Legislature(2015 - 2016)SENATE FINANCE 532
02/25/2016 09:00 AM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB74 | |
| Public Testimony | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 74 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE FINANCE COMMITTEE
February 25, 2016
9:06 a.m.
9:06:51 AM
CALL TO ORDER
Co-Chair MacKinnon called the Senate Finance Committee
meeting to order at 9:06 a.m.
MEMBERS PRESENT
Senator Anna MacKinnon, Co-Chair
Senator Pete Kelly, Co-Chair
Senator Peter Micciche, Vice-Chair
Senator Click Bishop
Senator Mike Dunleavy
Senator Lyman Hoffman
Senator Donny Olson
MEMBERS ABSENT
None
ALSO PRESENT
Erin Shine, Staff, Senator Anna MacKinnon; Stacie Kraly,
Assistant Attorney General, Department of Law; Heather
Shadduck, Staff, Senator Pete Kelly; Valerie Davidson,
Commissioner, Department of Health and Social Services;
Becky Hultburg, President and CEO, Alaska State Hospital
and Nursing Home Association; Jeff Jessee, Chief Executive
Officer, Alaska Mental Health Trust Authority; Patrick
Sidmore, Planner, Alaska Mental Health Board/ Advisory
Board on Alcoholism and Drug Abuse, Juneau; Carlton Heine,
Board Member, Alaska State Medical Association, Juneau;
Shailee Nelson, Compliance Administrator, Yukon-
Kuskokwim Health Corporation, Bethel; Pamela Watts,
Executive Director, Juneau Alliance for Mental Health,
Inc., Juneau; Tom Chard, Executive Director, AK Behavioral
Health Assoc., Juneau.
PRESENT VIA TELECONFERENCE
Nancy Merriman, President, Alaska Primary Care Association,
Anchorage; Mary Minor, Self, Anchorage; Michael Bailey,
CFO, HOPE Community Resources, Anchorage; Connie Sipe,
Executive Director, Center for Community, Sitka; Anne Zink,
American College of Emergency Physicians, Palmer;
Elizabeth Ripley, Executive Director, Mat-Su Health
Foundation, Wasilla; Jeremy Gitomer, AIM, Anchorage;
Kathleen Yarr, Self, Ketchikan; Robert Lane, AK
Psychological Assoc., Anchorage; Andrew Peterson, Director,
Medicaid Fraud, Department of Law, Anchorage; Carolyn
Heyman-Layne, Health Law Attorney, Anchorage; Julia
Jackson, Vice-President, Treatment Services, Volunteers of
America, Anchorage; John Laux, Self, Anchorage; Deborah
Brollini, Self, Anchorage.
SUMMARY
SB 74 MEDICAID REFORM/PFD/HSAS/ER USE/STUDIES
SB 74 was HEARD and HELD in committee for further
consideration.
SENATE BILL NO. 74
"An Act relating to permanent fund dividends; relating
to a medical assistance reform program; establishing a
personal health savings account program for medical
assistance recipients; relating to the duties of the
Department of Health and Social Services; establishing
medical assistance demonstration projects; and
relating to a study by the Department of Health and
Social Services."
9:07:31 AM
Co-Chair Kelly MOVED to ADOPT proposed committee substitute
for SB 74, Work Draft 29-LS0692\V (Glover, 2/23/16).
Co-Chair MacKinnon OBJECTED for purposes of discussion.
Co-Chair MacKinnon explained that the Senate Finance
Subcommittee on Medicaid believed that there would be
several issues in the bill that it expected the Senate
Finance Committee to address, and the issues were not
included in the work draft being considered. She expected
that the committee process would work slowly so that the
members could work to gain understanding on each section.
Co-Chair Kelly asked if the sectional analysis before was
the one he had previously examined.
Co-Chair MacKinnon explained that the committee was
reviewing a draft document from the previous evening.
Senator Hoffman asked which members served on the Medicaid
subcommittee.
Co-Chair MacKinnon specified that the subcommittee was
comprised of Senator Olson, Senator Micciche, Senator
Kelly, Senator Kelly, and herself.
9:10:02 AM
ERIN SHINE, STAFF, SENATOR ANNA MACKINNON, explained that
the Medicaid Reform subcommittee had met 13 times to review
and discuss a wide variety of topics and issues in aid of
considering SB 74, as well as SB 78 (the governor's
proposal for Medicaid reform). She referred to the draft
sectional analysis for CSSB 74(FIN) (copy on file);
specifying that portions of the bill had been amended.
Additionally, sections of the original bill had remained
untouched, and sections of SB 78 had been moved into the
work draft for SB 74. She continued that she would point
our new sections of the bill as she reviewed the CS.
Ms. Shine directed attention to page 2, Section 1, line 6;
and explained that the section was part of a robust package
of fraud language that the governor had proposed.
Co-Chair MacKinnon recognized legislative staff in the
gallery.
STACIE KRALY, ASSISTANT ATTORNEY GENERAL, DEPARTMENT OF
LAW, stated she would review initial sections in the CS
related to fraud that had originally been contained in SB
78. She referred to Section 1 and 2 on page 2, which were
statute of limitations provisions which amended Title IX of
Alaska Statutes to identify when claims pertaining to the
false claims act could be brought. Section 3 on pages 2
through 10 created a new chapter in Title IX, which was the
Alaska Medical Assistance False Claim and Reporting Act.
Ms. Kraly explained that the act created a new cause of
action whereby the State of Alaska, in conjunction with
individuals that identified false claims or fraud in the
Medicaid program, may pursue recovery of the claims through
civil action. She detailed that there had been a number of
new statutes established under the act:
AS 09.58.010. False claims for medical assistance;
civil penalty. She explained that generally there was
a list of activity that would be considered to be
false claims. A full list of the activities could be
found on page 2, line 26 through the end; and page 3,
through line 11. The penalties for false claims would
be civil penalties not less than $5500 and not more
than $11,000, three times the amount of actual
damages, reasonable attorneys' fees and costs as
provided in court rules, possible reduction in
penalties, and establishes corporate liability for
false claims.
AS 09.58.015. Attorney General invitation; civil
action. Authorizes the attorney general to investigate
claims brought under this statute and to work
collaboratively with DHSS on such matters.
Ms. Kraly elaborated that after an individual identified a
false claim and filed a lawsuit with the Superior Court of
Alaska, the action would be filed under seal and
immediately served upon the attorney general's office. The
attorney general's office, upon receipt of the complaint,
must take 60 days to evaluate the claim; then must: take
over the action, defer the action to the individual who
brought the claim, or determine that the claim was without
merit and dismiss the action outright.
9:14:45 AM
Co-Chair MacKinnon asked Ms. Kraly to explain the
department's perspective on corporate liability versus
individual liability in the case that a member of a
corporation commits fraud.
Ms. Kraly stated that the general premise (which had
already been in existence prior to the proposed new
statute) was that a corporation was responsible for the
corporate integrity of its organization through established
internal controls to ensure individuals working under and
with corporate authority were acting appropriately. She
clarified that AS 09.58.010 would establish that if a
corporation failed to have such internal controls, it would
be held liable for the activity of its employees. She
reiterated the corporate liability was established outside
of the false claims act.
Co-Chair MacKinnon stated that (inside the legislation) the
administration had made the recommendation for audits for
the companies performing medical services. She wondered if,
in addition to having corporate liability, responsibility
for federal dollars would be embedded in the new statutes.
Ms. Kraly answered in the affirmative, and added that there
was another provision later in the bill that addressed the
subject of audits.
9:18:23 AM
Ms. Kraly continued discussing provisions under the false
claims act. She discussed AS 09.58.020, which dealt with
how the attorney general acted as a check and balance to a
claim brought under the act. She discussed AS 09.58.025,
which granted the attorney general the authority to issue
subpoenas in order to assist in the investigation of a
claim. She addressed AS 09.58.030, which discussed the
rights within the false claims provision, if an action was
brought:
AS 09.58.030. Rights in fraudulent claims actions.
This outlines the relative role of the parties in the
event that the attorney general intervenes in a case
(exclusive authority over the case/action), including
moving to dismiss the case at any time or settling
with the provider despite the objection of the
relator. If the attorney general defers to the
relator, the attorney general can ask to be served on
all pleadings and intervene at any time. Further, the
attorney general can ask that discovery in the case be
stayed during the pendency of the criminal
investigation.
Ms. Kraly described AS 09.58.030 as a "safety valve" to
ensure that claims were properly prosecuted.
Co-Chair MacKinnon asked if the section included standard
language from other states that specified the attorney
general would have ultimate veto authority on a case versus
the judicial branch.
Ms. Kraly stated that it was general language that had been
adopted after review of guidelines for program
certification from the U.S. Department of Health and Human
Services Office of Inspector General. She continued that
the language was a general provision in most false claims
acts and can be found in the federal false claims act.
Ms. Kraly addressed 09.58.040:
AS 09.58.040. Award to false or fraudulent claim
plaintiff.
Outlines how the relator will be compensated in a
filed claim act.
(1) If the attorney general intervenes, the relator
will be awarded 15% to 25% of the total award;
(2) If the attorney general defers and allows the case
to go forward, the relator receives 25% to 30% of the
total award; and,
(3) Authorizes the court to limit or reduce the award
if the evidence takes into account the role of the
relator in bringing the case and the overall scheme.
9:21:53 AM
Senator Dunleavy asked Ms. Kraly to illustrate a brief
scenario on how a fraudulent claim process might work.
Ms. Kraly described a scenario whereby an individual (an
employee of an organization or a Medicaid recipient)
believed something inappropriate was occurring. The
individual would hire a private attorney to investigate and
help determine if there was sufficient evidence to bring a
false claim. If sufficient evidence was found, the attorney
would file a lawsuit in the superior court. The lawsuit
would be filed under seal and be sent to the superior court
while contemporaneously sent to the attorney general's
office. The attorney general's office would then
investigate to determine the merit of the case and
determine a course of action as to whether to bring the
case forward and as to whom would prosecute the case.
Finally, if the attorney general found no merit to the
claim, the case would be dismissed. If the case went
forward' a full civil trial would ensue to include
discovery, depositions, and potentially a bench trial in
front of a judge. If a judge determined fraud had occurred,
an award would be identified and damages would be awarded.
9:24:12 AM
Senator Dunleavy wondered if the hire of a private attorney
indicated that any claim would need to be of a significant
magnitude to justify the expense. He thought that most of
the incidents would probably take place against
institutions and entities.
Ms. Kraly stated that a claim could be against any Medicaid
provider regardless of the provider's size. She added that
there was a limit in the statute that stipulated one could
not bring a false claim for anything less than $5,500. She
stated that he was correct in that there was a cost-benefit
analysis to determine whether or not to file a claim. She
thought most claims would be in excess of $5,500.
9:25:02 AM
Senator Dunleavy asked if there could potentially be many
issues below the amount of $5,500 that over time could
accumulate to a substantial sum.
Ms. Kraly answered in the affirmative.
9:25:30 AM
Senator Olson asked about potential lawsuits and wondered
if the attorney general decided to dismiss the case, if
there was an appeal process for the plaintiff.
Ms. Kraly understood that if DOL dismissed a case, the case
would end. She assumed the decision would be appealable by
the plaintiff to the Supreme Court, however was not aware
of a circumstance in which it had happened before.
9:26:32 AM
Senator Bishop remarked that the attorney general possessed
a lot of power in the situation, and wondered about the
eventuality of new evidence being presented after case
dismissal.
Ms. Kraly thought the reopening of a case to consider new
evidence depended upon whether the case was dismissed with
or without prejudice. She thought some cases might be left
for additional evidence to come forward, and others would
be dismissed after finding insufficient evidence.
9:27:45 AM
Senator Hoffman wondered if the CS contained provisions for
whistle-blower protection. He asked if there were monetary
incentives for individuals to bring false claims forward.
Ms. Kraly stated that there were whistle-blower
protections, and she would discuss them later in her
presentation. She clarified that there was incentive
through the potential of enhanced recovery - that an
individual could obtain a portion of the recovery if a
false claim was established.
9:29:00 AM
Ms. Kraly continued to discuss the provisions of the CS:
AS 09.58.050. Certain actions barred.
Provides a list of situations that do not constitute a
false claim, such as a claim that is currently subject
to a criminal or civil action by the State. (For full
list page 12, line 18 - page 13, line 1).
AS 09.58.060. State not liable for attorneys' fees and
other expenses. Provides that the State is not
responsible for the costs and fees of a relator in
bringing an action.
9:30:18 AM
Co-Chair MacKinnon asked if there was a definition of the
term "relator" within the false claims act section. She
thought the general public might have a different
understanding of the word than how it was being employed in
the bill.
Ms. Kraly clarified that a relator was the private citizen
who had brought the false claim to the attention of the
attorney general's office. She confirmed that the term was
used in the formal statutes that governed false claims.
9:30:58 AM
Co-Chair Kelly thought the word "relator" was pronounced
differently than the more commonly known word "realtor."
Ms. Kraly concurred.
9:31:15 AM
Ms. Kraly pointed out AS 09.58.070 which was the section
pertaining to whistleblower protection. She discussed AS
09.58.080, which allowed for the development of regulations
to implement the act. She described AS 09.58.090, which set
the minimum threshold to bring a false claims act at
$5,500.
9:31:52 AM
Senator Hoffman asked how the $5500 minimum threshold
amount was established. Ms. Kraly explained that the
language was drafted after a review of federal guidelines
from the Office of Inspector General. By using the specific
provisions, including the threshold damage amount of
$5,500; the federal government would certify the false
claim act and thereby increase the state recovery match.
She explained that under Medicaid there was both a federal
and state match; funds from recoveries were split at 50
percent. Under the false claims act (if certified), the
state would receive a 5 percent enhancement and receive 55
percent of the recoveries.
9:32:54 AM
Ms. Kraly explained that the final sections pertaining to
the false claim act concerned definitions and short title.
9:33:05 AM
Ms. Shine addressed Section 4 through Section 9, which were
comprised of new language neither from SB 74 or SB 78. She
discussed a subcommittee meeting on the topic of opioid
abuse, in which it reviewed recommendations from the
Controlled Substance Advisory Committee for the
Prescription Drug Monitoring Program (PDMP). She explained
that the sections being discussed incorporated the nine
recommendations that had been sent to the Board of
Pharmacy. She detailed that in Section 4, it required the
collection of dispensing data and to update the PDMP on a
weekly basis.
Ms. Shine discussed Section 5:
Section 5(page 11-13) New Section
AS 17.30.200(d)
(3) Amends to authorize a licensed practitioner to
delegate database access to supervised employees or
clinical staff;
(4) Amends to authorize a registered pharmacists to
delegate database access to supervised employees or
clinical staff;
(7) Adds a new section to authorize PDMP database
access to the State of Alaska Medicaid Pharmacy
Program;
(8) Adds a new section to authorize PDMP database
access to the State of Alaska Medicaid Drug
Utilization Review Committee;
(9) Adds a new section to authorize PDMP database
access to the State of Alaska Medical Examiner;
(10) Adds a new section to authorize de-identified
PDMP data access to the State of Alaska Department of
Health and Social Services Division of Public Health.
The Division of Public Health would not need access to
identifiable data to fulfill public health objectives
regarding controlled substances including prescription
opiates.
Ms. Shine explained that currently a licensed practitioner
or registered pharmacist only had access to the PDMP
themselves, and found the practice of checking the PDMP
database before the prescribing and dispensing or
prescribing an opioid to be time-prohibitive. She directed
attention to the four new subsections in Section 5.
9:35:19 AM
Ms. Shine discussed Section 6:
Section 6(page 13) New Section
AS 17.30.200(e)
Amends to require all prescribers and all pharmacists
to register with the Alaska PDMP. Failure to register
is grounds for the board to take disciplinary action
against the license or registration of the pharmacy or
pharmacist.
Ms. Shine commented that the subcommittee had heard that
there might be an issue regarding response time of
emergency room physicians required to participate in the
PDMP.
9:36:10 AM
Ms. Shine discussed Sections 7 through 9:
Section 7(page 13) New Section
AS 17.30.200(h)
Amends to require prescribers and pharmacists to
review the PDMP database when prescribing or
dispensing a controlled substance to a patient.
Immunity for using the PDMP remains even with the
change from optional to mandatory.
Section 8(page 13-14) New Section
AS 17.30.200(k)
Amends to adopt regulations to:
(3) Set a procedure and time frame for registration;
(4) Require prescribers and pharmacists to review the
PDMP database when prescribing or dispensing a
controlled substance to a patient.
Section 9(page 14) New Section
AS 17.30.200
Adding new subsections to:
(o) Require prescribers and pharmacists to review the
PDMP database when prescribing or dispensing a
controlled substance to a patient.
(p) Require notification to boards when a practitioner
registers with the database.
(q) Authorize the Board of Pharmacy to forward
unsolicited notifications to prescribers and
dispensers of database information about patients who
may be obtaining controlled substances inconsistent
with generally recognized standards of care.
(r) Collect dispensing data and updating the PDMP
database weekly.
9:37:22 AM
Co-Chair MacKinnon stated that the previously discussed
sections were a departure from previous state statute, were
based on a recommendation from a task force, and may be
controversial. The language pertained to opioids only, and
was moving from language of "may report" to "shall report"
on the prescription and use of opioids. She understand the
language was in aid of understanding where the drugs were
going. She referred to testimony from a physician the
previous day regarding drug abuse versus drug selling. She
thought the optional program had made it difficult to curb
drug abuse activities, and pondered that the mandatory
participation in the PDMP would help mitigate the problem.
She wanted to recognize that there was a huge drug
addiction issue in the state, and expressed concern for
individuals who might perceive the changes as a barrier to
their personal pain management. She related a personal
experience in Fairbanks wherein she spoke with individuals
in a public setting about their experience with opioid
abuse in the community and the ease with which the general
population could access opioids. She recognized that there
would be different perspectives on the PDMP component of
the bill, and clarified that the subcommittee made the
recommendation based on what was in the best interest of
the state.
9:41:13 AM
Senator Dunleavy concurred that drug abuse was an epidemic
in the state, and related personal knowledge of young
adults that had experienced drug addiction after being
legitimately prescribed pain medication.
9:42:08 AM
Co-Chair MacKinnon discussed over-prescription of pain
medication. She mentioned her experience as the former
executive director of Hospice of Anchorage and discussed
pain management as part of end-of-life issues. She did not
want to restrict pain medication to people suffering from
terminal disease or unmanageable pain.
9:43:31 AM
Senator Bishop referred to Section 9, subsection (r) and
wondered who had access to the PDMP information.
Ms. Shine stated that currently access to the PDMP was
limited to pharmacists and the prescribing doctor. She
continued that there was a recommendation in Section 5 that
would allow access to other entities such as an agent of
the state or an employee of a doctor or pharmacist. She
reiterated the concern with the time necessary for
providers to access the PDMP database, and thought it might
have inhibited doctors from voluntarily coming to the
program.
9:45:00 AM
Co-Chair MacKinnon clarified that there it was a better use
of a doctor's time and more cost effective to be with
patients and was a better use of an employee's time to use
the PDMP database.
9:45:26 AM
Senator Bishop was concerned that drug companies may be
able to access data from the PDMP for marketing purposes.
Ms. Shine confirmed that it was not the intent of the
legislation to allow for such access, and she would ensure
that it was not in the bill. She discussed the limited
nature of access to the PDMP database.
9:46:02 AM
Co-Chair MacKinnon stated that there had been conversation
about protecting privacy, and indicated that currently even
the state pharmacist did not have access to detailed
information in the PDMP database.
Ms. Shine added that 31 other states had added allowed
access for state Medicaid pharmacists.
9:46:58 AM
Ms. Kraly addressed Section 10:
Section 10(page 14) Previously CS SB 78(FIN) Section 5
AS 37.05.146(c)
Amends to include a new paragraph (88) adding monetary
recoveries from the Alaska Medicaid False Claims Act
to the program and non-general fund program receipts
definitions.
9:47:27 AM
Senator Hoffman asked for the justification for not
forwarding the recoveries to the GF.
Ms. Kraly understood that under statute, other Medicaid
receipts were included under the non-GF designation. She
stated she would look into the matter and provide Senator
Hoffman with the information.
9:48:12 AM
Senator Hoffman asked what the receipts would be eligible
to be utilized for. Ms. Kraly was not sure of how the funds
could be used.
Co-Chair MacKinnon made note of the two questions for later
discussion. She thought that the direction of the funds had
to do with the state and federal funding split and the need
for proper accounting. She indicated that the committee
would request further information from DOL.
9:48:52 AM
Ms. Kraly reviewed Section 11:
Section 11(page 14) Previously CS SB 78(FIN) Section 6
AS 40.25.120(a)
Amends to include a new paragraph (15) a conforming
amendment to include new AS.09.58.010 to existing
public records statutes.
Ms. Kraly elaborated that the section had to do with
protection of the filing the case under seal, and other
information. Once the case went forward and was open, the
matters would be public as any other civil litigation.
There was a process whereby the department was
investigating and determining the merits of the case, and
the information needed to be maintained as confidential.
She confirmed that the section would add the false claim
act provisions to the Alaska Public Records Act.
9:49:44 AM
HEATHER SHADDUCK, STAFF, SENATOR PETE KELLY, discussed
Section 12:
Section 12 (page 14-15) Previously CS SB 74(STA)
Section 1
AS 47.05.015
Amends by adding a new subsection to allow the
Department of Health and Social Services (DHSS) to
enter into a contract through the competitive bidding
process under the State Procurement Code for durable
medical equipment or specific medical services
provided in the Medicaid program.
9:50:30 AM
Senator Hoffman asked if there was a monetary threshold
that was required in the statute. He thought it did not
make sense to go to competitive bid for a small amount.
Ms. Shadduck stated that there was not a monetary threshold
specified - the language was acquired through an amendment
made the previous session in the Senate State Affairs
Committee. She clarified that the section was also left as
permissive language that the department could use as a
tool. She mentioned that there had been other suggestions
from other groups such as the Key Campaign regarding how to
purchase medical supplies, and noted that the allowance was
an option rather than a requirement.
9:51:10 AM
Ms. Shadduck addressed Section 13:
Section 13(page 15-16) Previously CS SB 74(STA)
Section 2 (Amended)
AS 47.05.105 Enhanced computerized eligibility
verification system.
Amends by adding a new subsection requiring the
department to establish a computerized enhanced
eligibility verification system to verify eligibility
and to deter waste and fraud. It also requires DHSS
enter into a competitively bid contract with a third-
party vendor for the eligibility verification system.
The annual savings must exceed the cost of
implementing the system.
Ms. Shadduck pointed out that the section would require
DHSS to use a system that would complement Alaska's
Resource for Integrated Eligibility Services (ARIES)
system. She continued that added new subsections (c) and
(d) clarified that the system was separate from ARIES (how
the division of public assistance determined program
eligibility); and would utilize a nation-wide system to try
and capture waste and abuse. Subsection (d) prevented a
conflict of interest by stipulating that the department may
not award the contract to the same entity that ran the
eligibility system.
9:52:59 AM
Senator Bishop expressed appreciation for Ms. Shadduck's
earlier mention of efficacy of past computer programs. He
pondered that she was considering programs that had a
positive track record.
Ms. Shadduck affirmed that it was the intent of the
sponsors of the legislation to acquire a program with a
positive track record.
9:53:41 AM
Ms. Kraly addressed Section 14:
Section 14(page 16) Previously CS SB 78(FIN) Section 8
AS 47.05.200
a) Amends Medicaid Audits statute, changes the number
of program audits to no less than fifty per year and
adding that the state shall attempt to minimize
concurrent state or federal audits.
Ms. Kraly detailed that Section 14 would reduce the number
of audits that DHSS must contract for from 75 to 50. She
discussed the state being cognizant of the multitude of
other audits occurring at the federal level, and trying not
to duplicate services.
9:54:38 AM
Co-Chair MacKinnon relayed that the subcommittee had
communicated with the department regarding the question of
a shared services agreement pertaining to audits. She
understood that DHSS and the federal government were
sharing audit information. She indicated that DHSS
Commissioner Valerie Davidson indicated affirmatively from
the gallery.
9:55:56 AM
AT EASE
9:58:47 AM
RECONVENED
Ms. Kraly addressed Section 15:
Section 15(page 16-17) Previously CS SB 78(FIN)
Section 9 (Amended)
AS 47.05.200(b)
Amends so that the Department may assess interest and
penalties on overpayments, identified in audits
conducted under this section, by calculating interest
using existing statutory rates from the date of the
final agency decision.
Ms. Kraly qualified that the section would mirror what
happened in civil litigation and would encourage prompt
repayment.
Ms. Kraly addressed Section 16:
Section 16 (page 17) Previously CS SB 78(FIN) Section
10 (Amended)
AS 47.05.235. Duty to identify and repay self-
identified overpayments.
Amends by adding a new section which requires all
enrolled Medicaid providers to conduct one annual
review or audit of all claims, and if overpayments are
identified, to report those findings to the department
within ten business days, and to establish a repayment
agreement with the state.
10:00:20 AM
Co-Chair MacKinnon asked how the department was working
with providers to establish safety nets for the annual
review of claims.
Ms. Kraly was aware that DOL and DHSS worked with providers
on a regular on-going basis to provide technical assistance
pertaining to regulatory interpretation and record-keeping.
She referred to webinars, trainings, and seminars provided
by DHSS to assist providers with information to mitigate
occurrences of overpayment.
Co-Chair MacKinnon appreciated Ms. Kraly's response. She
referred to previous testimony by the department, as well
as discussions about transition to a new Medicaid
enrollment system. She had heard that there was a
substantial amount of money that had not been returned to
the state, and wondered if interest was being charged.
Ms. Kraly was not aware of whether interest was being
charged, and directed Co-Chair MacKinnon's inquiry to the
department.
10:02:37 AM
Ms. Kraly discussed Section 17:
Section 17(page 17-22)
AS 47.05.250. Civil penalties. Previously CS SB
78(FIN) Section 11 (Amended)
Authorizes the department to develop regulations to
impose civil fines and sets limits on the amount of
the fines.
AS 47.05.260. Seizure and forfeiture of real or
personal property in medical assistance fraud cases.
Authorizes the department, after application to the
court and a finding of probable cause, to seize
certain real or personal property of a medical
assistance provider who has committed or is committing
medical assistance fraud, to offset the cost of the
alleged fraud. The court may authorize seizure of real
or personal property to cover the cost of the alleged
fraud.
This section provides a list of possible real or
personal properties, including bank accounts,
automobiles, boats, airplanes, stocks and bonds, and
inventory.
This section, upon issuance of the court order of
seizure, prohibits the owners of property from
disposing of the property, with a provision of good
faith in the event property is sold without written
permission of the court. This section further
authorizes the forfeiture of any seized property if
the Medicaid provider is eventually convicted of
medical assistance fraud. This section provides
instructions to the state to sell or return
properties, and depositing funds from disposal of
seized properties.
This section also allows for the action of forfeiture
to be joined with another civil or criminal action for
damages resulting from alleged medical assistance
fraud.
10:04:18 AM
Ms. Shadduck further discussed Section 17, and highlighted
the changes to an additional section:
AS 47.05.270. Medical assistance reform program.
Previously CS SB 74(STA) Section 4
Under (a), the reform program must include 11 items:
1) Referrals to community and social support services,
including career and education training services
available through the Department of Labor & Workforce
Development, the University of Alaska, or other
sources
2) Electronic distribution of benefits (EOBs) to
recipients
3) Expanding the use of telemedicine for primary care,
behavioral health and urgent care
4) Enhancing fraud prevention, detection, and
enforcement
5) Reducing the cost of behavioral health, senior, and
disabilities services provided of Medicaid under the
state's home and community-based services waivers
6) Pharmacy initiatives
7) Enhanced care management
8) Redesigning the payment process by implementing fee
agreements that include: premium payments for centers
of excellence, penalties for hospital-acquired
infections, readmission, and outcome failures, bundled
payments, or global payments.
9) Stakeholder involvement in setting annual targets
for quality and cost-effectiveness
10) Reducing travel by requiring a recipient to obtain
care in their home community to the extent appropriate
services are available.
11) Establish guidelines for health care providers to
develop health care delivery models that encourage
wellness and disease prevention.
New Subsection (b): Requires the department to
efficiently manage a comprehensive and integrated
behavioral health system that uses evidence based
practices that are data driven with measureable
outcomes. The department and the Alaska Mental Health
Trust Authority must provide a plan for a continuum of
community based services that includes house,
employment and criminal justice issues.
Subsection (c): Has the department identify the areas
of the state where improvements in access to
telemedicine would be most effective in reducing the
costs of Medicaid. Allows the department to enter into
agreements with IHS providers if necessary to improve
access to telemedicine facilities and equipment.
Subsection (d): Requires the department to prepare and
submit a report around reforms, savings and costs
related to the Medicaid program on or before October
15 of each year.
Subsection (e): Provides a definition for
telemedicine.
Ms. Shadduck detailed that item 11 was new and comprised of
language from SB 78. Item 11, Subsection (b) was new and
had been formulated in coordination with Jeff Jessee, Chief
Executive Officer of the Alaska Mental Health Trust
Authority.
Ms. Shadduck read from the bill starting on Page 20, line
24:
The goal of the program is to assist recipients
of services under the program to recover by achieving
the highest level of autonomy with the least
dependence on state-funded services possible for
each person.
Ms. Shadduck expanded that the bill was focused on
continuum of care, linking individuals to community-based
services, addressing housing, employment, and criminal
justice.
10:07:50 AM
Senator Bishop asked to revisit Subsection (d), and
wondered if the specified date of October 15 was amenable
to all parties.
Ms. Shadduck conveyed that the date was chosen with the
intent that the report would be delivered to the
legislature with time for bills to be drafted or budget
items to be prepared. She referred to comments from DHSS
Commissioner Davidson regarding her work with the governor,
in the light of the departmental reporting requirement
listed on Page 21, line 19 of the bill:
(4) recommendations for legislative or budgetary
changes related to medical assistance reforms
during the next fiscal year;
Senator Bishop supported the section, but wondered if the
date allowed for ample time for the department to provide
full information.
Co-Chair MacKinnon relayed that the subcommittee had
allowed for brief testimony from DHSS. She relayed that the
commissioner had thought that some of the dates could pose
a challenge for the department to achieve. She avowed to
continue working with the department to align dates and
make it easier to accomplish the reporting task. She
reiterated Ms. Shadduck's point about the legislature
receiving information in a timely fashion prior to the
legislative session in order to start work on an issue. SHe
thought that if the governor chose not to advance a
particular topic, he would have reasons behind his choice.
Ms. Shadduck concurred.
10:10:35 AM
Senator Bishop was supportive of Co-Chair MacKinnon's
comments. He considered the newness of the program and
thought it might be prudent to give more time in the first
year for adjustment to the reporting schedule.
Co-Chair MacKinnon thought Senator Bishop made a valid
point.
10:10:55 AM
Senator Olson referred to Page 19, line 25 of the bill:
(2) electronic distribution of an explanation of
medical assistance benefits to recipients for health
care services received under the program;
Senator Olson expressed support for electronic connectivity
of businesses, but wondered if there were care providers
that did not have access to the internet or means of
complying with the section.
Ms. Shadduck understood that the distribution of
explanation of benefits (EOBs) would have to be added to
the current Xerox Medicaid Management Information System
(MMIS). She thought it would be up to the department to
comply with the requirement and ensure that individuals had
access to the EOBs.
10:12:16 AM
Co-Chair Kelly thought there was nothing in the language
that prohibited other types of distribution.
Senator Olson asked for confirmation that other forms of
distribution were available.
Co-Chair Kelly answered in the affirmative.
10:12:28 AM
Co-Chair MacKinnon relayed that the cost of paper may have
precluded the idea of printed EOBs in a cost-benefit
analysis. She mentioned that one way for individuals to see
if providers were over-charging was to understand the
services that Medicaid was being billed for. She described
the new system as a test, and thought that there would be a
benefit if individual Alaskans could help monitor what
providers were charging.
10:13:35 AM
Ms. Shine discussed Section 18:
Section 18 (page 22-23) Previously CS SB 78(FIN)
Section 17 (Amended)
AS 47.07.030(d)
Amends to require DHSS to implement the primary care
case management system. The purpose of this new system
is to increase Medicaid enrollees' use of primary and
preventive care, while decreasing the use of specialty
care and hospital emergency department services.
10:14:21 AM
Ms. Shine addressed Section 19:
Section 19 (page 23-24) Previously CS SB 78(FIN)
Section 12(Amended)
AS 47.07.036
Amends by adding new subsections (d)-(f) to outline
cost containment and reform measures DHSS may
undertake, including seeking demonstration waivers
related to innovative service delivery models,
applying for other options under the Social Security
Act to obtain or increase federal match, and improving
telemedicine for Medicaid recipients. This section
also requires DHSS to apply for an 1115 waiver for a
demonstration project for one or more groups of
Medicaid recipients in one or more geographic area.
The demonstration project may include managed care
organizations, community care organizations, patient-
centered medical homes, or other innovative payment
models.
10:15:16 AM
Ms. Shadduck reviewed Section 20:
Section 20(page 24-27)
AS 47.07.038. Collaborative, hospital-based project to
reduce use of emergency department services.
Previously CS SB 74(STA) Section 6(Amended)
Requires the department to partner a statewide
professional hospital organization to design and
implement a demonstration project to reduce non-urgent
use of emergency departments by Medicaid recipients.
AS 47.07.039(a) New Section
Requires DHSS to solicit and contract with one or more
third-party entities for coordinated care
demonstration projects for individuals who qualify for
Medicaid benefits on or before December 31, 2016.
DHSS may use an innovative procurement process as
described under AS 36.30.308. A proposal for considers
must include one or more of the following:
(1)Comprehensive primary-care-based management,
including behavioral health services
(2)Care coordination, including the assignment of a
primary care provider located in the local geographic
area of the recipient
(3)Health promotion
(4)Comprehensive transitional care and follow-up care
after inpatient treatment
(5)Referral to community and social support services,
including career and education training services
(6)Sustainability and the ability to replicate in
other regions of the state
(7)Integration and coordination of benefits and
services
(8)Local accountability for health and resource
allocation
10:16:12 AM
Co-Chair Kelly thought it was important to note the
requirements that had been interjected in the system:
identifying frequent users, electronic exchange of patient
information, dissemination of a list of frequent users,
education of patients, guidelines for prescribing
narcotics, and a drug monitoring program. He thought the
section was a significant piece of the legislation.
10:16:57 AM
Ms. Shadduck continued to discuss the coordinated care
project, which was pursuant to a subcommittee discussion
regarding the proposal for a managed care program, along
with the department's proposal for an accountable care
organization. There had been much debate pertaining to what
type of payment model or project to put forward. The CS
proposed that the department should contract with one or
more third-party to implement coordinated care projects, in
order for the best projects to come forward to the review
committee. She referred to the list of items 1 through 8.
10:18:34 AM
Ms. Shadduck gave an overview subsection (b):
AS 47.07.039(b)
Establishes a project review committee for proposals
submitted under (a) of this section.
The committee is comprised of:
1) The DHSS commissioner or their designee
2) The director of the Division of Insurance, DCCED or
their designee
3) The CEO of the Alaska Mental Health Trust Authority
or their designee
4) Three representatives of stakeholder groups
appointed by the Governor
5) A Non-voting member of the Senate appointed by the
Senate President
6) A Non-voting member of the House of Representatives
appointed by the Speaker of the House of
Representatives
Ms. Shadduck noted that the subsection listed an even
number of voting members for the review committee in
subsection (b) and surmised that the issue would need to be
addressed in another work draft.
10:19:21 AM
Senator Hoffman asked if there was a list of the
stakeholders related to the review committee. Ms. Shadduck
replied that the stakeholders were not listed.
Senator Hoffman clarified that he wanted to see a list so
as to know who might be appointed. Ms. Shadduck offered
that the department had worked extensively with
stakeholders during the interim, and offered to work with
the commissioner to provide a list. She continued that
stakeholders generally included the State Medical
Association, the Primary Care Association, the Alaska State
Hospital and Nursing Home Association, and others.
Senator Hoffman wondered how many stakeholders there might
be.
Co-Chair MacKinnon confirmed that there were hundreds of
stakeholders.
10:20:26 AM
Co-Chair Kelly reiterated that his office would provide
Senator Hoffman with a list as soon as it could be
obtained.
10:20:49 AM
Senator Hoffman asked if there would be terms of service
for the committee members, and wondered how members would
be replaced.
Ms. Shadduck thought that the specified members would
change as did any other committee or board, and thought it
might be good to specify length of terms for stakeholder
groups. It was the sponsor's intention that the project
would continue on. She clarified that the committee could
be used in perpetuity should the occasion arise that the
Centers for Medicaid and Medicare came forward with another
innovative model in the future.
10:21:39 AM
Ms. Shadduck discussed subsections (c), (d), and (e):
AS 47.07.039(c)
Grants DHSS authority to contract with third-parties
to implement the demonstration projects listed under
(a) of this section that include managed care
organizations, primary care case managers, accountable
care organizations, prepaid ambulatory health plan, or
a provider-led entity. Requires a per capita fee and
allows for value payment models.
AS 47.07.039(d)
Requires any project under (a) to include cost-saving
measures including the expanded use of telemedicine
for primary care, urgent care, and behavioral health
services.
AS 47.07.039(e)
Requires DHSS to contract with a third-party actuary
to review demonstration projects after one year of
implementation and make recommendations for the
implementation of a similar project on a statewide
basis. On or before December 31, 2018, and each year
thereafter, the actually shall submit a final report
to the DHSS for any project that has been in operation
for at least one year.
Ms. Shadduck confirmed that subsection (c) included that
fee structures may include global payments, bundled
payments, shared savings, or other payment structures. She
clarified that the intent of subsection (e) was to have
good information regarding what projects should be launched
in a wider regional or statewide basis.
10:22:45 AM
Ms. Shadduck reviewed subsections (f) and (g):
AS 47.07.039(f)
Directs DHSS to prepare a plan regarding regional or
statewide implementation of a coordinated care project
based on the results of the demonstration projects
under this section. Requires DHSS on or before June
30, 2019 to submit a report to the legislature on any
changes or recommendations for wider regional or
statewide implementation.
AS 47.07.039(g)
Refers to the definition of telemedicine in AS
47.05.270(e)
10:23:24 AM
Ms. Shadduck continued on Section 21:
Section 21 (page 27-28) Previously CS SB 74(STA)
Section 7
AS 47.07.076 Report to legislature.
Requires the department and the attorney general to
annually prepare a report regarding fraud prevention,
abuse, prosecution, and vulnerabilities in the
Medicaid program.
Ms. Shadduck expanded that the section would provide the
legislature with a report detailing payment error rates and
other details of fraud prevention. She noted that the
report would be due on October 15th of each year.
10:24:07 AM
Ms. Shine discussed Sections 22 and 23:
Section 22 (page 28) Previously CS SB 78(FIN) Section
13(Amended)
47.07.900(4)
Amends Medicaid Administration definitions, by
removing the grantee status requirement for outpatient
mental health clinics serving Medicaid patients.
Section 23 (page 28-29) Previously CS SB 78(FIN)
Section 14 (Amended)
AS 47.07.900(17)
Amends by removing the grantee/contractor status
requirement from drug and alcohol treatment centers
and outpatient mental health clinics. This change, and
the one in the previous section, allows mental health
and drug treatment service providers who do not
receive grants from the department to become enrolled
Medicaid providers and deliver services to Medicaid
recipients.
10:24:46 AM
Co-Chair MacKinnon stated that there was discussion in the
subcommittee that removal of the word "community" in
Section 23 could have an adverse effect. She stated that
the subcommittee would look into the issue further through
dialogue with the department. She clarified that currently
in order to receive a Medicaid benefit for mental health
services, a service provider must be a grantee of the state
of Alaska. The legislation would allow an opportunity for
other providers an opportunity to help meet the needs of
the community. Ms. Shine agreed.
10:25:29 AM
Ms. Kraly commented on Section 24:
Section 24 (page 29) Previously CS SB 78(FIN) Section
15
Uncodified: Indirect Court Rule Amendments.
Adds a new section to outline court rule amendments as
a result of the enactment of section 3 and 17.
Ms. Kraly explained that the section would outline the
court rule amendments required with the passage of the
false claims act.
Ms. Shine addressed Section 25:
Section 25(page 30) Previously CS SB 78(FIN) Section
16(Amended)
Uncodified: Implement Federal Policy on Tribal
Medicaid Reimbursement.
Requires DHSS to collaborate with Alaska Tribal health
organizations and the U.S. DHHS to implement new
federal policy regarding 100% federal funding for
services provided to Medicaid-eligible American Indian
and Alaska Native individuals within six months of the
rule change being finalized. Requires DHSS to report
to the co-chairs of Finance the estimated savings and
calculations of savings to the state general fund
within thirty days of the rule being finalized.
Ms. Shine relayed that the intent of the report required in
Section 25 was to gain understanding of what GF relief
there might be after implementing impending new federal
policy.
10:27:03 AM
Co-Chair MacKinnon relayed that the subcommittee had been
told that some of the travel that happened with Indian
Health Service recipients would be 100 percent reimbursable
rather than the state contributing. She continued that the
report would help to ensure that the department started
implementation of the rules as quickly as possible.
Ms. Shine added that in addition to travel, services not
available in the community or tribal health facility could
potentially be covered at 100 percent.
10:27:53 AM
Co-Chair MacKinnon thought the new rules might result in
significant cost savings and stated that travel for FY 15
was just under $80 million for the Medicaid program.
10:28:07 AM
Ms. Shine discussed Section 26:
Section 26(page 30-31) Previously CS SB 78(FIN)
Section 18
Uncodified: Health Information Infrastructure Plan.
Requires DHSS to develop a plan to strengthen the
health information infrastructure, including health
data analytics capability, to support transformation
of the health system in Alaska.
10:28:31 AM
Ms. Shadduck addressed Section 27:
Section 27(page 31) Previously CS SB 74(STA) Section 9
(Amended)
Uncodified: Department of Health and Social Services
Feasibility Study.
(a)Requires the department to conduct a study
analyzing the feasibility of privatizing the Alaska
Pioneers' Homes and select facilities of the division
of juvenile justice.
(b)Requires the Alaska Mental Health Trust Authority
to conduct a study analyzing the feasibility of
privatizing the Alaska Psychiatric Institute.
(c)Requires the Legislative Audit and Budget Committee
to conduct a study analyzing the feasibility of
creating a Health Care Authority that manages a single
community-related risk pool for all State of Alaska
Employees, State of Alaska retirees, Teacher retirees,
Medicaid Assistance recipients, and active school
district employees.
Ms. Shadduck clarified that before the state was allowed to
privatize facilities that employed union employees, it was
required to complete a feasibility study. She added that
she thought that the language in subsection (b) would need
to be adjusted slightly after collaboration with the Alaska
Mental Health Trust Authority.
Ms. Shadduck discussed subsection (c)//
10:30:36 AM
Co-Chair MacKinnon referred to a report from // She thought
that the state paid for approximately // Ms. Shadduck
concurred //
Ms. Shadduck //
10:31:17 AM
Ms. Shadduck addressed Section 28, //
Ms. SHadduck discussed Section 29, //
Ms. SHadduck discussed SEction 30, // The section was
created with Leg elgal //
Ms. SHaddauck summariazed that Section s
10:32:32 AM
Co-Chair MacKinnon conveyed that the subcommittee was
explicit that the issue of Medicaid expansion was not on
the table, and the CS being considered pertained solely to
reform //
10:33:07 AM
Co-Chair Kelly //
10:33:23 AM
Co-Chair MacKinnon WITHDREW her objection. it was so
ordered. CS SB 74(FIN) was adopted.
10:34:35 AM
VALERIE DAVIDSON, COMMISSIONER, DEPARTMENT OF HEALTH AND
SOCIAL SERVICES, complimented the work of the subcommittee.
// She stated that there were versions of the bill that
could benefit from enhancement. //
She referred to Section 4, page 11, line 8; that required
reporting on a weekly basis. She relayed that providers had
commented // She suggested adding the words "at least" to
accomdate for real-time information that could be //
10:36:50 AM
Commissioner Davidson appreciated the clarification of //
She asked for more clarification on the com
Commissioner Davidson section 13, page 15, lines 30 and 31,
regarding enhanced computerized eligibility // All but two
of the requirements //
10:38:55 AM
Co-Chair Kelly relayed that it was the intention to have //
10:39:31 AM
Co-Chair MacKinnon // SHe did not want the department to //
She thought //
10:40:07 AM
Vice-Chair Micciche reiterated // Commissioner Davidson
clarified that //
10:40:47 AM
Co-Chair Kelly made jokes.
10:41:36 AM
Senator Olson wondered about the cost of implementing a
second system. Commissioner Davidson anticipated that the
pertinent fiscal notes would be transmitted the following
Monday.
10:42:16 AM
Co-Chair MacKinnon
Vice-Chair Micciche drew attention to line // Commissioner
Davidson appreciated the clarification.
10:42:58 AM
Co-Chair MacKinnon //
Commissioner Davidson referred to section 17, //
on lines 8 and 9, subsection 12, requiring // The
department recommended //
Commissioner Davidson referred to section // She expressed
a desire for latitude to consider individuals in end of
life scenarios who were //
10:45:24 AM
Senator Olson asked for the n7mber of people that would be
affected. Commissioner Davidson did not have the in
10:45:52 AM
Commissioner Davidson addressed // The department felt
strongly that // and wanted the process to be ongoing // It
recommended adding the language "and every year thereafter
" //
Commissioner Davidson addressed // She
10:47:29 AM
Commissioner Davidson pointed out section 25, page 30, line
1 - // She // SHe pointed out
Commissioner Davidson discussed a point that was raised the
previous day, referring to several references //
Commissioner Davidson expressed her thanks //
10:49:10 AM
AT EASE
10:49:20 AM
RECONVENED
BECKY HULTBURG, PRESIDENT AND CEO, ALASKA STATE HOSPITAL
AND NURSING HOME ASSOCIATION, // expressed appreciation //
She thought the bill // She remarked on the flexibility //
10:52:33 AM
Ms. Hultburg continued, stating that // SHe relayed the
model was based on a model in Washington state //
10:53:17 AM
Ms. Hultburg highlighted areas of concern in the bill. //
She commented on administrative burden brought about by //
She expressed that the magnitude of the changes were
difficult for the provider community to understand //
Ms. Hultburg referred to Section 3, which would incentivize
frivolous lawsuits //
Ms. Hultburg suggested that the bill created a double
standard, while //
10:56:00 AM
Ms. Hultburg continued, and // She expressed support for
the sections pertaining to //
10:56:44 AM
Senator Hoffman thought the primary thrust of the
legislation was to address fraud, and wondered if ASHNA had
specific suggestions // Ms. Hultburg //
10:57:42 AM
JEFF JESSEE, CHIEF EXECUTIVE OFFICER, ALASKA MENTAL HEALTH
TRUST AUTHORITY, praised the transparent, inclusive, // He
expressed support for the bill, which he thought // He
thought behavioral health had been recognized as a key
element // He conveyed that the trustees thought the bill
was the most important // He discussed internal scrutiny of
funding // He expressed commitment //
11:00:41 AM
NANCY MERRIMAN, PRESIDENT, ALASKA PRIMARY CARE ASSOCIATION,
ANCHORAGE (via teleconference), expressed // She expressed
appreciation for the time that //
11:02:00 AM
Ms. Merriman expressed APCA's concern with //
She expressed concern with Section //
In Section 17, referring to medical assistance reform
program // she suggested // She conveyed that the
association would not support the //
In Section 18,
Ms. Merriman conveyed that the association //
11:04:31 AM
Ms. Merriman //
Ms. Merriman related that the association //
talking too fast…
11:05:59 AM
Senator Olson referred to // asked about other
demonstration projects // Ms. Merriman referred to other
states, and emphasized that Alaska presented unique //
11:07:02 AM
Senator Olson asked aobu the audits and administrative
obstacles // He wondered if ASHNA considered the amount of
required audits // Ms. Merriman understood that the 50
audits would be conducted by the state, and her concern //
11:08:19 AM
Co-Chair MacKinnon discussed the schedule for the remainder
of the day //
11:09:00 AM
RECESSED
1:09:09 PM
RECONVENED
^PUBLIC TESTIMONY
1:10:40 PM
MARY MINOR, SELF, ANCHORAGE (via teleconference),
testified in support of Medicaid expansion. She shared a
personal medical situation. She felt that there were some
items that should not be left to the private sector. She
felt that the country should be healthy, and had the
opportunity to enhance the nation's health.
1:13:15 PM
MICHAEL BAILEY, CFO, HOPE COMMUNITY RESOURCES, ANCHORAGE
(via teleconference), testified in support of protection
against continued litigation. He urged the expansion of
protections against false claims. He explained that there
were various organizations that conducted internal audits
and reviews of compliance. He felt that an annual review
and audit of all claims would be an administrated unfunded
burden to providers. He looked at Section 1, page 2, and
expressed concern regarding the reporting timeframe. He
felt that the expanded litigation processes would be
expensive, and could not withstand the exposure.
Co-Chair MacKinnon wondered if Mr. Bailey had any closing
comments. Mr. Bailey replied that he was concerned with the
definition of "agent", as outlined in the bill.
1:17:47 PM
CONNIE SIPE, EXECUTIVE DIRECTOR, CENTER FOR COMMUNITY,
SITKA (via teleconference), echoed Mr. Bailey's comments.
She expressed concern about the vagueness of the definition
of "agent." She suggested additional language. She added
that she was concerned about the word, "knowingly." She
testified in support of the language related to over-
payment. She urged separating the False Claims and
Reporting Act out of the bill, to ensure that Medicaid
providers were not driven out of business. She remarked
that the annual audit section be clarified, because of the
undue administrative burden.
1:21:12 PM
ANNE ZINK, AMERICAN COLLEGE OF EMERGENCY PHYSICIANS,
PALMER (via teleconference), expressed concern regarding
the database portion related to mandating the
administration of medication. She further //
1:22:19 PM
Senator Olson wondered if Dr. Zink was in // Dr. Zink
replied
1:22:36 PM
Senator Olson // Dr. Zink replied that page 14, lines 6
through 9 //
1:23:46 PM
Co-Chair MacKinnon // Dr. Zink replied in the affirmative.
1:24:07 PM
ELIZABETH RIPLEY, EXECUTIVE DIRECTOR, MAT-SU HEALTH
FOUNDATION, WASILLA (via teleconference), testified in
support of the provisions to reduce the super utilizers.
She stated that there was no vision for an adequate and
comprehensive behavioral health system, therefore there
were many gaps within the system. She felt that the
legislation would take an important step to better
behavioral health care access.
1:27:41 PM
JEREMY GITOMER, AIM, ANCHORAGE (via teleconference),
shared that his group had examined the opportunities within
Medicaid, as related to patients admitted with a specific
diagnosis. He remarked that //
1:32:31 PM
KATHLEEN YARR, SELF, KETCHIKAN (via teleconference), //
1:32:47 PM
Co-Chair MacKinnon clarified that the bill was related to
Medicaid reform, not Medicaid expansion.
1:33:10 PM
Ms. Yarr expressed concern about individuals who were
alcoholics, and attempted to receive care at an emergency
room. She felt that individuals were treated poorly, and
should not be turned away in the emergency rooms. She felt
that the best place for intervention for an addict would be
in the hospital. She stressed that many people would return
to the hospital later, because they were not given the
proper treatment at the initial visit.
1:35:32 PM
Co-Chair MacKinnon shared that Ms. Yarr's comments were
relevent to the legislation.
1:36:01 PM
PATRICK SIDMORE, PLANNER, ALASKA MENTAL HEALTH BOARD/
ADVISORY BOARD ON ALCOHOLISM AND DRUG ABUSE, JUNEAU, shared
that there were many aspects of the bill that were in line
with his boards' constituents. He remarked that evidence-
based practices were important aspects of the legislation.
He understood that there was an administrative burden on //
He suggested language that would allow a person to choose
to be enrolled in a behavioral health provider. He
supported the expansion of a broader base of behavioral
health providers. He noted that there may be a required
regulatory change. He suggested intent language that
allowed new providers to be equal to existing providers.
1:39:09 PM
CARLTON HEINE, BOARD MEMBER, ALASKA STATE MEDICAL
ASSOCIATION, JUNEAU, testified in support of // He shared
that there were approximately 10 percent of people that //
He stated that there were a fairly small number of people
that used emergency services to receive medication for
chronic pain. He felt that using //
1:42:30 PM
Vice-Chair Micciche remarked that there were some
practitioners that were irresponsible. He wondered if there
was value on the side of the provider. Dr. Heine replied
that there were some providers that were not //
1:44:16 PM
SHAILEE NELSON, COMPLIANCE ADMINISTRATOR, YUKON-
KUSKOKWIM HEALTH CORPORATION, BETHEL, looked at Section
16, and echoed the comments of some previous testifiers as
related to an annual review. She stressed that auditing
every claim would cause an undue administrative burden.
1:45:48 PM
PAMELA WATTS, EXECUTIVE DIRECTOR, JUNEAU ALLIANCE FOR
MENTAL HEALTH, INC., JUNEAU, urged the committee to
consider three points.
1:49:26 PM
Co-Chair Kelly requested the suggestions in writing. Ms.
Watts agreed to provide that information.
1:49:53 PM
TOM CHARD, EXECUTIVE DIRECTOR, AK BEHAVIORAL HEALTH ASSOC.,
JUNEAU, supported many provisions in the bill,
specifically related to behavioral health care. He hoped
that the process continued to be all-inclusive. He
expressed support of the fraud protection, but remarked
that there should not be undue audit requirements. He
stated that there were already many audit requirements. He
remarked that the committee should remove the grant
requirement outlined in the bill. He stated that the law
should bear more thorough examination.
1:53:30 PM
Co-Chair MacKinnon wondered if the grantee language was in
the governors bill in the year prior. Mr. Chard replied in
the affirmative.
1:53:46 PM
Co-Chair MacKinnon // Mr. Chard replied that he had
provided his comments to all
1:54:24 PM
ROBERT LANE, AK PSYCHOLOGICAL ASSOC., ANCHORAGE (via
teleconference), felt that the Medicaid program should
cover psychological care. He remarked that Medicaid
patients should be allowed the same psychological care. He
urged the committee to change the definition of "physician"
to include "psychologists." He shared that many other
states had crafted language to accomplish the
recommendations. He stated that currently licensed
psychologists could not provide the full range of services,
unless supervised by a physician. He stressed that
psychologists could not currently bill for services, unless
supervised by a physicians. He urged the committee to allow
doctoral psychological interns to bill Medicaid for
testing, which would allow for better qualified providers
to serve the communities.
1:58:42 PM
Co-Chair MacKinnon wondered if he should be addressed as
"Dr. Lane." Dr. Lane provided in the affirmative.
1:59:07 PM
Co-Chair MacKinnon wondered if Ms. Pemberton wanted to
testify.
1:59:28 PM
ANDREW PETERSON, DIRECTOR, MEDICAID FRAUD, DEPARTMENT OF
LAW, ANCHORAGE (via teleconference), replied that he was
available for questions.
2:00:09 PM
CAROLYN HEYMAN-LAYNE, HEALTH LAW ATTORNEY, ANCHORAGE
(via teleconference),
2:04:23 PM
Co-Chair MacKinnon requested Ms. Heyman-Layne submit her
testimony in writing.
2:04:51 PM
JULIA JACKSON, VICE-PRESIDENT, TREATMENT SERVICES,
VOLUNTEERS OF AMERICA, ANCHORAGE (via teleconference),
2:07:04 PM
Co-Chair MacKinnon announced the number for individuals to
call in
2:07:47 PM
JOHN LAUX, SELF, ANCHORAGE (via teleconference), expressed
appreciation for Medicaid reform. He shared that he did not
have any prepared comments. He encouraged the committee to
provide further opportunities for public testimony. He
stressed that there was nuance and detail to the
legislation. He supported the language as related to
behavioral and mental health.
2:10:18 PM
Co-Chair MacKinnon shared that the public had been notified
of all meetings related to the legislation.
2:10:54 PM
AT EASE
2:17:09 PM
RECONVENED
2:17:54 PM
AT EASE
2:20:29 PM
RECONVENED
2:20:49 PM
DEBORAH BROLLINI, SELF, ANCHORAGE (via teleconference),
expressed concern as related to Tribal Health System, and
remarked that she was not eligible for Medicaid and the
system would not bill her insurance. She urged the
committee to examine the billing system in Medicaid,
because it should not be through Chase billing.
Co-Chair MacKinnon CLOSED public testimony.
2:24:06 PM
Co-Chair MacKinnon shared that she heard from testifiers
that the grantee requirement should be removed from the
legislation. She felt that there would be a provider issue,
and the quality of care. She furthered that the mandatory
language on pharmacy and the emergency room requirement to
access the PDMP database before a narcotic prescription was
administered. She announced that there was also a concern
for the annual audit, and the suggestion to streamline the
audit.
2:26:26 PM
Senator Olson agreed with Co-Chair MacKinnon's concerns.
2:26:35 PM
Co-Chair MacKinnon asked for specific concerns as related
to the audits.
2:27:08 PM
Co-Chair Kelly did not have any objection to Co-Chair
MacKinnon's suggestions. He stated that the intention of
the legislation was an increased quality of care, and
addressing efficiencies. He felt that the highlighted
concerns should be addressed. He shared that the House had
a Medicaid reform bill, and furthered that the bill would
be vetted throughout the legislative process.
2:29:20 PM
Co-Chair MacKinnon shared that the goal was to pass the
bill at the beginning of March. She hoped that the
committee substitute would be drafted //
2:30:14 PM
Co-Chair MacKinnon stated that the committee was on
schedule.
2:30:22 PM
Senator Bishop felt that the public comment spoke volumes
to the quality of work of the committee.
2:30:40 PM
Vice-Chair Micciche appreciated the subcommittee process.
He remarked that the state budget was largely made up of
the Medicaid. He appreciated the legislation. He felt that
the bill provided the only substantive change to health
care costs in the state.
2:31:36 PM
Co-Chair Kelly shared that Medicaid reform was essential in
conducting the work required to draft the legislation.
2:32:33 PM
Co-Chair MacKinnon announced that Medicaid was $775 million
of the general fund. She stated that it also attracted $1
billion from the federal government. She // She restated
that Medicaid was a large cost driver to the state. // She
remarked that the items should remain in the committee
substitute, and stressed that the overutilization of the
hospital stays were large cost drivers. She declared that
the opioid overuse in the state should be a focus of the
legislation. She thanked the efforts of Co-Chair Kelly and
his staff in the work on the legislation. She stated that
she would not halt the bill, so individual advocacy group
could block legislation. She stressed that lobbyists were
attempting to block the legislation, and hoped that the
legislators would not succumb to that pressure. She
exclaimed that the state was the last in the country /
SB 74 was HEARD and HELD in committee for further
consideration.
ADJOURNMENT
2:36:21 PM
The meeting was adjourned at 2:36 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 74 JAMHI Testimony.pdf |
SFIN 2/25/2016 9:00:00 AM |
SB 74 |
| SB 74 AK-PA Letter regarding Medicaid Expansion and Reform.pdf |
SFIN 2/25/2016 9:00:00 AM |
SB 74 |
| SB 74 ABHA Testimony re-Grant Req.pdf |
SFIN 2/25/2016 9:00:00 AM |
SB 74 |
| SB 74 AKPA Testimony Revising Sec 22 AS 47 07 900.pdf |
SFIN 2/25/2016 9:00:00 AM |
SB 74 |
| SB 74 ACEP Testimony - AK PDMP.pdf |
SFIN 2/25/2016 9:00:00 AM |
SB 74 |
| SB 74 Public Testimony - Stukey.pdf |
SFIN 2/25/2016 9:00:00 AM |
SB 74 |
| SB 74 Public Testimony - Federico.pdf |
SFIN 2/25/2016 9:00:00 AM |
SB 74 |
| SB 74 JAMHI Testimony Version V.pdf |
SFIN 2/25/2016 9:00:00 AM |
SB 74 |
| SB 74 ASHNHA Testimony - Version V.pdf |
SFIN 2/25/2016 9:00:00 AM |
SB 74 |
| SB 74 022516 DHSS Feedback for Consideration_02262016.pdf |
SFIN 2/25/2016 9:00:00 AM |
SB 74 |
| SB 74 AADD Comments on CSSB74 Version V 022616 (1).pdf |
SFIN 2/25/2016 9:00:00 AM |
SB 74 |
| SB 74 Proposed Medicaid Reform Legislation- Sec 17 AS 47 05 Defining Sec 47 05 270 (e).pdf |
SFIN 2/25/2016 9:00:00 AM |
SB 74 |