CISSNA commented that the decision must be
outcome driven in order to meet the constitutional mandate to
promote and protect public health.
REPRESENTATIVE COGHILL offered to distribute the policy
initiatives from the House Health and Social Services Finance
Subcommittee to all the House Health and Social Services
Standing Committee members.
4:46:04 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:46 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| 5-Part Autism Initiative Overview.doc |
HHSS 2/10/2009 3:00:00 PM |
|
| Autism Plan.doc |
HHSS 2/10/2009 3:00:00 PM |
|
| Rate Increase HSS presentation.doc |
HHSS 2/10/2009 3:00:00 PM |
|
| Autism Presentation 2-10-09.ppt |
HHSS 2/10/2009 3:00:00 PM |
|
| Diagnosis of Autism Spectrum Disorders.doc |
HHSS 2/10/2009 3:00:00 PM |