Legislature(2015 - 2016)CAPITOL 106
03/19/2015 03:00 PM House HEALTH & SOCIAL SERVICES
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| Presentation: Medicaid 101 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
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ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 19, 2015
3:05 p.m.
MEMBERS PRESENT
Representative Paul Seaton, Chair
Representative Liz Vazquez, Vice Chair
Representative Louise Stutes
Representative David Talerico
Representative Geran Tarr
Representative Adam Wool
MEMBERS ABSENT
Representative Neal Foster
OTHER LEGISLATORS PRESENT
Representative Dan Saddler
COMMITTEE CALENDAR
PRESENTATION: MEDICAID 101
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
JON SHERWOOD, Deputy Commissioner
Medicaid and Health Care Policy
Office of the Commissioner
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Presented a PowerPoint and answered
questions during the presentation on Medicaid 101.
MARGARET BRODIE, Director
Director's Office
Division of Health Care Services
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Presented a PowerPoint and answered
questions during the presentation on Medicaid 101.
ACTION NARRATIVE
3:05:17 PM
CHAIR PAUL SEATON called the House Health and Social Services
Standing Committee meeting to order at 3:05 p.m.
Representatives Talerico, Wool, Stutes, and Seaton were present
at the call to order. Representatives Tarr and Vazquez arrived
as the meeting was in progress. Representative Saddler was also
in attendance.
^PRESENTATION: Medicaid 101
PRESENTATION: Medicaid 101
3:05:39 PM
CHAIR SEATON announced that the only order of business would be
a presentation on Medicaid.
3:07:24 PM
JON SHERWOOD, Deputy Commissioner, Medicaid and Health Care
Policy, Office of the Commissioner, Department of Health and
Social Services, introduced himself.
3:07:56 PM
MARGARET BRODIE, Director, Director's Office, Division of Health
Care Services, Department of Health and Social Services, began a
PowerPoint on Medicaid, [Included in members' packets] which she
said was intended to provide an overview of the Medicaid program
on a national as well as a state level. She turned to slide 2,
"Medicaid Goals," and outlined the goals, which included to
integrate and coordinate services and to strategically leverage
technology. She shared that the Centers for Medicare and
Medicaid Services (CMS) has a vision for how it would like to
see the different enterprise systems established for eligibility
or claims processing. The CMS also would like to implement
sound policy, practice fiscal responsibility, and measure and
improve performance.
MS. BRODIE, turning to slide 3, "Medicaid Services Overview,"
provided a brief history of the Medicaid program, which is a
shared program by the federal government and states that began
in 1965. She reported that each state runs its program
differently, with different options, waivers, and populations.
Currently, Medicaid provides insurance to more than 80 million
people, she reported, and in 2014, 138,300 of 158,853 people
enrolled in Alaska actually utilized the services.
MS. BRODIE directed attention to slide 4, "The Role of
Medicaid," which outlined where the 80 million people are
located, including that 33 million children and 19 million
adults obtain Medicaid health insurance coverage; 10 million
elderly and disabled person receive assistance as Medicare
beneficiaries; and 1.5 million institutional residents and 2.9
million community-based residents receive long-term care
assistance. She reported that support for the health care
system and safety-net provide 16 percent of national health
spending, which represents half of long-term care spending. The
state capacity for health coverage in FY 2015 for federal match
rates [Federal Medical Assistance Percentage (FMAP)] ranged from
50 to 73.6 percent, with Alaska currently at a 50 percent
federal matching rate, which is the floor and the lowest
possible rate. In fact, if a floor did not exist the FMAP rate
would be 42.1 percent, she said. She turned to slide 5,
"Medicaid is an Integral Health Care Component," which
highlighted that Medicaid in Alaska provides services, helps the
economy, and provides jobs. She turned to slide 6, "Services,"
and said the Medicaid program supports providers as one of many
payers in the system, and it also serves as a safety net for
individuals, children, and elders, by providing basic health
coverage for those who would otherwise be uninsured.
MS. BRODIE turned to slide 7, "Economy," and highlighted that
Medicaid is the primary payer for long-term care services, not
just in Alaska, but nationally, for behavioral health services
and for anti-psychotic medications. The health care
expenditures in Alaska were $7.5 billion in the last census, of
which Medicaid represented approximately 18 percent, and in 2014
Medicaid provided 34,100 health care jobs [slide 8]. She
directed attention to slide 9, "Who Pays for Health Care in
Alaska?" She reported that the University of Alaska Anchorage
Institute of Social and Economic Research (ISER) provided the
statistics depicted in the pie chart on this slide. She pointed
to the bottom of the pie chart, to two slices representing
Medicaid, with the red slice indicating the federal share at 12
percent and the yellow slice indicating the state general fund
payments at 5.5 percent. In addition, government employers are
the largest payers of health care in Alaska at 22 percent, with
self-insurance at 11 percent, employer premiums at 8.5 percent,
and again the combined federal and state Medicaid share at 17.5
percent.
MS. BRODIE directed attention to slide 10, "Medicaid
Expenditures by Service FY 2013," and pointed out these
expenditures actually cover long-term care, premiums for
enrollees to participate in the Medicare program, payments to
managed care organizations (MCOs) at 31.1 percent, other acute
care at 9.5 percent, inpatient hospital costs at 13.5 percent,
and pharmacy costs at 1.5 percent.
REPRESENTATIVE STUTES asked for further clarification on who
makes the premium payments for Medicare.
MS. BRODIE answered the State of Alaska's Medicaid program makes
the premium payments to Medicare since it represents the payer
of last resort. She emphasized the state's goal, which is to
have an insurance company or any entity pay for services prior
to the state payment.
REPRESENTATIVE STUTES maintained her interest in the premium
payments for Medicare.
MR. SHERWOOD replied that most Medicare recipients are required
to pay premiums for Medicare Part B. Most Medicaid recipients
are low-income individuals, but some Medicaid recipients are
also Medicare eligible. The premium coverage relates to
Medicare individuals who receive Medicare, not to contributions
withheld by employers for employees; however, once the low-
income recipient goes on Medicare and must pay the Medicare Part
B premium, Medicaid picks up the premium costs because it is
cost-effective to first allow Medicare coverage before Medicaid
pays.
MR. SHERWOOD clarified that a small number of individuals must
also pay Medicare Part A, and in those instances, the state
would also pay those costs since it is cost effective to do so.
3:14:51 PM
MS. BRODIE directed attention to slide 11, "Top 5% of Enrollees
Account for More than Half of Medicaid Spending," and reported
that the top 5 percent of enrollees spend 53 percent of Medicaid
funds and 95 percent spend 47 percent of the funds. She turned
to slide 12, "Medicaid Enrollees and Expenditures," and detailed
the percentage of Medicaid expenditures, with disabled at 42
percent, the elderly at 21 percent, adults at 15 percent, and
children at 21 percent.
MS. BRODIE directed attention to slide 13, "FY2014 Total
Medicaid Recipients," referred to the pie chart and read the
breakdown of recipients in Alaska: children - 59.6 percent,
adults - 26 percent, disabled adults - 12.1 percent, elderly -
5.6 percent, and disabled children - 1.5 percent. She commented
that Alaska has a higher percentage for covering children than
many states. She reviewed slide 14, "Medicaid Service
Population," which provided another way of looking at the
population served in Alaska.
REPRESENTATIVE STUTES asked if the higher percentage of children
served was for the dollar amount paid or the number covered.
MS. BRODIE clarified that it was the percentage of children
participating in the Medicaid program.
MS. BRODIE moved on to slide 15, "Growth in Per-Enrollee
Medicaid Spending vs. Other Health Spending," which she said
indicated the annual rate of growth from 2007 through 2012. She
pointed out that Medicaid has not increased as much as other
types of health care coverage, noting that private health care
insurance increased by 4.6 per enrollee while Medicaid only
increased by 3.1 percent.
3:17:07 PM
CHAIR SEATON asked for further clarification on whether this is
dollar increases or numbers of participants.
MS. BRODIE replied this was the percent of increase in spending
by type of coverage.
MS. BRODIE turned to slide 16, "Federal Medical Assistance
Percentage (FMAP)," and pointed out that this indicated the FMAP
rates in the Lower 48, with Alaska at 50 percent; however, the
state receives 65 percent for Title 21 children.
MR. SHERWOOD, in response to Chair Seaton, explained that Title
21, also known as CHIP [Children's Health Insurance Program],
refers to children who are covered at somewhat higher rates than
the rest of the children, with an enhanced federal match rate.
Some states have a stand-alone CHIP program, other states cover
them through Medicaid, with some states electing for a
combination of both. Alaska has elected to cover Title 21
children through the Medicaid program, but as Ms. Brodie
mentioned, at a higher federal match rate. In further response
to Chair Seaton, he agreed that the Title 21 children are ones
above the poverty line, although he noted that the CHIP is
triggered by age.
CHAIR SEATON asked for the Title 16 definition.
MR. SHERWOOD answered that Title 16 refers to the Supplemental
Security Income Program (SSI). He explained that Title 16
provides coverage for a number of elderly and disabled who often
qualify for Medicaid; however, Medicaid falls under Title 19.
Thus the department often differentiates between Title 19
Medicaid recipients and Title 21 Medicaid recipients, or the
CHIP component.
CHAIR SEATON asked for further clarification on the categories
of children.
MR. SHERWOOD answered that the category for Medicaid Title 19
children includes children below the poverty line and younger
children up to 133 percent of poverty using the traditional
standards; however, the categories have been further complicated
since they were converted in 2014 to the new modified adjusted
gross income standards. He apologized for not having those
specific figures with him today.
CHAIR SEATON, in response to Representative Stutes, asked to
review a few of the previous slides for members.
3:20:58 PM
REPRESENTATIVE WOOL asked if there were two categories of
poverty level for those children in the CHIP [Children's Health
Insurance Program].
MR. SHERWOOD answered that there are not two categories of
poverty levels. He explained that the CHIP starts where the
traditional Medicaid coverage ends. The standard for children
through the age of 5 in the regular Medicaid was higher than the
standard for children ages 6 to 18; however, the break point for
regular Medicaid to CHIP is different for younger children than
older children, he said.
CHAIR SEATON asked to return to slide 11, and related his
understanding that the top 5 percent of spenders accounted for
53 percent of the expenses.
MS. BRODIE answered yes. She explained that slide 12, "Medicaid
Enrollees and Expenditures" identifies them as the disabled and
the elderly.
CHAIR SEATON asked whether any specific diseases or causes
accounted for the top 5 percent of spenders that account for 53
percent of the expenditures.
MR. SHERWOOD answered that it does not relate to Medicaid
enrollees with a particular disease, but to a combination of
issues for individuals who needed an intense level of long-term
support, such as nursing home services. He added that this
category also included people with acute episodes that resulted
in extensive surgery or prolonged hospitalization; however not
all seniors and disabled are high spenders. Typically high
spenders include enrollees who had an event that put them in
hospitals for significant periods of time, or in nursing homes,
or those who received extensive long-term support in their own
homes or communities.
MS. BRODIE directed attention to slide 12, "Medicaid Enrollees
and Expenditures," which showed the correlation between the
percentage of each enrollee by type, including disabled and
elderly adults and children, and the amount of spending
attributed to them. She clarified that the department has not
said that there are not high cost individuals outside the
elderly or disabled category since there are a few in other
categories.
3:24:57 PM
MS. BRODIE moved on to slide 13, "FY2014 Total Medicaid
Recipients," and reported that nearly 60 percent of Medicaid
recipients are children, 5.6 percent are elderly, 12.1 percent
are disabled adults, and 26 percent are adults who are typically
single parents or two-parent households with young children.
She turned to slide 14 "Medicaid Service Population," which
showed the population being served and how these core services
fall in the department's priorities.
CHAIR SEATON asked whether the three priorities influence the
state's Medicaid expenditures.
MS. BRODIE replied that the department has actually gone through
an exercise to tie every single activity - whether it is
Medicaid or a division activity - to one of these core services.
She explained the department used a matrix to go down to the
lowest level to identify the core service that will be affected
for every potential program cut or expansion.
CHAIR SEATON asked if cuts in funding could eliminate an entire
department priority. He asked for further clarification on the
categories for priority 1, 2, or 3.
MR. SHERWOOD answered that the slide identified three different
priorities, however, they are not prioritized in order so it is
not a numbered order of precedence.
3:27:18 PM
REPRESENTATIVE TARR, referring to slide 13, asked for
clarification on whether the age of the children identified on
the pie at 59.6 percent is for children up to the 18 years of
age.
MS. BRODIE answered that is correct.
REPRESENTATIVE TARR reflected that slide 14 "Medicaid Service
Population" showed a category split for children in the ages of
[5-12], 13-17, and 18-24.
MS. BRODIE directed attention to slide 15, "Growth in Per-
Enrollee Medicaid Spending vs. Other Health Spending," which
depicted the annual growth in actual health care expenses from
2007 to 2012. She reported that Medicaid expenditures rose 3.1
percent while private health insurance per enrollee increased by
4.6 percent. She pointed out the graph for Medical Care CPI
[Consumer Price Index] at 3.1, but explained a separate index
exists for medical care than for everything else.
MS. BRODIE directed attention to slide 16, "Federal Medical
Assistance Percentage (FMAP)," and explained that this map
depicted the FMAP rates in the Lower 48, with the highest FMAP
rates primarily falling in the southern states. She explained
that the FMAP rates vary, for example, the Title 19 Medicaid
rate receives 50 percent federal match and the Title 21, or CHIP
children, receives 65 percent federal match. She also reported
women being treated for breast or cervical cancer receive 90
percent federal match, people engaged with family planning
activities receive 90 percent federal match, and beneficiaries
of Indian Health Service (IHS) who receive their services at an
IHS facility, receive 100 percent federal match. She stated
that the division continually monitors claims and utilization.
For example, the division reviews assistance for women who had
babies in an IHS facility, because according to the federal
rules, the state can't claim 100 percent for a non-Native person
in an IHS facility. However, she explained, that once the baby
is born and begins to receive IHS services, the state can cover
the pregnancy under the 100 percent rate for IHS participants.
She recapped IHS coverage for mothers, such that the state would
receive a 50 percent federal match up until the baby is born,
but the department could later reclaim it at 100 percent. She
emphasized that the department does attempt to obtain the
maximum federal participation.
3:30:49 PM
MS. BRODIE, in response to Representative Tarr, clarified that
the 50 percent figure on slide 16 was for federal match for the
basic Title 19 Medicaid recipients. She said the average FMAP
federal match typically would be at 63 percent, once blended,
but she predicted this rate will continue to rise due to the
state's activities.
MS. BRODIE directed attention to slide 17, "Alaska Medicaid
Organizational Chart," which showed the composition of the
Medicaid program organization. She pointed out that people
often think of Medicaid as just one entity; however, the
department represents the single entity. She listed positions
on the Medicaid organization chart, which included the
Commissioner, the Deputy Commissioner for Medicaid and Health
Care Policy, and Deputy Commissioner for Family, Community, and
Integrated Services. She stated that the Division of Public
Assistance, the Division of Health Care Services, and the
Division of Senior & Disabilities Services were under the Deputy
Commissioner for Medicaid and Health Care Policy. The Adult
Preventive Dental program was also under the Division of Health
Care Services, she said.
MS. BRODIE explained that the Children's Services Medicaid and
Behavioral Health Medicaid were under the Deputy Commissioner
for Family, Community, and Integrated Services. She clarified
that the Division of Behavioral Health now runs the Children's
Services Medicaid program.
3:32:35 PM
MR. SHERWOOD, in response to Representative Stutes, explained
the map on slide 16, such that the colors represented the basic
FMAP - federal match rate or share - for Medicaid in each state.
He highlighted that the formula compared per capita income
between the states. States with high per capita income would
have a low federal match rate whereas states with low per capita
income would have a high federal match rate. As previously
mentioned, many Southern states, with historically lower incomes
have higher federal match rates, while Northeastern states and
the Midwest, with historically higher incomes, receive lower
federal match rates. Alaska with its high per capita income,
has a lower federal match rate; however, no adjustment was made
for the cost of living. Therefore, Alaska has almost always
been at the floor for the FMAP, he said.
3:34:33 PM
MS. BRODIE, in response to Representative Stutes, agreed that
was what was meant by the "floor." She then directed attention
to slide 18 "Alaska Medicaid," and said that the Divisions of
Public Assistance and Health Care Services determine the
eligibility for every type of Medicaid, while the Division of
Health Care Services administers the Medicaid program and pays
the claims. She added that the Divisions of Health Care
Services, Behavioral Health, and Senior and Disability Services
(SDS) Home and Community Based Services are the divisions that
provide services by monitoring and licensing entities.
MS. BRODIE directed attention to slide 19, "All Medicaid Direct
Services Beneficiaries & Expenditures," which showed the
Expenditures and enrollment figures for FY 2014. She indicated
that these figure were taken out of the MMIS [Medicaid
Management Information System], which identified the dollar
amount of the claims. In response to Chair Seaton she
identified MMIS as the Medicaid Management Information System,
which she stated was the computer system used to pay claims.
MS. BRODIE returned to slide 19, which identified the dollar
amount of claims paid and the number of individuals for claims
paid in a fiscal year. She reiterated that these figures were
taken from the Medicaid Management Information System because in
reality the number of Medicaid enrollees increased in 2014.
MS. BRODIE moved on to slide 20 "Allocation Summary 2007 -
2016," which was provided by the Legislative Finance Division
and identified the spending by the different divisions. The top
pink line depicted health care services, the blue line referred
to behavioral health services expenditures, and the bottom line
depicted Children's Medicaid Services and adult dental figures.
CHAIR SEATON asked for the reason why the top two lines are
showing such a dramatic upturn as compared to the other line.
MS. BRODIE answered that the lines went up dramatically. She
identified the lines in question as the amount of general fund
expenditures. The state received American Recovery and
Reinvestment Act (ARRA) funding, but the state also had enhanced
federal funding during that period of time that was lost, after
which the line dramatically rose, she said. She pointed out
that every line on the graph has leveled off in the last few
years.
3:38:54 PM
REPRESENTATIVE VAZQUEZ asked if the FMAP federal rate hasn't
changed, whether a block grant occurred.
MR. SHERWOOD answered that was due to an enhancement in the FMAP
federal rate. Although the basic rate was still calculated, the
federal government gave all states an add-on rate; however, he
said he did not recall the exact percentage states received
during the economic recession period. This type of additional
funding has happened several times over the course of Medicaid,
in which the Congress decided that, due to the general state of
the national economy, it would provide an enhancement to the
federal matching rate for Medicaid. He further explained that
the increase shows up over the course of a few years because the
timing of the enhanced rate doesn't coincide perfectly with
Alaska's fiscal year. Thus the changes, which occurred mid-
year, were worked in over the course of a couple of years.
MS. BRODIE directed attention to slide 21, "General Fund 2006-
2015," which she said depicted the total general fund spending
from the FY 06-FY 15 Governor's Medicaid formula appropriations.
MS. BRODIE directed attention to slide 22, "Controlling Growth
in Medicaid," and pointed out that the last two slides depicted
what the department has done in the past few years. She
highlighted that the options to control Medicaid costs are
limited; however, the state has options, for example, it could
change its eligibility criteria or its covered services. She
said the state could choose to eliminate coverage for inpatient
hospital services, which is not an option, but that issue would
be covered later. However, the state could change the rates it
pays to providers for services or equipment, or it might decide
to implement utilization controls, such that a recipient would
be limited to five sessions of a service instead of having
unlimited access to the service. Further, the state could work
on its compliance/anti-fraud efforts or it could work to improve
innovation in service delivery or try to maximize its revenue.
MS. BRODIE cautioned that although eligibility criteria could be
changed, it takes significant time to do so. She highlighted
that she and Mr. Sherwood previously worked on the last
eligibility change, but it took over a year to get the federal
government to agree with the state. She concluded that it is
not simple to make a change and it would require significant
negotiations and substantial work to accomplish.
CHAIR SEATON asked whether that type of change would include
going from 200 percent of poverty level to 175 percent.
MR. SHERWOOD answered that the department has previously done
so. He recalled that in 2003, the state reduced eligibility at
one time to 150 percent of the poverty level and the standard
was frozen, which illustrated an example of reducing
eligibility. However, eligibility requirements are complicated,
and it can be difficult in some cases to ensure that the state
meets its maintenance requirements, although he said he did not
wish to go into detail at this time. He suggested that the
expansion group would not be subject to any maintenance of
effort group so it would be a relatively easy one to change.
MS. BRODIE directed attention to slide 23, "Covered Services,"
and shared that the state has mandatory and optional services it
provides through the Medicaid program, which are outlined on
slide 24. Although the state can limit certain benefits,
typically those limits merely create cost shifts. For example,
drugs are considered an optional service; however, if the state
stopped covering pharmacy costs, the burden would shift to
another area of Medicaid. Thus, if the state no longer allowed
recipients with hypertension to obtain prescriptions, these
patients will end up with heart attacks or strokes and in an
emergency room, as inpatients. In addition, these patients
would need further rehabilitation. In fact, these patients
could end up in nursing homes for a period of time, which would
be very costly, as opposed to the state paying $30 per month for
their medications.
MS. BRODIE turned to another optional service, personal home
health care, but pointed out these recipients were already
qualified to be in institutions so they would need an
institutional level of care. If the state denied them home
health care, the state would then need to find nursing home beds
for these individuals. She reminded members that the state did
not build its Medicaid program on a nursing home model, but,
instead, based it on a home and community-based model. If the
state denied optional personal home health care services, she
predicted that the state would not have enough institutional
beds to meet their needs. She turned to optional therapies, and
recalled her earlier scenario in which patients were denied
their medications and suffered strokes. She said many stroke
patients need speech therapy in order to learn to talk or walk
again. She cautioned that if the state does not provide
optional Medicaid services, recipients will simply end up in
nursing homes or hospitals, which would result in cost shifts,
often at higher rates. In response to Chair Seaton, she
explained the abbreviations for the therapies, including
physical therapy (PT), occupational therapy (OP) and speech
language pathology (SLP). She said that the state doesn't have
a choice with respect to mandatory services since these services
must be provided if the state has a Medicaid program.
CHAIR SEATON asked whether slide 24, "Mandatory VS Optional
Services" referred to the services required for every Medicaid
program or if these services would be required as part of the
state negotiated plan with the federal government.
MS. BRODIE answered that the aforementioned mandatory services
are ones required by every Medicaid program in each state and
territory.
3:47:30 PM
MS. BRODIE directed attention to slide 25, "Rates," which she
said was one thing other states have closely reviewed. Last
year, the CMS [Centers for Medicare and Medicaid Services]
mandated that states must raise the rates paid to physicians to
at least the level of Medicare. In fact, a number of other
states had to raise their rates because they were lower than the
Medicare rates; however, Alaska's rates were not lower, she
said. She remarked that some states often "play games" with the
rates, for example, by freezing them for years. She said that
Alaska has experienced several instances when its rates were
frozen due to regulations, such that its regulations spoke to a
specific date and time and did not allow for any updates. In
fact, Alaska currently uses the 2006 rates for durable medical
equipment for that very reason, she said. In addition,
providers have rights during rate changes and recipients have
rights to an appeal process, therefore, litigation often occurs.
At any given point in time, states have active litigation
related to rate reductions or the methodology being changed.
MS. BRODIE emphasized that states must receive approval from the
Centers for Medicare and Medicaid Services (CMS) for any changes
they make. Thus for every Medicaid change, Alaska must prepare
a state plan amendment. She emphasized the need to be proactive
and seek prior approval in order to avoid accruing three months
of expenditures only to find out that the CMS denied the change.
She pointed out that CMS considers whether the proposed change
would impact access or quality of care for recipients. If such
a denial were to occur, the state would be 100 percent
responsible for the expenditures.
CHAIR SEATON asked for further clarification that if the
proposed change impacts access or quality of care for
recipients, it might not be approved.
MR. SHERWOOD stated his agreement. He explained the standard,
such that Medicaid services have to be accessible to Medicaid
recipients to the same extent those services would be available
to the general public. This does not mean the state must pay to
ensure that a neurosurgeon would be available in each community,
but if the general public has access to the neurosurgeon's
services, Alaska's Medicaid recipients must have the same
access. He noted that CMS can deny a plan if the state's
reduction would adversely impact access to the point that there
was a substantial difference in access.
MS. BRODIE shared that the CMS imposes a start/stop time for
plan amendments so when the state requests a plan amendment, the
CMS starts the clock. In the event the CMS believes the
proposed plan change will impact access or quality of care, the
agency will send a letter indicating the state has "x" amount of
time to resolve the issue; however, it also offers technical
assistance to states. She characterized this process as being
helpful, since the department might overlook an impact to the
quality of care or access.
3:52:05 PM
MS. BRODIE directed attention to slide 26, "Utilization
Controls," and reported that the state manages its costs with
utilization controls. Some of these controls consist of
computer system edits; for example, if a claim comes in by a 30-
year old male for a hysterectomy, the system would edit the
claim for appropriateness. She related her understanding that
over 8,000 edits are applied to each claim prior to payment.
REPRESENTATIVE VAZQUEZ asked whether any edits were turned off.
MS. BRODIE answered, yes. In further response to Representative
Vazquez she responded that there were about eight edits
purposefully turned off.
REPRESENTATIVE VAZQUEZ asked if the MMIS [Medicaid Management
Information Systems], now known as the [Alaska Medicaid Health]
Enterprise system is broken, as everyone in the provider
community is aware that it is, how can the state rely on the
information with respect to utilization costs.
MS. BRODIE replied that the [Alaska Medicaid Health] Enterprise
[AMHE] system, also known as the MMIS, had vastly improved in
the last three months. In fact, the state has been paying 97
percent accurately and correctly the first time, she said. She
reported that the department has been working through its
backlog of claims that were paid incorrectly, with two more big
deployments scheduled to go out in the next two weekends. She
said the department hoped this would be the last of payment
issues; however, as the department has worked through the
defects in the system related to payments, it has found 27
additional defects. She further reported that the department
has successfully addressed 22 defects to date and hoped not to
discover any additional ones. She concluded by stating that the
AMHE has vastly improved.
MS. BRODIE returned to slide 26, "Utilization Controls," and
highlighted another control used for cost control was "prior
authorization." She stated that recipients must obtain prior
authorizations for such items as an extended hospital stay, in
which recipients must obtain prior approval for the fourth day
and beyond. Patients would also need to obtain prior
authorization for other types of care, including long-term care
services, travel, and behavioral health services. In addition,
these prior authorizations limit eligibility for the number of
services recipients can receive.
MS. BRODIE indicated the department conducts post-payment
reviews, which includes reviewing medical documents to ensure
that the documents support the claims just paid. She noted
there are hard or soft edits in the system. One of the edits
the department turned off related to behavioral health payments.
An issue arose and the department was unable to make significant
health payments. Health insurance was supposed to pay for
behavioral health claims but the insurance industry was not
reacting well to the [Patient Protection and] Affordable Care
Act (ACA) so providers were not being paid. Therefore the
department has temporarily turned off the edit that required
billing insurance first, followed by Medicaid coverage; instead,
with the edit turned off, Medicaid now pays the claims and then
bills the insurance providers.
MS. BRODIE turned to another utilization control, new edits and
audits for fee-for-service (FFS) [slide 26]. She stated that
the National Correct Coding Initiative [NCCI] edits previously
pertained to Medicare; however, about two years ago it also
applied to Medicaid and the state has mandatory quarterly
updates it needs to apply.
3:57:30 PM
MS. BRODIE directed attention to slide 27, "States that Contract
with Managed Care Organizations (MCOs)," which related to a map
that indicates the number of states with 100 percent managed
care and those without managed care.
REPRESENTATIVE WOOL asked whether population or the number of
providers determined those managed care and those without
managed care. He related his understanding that Alaska does not
have sufficient providers to have a proper managed care system.
MS. BRODIE answered that the type of care varies for each state.
Granted, Alaska does not have a large population; however, she
said she was unsure whether Alaska could attract big businesses
who provide managed care. She indicated that there was not
currently any managed care organization in Alaska.
MR. SHERWOOD remarked that typically managed care organizations
charge per member per month fees, with an assumption of risk.
Thus states must meet a certain population size before entities
would be willing to assume the risk. Further, one of the
advantages and reasons managed care organizations are willing to
take on that risk is that they can negotiate favorable rates.
In areas without multiple providers for the same service, these
entities often lack a good bargaining position, which may well
contribute to the lack of managed care in Alaska; however, he
could not attest to that being the only reason these
organizations do not operate in Alaska. In response to Chair
Seaton, he answered that the managed care organizations would
negotiate rates with the direct health care providers, such as
hospitals, pharmacies, and physicians who provide the actual
services. Typically these managed care organizations would
offer a certain number of providers a contract with a certain
rate, he explained.
4:00:19 PM
REPRESENTATIVE TARR referenced the patient-centered medical home
model which the Anchorage Neighborhood Health Center used, and
asked whether this was a good alternative for managed care and
administration of the continuum of care.
MR. SHERWOOD replied that the department was seriously looking
at this as a way to bring "more explicit care management into
the system" when it was not possible to access more conventional
managed care organizations.
CHAIR SEATON asked whether a community with a community health
service would fit under this model, as the services were most
often in a regional center or a larger hospital. He asked for
more definite parameters for managed care in Alaska.
MR. SHERWOOD shared that he was not a managed care expert. He
explained that there were a number of degrees of care management
which were included in the area of managed care. He said that
the more recent models, community care organizations and
accountable care organizations, looked at providing bundled
payment for services and allowed for sharing of cost and reward
for efficiencies. He noted that the department was reviewing
these models, and had had discussions with entities interested
in pursuing these models, although these discussions were still
in preliminary stages. He declared that most communities in
Alaska still needed some services outside their system. He
pointed out that this would become a point of negotiation so
that the "hard cases" were not just shipped out.
MS. BRODIE acknowledged that there were some patient-centered
medical home models, including a pilot program at Providence
Alaska Medical Center in Anchorage. She spoke about the managed
care operations and their contracts with the state Medicaid
agencies for provision of all services for an agreed upon amount
per member per month. As neither the managed care operations
nor the state had planned for the costs of the very expensive
specialty drugs which had come on the market, it had become
necessary for re-negotiation of these contracts, with removal of
pharmacy coverages because of the specialty drugs.
4:04:47 PM
MS. BRODIE directed attention to slide 28, "Compliance/Anti-
Fraud," and declared that fraud in Medicaid was a reality. She
stated that the department had a fraud control unit which worked
with the Department of Law and program integrity unit. She
shared that the program integrity unit worked from the
commissioner's office and worked closely with the Divisions of
Behavioral Health, Senior and Disabilities Services, and Health
Care Services. She noted that the task force worked on every
area of fraud, but that it was "always a politically popular
reduction." She acknowledged that she did not have figures for
the return of investment for the fraud unit, but stated that it
did bring to a stop these fraudulent claims.
REPRESENTATIVE WOOL asked if this was a reference to
reimbursement for false claims by providers.
MS. BRODIE replied it could be providers or recipients.
REPRESENTATIVE WOOL asked for an example for recipient fraud.
MS. BRODIE explained that a recipient may not be eligible for
Medicaid, as they may not have been honest about their income or
their resources. She stated that, in some cases, the recipient
could be in collusion with the provider.
REPRESENTATIVE TARR referenced the Medicaid Task Force which was
responsible for reviewing this, and asked whether the task force
had been responsible for uncovering new ways to identify fraud,
or had this been recognized by other means.
MS. BRODIE explained that there was now a coordinated effort
across departments and divisions to address fraud, whereas the
effort had previously been "in silos."
MR. SHERWOOD explained that there had been systems changes,
offering as an example that each attendant in the personal care
program was required to enroll as a rendering provider. This
collaboration of resources allowed the department to better
review claims for work if the department suspected any fraud.
4:08:43 PM
MS. BRODIE skipped slide 29, and addressed slide 30, "FY 2014
Medicaid Expenditures by Division," which depicted where the
money was spent by division. She relayed that Health Care
Services spent 53 percent, Senior and Disabilities Services
spent 33 percent, Behavioral Health spent 12 percent, and Adult
Dental and the Office of Children's Services Medicaid each spent
1 percent. She clarified that Health Care Services was basic
medical care, the in-patient and out-patient hospital care, the
physician services, the lab and x-ray services, and any other
basic medical service. She explained that Senior and
Disabilities Services included home and community based waivers
and nursing homes. She noted that Behavioral Health Services
covered behavioral health. She explained that the Office of
Children's Services Medicaid paid for children in facilities,
and that the Adult Preventative Dental had a specific yearly
limit for an individual's dental work. She noted that two years
of this service, which was the cost of a set of dentures, could
be combined in one year, with a subsequent loss of any benefit
for the following year.
MR. SHERWOOD reported that this addition was the most recent
level of coverage, and he offered his belief that its expansion
had brought concern for potential growth in the use of this
service. There had been a request for it to have a separate
budget structure from the other services.
CHAIR SEATON asked whether the remainder of dental care was
included in health care services.
MR. SHERWOOD clarified that all children's dental and any
emergency dental, treatment for acute pain and infection that
could lead to hospitalization, were included in health care
services.
MS. BRODIE moved on to slide 31, "Services Requiring Prior
Authorization to Contain Costs," which specifically outlined the
services which needed prior authorization. She pointed out that
the high cost imaging was for MRIs performed by physicians who
owned the MRI machine, as assurance by a third party contractor
for medical necessity was required.
4:12:29 PM
REPRESENTATIVE TARR asked what was included by the waiver
services for a child with special needs.
MR. SHERWOOD explained that the waiver services were prior
authorized as a total service plan for an individual. However,
use of another service would not be authorized if it was
duplicative. He allowed that this sometimes required more
research to better understand what some services would entail,
in order to avoid overlap.
REPRESENTATIVE TARR asked if every waiver established a
comprehensive plan that included community support.
MR. SHERWOOD expressed his agreement that a complete picture
which identified adequacy with other supports, without
duplication, was the goal for a plan of care. He noted that a
goal was also to promote independence and integration.
4:16:05 PM
REPRESENTATIVE VAZQUEZ asked which division funded the Tax
Equity and Fiscal Responsibility Act (TEFRA) program.
MR. SHERWOOD replied that TEFRA was an eligibility option which
did not pay for a specific service. He said that most of the
services available to a child on TEFRA would be paid through the
Division of Health Care Services, and was typically the primary
and acute care services. He allowed that there might be some
behavioral health or personal care services through TEFRA
eligibility. He declared that this was the Tax Equity and
Fiscal Responsibility Act of 198[2], and it included an option
to allow eligibility for children to be considered as if they
were living in an institution and met that institutional level
of care. He explained that parental income and assets did not
count for eligibility determination if a child lived in an
institution. He offered some background for the act, explaining
that some children in institutions and hospitals could not go
home because Medicaid paid the bills while in the hospital, but
would not offer coverage at home. This special option allowed
for coverage of children who met an institutional level of care
when they returned home to the care of their parents. He
reported that Alaska also covered in-patient psychiatric
hospital level of care, and intermediate care facilities for
individuals with intellectual disabilities.
MS. BRODIE returned attention to slide 31, noting that certain
drugs also required prior authorizations.
CHAIR SEATON asked what types of drugs required the
authorization.
MS. BRODIE replied that behavioral drugs and the new specialty
drugs were included. She noted that the drug for Hepatitis C
cost a lot, but that, as the Medicaid population had a higher
rate than the general population, it was included under certain
criteria. One of these criteria included sobriety for six
months and stage 3 for fibrosis of the liver. She stated that
there had since been negotiation with other drug companies, and
the price had been lowered, so the department had redefined the
criteria for coverage to include stage 2. She reported that new
types of drugs were coming that would also be high cost.
4:20:42 PM
REPRESENTATIVE TARR asked about limitations for certain
combinations of drugs for treatment under the Patient Protection
and Affordable Care Act, and whether there would be this same
impact on Medicaid, in order to deliver the best health outcome
possible.
MS. BRODIE replied that the department reviewed these requests
on a one by one basis because there were so many new and
experimental drugs, as well as new therapies. She added that
this was even more typical for children, and that there were
fair hearing rights if the initial request was denied.
MR. SHERWOOD added that some of the drug coverage through
various insurance plans used tiered pricing and were given a
very high co-pay. He noted that, although Medicaid typically
restricted the amount of co-pay, the tiered pricing was not the
same degree of consideration as the limits on cost sharing He
directed attention to the adequacy for the number of drugs in
the insurer's formulary.
REPRESENTATIVE TARR asked if there should be more concern for
the number of drugs available in the pool to ensure the option
for a drug that worked.
MR. SHERWOOD expressed his agreement.
4:23:51 PM
CHAIR SEATON, referencing slide 31, asked if Ms. Brodie had
addressed cost containment for behavioral health.
MS. BRODIE explained that all behavioral health services had to
have prior authorization, and that their plan of care was
similar to that of the Division of Senior and Disabilities
Services.
MS. BRODIE addressed slide 32, "Other Savings," and noted that
including the rendering providers on claims was an important
aspect for the detection of fraud. She reported that, as the
behavioral health providers did not list the rendering
providers, this next step would be for them to detail the
rendering, referring, ordering, and prescribing providers on
claims. This information was necessary to better facilitate the
detection of fraud.
REPRESENTATIVE WOOL asked for the definition of a rendering
provider.
MS. BRODIE explained that this was an individual who provided
the services. She offered an example for a PCA (personal care
attendant) agency which employed many attendants who provided
the services to recipients. She reported that the agency would
bill the department for these services, but, in the past, it was
unclear who exactly provided the services. She stated that it
was now required to list the individuals who provided each
service. She pointed out that, currently, the behavioral health
providers did not have to list exactly who provided the services
to the Medicaid recipients. She offered her belief that, as
these recipients were a very vulnerable population, it was
necessary for the department to know the service providers and
each of their backgrounds in order to ensure the safety of the
recipients.
MS. BRODIE continued with slide 32, and allowed that auditing
providers was not a popular subject. She shared that steps had
recently been taken to help the providers by removing some of
the burden, and she explained that the problem in Alaska was
that not many of the providers only provided one service, but
provided an array of services. She reported that, as a provider
could be audited for one specific service, they could
subsequently be audited for another service. She shared that
current practice was to now audit all the lines of service by a
provider. She addressed that another savings would be for
partnerships with the tribes to look for efficiencies, as they
had a huge health care network.
4:28:19 PM
MS. BRODIE moved on to slide 33, "Additional Savings," and
listed that commercial insurance recoupment would save general
fund dollars. She reported that the department worked with a
company which researched existing insurance policies for every
Medicaid recipient, as the custodial parent may not be aware of
these policies. She spoke about the substitution to generic
medication, and offered an anecdote for a drug that was soon to
be available as a generic, which could save the state millions
of dollars. She pointed out that generic medications were
required, if available, although this could be overruled for
medical necessity.
CHAIR SEATON asked about the percentage of prescriptions which
required the brand name.
MS. BRODIE replied that some drugs did not have generic
equivalents, and she offered to research the response.
MS. BRODIE returned attention to slide 33, and explained that a
negative balance was possible when a provider had made an
adjustment to its claim, and the result was that the provider
owed money to the department. She said that, as more than
155,000 claims were processed each week, this happened
routinely. She explained that every May the department sent an
amnesty letter to each provider with a negative balance,
offering that each of these providers pay or be subject to an
audit. She reported that this letter had a 98 percent success
rate. She explained that surveillance and utilization reviews
were detailed reviews of claims for patterns of over
utilization, offering an example of a drug seeker going from
emergency room to emergency room, or to clinics, for medication
without a prescription. She shared that, although they were not
able to do as many reviews as preferred, the division was
mandated for a certain number. She shared that each of the
Medicaid agencies had quality assurance sections.
MS. BRODIE discussed slide 34 "Independent Review," and
explained the pain management contract which allowed for a
nationally certified, independent pain management specialist to
review the prescriptions for pain medications to ensure these
were the proper medication and the proper dosage for the
condition. She allowed that, although many doctors did not like
the oversight, there had been a stop to these questionable
prescriptions. She explained that the contract for psychotropic
medication review for children in Office of Children's Services
(OCS), the Division of Juvenile Justice (DJJ) custody, and those
on Medicaid, was being rolled out one at a time, beginning with
OCS. She shared that there was national concern that children
in state custody or on public assistance were being over
medicated, and that this review would ensure that this did not
happen in Alaska.
4:35:06 PM
MS. BRODIE referred to slide 35, "Future Cost Containment
Strategies," and explained that updates to regulations for
payment for durable medical equipment were coming, which would
allow for the use of used equipment. She noted that there would
not be a drastic savings, as some equipment could not be re-
used.
REPRESENTATIVE TARR noted that this had been a suggestion from
the Key Campaign during its visit to the capital.
MR. SHERWOOD expressed agreement that soon to be released
regulations, with a price schedule, would allow for the payment
for gently used durable medical equipment. He declared that
there would not be any special structure, but it would reimburse
providers for used equipment.
MS. BRODIE continued and stated that collecting the patient
share of cost for waiver recipients, which maintained their
eligibility for Medicaid, had regulation changes beginning July
1, 2015, to now allow the state to collect on a monthly basis,
similar to that for the working disabled.
MR. SHERWOOD said that this cost of care obligation applied to
people who needed long term care, nursing home care, or home and
community based waiver care services. He stated that there were
some modest co-pays for other services applied to adults,
although the recipients for these long term services were in a
special category which required payment of all their income
above a certain level toward their cost of care.
MS. BRODIE discussed a project for the acuity rate which would
now pay for the service provided. She explained that,
regardless of the needs for an individual in an assisted living
home, the department currently paid the same rate, which
eliminated any incentive for the assisted living home to work
with people having higher needs. Under the proposed plan, a
person with more needs would receive a higher payment. She
opined that this would open up more living assistance for those
with higher needs.
MS. BRODIE discussed the automated service plan, a computer
system that she declared was working. She explained that this
system would "talk directly" to the Medicaid Management
Information System (MMIS) system and upload the service
authorizations for individuals, instead of the current manual
process.
CHAIR SEATON asked for an explanation to the automated service
plan.
MR. SHERWOOD explained that the automated service plan was a
computer system that automated the process for evaluation of
individuals for long term services and support, such as waivers,
nursing homes, and personal care, administered through the
Division of Seniors and Disabilities Services. He pointed out
that this would put all assessment and care planning into the
system, and allow it to be transferred between the providers and
the agency for approvals. This data could be transferred to the
MMIS system for prior authorizations, and would eliminate the
need to manually process the information. He opined that this
plan would gain substantial efficiencies, especially as the
demand for these covered services had historically been growing,
but the number of staff had not increased.
4:42:38 PM
MS. BRODIE explained slide 36, "Expenditures Avoided," and said
that the blue was the status quo, and that the brown line
reflected health care price inflation. She reminded the
committee that health care had its own inflation index, as
depicted here. She pointed out that the enrollment and the
utilization and intensity of services both added to the cost,
although nothing compared to the health care price inflation.
She stated that the focus needed to be on this inflation.
MR. SHERWOOD offered his belief that this argued the need to
partner with other players to finance health care services, if
there was going to be reform. He pointed out that Medicaid
alone would not influence the spending, as the department was
required to pay enough to ensure adequate access to health care
and could not simply freeze or lower its rates in order to
compete for provider participation. He allowed that, although
the department could hold off raising prices for a period,
eventually it would run into an access issue. He declared that
it was critical for everyone to reduce health care inflation.
CHAIR SEATON asked about the calculated medical inflation rate
used on the chart.
MR. SHERWOOD replied that it was just under 3 percent.
MS. BRODIE directed attention to slide 37, "Expenditures
Avoided," which depicted the cost differences from the
initiatives already put in place. She noted that the top line
reflected what spending would have been with no change, and the
bottom line depicted the projected savings through 2033, without
including the aforementioned initiatives.
CHAIR SEATON asked if the average annual increase reflected a
combination of all the different factors including increased
enrollment and medical price inflation.
MS. BRODIE expressed her agreement.
4:47:05 PM
REPRESENTATIVE VAZQUEZ reflected that slide 3 stated that Alaska
had 158,853 enrolled in Medicaid in 2014, whereas slide 13
stated a total of 165,783 Medicaid recipients. She asked for an
explanation for this discrepancy.
MS. BRODIE explained that this would depend on how the data was
pulled. She pointed to slide 3, which stated that Alaska had
158,853 enrollees with 138,300 people using the services, and
reported that this information was drawn from the eligibility
system. Information on the slide with the bar graph was taken
from the MMIS and was based on claims actually paid, although it
did not incorporate all the recipients who used services, as
some behavior health providers had not yet been paid. She
stated that the information from slide 13 was drawn specifically
from the numbers reported to the Medicaid budget. She pointed
out that these were all drawn from different sources at
different points in time.
REPRESENTATIVE VAZQUEZ said that, although she was able to
understand the concept for enrolled individuals, slide 13 lead
her to believe that these enrollees, now Medicaid recipient
beneficiaries, totaled 165,783. She asked if there were 7,000
more recipients than enrollees.
MS. BRODIE explained that there could be duplication to the
categories, offering an example of a child being included in one
category, and then, after becoming disabled, being included in
the second category, as well. She pointed out that an adult
could be initially in the adult category, then become part of
the adult disabled category, and then also move into the elderly
category. She explained that the expenditures for each
individual were for that specific category.
REPRESENTATIVE VAZQUEZ asked for an example.
MR. SHERWOOD offered another example. He described a 64 year
old who started the year eligible in the disability category,
and received services. Then, during the year, this person
turned 65 years of age and again received services. This
individual would then be included in the elderly category for
those services received. He reported that some individuals were
also subject to retroactive eligibility determinations, which
could be reflected in the data depending on when it was
reported. He noted that this could be typically for disabled or
for those eligibilities acquired through the Fair Hearing
process.
CHAIR SEATON asked for further information.
REPRESENTATIVE VAZQUEZ, addressing Mr. Sherwood, declared that
after a family eligibility determination, the children were
enrolled individually in Medicaid, and not as a family block.
She stated that she did not understand the discrepancy for 7,000
more recipients than enrollees.
4:53:36 PM
REPRESENTATIVE TARR noted that she understood the examples
offered by Mr. Sherwood. She asked whether a child eligible for
dental services through Denali Kid Care, but not diagnosed for
autism spectrum disorder, would have their dental service billed
through the general children category, and then have their
subsequent early intervention services for autism provided and
billed through the disabled children category. She noted that
the same child would have then billed through two categories of
service.
CHAIR SEATON asked for actual data to support the explanations
for discrepancy.
REPRESENTATIVE TARR asked about [indisc.] and whether it was
included in the projections. She noted that a goal of the
Patient Protection and Affordable Care Act was to decrease this
by widening the pool of individuals purchasing health care. She
asked if there was a standard amount of reduction, or was it too
early to realize any effect from these cost control measures.
MR. SHERWOOD said that he did not have a number he associated
with the act and how all the provisions would work together. He
acknowledged that some assumptions were built in when the act
was costed out, although these were relative to specific changes
to specific government programs. He stated that he did not know
if there was a more general estimate.
REPRESENTATIVE STUTES referenced slide 22, which read:
"controlling growth in Medicaid," and surmised that this was the
opposite of what would happen with Medicaid Expansion. She
expressed her concern for how these related.
MS. BRODIE explained that this was about controlling the dollar
costs for Medicaid from the general fund.
REPRESENTATIVE VAZQUEZ asked how reimbursement rates were
determined for Medicaid doctors.
MR. SHERWOOD explained that the department used the resource
based relative value system to determine payment levels, the
same system as used by Medicare. This system used a number of
different factors for calculation to capture the various costs
of practice in delivering a particular service to an individual.
He reported that these factors were multiplied together, and
that Alaska used a basic Medicare formula with an adjuster, a
multiplier which increased the Medicare rate by about 30
percent. He offered to provide more explicit information for
specifics to the formula.
REPRESENTATIVE VAZQUEZ asked if this formula was used for other
providers.
MR. SHERWOOD said that the rate for facilities, hospitals, and
nursing homes was based on the cost of doing business,
established from the cost reports submitted by each. The
department would then calculate rates using an inflation factor,
and then re-base every four years based on the cost reports. He
reported that for other services the department used a
collection of historical methods, which included studies for
cost or price that fixed a rate which may or may not have
included an inflation factor. He said that most of the
behavioral health rates were not regularly inflated, although
other rates were inflated. He said that the same methodology
used for physicians was used for similar practitioners,
including physician assistants, advanced nurse practitioners,
and community health aides. He reported that facilities in the
tribal health system were paid at a federally established
encounter rate that was done in conjunction between Indian
Health Service and the Centers for Medicare and Medicaid
Services. He stated that for pharmacies the department used a
formula for both a dispensing fee and a national cost of
acquisition.
CHAIR SEATON, referencing the pharmaceuticals, asked if there
was anything in statute to prevent negotiation of lower prices
for drug purchases.
MR. SHERWOOD replied that a federal statute required that drug
manufacturers provide rebates to Medicaid agencies. He said
that this statute also dictated how much of the rebate went to
the federal government and how much to the state. He pointed
out that states were allowed to negotiate supplemental rebates,
although recent changes in federal law to mandatory rebates
diminished the opportunity for many supplemental rebates.
CHAIR SEATON asked that the department notify the committee if
there were any statutory roadblocks for lowering costs.
5:02:24 PM
REPRESENTATIVE VAZQUEZ asked about the recommendations from an
audit on the Department of Health and Social Services issued by
the Division of Legislative Audit in 2014.
MR. SHERWOOD replied that he was generally familiar with this,
and that there were recommendations every year, with some repeat
recommendations when the department was still in progress for
resolution to these. He asked if Representative Vazquez had any
specifics, noting that he did not recollect all the
recommendations related to Medicaid in 2014.
CHAIR SEATON asked if Representative Vazquez was referencing the
initial required performance audit.
MR. SHERWOOD explained that there was the Statewide Single Audit
each year which audited all programs receiving federal funds,
including Medicaid, and that the Department of Health and Social
Services was also currently involved in the process of the
performance audit, which was not yet complete.
CHAIR SEATON acknowledged that the performance audit of the
Department of Health and Social Services was the first of the
audits to all the departments.
REPRESENTATIVE TARR reported that the Department of Corrections
had been the first of these performance audits.
REPRESENTATIVE VAZQUEZ declared that "legislative audits have
been done for years and I'm interested in the latest legislative
audit, the recommendations, and what specific steps the
department is taking to implement those recommendations."
MR. SHERWOOD said they would provide the information.
REPRESENTATIVE TARR suggested that it would be helpful to
understand the unexpected outcome if the rates were too low, as
an increase of rates can be beneficial to the state by adding
federal dollars to defer the cost, and then realizing a cost
savings.
5:06:07 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:06 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Medicaid 101 Presentation March 2015.pdf |
HHSS 3/19/2015 3:00:00 PM |
Medicaid |