Legislature(2017 - 2018)CAPITOL 106
04/18/2017 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB215 | |
| HB176 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 215 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 176 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 18, 2017
3:04 p.m.
MEMBERS PRESENT
Representative Ivy Spohnholz, Chair
Representative Bryce Edgmon, Vice Chair
Representative Sam Kito
Representative Geran Tarr
Representative David Eastman
Representative Jennifer Johnston
Representative Colleen Sullivan-Leonard
MEMBERS ABSENT
Representative Matt Claman (alternate)
Representative Dan Saddler (alternate)
COMMITTEE CALENDAR
HOUSE BILL NO. 215
"An Act relating to program receipts; and relating to fees for
services provided by the Department of Health and Social
Services."
- HEARD & HELD
HOUSE BILL NO. 176
"An Act relating to medical assistance reimbursement for ground
emergency medical transportation services; and providing for an
effective date."
- MOVED CSHB 176(HSS) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 215
SHORT TITLE: DHSS: PUBLIC HEALTH FEES
SPONSOR(s): FINANCE
04/07/17 (H) READ THE FIRST TIME - REFERRALS
04/07/17 (H) HSS, FIN
04/18/17 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 176
SHORT TITLE: GROUND EMER. MEDICAL TRANSPORT PAYMENTS
SPONSOR(s): FANSLER
03/14/17 (H) READ THE FIRST TIME - REFERRALS
03/14/17 (H) HSS, FIN
04/13/17 (H) HSS AT 3:00 PM CAPITOL 106
04/13/17 (H) Heard & Held
04/13/17 (H) MINUTE(HSS)
04/18/17 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
TOM SPITZFADEN, Staff
Representative Paul Seaton
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 215 on behalf of the bill
sponsor, the House Finance Committee.
JILL LEWIS, Deputy Director - Juneau
Central Office
Division of Public Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions during the
presentation of HB 215.
REPRESENTATIVE ZACH FANSLER
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified and answered questions on HB 176,
as the sponsor of the bill.
RICHARD ETHERIDGE, Chief
Capital City Fire and Rescue
Juneau, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
176.
TOM WESTCOTT, President
Alaska Professional Firefighters
Eagle River, Alaska
POSITION STATEMENT: Testified in support of HB 176.
MARGARET BRODIE, Director
Director's Office
Division of Health Care Services
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
176.
ACTION NARRATIVE
3:04:36 PM
CHAIR IVY SPOHNHOLZ called the House Health and Social Services
Standing Committee meeting to order at 3:04 p.m.
Representatives Spohnholz, Tarr, Sullivan-Leonard, Johnston, and
Eastman were present at the call to order. Representatives Kito
and Edgmon arrived as the meeting was in progress.
HB 215-DHSS: PUBLIC HEALTH FEES
3:05:21 PM
CHAIR SPOHNHOLZ announced that the first order of business would
be HOUSE BILL NO. 215, "An Act relating to program receipts; and
relating to fees for services provided by the Department of
Health and Social Services."
3:06:03 PM
TOM SPITZFADEN, Staff, Representative Paul Seaton, Alaska State
Legislature, paraphrased from the Sponsor Statement [Included in
members' packets], which read:
This bill would amend AS 44.29.022(a) to grant the
Alaska Department of Health and Social Services the
authority to collect fees to support the
administration of public health programs. The bill
would also add public health fees to the list of
designated general fund program receipts in AS
37.05.146(c), making clear that the fees collected
would be used to support public health operations.
Currently, the division is not able to charge fees for
all the potential public health services it could
because the list of "public health related duties" for
which fees are allowed is limited to maternal and
child health, preventive medical services, public
health nursing, nutrition, health education, and
laboratories.
This bill will give the Division of Public Health the
opportunity to collect reasonable fees to support
essential public health services consistent with its
duties and authority under state law; services that
protect Alaskans from preventable illness, injury and
death. Examples of public health services and
functions provided by the Department that currently
lack fee authority include data extraction and
analysis, training, expert consultation, inspections
and certifications, enforcement activities,
administrative functions, and professional services.
HB 215 is necessary to allow the Department of Health
and Social Services' Division of Public Health to
increase and diversify revenue opportunities, ensuring
the means to support public health operations and
thereby reducing reliance on general funds. The
Division of Public Health budget includes nearly $7
million in revenue from fees, primarily for clinical
laboratory and public health nursing services and
certified copies of vital records. The widening gap
between public health costs and state general funds
jeopardizes our ability to protect and promote the
health of Alaskans. It is necessary in public health
that those who can pay, should contribute to support
these essential services.
3:09:21 PM
MR. SPITZFADEN paraphrased from the Sectional Analysis [included
in members' packets], which read as follows [original
punctuation provided]:
Section 1 (page 1, line 4) Adds public health
program fees under AS 18.05.010 to the definition list
of designated general fund program receipts and non-
general fund program receipts AS 37.05.146(c) that are
accounted for separately and appropriations from these
program receipts are not made from the unrestricted
general fund.
Section 2 (page 1, line 7) Amends AS 44.29.022(a) to
allow the Commissioner of the Department of Health &
Social Services to create a schedule of fees for
services for public health programs under AS
18.05.010.
3:10:16 PM
JILL LEWIS, Deputy Director - Juneau, Central Office, Division
of Public Health, Department of Health and Social Services, said
that the Division of Public Health focused on programs that
addressed the health status of every Alaskan and community. The
Public Health Services controlled infectious diseases, prevented
chronic diseases and injuries, protected maternal and child
health, and promoted healthy life styles. She stated that there
was a widely held belief that the division should do more to
maximize collections for billable services where possible. She
reported that public health had traditionally relied on federal
grants and state general funds rather than fees; whereas
national public health agencies had now been forced to reexamine
fees as a funding stream in order to continue providing
essential services, and Alaska was no different. She pointed
out that the division was not able to charge fees for all the
services offered. She said that there was an opportunity to
collect fees for immunization, as well as health and safety
issues; for birth and marriage certificates and data extraction
and analysis; for lab tests, training and expert consultations.
She pointed out that the proposed bill would enable the division
to be more self-sufficient and collect reasonable fees to
support these public health services. She offered some examples
of these fees, which included: inspection of devices such as x-
ray, CT scan, and MRI; reasonable fees for custom statistical
and epidemiological analysis on the public health data sets, as
the division resources were consumed in simply collecting the
data. She reported that other states charged an annual or an
hourly fee for analytical work. She pointed out that the
division turned away these requests for analytical work because
there were no longer the staff. She noted that only the
radiologic health would be a required fee, whereas the other
fees would be optional, as communities could decide if they
wanted the service or preferred to use a private vendor. She
explained that for each new fee, the division would establish a
separate regulation to allow the public and the stakeholders
ample opportunity for input. She pointed out that the rates
were limited to the actual cost for providing the service, and
fees were only charged when the cost benefit was economical, in
the public interest and did not undermine the mission to protect
and promote the public health of Alaskans. She added that there
would be a system of waivers or a sliding scale of fees, to
ensure that the fees were applied equitably. She declared that
the collected receipts would be applied back to the generating
program, instead of the general fund. She stated that the
"widening gap between our public health costs and our state
general fund jeopardizes our ability to provide the services
that protect Alaskans from preventable illness, injury, and
death." She emphasized that the proposed bill was necessary to
allow the Division of Public Health to be more self-sufficient
and reduce the reliance on general funds.
3:17:16 PM
REPRESENTATIVE JOHNSTON asked if there was a benefit for the
department to contract out the services until it was established
what fee services were necessary.
MS. LEWIS acknowledged that there was uncertainty "around the
amounts that we put in the fiscal note and what we think we
might be able to collect right off the bat." She stated that
there would be opportunities during the upcoming fiscal year to
review this through the regulation packages and assess the need.
She pointed out that the fiscal note began in FY 2019. She
suggested that the position might need to be spread among many
people, and that it would take some time to realize the overall
potential.
3:20:40 PM
REPRESENTATIVE SULLIVAN-LEONARD asked if the division had spoken
with outside groups regarding assistance.
MS. LEWIS expressed agreement that they did work with their
partners, although relying on the kindness of these partners was
not a good long-term strategy for the division. She explained
that establishing a fee would bring the cost up front.
3:22:51 PM
REPRESENTATIVE SULLIVAN-LEONARD asked how to determine a
reasonable fee, what mechanism would be used to determine the
fee, and who would be charged.
MS. LEWIS said that this fee would vary for each service and, as
they would be limited to the cost, they first needed to figure
the cost. She suggested that review of data, training, and
consultation would most likely be an hourly or annual fee. She
reiterated that all these fees would be cost based, and if they
were not economical, the division would not continue to pursue
these.
3:24:33 PM
REPRESENTATIVE SULLIVAN-LEONARD offered an example of a chest x-
ray.
MS. LEWIS explained that the division did not have x-ray
machines, although they inspected them. She said that the
division was already charging fees to organizations. She
suggested that there was an opportunity to do analysis for
community organizations and non-profits, and less likely for
individuals.
3:26:11 PM
CHAIR SPOHNHOLZ commended the department for its review,
especially given the new fiscal reality. She shared that as she
had done community health needs assessments and data analysis,
the ability to purchase this data analysis "could be really
valuable, there's been a lot of times, I think, when non-profit
organizations have wanted that kind of information and being
able to ... essentially buy additional information analysis
could be really useful." She suggested that the proposed bill
be set up for more transparency for other organizations to
better understand how this could work. She shared her concern
that the proposed bill had brought to her attention that there
were not inspections to much of the radiologic equipment, as
currently only x-rays were billable. She explained that a
Department of Law determination stated that the other
inspections could not be charged for as there was not an
explicit authority.
MS. LEWIS expressed agreement, pointing out that although the
department had the broad authority to inspect, certify, and
register radiologic devices for humans, they did not have the
authority to charge a fee. As there was no other revenue
source, and there was only one health physicist for the state,
it would be necessary to make a second hire. She stated that
the proposed fees would be based on the cost of personnel and
the expected travel, with a small additional cost for supplies.
CHAIR SPOHNHOLZ asked if there was a sense for the amount of
equipment that should be inspected.
MS. LEWIS replied that there were hundreds, if not thousands,
mostly found in the larger clinics and hospitals.
CHAIR SPOHNHOLZ asked whether this inspection would require
special expertise.
MS. LEWIS explained that this was not the same person as would
conduct the clinical service, and it required special equipment
to calibrate the machines and ensure they were operating safely.
3:31:13 PM
REPRESENTATIVE EASTMAN asked about the steps taken to identify
the availability for private inspectors.
MS. LEWIS replied that there were no independent private
inspectors in Alaska, although there were inspectors out of
state. She reported that Department of Health and Social
Services did not have the funding for this.
3:32:04 PM
REPRESENTATIVE TARR asked if the department was limited to a
charge for services and was not allowed for any extra revenue.
MS. LEWIS replied that they were only allowed to charge fees for
cost.
3:32:42 PM
REPRESENTATIVE EASTMAN directed attention to page 2, [line 2],
of the proposed bill, musing that "it sounds rather vague," and
asked if this should be interpreted to mean that a refusal to
pay was not economically feasible to collect, or was this per
case.
MS. LEWIS clarified that the department would perform an overall
review to determine whether this was an economical fee to pursue
for the service. She stated that the waivers would be granted
on an individual basis. She reported that the process for
application to a waiver, including criteria and qualification,
was already in regulations to be applied equally to everyone.
3:34:47 PM
CHAIR SPOHNHOLZ announced that HB 215 would be held over.
HB 176-GROUND EMER. MEDICAL TRANSPORT PAYMENTS
3:34:57 PM
CHAIR SPOHNHOLZ announced that the final order of business would
be HOUSE BILL NO. 176, "An Act relating to medical assistance
reimbursement for ground emergency medical transportation
services; and providing for an effective date."
REPRESENTATIVE ZACH FANSLER, Alaska State Legislature, recapped
HB 176, and paraphrased from the Sponsor Statement [included in
members' packets], which read as follows [original punctuation
provided]:
Emergency Medical Transportation Services (EMTS)
relates to the emergency transportation of patients.
For what is traditionally considered an ambulance
ride, EMTS reflects Alaska's unique geographical
challenges to include air, water, and other approved
medical transport services. As it currently stands,
Alaska's emergency medical service providers incur
additional uncompensated costs when providing services
to Medicaid beneficiaries, by as much as sixty
percent.
Reimbursement for ground emergency medical
transportation services occurs when the providers
submit a billing to the department (specifically to
the Medicaid fiscal agent Conduent) for eligible
services provided; the department reimburses the
provider using the established Medicaid methodology
and rate; the department submits documentation
supporting the payment of the federal financial
participation (FFP) to Centers for Medicare and
Medicaid Services (CMS); and once it is approved, the
department receives reimbursement for the FFP from CMS
that amounts to the appropriate federal assistance
percentage (FMAP).
By enacting this legislation along with an amendment
to the state Medicaid plan, public EMS providers are
eligible to access enhanced federal funding for
emergency medical transportation of Medicaid patients.
The use of transfers is clearly authorized in federal
statute and is both legal and useful. Further, CMS
provides reimbursement for the administrative costs
associated with administrating EMTS by as much as
twenty percent.
Anchorage, Juneau, Kenai, and Ketchikan, combined
serve approximately forty-eight percent of the state's
population. In 2015 (for Kenai) and 2016 for the
others, these departments provided 7,035 transports to
Medicaid patients, without EMTS, the departments
received just $2.1 million in reimbursements; a total
collective under-compensation of roughly $3.9 million.
Were they EMTS eligible, they could have collected a
total of $6 million.
HB 176 would allow EMS providers around the state to
collect underfunded costs from the effective date,
providing a financial boon to those organizations and
communities. Even smaller communities such as Bethel
can see over a quarter of a million dollars in EMTS
reimbursements per year.
As you can see from the attached bill packet, there is
widespread support for HB 176 throughout the state to
help our local communities receive payments to
actively cover the services they provide.
3:37:23 PM
REPRESENTATIVE SULLIVAN-LEONARD asked why the various
municipalities would not do this independently, without any
state oversight.
REPRESENTATIVE FANSLER explained that there needed to be state
acceptance to receive this expanded reimbursement and was not an
individual decision made by a municipality. He pointed out that
there was no obligation for a municipality to participate.
REPRESENTATIVE SULLIVAN-LEONARD asked if they would have to
follow the state mandate.
REPRESENTATIVE FANSLER replied that this was his understanding.
CHAIR SPOHNHOLZ suggested that "authorization" could be another
way of framing this.
3:38:54 PM
REPRESENTATIVE EASTMAN directed attention to page 2, line [13],
of the proposed bill, and read: "is owned or operated by the
state, a political subdivision of the state, or a federally
recognized tribe or tribal organization;" He asked about the
reason for this language, whether it was dictated by the federal
government.
REPRESENTATIVE FANSLER said that this language was required and
was dictated by the program, that community programs which could
receive this expanded Medicaid reimbursement could only be
governmental.
3:40:17 PM
REPRESENTATIVE JOHNSTON asked about the changes to the committee
substitute.
REPRESENTATIVE FANSLER explained that as the original bill had
been written for ground emergency medical transportation
services, and was hence limited, it had been recommended to
expand the proposed bill and address emergency transportation
services.
REPRESENTATIVE JOHNSTON expressed her concern for the increase
in usage of emergency rooms and ambulances. She questioned how,
policy wise, to put "sidebars" on this. She stated that the
original policy was to move individuals away from the use of
emergency services and the emergency rooms and that the proposed
bill was not moving in that direction.
3:43:51 PM
REPRESENTATIVE FANSLER acknowledged that he was very cognizant
of these concerns for an enticement that people would use
emergency services, which had higher costs. He declared that
the focus of the proposed bill was for transportation. He
shared that he "would love to figure out a policy that starts to
say let's have people using their primary care situation
better." He suggested that there was a need for additional
service providers and better education for defining a true
emergency. He stated that it was his belief that the proposed
bill did not entice the use of these services or would "drive up
the use of emergency rooms."
REPRESENTATIVE JOHNSTON asked if he was interested to putting a
sunset clause in the bill, or an amendment for accountability,
which could include a reporting mechanism. She stated that she
had concerns for the proposed bill.
3:46:26 PM
REPRESENTATIVE FANSLER replied that he had no interest in either
an amendment or a sunset provision, at this time. He offered
his belief that public testimony indicated that the use of these
services was increasing statewide. He suggested a cause and
effect type of experiment prior to deciding that the proposed
bill had created an increase in the use of emergency services.
He opined that the legislature was "inclined to be our own
sunset provision or our own sidebars on these kinds of thing."
CHAIR SPOHNHOLZ reminded the committee that emergency room
physicians were working on a database of causes for emergency
room utilization, and she suggested that this may offer a more
direct solution to the aforementioned problem.
3:48:46 PM
REPRESENTATIVE SULLIVAN-LEONARD asked if CPT codes were used for
transportation or were the transportation billings separate.
REPRESENTATIVE FANSLER said that he did not know how the medical
billing was handled, although he offered his belief that a CPT
code was used. He clarified that each municipality handled its
own transportation for the Medicaid reimbursement and he offered
an example for the City of Bethel.
REPRESENTATIVE SULLIVAN-LEONARD asked if the basic
transportation fee was separate from any other charges and how
was it billed and matched to the patient.
REPRESENTATIVE FANSLER said that he did not know.
3:53:24 PM
RICHARD ETHERIDGE, Chief, Capital City Fire and Rescue,
explained that most fire departments and EMS departments used
third party billers. He said that the department would fill out
an EMS report with detailed descriptions for everything done, as
there were different rates for each type of transportation and
care, and then the billing company would sort out the billing
codes to go to either the insurance companies or Medicare or
Medicaid.
REPRESENTATIVE SULLIVAN-LEONARD asked if Medicaid made its
decision based on whether the patient was injured, or if it only
paid for transportation.
MR. ETHERIDGE expressed his agreement. He addressed an earlier
question from Representative Eastman regarding the outlying
departments around Anchorage. He stated that if an organization
was affiliated with a municipality and had a relationship
whereby they could bill through them, that organization would be
included in this program.
3:55:13 PM
CHAIR SPOHNHOLZ opened public testimony.
3:55:24 PM
TOM WESTCOTT, President, Alaska Professional Firefighters,
stated support for proposed HB 176. He said that fire
departments and EMS providers around the state determined the
cost of ambulance transports and charged accordingly. He noted
that Medicaid only reimbursed a percentage of the actual cost,
which lead to local tax payers needing to make up the difference
to maintain adequate EMS services. He stated that the proposed
bill would allow departments the opportunity to demonstrate the
actual costs of transports and be reimbursed accordingly when
transporting Medicaid patients. He pointed out that the
increase in revenue could then be spent as seen fit by the local
government. He reminded the committee that as the cuts at the
state level had resulted in cost shifting in local
municipalities, the proposed bill would help the cities to
better deal with the increased costs. He pointed out that there
was about a 12-month lag for implementation of the program.
3:57:48 PM
REPRESENTATIVE JOHNSTON asked about any statistics for the usage
of transport for Medicare or Medicaid.
3:58:12 PM
MARGARET BRODIE, Director, Director's Office, Division of Health
Care Services, Department of Health and Social Services, said
that although they did keep statistics, she did not know the
exact costs to the municipalities because the transportation
rates were capped.
REPRESENTATIVE JOHNSTON asked if the statistics included
anything regarding the need for transport.
MS. BRODIE said that the statistics only included the
transportation although projects had reviewed the claims data
for emergency rooms in alignment with the transportation to see
how much was for real emergency transport.
REPRESENTATIVE JOHNSTON asked if this was an ongoing project.
MS. BRODIE, in response to Representative Johnston, reported
that this had been done as "a pilot type project to ensure that
the use of emergency services aren't being abused."
4:00:04 PM
CHAIR SPOHNHOLZ closed public testimony on HB 176.
The committee took a brief at-ease.
4:01:59 PM
CHAIR SPOHNHOLZ brought the committee back to order.
4:02:19 PM
REPRESENTATIVE EDGMON moved to report CSHB 176, Version 30-
LS0705\J, Glover, 4/7/17, out of committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, CSHB 176(HSS) was moved from the House Health and
Social Services Standing Committee.
4:02:48 PM
The committee took a brief at-ease.
4:04:49 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:05 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB0215 ver D 4.7.17.pdf |
HHSS 4/18/2017 3:00:00 PM HHSS 4/25/2017 3:00:00 PM HHSS 5/9/2017 3:00:00 PM |
HB 215 |
| HB215 Fiscal Note DHSS--PHAS 4.17.17.pdf |
HHSS 4/18/2017 3:00:00 PM HHSS 4/25/2017 3:00:00 PM HHSS 5/9/2017 3:00:00 PM |
HB 215 |
| HB215 Sectional Analysis ver D 4.7.2017.pdf |
HHSS 4/18/2017 3:00:00 PM HHSS 4/25/2017 3:00:00 PM HHSS 5/9/2017 3:00:00 PM |
HB 215 |
| HB215 Sponsor Statement ver D 4.7.2017.pdf |
HHSS 4/18/2017 3:00:00 PM HHSS 4/25/2017 3:00:00 PM HHSS 5/9/2017 3:00:00 PM |
HB 215 |
| HB 176 Sponsor Statement 4.12.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Supporting Document - City of Bethel resolution 4.5.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Supporting Document - FNSB memo 4.5.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Supporting Document - FNSB resolution 4.5.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Supporting Document - Letter AK Fire Chiefs Assoc 4.5.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Supporting Document - letter AK Prof Firefighters Assoc 4.11.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Supporting Document - memo Bethel FD 4.5.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Supporting Document - North Pole resolution 4.5.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Additional Document AK FD budget reimb process 4.5.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 ver A.PDF |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Additional Document DHSS review 4.5.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Draft Proposed CS ver J 4.5.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Fiscal Note DHSS--HCMS 4.10.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB 176 Fiscal Note DHSS--MAA 4.10.17.pdf |
HHSS 4/13/2017 3:00:00 PM HHSS 4/18/2017 3:00:00 PM |
HB 176 |
| HB215 Supporting Document - Division of Public Health Fee Summary 4.7.17.pdf |
HHSS 4/18/2017 3:00:00 PM HHSS 4/25/2017 3:00:00 PM HHSS 5/9/2017 3:00:00 PM |
HB 215 |
| HB215 Supporting Document - Division of Public Health Funding Sources 4.7.17.pdf |
HHSS 4/18/2017 3:00:00 PM HHSS 4/25/2017 3:00:00 PM HHSS 5/9/2017 3:00:00 PM |
HB 215 |