Legislature(2019 - 2020)DAVIS 106
03/21/2020 09:00 AM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
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| Start | |
| Overview: Public Assistance & Medicaid Services Covid-19 Response | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 21, 2020
9:03 a.m.
MEMBERS PRESENT
Representative Tiffany Zulkosky, Chair
Representative Ivy Spohnholz, Vice Chair
Representative Matt Claman
Representative Harriet Drummond
Representative Geran Tarr
Representative Sharon Jackson (via teleconference)
MEMBERS ABSENT
Representative Lance Pruitt
OTHER LEGISLATORS PRESENT
Representative Louise Stutes
COMMITTEE CALENDAR
OVERVIEW: PUBLIC ASSISTANCE & MEDICAID SERVICES COVID-19
RESPONSE
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
ALBERT WALL, Deputy Commissioner
Office of the Commissioner
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during the informational
hearing on Medicaid Services and Public Assistance programs.
SHAWNDA O'BRIEN, Director
Director's Office
Division of Public Assistance
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions during the informational
hearing on Medicaid services and public assistance programs.
ACTION NARRATIVE
9:03:42 AM
CHAIR TIFFANY ZULKOSKY called the House Health and Social
Services Standing Committee meeting to order at 9:03 a.m.
Representatives Zulkosky and Claman were present at the call to
order. Representatives Drummond, Tarr, Spohnholz, and Jackson
(via teleconference) arrived as the meeting was in progress.
Also in attendance was Representative Stutes.
^OVERVIEW: Public Assistance & Medicaid Services COVID-19
Response
OVERVIEW: Public Assistance & Medicaid Services COVID-19
Response
9:04:18 AM
CHAIR ZULKOSKY announced that the only order of business would
be an Overview on Public Assistance & Medicaid Services COVID-19
Response by the Department of Health and Social Services.
9:05:01 AM
ALBERT WALL, Deputy Commissioner, Office of the Commissioner,
Department of Health and Social Services (DHSS), began the
overview on Public Assistance & Medicaid Services COVID-19
Response. He said simultaneous efforts were taking place
regarding safety and modification of systems while providing
access to health care during [the pandemic]. The department's
Emergency Operations Center (EOC) efforts were ongoing, with
twice-daily meetings headed by Chief Medical Officer Anne Zink
and Director of the Division of Public Health within DHSS Heidi
Hedberg. He said EOC put out alerts and advisories from the
Office of the Governor. Mr. Wall spoke to the department's
relaxation of those policies which impeded quality of care, such
as requirements around background checks in licensure for
certified nursing assistants (CNAs), for the purpose of speeding
up the licensure process and ensuring a supply of health care
providers. While people are in isolation, telehealth is also a
priority, he related: efforts by the director of the Division
of Health Care Services and the director of the Division of
Behavioral Health to determine from where health care originated
would relax the medium through which healthcare could be
provided, adding audio and visual components that had not been
tested to this extent. The third policy change focused on the
elderly population on Medicaid.
9:09:49 AM
MR. WALL said the effort was being led by John Lee, Director of
Senior and Disabilities Services. In order to implement the
federal requirements for change, Mr. Wall stated, an appendix,
or emergency response, to the waiver must be put together. He
said an application for the waiver had been made at the time of
his testimony and DHSS was waiting to hear back from the
[federal] Centers for Medicare & Medicaid Services (CMS). He
said he would provide changes to the committee when the waiver
was accepted by CMS. The final policy change was an 1135
waiver, under a section of Medicaid that allowed for emergency
regulatory change during times of pandemics and disaster. The
1135 was last activated during the earthquake, he said. The
waiver was still being drafted, he stated, and it would be
submitted to the committee as well.
9:13:13 AM
REPRESENTATIVE SPOHNHOLZ asked about the 1915K waiver.
MR. WALL replied it was an appendix to a C waiver, which is what
all senior disability services were provided through Medicaid,
and the K appendix is the emergency appendix that went to the C
waiver.
9:14:08 AM
REPRESENTATIVE TARR asked how the emergency regulatory change on
the 1135 waiver would be used.
MR. WALL replied that every area of service would be covered,
such as allowing the use of tents in parking lots rather than
requiring people receive care in a building. In response to a
request for more information on the 1135 waiver services, he
offered to send a summary sheet.
9:17:05 AM
CHAIR ZULKOSKY reviewed considerations regarding bolstering
provider workforce when looking at the federal Medicaid
guidelines regarding public health crisis response: temporarily
waiving screening requirements including the payment of
application fees, background checks, and site visits; ceasing
revalidation of providers located in state or otherwise directly
impacted; temporarily waiving requirements for out-of-state
providers to be licensed in-state; and allowing facilities to
provide services in an alternate setting. She then asked
whether the considerations were being made in Alaska because the
state foresaw a possible increase in Medicaid-eligible
individuals.
MR. WALL confirmed that a comprehensive letter had been written
including the four considerations, and a response was
anticipated presently. He reiterated that "pretty much anything
having to do with access to care" was included in the 1135
waiver.
CHAIR ZULKOSKY asked about the intersection of Mr. Wall's work
with DHSS and EOC.
MR. WALL replied that until an actual state of emergency is
declared, EOC is somewhat dormant and runs training missions.
He added that EOC had footholds in the Department of Military &
Veterans' Affairs (DMVA) as well as "homeland security," so when
emergency was declared EOC worked with DHSS to respond. He
added that EOC was also connected to the Federal Emergency
Management Agency (FEMA) to provide protective equipment and, in
some cases, personnel.
9:20:39 AM
CHAIR ZULKOSKY asked Mr. Wall about his work in relation to the
efforts of the EOC regarding Medicaid services in Alaska
considering COVID-19.
MR. WALL said they met at least twice daily to exchange
information and contacts.
CHAIR ZULKOSKY asked Mr. Wall to speak to DHSS's efforts
regarding additional benefits currently not in the state plan,
such as waiving prior authorization requirements.
MR. WALL said DHSS had asked to waive various specific ongoing
monthly checks so that administrative burdens could be
alleviated and the focus remain on actual care.
CHAIR ZULKOSKY asked for updates regarding availability of
personal protective equipment (PPE) in Alaska.
MR. WALL replied that many PPE manufacturers were in China, but
EOC and DHSS were working on the issue.
9:24:57 AM
REPRESENTATIVE TARR opined that something more aggressive should
be done regarding travel, especially regarding International
travelers and passengers transiting through Seattle-Tacoma
International Airport, and she asked Mr. Wall whether he had any
updates.
MR. WALL responded that the issue was discussed by DHSS on a
daily, if not hourly, basis, and he would provide the committee
with a specific statement from Dr. Anne Zink on the matter.
REPRESENTATIVE TARR suggested that the American Red Cross could
be passing out information or doing temperature screenings at
airports. She offered more suggestions on getting information
to the public.
MR. WALL offered to supply a specific writeup of all the efforts
in that area, including "the public messaging piece" and
screenings.
9:27:49 AM
CHAIR ZULKOSKY expressed her agreement with Representative Tarr
and implored Mr. Wall to continue to advocate within DHSS. She
also mentioned recent epidemiology studies which showed Alaska
had less than eight days to shut down the state before the
possibility of becoming overwhelmed with hospitalizations.
9:29:08 AM
REPRESENTATIVE DRUMMOND referenced a radio interview with Rorie
Watt, City Manager for the City and Borough of Juneau (CBJ),
during which Mr. Watt stated he was setting up volunteer
screening at the Juneau International Airport, which is run by
CBJ. Representative Drummond opined there also should be
screening at the Ted Stevens Anchorage International Airport and
at additional voluntary screening checkpoints. She said Alaska
must take swifter action.
9:30:28 AM
CHAIR ZULKOSKY said HB 206 had allocated $13 million to DHSS for
response and mitigation efforts related to COVID-19. She
related that the committee was aware some of these funds had
been spent on public health nurses, epidemiologists, and
microbiologists, and she asked Mr. Wall whether he knew how the
remainder would be spent.
MR. WALL replied that organizations that typically operated in a
congregate setting were basically unfunded and would have to be
modified. He said PPE would be ordered and more emergency staff
would be hired. He remarked that the money would be used "in a
variety of ways," and he said he would supply a list of what the
expenditures would be. He added that a small amount would be a
contingency fund.
9:32:50 AM
REPRESENTATIVE TARR asked what additional resources needed to be
provided in terms of public health education and screening,
because there was still funding available.
MR. WALL said he would defer to Dr. Anne Zink for the response.
9:34:00 AM
REPRESENTATIVE JACKSON asked for confirmation that Mr. Wall
would provide the committee with the list of important numbers
he had mentioned.
MR. WALL confirmed he would supply the list.
REPRESENTATIVE JACKSON asked for reconfirmation that nurses
licensed in other states would have their licensure requirements
suspended.
MR. WALL replied that it must be determined whether services
would be able to be provided in Alaska and how to pay for them.
Mr. Wall said DHSS was working with Occupational Licensing on
the issue. He added this was all in the 1135 waiver.
REPRESENTATIVE JACKSON asked whether the information available
at airports had been translated.
MR. WALL said Dr. Anne Zink was the appropriate person to field
this question as well, and he would provide her answer.
9:36:22 AM
REPRESENTATIVE TARR said she had not seen the information
translated but had personally sent materials to the Center for
Disease Control (CDC) to be translated. She agreed translating
information should be a high priority.
9:37:31 AM
REPRESENTATIVE DRUMMOND said the Anchorage School District had
language experts who may be able to help translate.
MR. WALL said he called in to answer questions about Medicaid
services, but DHSS may be able to provide a representative from
EOC to answer questions on screening and the like.
CHAIR ZULKOSKY replied that the committee did not wish to take
those in emergency operations away from their efforts to answer
legislative questions, but if needed they would circle back.
9:39:30 AM
SHAWNDA O'BRIEN, Director, Division of Public Assistance (DPA),
Department of Health and Social Services, shared a list of
implementation efforts. Relaxing DHSS eligibility requirements
and allowing clients to give information over the phone, thus
avoiding in-person contact, were two major ones. She said
Medicaid cases would not be closed due to eligibility
requirements. She related that state regulations would be
relaxed around recertification of eligible programs; if people
were required to recertify or renew in March, April, May, or
June, those periods would be extended for a period of six
months. She added that DPA was working to balance employees'
work and childcare needs.
9:44:17 AM
REPRESENTATIVE TARR asked about payment for testing and whether
folks were being charged.
MR. WALL replied testing was covered under Medicaid.
9:45:45 AM
CHAIR ZULKOSKY asked Ms. O'Brien for a list of the suspensions.
MS. O'BRIEN said DPA had more approvals pending, and she said
she would provide a list that would be updated daily. In
response to a follow-up question, she said there had been no end
date for the relaxation of work requirements; however, DPA was
monitoring the situation.
9:48:40 AM
CHAIR ZULKOSKY asked whether DPA was prepared for a sustained
increase in demand on public assistance programs and what
preparations had been put in place.
MS. O'BRIEN replied there was enough funding for meeting the
most immediate needs, and it had not been indicated DPA would
lose federal funding.
CHAIR ZULKOSKY asked whether there had been telecommuting
mandates put forward to the teams handling the processes and
steps taken to address a possible bottleneck in managing
applications and eligibilities.
MS. O'BRIEN replied that certain levels of leadership had
telework agreements, especially those with health- or childcare-
related issues. She added a certain number of staff needed to
work from the office and the department was working daily to
find the right balance.
9:52:16 AM
CHAIR ZULKOSKY asked whether, while DHSS has considered relaxing
eligibility requirements, there had been evaluation or guidance
to increase the permitted amount of countable assets that would
allow Alaska to expand eligibility to various programs.
MS. O'BRIEN replied there had not been a lot of conversation
with federal partners on the topic at the time of her testimony.
9:54:02 AM
REPRESENTATIVE TARR asked whether a federal government payout
would be under a similar provision as the hold harmless portion
of the state permanent fund dividend (PFD).
MS. O'BRIEN replied she was not aware of anything at the federal
level which would impact program recipients. The focus was
trying to keep folks eligible and to relax as many rules as
possible to keep folks enrolled in programs.
REPRESENTATIVE TARR said that if the federal government did a
payout, then some folks could be kicked off their programs
because of money received, and she said this should be avoided.
She asked whether DHSS was doing anything for those seasonal
workers whose work is reduced in the summer months, especially
regarding the Alaska Temporary Assistance Program (ATAP) and
Temporary Assistance for Needy Families (TANF).
9:58:58 AM
MS. O'BRIEN answered that DHSS was prioritizing what was more
urgently needed, such as preventing any loss of benefits.
REPRESENTATIVE TARR said she feared disruption in income could
lead to more homelessness.
MS. O'BRIEN said external communications were still being put
together.
9:59:42 AM
REPRESENTATIVE JACKSON related a question from a dentist as to
whether medical professionals could help in terms of public
health screenings.
MR. WALL replied that DHSS would gladly accept a network of
professionals interested in helping. He added that interested
parties were welcome to contact him directly via his cell phone.
In response to Chair Zulkosky, he said anyone calling would be
directed to the appropriate person for assistance.
REPRESENTATIVE JACKSON asked whether a direct number could be
provided.
MR. WALL replied his cell phone number was (907)465-1610.
10:03:47 AM
REPRESENTATIVE SPOHNHOLZ remarked that taking advantage of
medical professionals' expertise would be in the best interest
of the public.
10:04:59 AM
MS. O'BRIEN, in response to a question from Chair Zulkosky about
the status of the hold harmless provision, said DHSS had full
funding and no programs had been reduced.
CHAIR ZULKOSKY asked, in the absence of legislation providing
statutory authority to DHSS for hold harmless, and if a federal
stimulus check were to be provided to Alaskans, whether DHSS had
considered being proactive in holding Alaskans harmless from
that as a countable asset.
MS. O'BRIEN replied that DHSS had not been given guidance on how
to handle funds, but traditionally the department would not be
considered hold harmless-eligible, because it was not under the
PFD for Alaska.
10:07:04 AM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 10:07 a.m.
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