02/04/2014 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB263 | |
| Presentation: Mmis, Department of Health and Social Services | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 263 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 4, 2014
3:05 p.m.
MEMBERS PRESENT
Representative Pete Higgins, Chair
Representative Wes Keller, Vice Chair
Representative Benjamin Nageak
Representative Lance Pruitt
Representative Lora Reinbold
Representative Paul Seaton
Representative Geran Tarr
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 263
"An Act extending senior benefits."
- MOVED CSHB 263(HSS) OUT OF COMMITTEE
PRESENTATION: MMIS~ DEPARTMENT OF HEALTH AND SOCIAL SERVICES
- HEARD
PREVIOUS COMMITTEE ACTION
BILL: HB 263
SHORT TITLE: EXTEND SENIOR BENEFITS PAYMENT PROGRAM
SPONSOR(s): REPRESENTATIVE(s) HAWKER
01/21/14 (H) READ THE FIRST TIME - REFERRALS
01/21/14 (H) HSS, FIN
02/04/14 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
REPRESENTATIVE MIKE HAWKER
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 263 as the sponsor of the
bill.
RON KREHER, Director
Director's Office
Division of Public Assistance
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
263.
WILLIAM STREUR, Commissioner
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions during a discussion of
the Medicaid Management Information System and the Department of
Health and Social Services.
DAVID HAMILTON, Group President
Government Health Care Solutions
Xerox Corporation
Lexington, Kentucky
POSITION STATEMENT: Testified and answered questions during the
discussion on the Medicaid Management Information System (MMIS).
CRAIG STEFFEN, Managing Director
SVP Health Enterprise Operations
Government Health Care Solutions
Xerox State Health Care, LLC
Atlanta, Georgia
POSITION STATEMENT: Testified and answered questions during the
discussion on the Medicaid Management Information System (MMIS).
LISA SMITH, Acting Executive Director
Choices, Inc. & Soteria-Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified and answered questions during the
discussion on the Medicaid Management Information System (MMIS).
KAREN PERDUE, President and CEO
Alaska State Hospital & Nursing Home Association (ASHNHA)
Anchorage, Alaska
POSITION STATEMENT: Testified and answered questions during the
discussion of the Medicaid Management Information System.
CHERYL CAMPBELL
Alaska Speech and Language Depot, Inc.
Anchorage, Alaska
POSITION STATEMENT: Testified during a discussion of the
Medicaid Management Information System.
JULIE DYER
Catholic Community Service
Juneau, Alaska
POSITION STATEMENT: Testified during a discussion of the
Medicaid Management Information System.
NANCY LOVERING
Anchorage, Alaska
POSITION STATEMENT: Testified during a discussion of the
Medicaid Management Information System.
ROSALIE NADEAU, CEO
Akeela
Anchorage, Alaska
POSITION STATEMENT: Testified during a discussion of the
Medicaid Management Information System.
SUSAN GARNER, Finance Director
Mat-Su Services for Children and Adults, Inc.
Wasilla, Alaska
POSITION STATEMENT: Testified during a discussion of the
Medicaid Management Information System.
MALANE HARBOUR, Executive Director
Primrose Retirement Community
Wasilla, Alaska
POSITION STATEMENT: Testified during a discussion of the
Medicaid Management Information System.
TOM CHARD, Director
Alaska Behavioral Health Association
Juneau, Alaska
POSITION STATEMENT: Testified during a discussion of the
Medicaid Management Information System.
THERESA SABENS, Occupational Therapist
Building Blocks Rehab
Fairbanks, Alaska
POSITION STATEMENT: Testified during a discussion of the
Medicaid Management Information System.
SANDRA JAMISON, Owner
Talkabout, Inc.
Fairbanks, Alaska
POSITION STATEMENT: Testified during a discussion of the
Medicaid Management Information System.
ACTION NARRATIVE
3:05:28 PM
CHAIR PETE HIGGINS called the House Health and Social Services
Standing Committee meeting to order at 3:05 p.m.
Representatives Higgins, Pruitt, Nageak, Keller, Seaton, and
Reinbold were present at the call to order. Representative Tarr
arrived as the meeting was in progress.
HB 263-EXTEND SENIOR BENEFITS PAYMENT PROGRAM
3:06:44 PM
CHAIR HIGGINS announced that the first order of business would
be HOUSE BILL NO. 263, "An Act extending senior benefits."
3:07:11 PM
REPRESENTATIVE MIKE HAWKER, Alaska State Legislature, as sponsor
of HB 263, offered an overview of the bill. He explained that
this proposed bill would extend the termination date of the
Senior Benefits Payment Program from June 30, 2015 to June 30,
2021. He shared that the program had been established in 2007,
in response to the recognition for the unsustainability of the
original Longevity Bonus Program, which was not a needs based
program. He reported that there was still a need and a desire
to address the expenses of living in Alaska for low income
seniors. He explained that this was a three tiered program for
benefit payments of $125, $175, or $250 each month, based on
household income relative to the federal poverty level index.
He declared a desire to help Alaskan seniors with the proposed
bill, which would extend the program for six years through 2021.
3:10:40 PM
REPRESENTATIVE PRUITT asked for an explanation to the program
extension being presented this year, as it would not expire
until next year.
REPRESENTATIVE HAWKER, in response, said that the program was a
"life-safety security for these seniors." He explained that
waiting until next session would create greater angst for
seniors, while this proposed bill would let them know in advance
that the program was being extended. He declared that the
average age of the recipients was 75 years, and he said "quite
frankly, those are folks I don't want to cause trauma and
concern for over the course of the coming year."
3:12:17 PM
REPRESENTATIVE SEATON expressed his agreement with bringing this
issue forward early, although he stated concern for the six year
length of the proposed extension. He pointed out that the
current rate of deficit spending had reduced savings, which were
projected to run out sometime in the not too distant future. He
suggested amending the proposed bill to a three year extension,
as this would not put fiscal constraints on a future
legislature.
3:13:59 PM
REPRESENTATIVE HAWKER offered his opinion that the values of the
elected representatives to the State of Alaska should prioritize
programs which benefited all low income seniors across the
state. He asked to give low income seniors this additional
surety that the program had endorsement from the legislature for
more gravitas in the future. He allowed that the program would
always have to compete in the budget process for adequate
funding, although it should not have to "fight for its very
existence in a subsequent reauthorization." He declared that
this was the right thing to do, and the best thing to do, for
our seniors, and that it was possible for this to be done right
now.
3:16:22 PM
CHAIR HIGGINS expressed agreement with Representative Hawker,
although he stated his agreement with Representative Seaton for
fiscal conservatism. He declared that elders and children were
valuable resources in Alaska, and this value should not be
questioned. He endorsed the proposed bill in its current form.
REPRESENTATIVE HAWKER indicated AS 47.45.301(c), which stated
that program funding could be reduced or eliminated in a fiscal
year by the Department of Health and Social Services (DHSS) if
it estimated that appropriations for the program were
insufficient to meet the demands of the program. He declared
that there was an expansion and contraction mechanism in the
program, which would accomplish the same goal as intended by
Representative Seaton, without prematurely terminating the
program.
3:18:17 PM
REPRESENTATIVE SEATON asked if the current statute allowed the
department to shift payments to the most economically
challenged, as opposed to a pro rata reduction.
3:19:08 PM
REPRESENTATIVE HAWKER directed the question to DHSS for its
interpretation of the statute and its intentions. He reported
that low income seniors were not funded if in prison, in state
nursing homes, in veterans or Pioneer homes, or in public or
private institutions for mental disease. He declared that the
state was "very prudent with our spending of the money for this
program."
3:20:18 PM
RON KREHER, Director, Director's Office, Division of Public
Assistance, Department of Health and Social Services, said that
generally a pro rata reduction to balance across the groups
served would be followed, but ultimately DHSS desired to ensure
that those at greatest risk with the lowest income would be
ensured of the benefit.
3:21:14 PM
REPRESENTATIVE SEATON asked if the statute would require a pro
rata approach, or could the majority of payment be directed to
the most economically challenged group.
3:21:39 PM
MR. KREHER offered his belief that the statute allowed
flexibility for either approach, as this specific program was
not heavily regulated.
3:22:15 PM
REPRESENTATIVE NAGEAK clarified the income limits for benefits.
REPRESENTATIVE HAWKER pointed out an inconsistency regarding the
income limits of the federal poverty level in the sponsor
statement. Since it was written, there had been an adjustment
of the federal poverty level and he said he would revise the
sponsor statement. He stated that the smallest payment, $125
per person per month, applied to an individual senior with a
personal annual income of less than $25,515, or a married senior
couple with annual income less than $34,405. He said this was
bench marked to 175 percent of the federal poverty level. He
reported that the $250 per person per month payment went to
individual seniors with a personal income of $10,935 or less, or
married senior couples with an income of $14,745 or less, which
was 75 percent of the federal poverty level. He emphasized the
difficulty for these elders with the costs of living in Alaska.
He reflected that a lot of time had been spent creating these
tiers on the original bill, and that the program has proven its
importance and its durability and workability for the state. He
declared that DHSS had wide latitude to determine equitable
funding for the program, if it could not be fully funded.
3:26:14 PM
CHAIR HIGGINS closed public testimony.
3:26:31 PM
REPRESENTATIVE KELLER moved to adopt Amendment 1, labeled 28-
LS1256|A.1, Mischel, 1/31/14, which read:
Page 1, line 1:
Following "extending":
Insert "the Alaska"
Following "benefits":
Insert "payment program"
There being no objection, it was so ordered.
REPRESENTATIVE HAWKER, as the sponsor of proposed HB 263,
expressed his support for Amendment 1.
The committee took a brief at-ease.
3:28:16 PM
REPRESENTATIVE SEATON referenced his earlier concern for the six
year extension in proposed HB 263. He moved to adopt conceptual
Amendment 2, "which would be to change on line 6, page 1, 2021
to 2017."
3:29:11 PM
REPRESENTATIVE KELLER objected for discussion.
REPRESENTATIVE SEATON offered his belief that the department
[DHSS] would pro rata everything down, and he offered examples
to these payments. He opined that the legislature should
determine the payments. He expressed his concern for extending
a $25 million annual program for six years, when a budget
deficit was projected in the near future.
3:30:45 PM
REPRESENTATIVE PRUITT, referencing the proposed conceptual
Amendment 2, asked if Representative Seaton had intended the
proposed expiration date to be 2018, instead of 2017, as that
would be three years after the current expiration.
3:31:17 PM
REPRESENTATIVE SEATON asked to restate the expiration date in
his proposed conceptual Amendment 2 to be 2018.
3:31:45 PM
REPRESENTATIVE NAGEAK noted that the value of income levels was
dependent upon the cost of living in various areas of the state.
REPRESENTATIVE HIGGINS reminded committee members that
discussion should be limited to proposed conceptual Amendment 2.
REPRESENTATIVE KELLER expressed his support for the Senior
Benefits program, as it was an Alaska program, and was not
initiated through a federal matching program. He explained:
It's one we saw the need, we see the need, and we're
addressing it, and the reason that is significant to
the amendment, is that I personally prefer to give the
seniors a leg up on this one, because, if we get in,
like we are all very concerned about, the legislature,
if we get into this boat of looking for ways to cut,
this is going to be low hanging fruit, because its
dollar for dollar; in other words, they cut a dollar
out of spending for senior programs, it's a dollar
more in general funds; whereas a lot of the Medicaid
stuff, you know, we have to cut twice as much in the
spending in order to get the same savings.
REPRESENTATIVE KELLER expressed his desire to pass the proposed
legislation, and declared his opposition to proposed conceptual
Amendment 2.
3:34:08 PM
REPRESENTATIVE TARR expressed her opposition to proposed
conceptual Amendment 2, stating that a longer term commitment
promoted better planning and encouraged seniors to stay in
Alaska.
3:35:11 PM
REPRESENTATIVE SEATON withdrew proposed conceptual Amendment 2.
He declared his support for the program, and suggested that the
legislature, and not a department, should have the latitude to
make any changes to the program.
3:35:37 PM
The committee took a brief at-ease.
3:36:03 PM
REPRESENTATIVE KELLER moved to report HB 263, as amended, out of
committee with individual recommendations and the accompanying
fiscal notes. There being no objection, CSHB 263(HSS) was moved
from the House Health and Social Services Standing Committee.
3:36:39 PM
The committee took an at-ease from 3:36 p.m. to 3:40 p.m.
^Presentation: MMIS, Department of Health and Social Services
Presentation: MMIS, Department of Health and Social Services
3:40:31 PM
CHAIR HIGGINS announced that the next order of business would be
a discussion regarding the Medicaid Management Information
System (MMIS) and the Department of Health and Social Services.
WILLIAM STREUR, Commissioner, Office of the Commissioner,
Department of Health and Social Services (DHSS), declared that
responsibility for the implementation of the MMIS rested with
him and with Xerox. He said that although DHSS did not have the
technological capabilities for this system, it would ensure that
the system worked as advertised. He relayed that the contract
with Xerox and ACS was $32,487,982, of which the state
commitment for development of the system was 10 percent, between
2007 and October, 2013. He clarified that there had been $146
million spent for development and seven years of operation with
130 Xerox employees. He reported that there had been a lot of
training for state and Xerox staff since July, 2013. This
training was conducted on the new platform to provide
availability 24/7 from any internet connected computer. He
noted that there were 37 courses available for internal system
users, with 130 classes scheduled to assist and enhance the
capabilities for provider use of the system during the first
three months of 2014. He acknowledged that a glaring weakness
had been a lack of sufficient advance communication, and that
DHSS would work closely with Xerox, as well as the provider
community, to fix the challenges to the system. He said that
there had been $118 million in advance payment to the providers
to assist with payment of claims for services. Directing
attention to the requirement for timely filing, he stated that
this had been temporarily suspended. He stated that allowances
would be made for other issues, including Medicare cost reports.
3:46:36 PM
CHAIR HIGGINS established that he was a dentist, and his offices
had felt the "domino effect" as this affected operations and
overhead. He declared that there were many questions, and that
people wanted information and transparency. He stated that the
system was three years late in the coming, and "it just simply
didn't work."
3:47:55 PM
DAVID HAMILTON, Group President, Government Health Care
Solutions, Xerox Corporation, confirmed that he was the Xerox
senior executive responsible for all of its government programs.
Reading from a prepared statement, he noted that Xerox had had
the fiscal agent contract since 2008 for both processing the
daily operation and implementing the new system. He reiterated
that there were 130 Xerox staff working day to day operations,
and including the project team, there were almost 400 people
working on the program. He declared a commitment to the state
and the providers for a rapid resolution. He shared that the
copy business was now the smallest piece of Xerox, whereas the
largest pieces were business and industry services, which
included public and private health care processing. He offered
that Xerox had worked with Medicaid since shortly after the
program was created in 1965, and that Xerox processed for nine
other states. He explained that the technology program in
Alaska "was our latest and greatest solution, it is one where we
have been up and running for roughly 9-10 months in New
Hampshire, both in terms of their claims programs and managed
care programs." He declared that this was a product and program
to which Xerox was very committed. He reported that this was a
large system, with about 7 million lines of code conforming to
more than 10,000 business requirements in Alaska. He declared
that this program replaced a 25 year old system which could not
accomplish all the mandates from health care reform. He
acknowledged that the program was "not where we want to be, but
signs of progress are beginning to show through." He referenced
key information from the claims and service authorization
processing for accessibility and turnaround times, which
reflected significant progress. He pointed out that the old
system processed about $25 million in claims per week, whereas
this system was better than that, processing over $30 million in
claims for the previous three weeks, while currently working
down the backlog of claims from the fourth quarter of 2013. He
stated his regret that the service authorizations had had
periods of 40-60 minutes for access. He stated that currently
the wait time was under 5 minutes, and would be sustained with
the addition of staff and system improvements. He acknowledged
the variation between processing paper and electronic claims, as
clean electronic claims were adjudicated very quickly, whereas
paper claims required manual processing. He offered his belief
that, as they were processing almost 8,000 claims each week, the
paper backlog would be cleared during the next three to four
weeks. He offered his belief that progress had been made and
extended his apologies for the disruptions, stating that Xerox
was escalating its response toward rapid completion.
3:55:13 PM
CHAIR HIGGINS asked if Alaska, as the second state to institute
this program, was used as a learning curve for Xerox.
MR. HAMILTON, in response, acknowledged that "there is a bit of
a learning curve that products in general mature in the market
place." There was a benefit of lessons learned for later
versions.
3:55:53 PM
REPRESENTATIVE KELLER asked how the 10,000 business
considerations in Alaska compared to the other states.
3:56:22 PM
CRAIG STEFFEN, Managing Director, SVP Health Enterprise
Operations, Government Health Care Solutions, Xerox State Health
Care, LLC, replied that, although every state was complex,
unique, and required tailoring around its policies, the number
of Alaska requirements were similar to those in New Hampshire.
He stated that although the core system did most of the day to
day managing and handling of claims from providers and
recipients, the specific policy of each state required complex
tuning, as each state was different. He declared that Alaska
was not a test site, and that the system was specific to the
needs of Alaska.
3:58:01 PM
REPRESENTATIVE SEATON, offering an anecdotal account from a
constituent regarding expiration dates on the insurance cards,
asked if this was a concern throughout the state and if there
was an update on the status.
3:59:03 PM
MR. STEFFEN replied that, although a year of eligibility was
printed on the cards, eligibility was issued on a monthly basis.
He established that Xerox received daily eligibility updates
from the Division of Public Assistance to post on the system.
He considered that the eligibility issue could have been either
with the system or with the individual member. He acknowledged
that there had been issues with timely eligibility transfers
into the system, and with communication to the pharmacy system.
He stated that whenever this had occurred, they had contacted
the pharmacy benefits administrator with appropriate eligibility
information.
4:00:24 PM
REPRESENTATIVE SEATON asked for clarification regarding the
dates on the benefit cards.
MR. STEFFEN offered his understanding that this was a policy of
the State of Alaska, and was not a Xerox protocol.
REPRESENTATIVE SEATON expressed concern for his constituents'
ability to obtain medication, and suggested there be a
notification process.
[Chair Higgins passed the gavel to Representative Pruitt.]
4:03:02 PM
MR. STREUR requested more details regarding the specific
instance, offering his belief that there was 24/7 access to
pharmacies.
REPRESENTATIVE SEATON observed that more communication was
necessary.
REPRESENTATIVE SEATON asked for assurance that the outstanding
money due to the large providers in Homer would be paid in a
timelier manner.
MR. STREUR, in response, said that there were advances available
for almost 100 percent of the billing amounts; however, the
larger providers were most reluctant about accepting an advance
with concerns for any future adjudication. He offered his
belief that no one had been denied an advance, especially to
"keep the doors open, to keep their staff working, and to ensure
that services continue." He offered to provide more details for
the availability of the advances.
REPRESENTATIVE TARR shared that the delay had affected the
ability for day to day operations with one of her constituent
providers. She questioned whether the availability for advances
had been communicated to all the eligible organizations.
4:06:33 PM
MR. STREUR, in response to Representative Seaton, said that
Medicaid Fair Hearings were not related to MMIS, and it was
primarily for claims and authorizations which had been disputed.
He offered to forward more information.
4:07:37 PM
REPRESENTATIVE PRUITT opened public testimony.
4:08:02 PM
LISA SMITH, Acting Executive Director, Choices, Inc. & Soteria-
Alaska, stated that her organization had received very little
communication once the new MMIS site went on-line in October,
although they had a backlog of Medicaid billings. She explained
that it had been necessary to draw from reserves for the
following month and a half. Neither she, nor the Medicaid
billing service they used, was able to access on-line. She
explained that it was now very difficult to meet the required
state matches to grants. She shared that she had twice
requested advances from the Division of Health Care Services,
but had yet to receive any response. She declared that the
current system was not working, and she had heard that all
Medicaid billing had been suspended for the next four to six
weeks. She predicted they would need to close business, if this
was not corrected. She detailed that this would affect both the
beneficiaries and the staff members.
4:10:09 PM
REPRESENTATIVE SEATON asked for more specifics about the request
for an advance.
4:10:51 PM
MS. SMITH, in response to Representative Tarr, explained that
Choices, Inc. was an outpatient service for adult behavioral
health, except for medication management. Through Choices, Inc.
they had Soteria-Alaska, which was an alternative residential
facility for people who wanted to make decisions on their own.
She reported that the organization had been pressured toward a
medical model in which beneficiaries apply for Social Security
and Medicaid.
4:12:22 PM
KAREN PERDUE, President and CEO, Alaska State Hospital & Nursing
Home Association (ASHNHA), sharing that she was representing the
30 members of ASHNHA, reported that ASHNHA had surveyed its
members in the last week regarding the MMIS implementation. She
directed attention to the survey results [Included in members'
packets]. She highlighted some of the issues and suggested
solutions. She reported that most facilities were showing
unusually high balances for Medicaid accounts receivable, with a
total for receivables of $198 million. She stated that the
status of the denials and re-submittals changed weekly, making
it more difficult to accurately report. She expressed a need
for benchmark statistics to better track over time. She
acknowledged the support from State of Alaska and Department of
Health and Social Services staff, although there was still a
feeling of frustration as the providers did not perceive the
improvements in the system which Xerox had described. She
reported that timeliness and accuracy were all rated poorly in
the survey. She offered to run the survey again in a few weeks
to gauge any improvement. She established that 62 percent of
the survey respondents stated that the system had not improved
since November, pointing out that the provider inquiry line with
its 30 minute waiting time was a huge source of frustration.
She reported that many providers had quit calling the inquiry
line. She mentioned that half the ASHNHA members had received
advance payment, although it was difficult to reconcile to
individual payments. She pointed out that the administrative
burden was high, as claims needed to be re-processed. She
endorsed support for the timely filing exemption, asking that it
be in writing, and for the tracking provided by Xerox. She
asked about metrics for solutions to ensure solutions were
attained. She emphasized the need for a focus on long term care
in the small hospitals, as these institutions were not able to
sustain the large accounts receivable debt. She declared that
transparent metrics for better tracking would raise provider
confidence.
4:17:44 PM
REPRESENTATIVE SEATON expressed his appreciation for the survey.
He asked if advances could be tied to specific claims and
whether this would solve the problem for those people wanting
the advance.
MS. PERDUE, in response, explained that it would be helpful if
the advance payment was a lump sum and did not have to be
reconciled similar to each individual advance payment.
REPRESENTATIVE SEATON expressed his agreement that this was a
short term solution for, hopefully, a short term problem. He
offered his belief that this would work for the providers, as
well as Department of Health and Social Services and Xerox.
MR. HAMILTON relayed that DHSS had made several recent attempts
to change the policies, and he offered to work with them for a
solution.
4:20:27 PM
REPRESENTATIVE TARR asked if the timely filing exception was an
already in-place remedy that would address this need. She asked
if these administrative issues were preventing any of the health
care providers from serving patients. She asked how the
organizations were taking on this additional burden for
processing.
MS. PERDUE, in response to Representative Tarr, offered her
belief that Department of Health and Social Services had
extended the timely filing requirement for one year. She
declared that the burden to small hospitals did not affect
direct patient care, although it did create more work for the
business office. She opined that it was an even greater impact
on the small community agencies.
REPRESENTATIVE TARR asked if there had been any decisions to not
provide care because of this processing problem.
MS. PERDUE opined that this was not the case.
4:22:43 PM
CHERYL CAMPBELL, Alaska Speech and Language Depot, Inc., relayed
that she was a speech language pathologist, and, as a sole
proprietor, she provided direct patient care and prepared the
billing. She declared that her biggest issue was for patients
with Medicaid as second insurance. She submitted these as paper
claims, in order to attach the third party insurance information
directly to the claim. She declared that she had not yet
received payment for any services to these clients since the
Xerox transition, and that Xerox would not offer any timeline
for reimbursement. She had not received any payment for these
clients since early September, 2013, with more than $13,000 in
outstanding claims for two clients. As of January 1, 2014, the
Centers for Medicare and Medicaid Services (CMS) had changed the
procedure codes for speech language evaluations from one to four
codes. She reported that she had discussed the procedure code
changes with Xerox in December, and had been informed that the
new codes would be valid on January 1. Her first claim was
denied by the electronic billing system on January 17, 2014,
and, when she called, she was informed that there was no
timeline to the availability for use of the codes. She was
advised not to bill any evaluation services until the new
procedure codes were available. She had, to this point, only
received minimal reimbursement, and her business was quickly
approaching a critical financial point. She noted that the call
time to provider inquiry was a minimum wait for 30 minutes, no
matter the time of day.
[Representative Pruitt returned the gavel to Chair Higgins]
MR. HAMILTON, in response, said that the Xerox staff would
follow up with DHSS in the next 48 hours.
4:28:38 PM
JULIE DYER, Catholic Community Service, stated that Catholic
Community Service (CCS) had a behavioral health division, a
senior services division, and a hospice and home health agency.
She reported that CCS was being reimbursed, which she opined was
due to its narrow code set. She declared that prior to October
1, 2013, there was a three week turnaround for a prior
authorization to Xerox, whereas now it was a three - four month
turnaround. For its waiver program, they had not received any
authorizations since the transition. She explained that they
were not the provider submitting the plans for care, however,
without an authorization, she did not know anything about each
waiver status. She offered her belief that discussions
regarding the viewing of authorizations were ongoing between the
state and Xerox. She declared that waiver claims would be at a
negative collection rate by the end of March, if authorizations
were not put in place. She directed attention to a suggested
fix that Xerox mail authorizations to providers, which was the
method under the previous system; however, the state had refused
as they believed that "providers should be able to see them on
the new system." She opined that this "seems like a really
simple fix to a very big problem." She expressed her
appreciation for the statement by Commissioner Streur that the
system will run as advertised; although, she pointed out, the
providers should not be the ones penalized in the meantime.
CHAIR HIGGINS asked where was the hold up for the waivers.
MR. HAMILTON, in response, stated that DHSS and Xerox can work
out a solution for the print copy.
MR. STREUR opined that the problem was with both DHSS and Xerox,
and he would investigate this problem.
4:34:32 PM
REPRESENTATIVE SEATON, reflecting on the authorizations, asked
if these were for new waivers.
MR. STREUR explained that eligibility for public assistance and
Medicaid came every month, while new authorizations for services
to be rendered to an individual were renewed annually.
REPRESENTATIVE SEATON asked if the monthly authorization was a
new procedure and if this was complicating the system.
MR. STREUR replied that this was not a new procedure. He stated
that an advantage of the healthcare reform was greater
flexibility in that area.
4:36:10 PM
NANCY LOVERING, expressed concern with the difficulty for
receiving reimbursement, as she was a sole proprietor with a
single employee. She was cautious regarding the proposed
advances for fear of audit. She reported that claims were
denied and no secondary claims were paid. She stated that Xerox
told her that the claims filed prior to the shutdown would have
to be re-filed, and she emphasized how costly multiple filing
was for a small business owner. She observed that the Xerox
system would often shut down in the middle of processing. She
lauded Darren Culp, a Xerox employee in Anchorage, who had been
extremely helpful and diligent.
ROSALIE NADEAU, CEO, Akeela, explained that Akeela was a
behavioral health program throughout Alaska. She shared that
most of the funding problems had been with mental health claims.
She confirmed that Akeela was having the same problems as those
listed by previous testifiers. She added that Xerox had no code
for an eligible Medicaid service. She stated that there was
major concern for a non-profit to take an advance, as it was
incumbent upon them to prove the claims against those advances
which created problems for audits and it cost a lot of extra
money for clerical staffing. She observed that Akeela had to
prove its legitimate billings against the advances, and she
opined that a better way would be to treat this as a loan
against the billings. She suggested that some smaller providers
would not be able to stay in business with this system.
CHAIR HIGGINS offered his belief that audits for this time
period would be a "nightmare," as any irregularities created an
issue.
MR. STREUR, in response, said that this was another example of
the need for better communication. He acknowledged that he had
previously worked in the private sector, and he declared the
necessity for separating advances from the billings. He
specified that DHSS would pay an amount against the submitted
claim. He pointed out that the recovery would be in consort
with the provider, as repayment would be against the advance,
and it would be treated as a loan. He declared that he would
keep these as separate processes, and not let the recovery of
the advance go against a remittance advice (RA).
4:46:51 PM
SUSAN GARNER, Finance Director, Mat-Su Services for Children and
Adults, Inc., reporting that she was representing the Alaska
Association on Developmental Disabilities (AADD), stated that
the system would have avoided a lot of these challenges had it
been tested prior to going live. She declared that a delayed
implementation would have been preferable to the current
situation. She shared that AADD had had a 97 percent claim
recovery rate in the final Medicaid processing under the
previous system on September 17, 2013, which was similar to most
other AADD agencies; however, the October recovery rate was zero
percent, with a subsequent increase to 61 percent. She shared
that her organization had experienced the same challenges as
others had already reported. She explained that it was
difficult to bill for services without authorization. She
declared that there had not been any reimbursement for new group
services or for code changes to ongoing services. She stated
that her group was currently owed $1.4 million in accounts
receivable, and its cash reserves were rapidly depleting. She
lauded the bi-weekly tele-conferences with the department which
had also allowed direct contact with Xerox.
4:50:12 PM
MALANE HARBOUR, Executive Director, Primrose Retirement
Community, reported that there had been between 13 to 16
Medicaid choice waiver residents in its community since
September, and she echoed the previously stated concerns. She
shared that Primrose had more than $300,000 for care already
provided due in accounts receivable billing. She noted that the
Primrose billing claims were not being received in the new
system, hence payment had stopped on September 15, 2013. She
reported that her organization had averaged 16 hours for billing
time every two weeks. She listed a variety of excuses she had
heard, including suggestions to continue to re-bill with the
hope that some will go through. She stated that they were now
receiving payment, sometimes duplicate payment, with no RAs, and
Xerox had stated that it did not know what service billing each
check was covering. She declared the necessity for prompt
payment, as Primrose had operating and payroll expenses. She
reported that a new staff member had been hired to primarily
work on these outstanding billings and that payments were being
posted as a credit until this could be straightened out. She
pointed out that it ultimately affected the Medicaid recipients.
4:54:41 PM
TOM CHARD, Director, Alaska Behavioral Health Association,
stated that the association had more than 50 business members,
many of which operated "at the margin, not profitable," and when
a large payer was behind in payments, the accounting nightmare
and audit risk was increased. He lauded the help from the staff
of the Division of Health Care Services. He expressed concern
that the providers would be "left cleaning up the mess."
4:56:52 PM
THERESA SABENS, Occupational Therapist, Building Blocks Rehab,
declared that its receivables were over $250,000. She shared
that the company employed 17 staff. She reported that the wait
time with Xerox was close to an hour, and that they had been
told to wait for eventual payment and not to re-submit claims
because "boxes and boxes are filling our rooms and we don't need
more boxes." The wait for payment had now extended to five
months, and they were not able to hire more staff or add more
equipment. She acknowledged receiving a call from Medicaid
regarding payment, however these payments were for people her
business had not served. She lamented that there were not any
repercussions for Medicaid and "we have to suffer for their
screw-up."
CHAIR HIGGINS said that the Department of Health and Social
Services would contact her.
4:59:39 PM
SANDRA JAMISON, Owner, Talkabout, Inc., acknowledged help from
Xerox, as well as receipt of some payments; however, the
majority of payment requests "are not even showing up in the
system at all."
5:01:10 PM
CHAIR HIGGINS said that everyone on the witness list would be
contacted.
CHAIR HIGGINS closed public testimony.
MR. HAMILTON expressed a continued commitment from Xerox to
"follow through not only the specific issues that have been
mentioned today, but continuing to knock down this backlog and
any of the issues that have been raised over the course of the
last few months." He declared that there would be progress,
discrepancies would be investigated, and there would be
transparency in sharing, clarity, communication, and resolution.
5:02:31 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:02 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 263.pdf |
HHSS 2/4/2014 3:00:00 PM |
HB 263 |
| HB 263 Sponsor Statement.pdf |
HHSS 2/4/2014 3:00:00 PM |
HB 263 |
| HB 263 SBP Fact Sheet (01-31-14).pdf |
HHSS 2/4/2014 3:00:00 PM |
HB 263 |
| HB263-DHSS-SBPP-02-03-14 Fiscal Note.pdf |
HHSS 2/4/2014 3:00:00 PM |
HB 263 |
| HB 263 ACoA Letter of Support.pdf |
HHSS 2/4/2014 3:00:00 PM |
HB 263 |
| HB263 AARP Letter of Support.pdf |
HHSS 2/4/2014 3:00:00 PM |
HB 263 |
| HB 263 Letter in support AGENET.pdf |
HHSS 2/4/2014 3:00:00 PM |
HB 263 |
| HB 263 Letter of support Community connections.pdf |
HHSS 2/4/2014 3:00:00 PM |
HB 263 |
| HB263 letter of support Carol Dejka.pdf |
HHSS 2/4/2014 3:00:00 PM |
HB 263 |
| AK MMIS Legistlative Review.pdf |
HHSS 2/4/2014 3:00:00 PM |
|
| Xerox MMIS Update.pdf |
HHSS 2/4/2014 3:00:00 PM |