Legislature(2015 - 2016)SENATE FINANCE 532
03/03/2016 09:00 AM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB74 | |
| 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
March 3, 2016
9:04 a.m.
9:04:11 AM
CALL TO ORDER
Co-Chair MacKinnon called the Senate Finance Committee
meeting to order at 9:04 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; Jon Sherwood,
Deputy Commissioner, Medicaid and Health Care Policy,
Department of Health and Social Services; Heather Shadduck,
Staff, Senator Pete Kelly; Kate Glover, Legislative Legal,
Juneau; Senator Cathy Giessel, Sponsor; Chuck Kopp, Staff,
Senator Peter Micciche.
PRESENT VIA TELECONFERENCE
Jay Butler, Chief Medical Officer/Director, Division of
Public Health, DHSS; Jeff Jessee, Chief Executive Officer,
Alaska Mental Health Trust Authority; Becky Hultberg,
President, AK State Hospital and Nursing Home Association,
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."
9:06:04 AM
Co-Chair MacKinnon shared that there would be an Amendment
27 from Senator Mia Costello's office. She shared that
there may be a recess in the meeting.
ERIN SHINE, STAFF, SENATOR ANNA MACKINNON, shared that
there were 26 amendments that were before the committee.
She remarked that she had worked with individuals,
departments, and staff to address the concerns raised in
the subcommittee and committee processes.
Co-Chair MacKinnon shared that there were individuals
online that would be available for questions and testimony.
Co-Chair MacKinnon remarked that the first amendments had
worked with Department of Health and Social Services (DHSS)
to enhance the bill.
JON SHERWOOD, DEPUTY COMMISSIONER, MEDICAID AND HEALTH CARE
POLICY, DEPARTMENT OF HEALTH AND SOCIAL SERVICES,
introduced himself.
Vice-Chair Micciche MOVED to ADOPT Amendment 1, 29-LS0692\
V. l6, Bruce/Glover 2/29/16 (copy on file):
Page 11, line 8, following "on":
Insert "at least"
Page 14, line 22, following "on":
Insert "at least"
Co-Chair MacKinnon OBJECTED for discussion.
Mr. Sherwood explained the amendment. He stated that the
amendment would allow for pharmacies to more than weekly
update the database.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 1 was adopted.
Vice-Chair Micciche MOVED to ADOPT Amendment 2, 29-LS0692\
V.46, Glover, 3/2/16 (copy on file):
Page 13, line 4:
Delete "under the program"
Insert "provided to recipients of medical assistance"
Co-Chair MacKinnon OBJECTED for discussion.
Mr. Sherwood explained Amendment 2. He stated that the
amendment would allow for the Medicaid pharmacists to
examine all prescriptions for Medicaid recipients, rather
than the prescriptions paid for by Medicaid. He stated
that, when someone abused the system, they may pay in cash
for prescriptions in addition to receiving prescriptions
through Medicaid. The amendment would allow the department
to identify fraudulent activity.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 2 was adopted.
Vice-Chair Micciche MOVED to ADOPT Amendment 3, 29-
LS0692\V. l7, Glover, 2/29/16 (copy on file):
Page 17, lines 14- 15:
Delete "An enrolled medical assistance provider shall
conduct at least one annual review or audit of all
claims submitted to the department for reimbursement
and, if'
Insert "Unless a provider is being audited under AS
47.05.200(a), an enrolled medical assistance provider
shall conduct a biennial review or audit of a
statistically valid sample of claims submitted to the
department for reimbursement. If'
Co-Chair MacKinnon OBJECTED for discussion.
Mr. Sherwood explained Amendment 3. The amendment would
make a change to replace the original language with
language that would reduce the administrative burden of
providers who would be undergoing a review. The amendment
would change to a statistically valid sample of claims, as
defined in statute.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 3 was adopted.
9:10:32 AM
Vice-Chair Micciche MOVED to ADOPT Amendment 4, 29-
LS0692\V.8, Glover, 2/26/16 (copy on file):
Page 20, line 5, following "include":
Insert "one or more of the following:"
Co-Chair MacKinnon OBJECTED for discussion.
Mr. Sherwood explained Amendment 4. He stated that it was a
minor language clarification to allow the department to
redesign the payment system with more than one of the items
listed in A through D of that section.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 4 was adopted.
Vice-Chair Micciche MOVED to ADOPT Amendment 5, 29-
LS0692\V. I 8, Glover, 2/29/16 (copy on file):
Page 20, line 19, following "models":
Insert "supported by evidence-based practices"
Co-Chair MacKinnon OBJECTED for discussion.
Mr. Sherwood explained Amendment 5. He stated that it was a
minor language clarification to ensure that the health
delivery model was designed to encourage wellness and
disease prevention as an evidence-based practice.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 5 was adopted.
Vice-Chair Micciche MOVED to ADOPT Amendment 6, 29-
LS0692\V.20, Glover, 2/29/16 (copy on file):
Page 21, line 10:
Delete "October"
Insert "November"
Page 27, line 18:
Delete "June 30, 2019"
Insert "November 15, 2019"
Page 27, line 20:
Delete "June 30"
Insert "November 15"
Page 28, line 17:
Delete "October"
Insert "November"
Co-Chair MacKinnon OBJECTED for discussion.
Mr. Sherwood explained Amendment 6. He stated that it was
the department's recommendation to simplify. The amendment
would standardize reporting dates as November 15 as the due
date. The date was chosen, because often the data would not
be available until November.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 6 was adopted.
Vice-Chair Micciche MOVED to ADOPT Amendment 7, 29-LS0692\
V.9, Nauman/Glover, 2/26/16 (copy on file):
Page 22, line 8:
Delete "average"
Page 22, line 9:
Delete "each"
Insert "the average"
Co-Chair MacKinnon OBJECTED for discussion.
Mr. Sherwood explained Amendment 7. He remarked that the
department assumed that the committee would want to know
the average cost, rather than each Medicaid recipient's
expenses from year to year.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 7 was adopted.
Vice-Chair Micciche MOVED to ADOPT Amendment 8, 29-LS0692\
V.35, Nauman/Glover, 3/1/16 (copy on file):
Page 22, line 26, following "of':
Insert "appropriate"
Co-Chair MacKinnon OBJECTED for discussion.
Mr. Sherwood explained Amendment 8. It would clarify the
language to say that the contract would be to increase the
appropriate use of primary and preventative care; as
opposed to "just" increase the use.
Senator Dunleavy queried documented instances of
inappropriate use, as the reason for the word,
"appropriate." Mr. Sherwood replied that some preventive
measures may not be appropriate for certain individuals. He
stated that an individual be screened for an issue every
year.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 8 was adopted.
9:15:22 AM
Vice-Chair Micciche MOVED to ADOPT Amendment 9, 29-
LS0692\V. l9, Glover, 2/29/16 (copy on file).
Page 23, line 1, following "subsection":
Insert", except that the department may exempt
recipients with chronic, acute, or terminal medical
conditions from the requirement under this paragraph"
Co-Chair MacKinnon OBJECTED for discussion.
Mr. Sherwood explained Amendment 9. He stated that the
language was intended to ensure that individuals with
multiple hospitalizations in the normal course of their
condition, would not necessarily be subject to an
additional layer of case management. He used the example of
individuals in hospital care.
Senator Bishop stated that he question was addressed.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 9 was adopted.
Vice-Chair Micciche MOVED to ADOPT Amendment 10, 29-
LS0692\V.ll, Glover, 2/26/16 (copy on file):
Page 25, line 22:
Delete "projects"
Insert "at least one project"
Following "may":
Insert "annually request proposals for additional
projects under this section thereafter. The department
may"
Page 25, line 23, following "AS 36.30.308":
Insert "to award a contract for a project under this
section"
Co-Chair MacKinnon OBJECTED for discussion.
Mr. Sherwood explained Amendment 10. He shared that the
amendment would make the care coordination demo projects an
annual process, rather than a one-time process.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 10 was adopted.
Vice-Chair Micciche MOVED to ADOPT Amendment 11, "29-
LS0692\ V .41, Glover, 3/2/16 (copy on file):
Page 27, line 29:
Delete "identify"
Insert "include the following information:"
Page 28, lines 14 - 15:
Delete all material and insert:
"(8) the most recent payment error rate measurement
report for the medical assistance program, including
fee for service programs and pilot or demonstration
projects; the report must also explain the reasons for
the payment errors and the total amount of state and
federal funds paid in error during the reporting
period and not recovered by the department at the time
of the report;"
Co-Chair MacKinnon OBJECTED for discussion.
Mr. Sherwood announced that he had lost his place.
Ms. Shine stated that there may be a drafting error, and
should read, "page 28, line 29."
9:17:48 AM
AT EASE
9:18:15 AM
RECONVENED
Mr. Sherwood continued to explain Amendment 11. He stated
that it amended page 28, lines 14 and 15 to replace the
language related to reporting on the Payment Error Rate
Measurement (PERM). He stated that the PERM was conducted
by the federal government every three years. The amendment
would require the department to provide the most recent
PERM report.
Co-Chair MacKinnon remarked that there was some confusion
with the amendment.
Ms. Shine clarified that on page 27, line 29, it would
identify and include the information to conform to the
changes presented on page 28, lines 14 through 15 with the
PERM audit changes.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 11 was adopted.
Vice-Chair Micciche MOVED to ADOPT Amendment 12, 29-
LS0692\V.26, Glover, 2/29/16 (copy on file):
Page 28, line 22:
Delete "[COMMUNITY]"
Insert "community"
Page 28, line 30:
Delete "[COMMUNITY]"
Insert "community"
Co-Chair MacKinnon OBJECTED for discussion.
Mr. Sherwood explained Amendment 12. He remarked that, in
Alaska statutes, "Community Health Clinic" is a term of
art. The department felt that aligning with the term would
be easiest.
Co-Chair MacKinnon surmised that the amendment was
reinserting original language. Mr. Sherwood responded in
the affirmative.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 12 was adopted.
Vice-Chair Micciche MOVED to ADOPT Amendment 13, 29-
LS0692\V.12, Nauman, 2/26/16 (copy on file):
Page 30, line 9:
Delete "adopts a final rule updating its"
Insert "issues a final"
Page 30, line 12, following "notify":
Insert "and submit a report to"
Page 30, line 12, following the second occurrence of
"the":
Insert "house and"
Page 30, line 12:
Delete "committee"
Insert "committees"
Page 30, lines 12 - 13:
Delete "and submit a report to the co-chairs of the
senate finance committee"
Page 30, line 14:
Delete "rule change"
Insert "final policy"
Page 30, line 15:
Delete "adopts the final rule"
Insert "issues the final policy"
Page 30, line 16:
Delete "rule"
Insert "policy"
Co-Chair MacKinnon OBJECTED for discussion.
Mr. Sherwood explained Amendment 13. The amendment was
intended to reflect the fact that the federal policy
referenced was not issued as a final rule, rather as a
policy letter to state health officials. The
Co-Chair MacKinnon shared that the intent of the language
was to allow the department to integrate the policy.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 13 was adopted.
Co-Chair MacKinnon wondered if the following three
amendments should be addressed immediately. Ms. Shine
replied that it was at the chair's discretion.
9:23:00 AM
AT EASE
9:23:13 AM
RECONVENED
9:24:14 AM
Vice-Chair Micciche MOVED to ADOPT Amendment 24, 29-
LS0692\V.43, Nauman/Glover, 3/2/16 (copy on file):
Page 14, line 7:
Delete"~"
Insert "review the information in"
Page 14, line 9, following "patient":
Insert "; the regulations must provide that a
pharmacist or practitioner is not required to review
the information in the database before dispensing,
prescribing, or administering a controlled substance
to a person who is receiving treatment
(A) in an inpatient setting
(B) at the scene of an emergency or in an ambulance;
in this subparagraph, "ambulance" has the meaning
given in AS 18.08.200;
(C) in an emergency room; or
(D) immediately before, during, or within the first
hours after surgery"
Co-Chair MacKinnon OBJECTED for discussion.
JAY BUTLER, CHIEF MEDICAL OFFICER/DIRECTOR, DIVISION OF
PUBLIC HEALTH, DHSS (via teleconference), explained
Amendment 24.
Co-Chair MacKinnon queried the reason for the amendment.
Ms. Shine replied that there was work with the department
to consider the committee's concerns. She remarked that
there was a thought that there may be an inhibited best
practice, should there be a mandate to check the BDMP prior
to administering a controlled substance in an emergency,
inpatient, or surgery situation.
Senator Olson looked at line 7 of the amendment, he queried
the interplay between community health aides. Dr. Butler
replied that the amendment focused on providers who were
prescribing opioids, which required a Drug Enforcement
Administration (DEA) number. He explained that any opioids
administered under the prescriptive authority of the
regional medical director or supervisor; so the health
aides would be covered.
Senator Olson looked at line 8 of the amendment, and noted
that the word "opioid" was not included. He remarked that
controlled substances included other medications besides
opioids. Dr. Butler agreed. He explained that the language
addressed the potential mixed substance preparations that
may include an opioid and other substances. He felt that it
may clarify the class of substances that included opioids,
while capturing a broader collection of prescription
medications that could be abused. He remarked that focusing
on only on opioids could potentially drive people to use
other substances.
9:29:04 AM
Senator Olson remarked that opioids were high on the
schedule list. He did not understand why the PDMP must be
consulted in the lesser addictive substances. Co-Chair
MacKinnon felt that the following amendment may address
some concerns.
Dr. Butler agreed, and felt that the question may be
addressed in the following amendment.
Vice-Chair Micciche remarked that the amendment was a
reasonable compromise, and would limit overprescribing. He
appreciated the proposed solution.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 24 was adopted.
Vice-Chair Micciche MOVED to ADOPT Amendment 25, 29-LS0692\
V.44, Bruce/Glover, 3/2/16 (copy on file).
Co-Chair MacKinnon OBJECTED for DISCUSSION.
Ms. Shine explained Amendment 25. She stated that the
amendment addressed the sections related to which drugs on
the federal and state levels would be addressed in the
PDMP. She remarked that someone prescribing a controlled
substance would have a DEA number that would align with the
federal controlled substance list. She believed that the
state controlled substance list was used for law
enforcement. She stressed that in all sections of 17.30.200
state classes 1.A, 2.A, 3.A, 4.A, and 5.A, would be
removed. She furthered that the federal classes 1 and 5
were removed.
Dr. Butler explained that the goal of the amendment was to
decrease the burden of the requirement of the use of the
PDMP as much as possible. He echoed Ms. Shine's comments.
Vice-Chair Micciche remarked that the intention was to
relieve the burden on physicians, while also protecting
Alaskans from overprescribing for Class 2, 3, and 4 drugs,
which included the opioids. Dr. Butler agreed.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 25 was adopted.
Dr. Butler thanked the committee for the hard work to what
is best for Alaskans, and address the challenges of drug
overdose.
9:36:43 AM
Vice-Chair Micciche MOVED to ADOPT Amendment 14, 29-
LS0692\V.34, Glover, 3/1/16 (copy on file):
Page 23, line 29, following "(d)":
Insert "and (f)"
Page 24, following line 8:
Insert a new subsection to read:
"(f) Notwithstanding (a) - (c) of this section, and in
addition to the projects and services described under
( d) and ( e) of this section, the department shall
apply for a section 1115 waiver under 42 U.S.C.
1315(a) to establish one or more demonstration
projects focused on improving the state's behavioral
health system for medical assistance recipients. The
department shall engage stakeholders and the community
in the development of a project or projects under this
subsection. The demonstration project or projects must
be consistent with the comprehensive and integrated
behavioral health program described under AS
47.05.270(b)."
Reletter the following subsection accordingly.
Co-Chair MacKinnon OBJECTED for discussion.
JEFF JESSEE, CHIEF EXECUTIVE OFFICER, ALASKA MENTAL HEALTH
TRUST AUTHORITY (via teleconference), introduced himself.
Ms. Shine explained Amendment 14. She stated that the
section was attempting to address some behavior health
issues.
Mr. Jessee stressed that the amendment was an important
amendment to make the Medicaid program sustainable.
Co-Chair MacKinnon surmised that the amendment did not
commit Alaska to a long-term group, but rather was a
project. Mr. Jessee agreed.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 14 was adopted.
Vice-Chair Micciche MOVED to ADOPT Amendment 15, 29-
LS0692\V.36, Bruce/Glover, 3/1/16 (copy on file):
Page 20, line 31:
Delete "primary care providers"
Insert "licensed or certified mental health and
primary care professionals"
Page 21, line 1, following "services":
Insert ", minimize administrative burdens,"
Co-Chair MacKinnon OBJECTED for discussion.
Ms. Shine explained Amendment 15.
Mr. Jessee explained that it was important to ensure that
in integrated settings there was the ability to utilize a
range of professionals who could provide services necessary
to ensure immediate and efficient services. He furthered
that the amendment also clarified that it was the intent to
minimize the administrative burdens on providers.
Senator Olson looked at the language related to licenses
and the certified professionals. He wondered if the
licenses were issued on a national or regional level. Mr.
Jessee stated that there were a number of certification
entities.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 15 was adopted.
9:42:25 AM
Vice-Chair Micciche MOVED to ADOPT Amendment 16, 29-
LS0692\V.13, Glover, 2/26/16 (copy on file):
Page 31, line 13:
Delete "Alaska Mental Health Trust Authority"
Insert "Department of Health and Social Services, in
conjunction with the Alaska
Mental Health Trust Authority,"
Page 31, line 14, following "The":
Insert "Department of Health and Social Services and
the"
Page 31, line 15, following "a":
Insert "joint"
Page 31, line 15, following the second occurrence of
"the":
Insert "Department of Health and Social Services and
the"
Co-Chair MacKinnon OBJECTED for discussion.
Ms. Shine explained Amendment 16. He shared that the
amendment was crafted with the help of Mr. Jessee.
Mr. Jessee announced that the amendments was intended to
have a feasibility study of privatizing services delivered
at the Alaska Psychiatric Institute. He shared that the
trustees were willing to participate.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 16 was adopted.
Mr. Jessee thanked the committee and staff.
9:45:03 AM
AT EASE
9:45:31 AM
RECONVENED
9:45:36 AM
Co-Chair Kelly MOVED to ADOPT Amendment 17, 29-LS0692\V.3l,
Glover, 3/1/16 (copy on file).
Co-Chair MacKinnon OBJECTED for discussion.
HEATHER SHADDUCK, STAFF, SENATOR PETE KELLY, explained
Amendment 17. She stated that the amendment addressed the
current Section 3 as related to the Alaska Medical
Assistance False Claim and Reporting Act. She shared that
there was feedback from providers across the state who felt
that the current provisions relating a private plaintiff
and their right of action was "a little scary." There was a
concern about frivolous lawsuit. A sunset was inserted
after three years related to all provisions related to the
private plaintiff. The intent was to allow for enough time
to explore the possibility of frivolous lawsuits against
providers. The amendment also allowed for the Department of
Law to present to the legislature in three years to either
remove the sunset or alter problems in the sections.
KATE GLOVER, LEGISLATIVE LEGAL, JUNEAU, spoke aloud.
Ms. Shadduck outlined the details of Amendment 17. She
noted the new Section 4, which referred back to the sunset.
The section of the bill related to subpoenas would continue
in law after the sunset. The section would take effect
after July 1, 2019, which coincided with the sunset date.
The added Section 5 would be a similar provision related to
the Whistleblower Act, so it would remove the reference to
the private plaintiff. That section would also take effect
after July 1, 2019.
Co-Chair MacKinnon asked for more information about the
technical aspects of the amendment. Ms. Glover replied that
the amendment would remove statutes that had been repealed.
She shared that there was also a reference to the court
rules that would affected by the repeal of certain
sections.
Ms. Shadduck noted that the actual sunset was on page 2 of
the amendment.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
further OBJECTION, Amendment 17 was adopted.
9:49:39 AM
Co-Chair Kelly MOVED to ADOPT Amendment 18, 29-LS0692\V.38,
Glover, 3/2/16 (copy on file):
Page 25, line 25:
Delete "one"
Insert "three"
Page 25, line 28, following the second occurrence of
services":
Insert "and coordination of long-term services and
support"
Page 26, line 8:
Delete "benefits and services"
Insert "benefits, services, and utilization
management"
Page 26, lines 15 - 16:
Delete all material and insert:
"(2) the commissioner of administration, or the
commissioner's designee;"
Page 26, line 19:
Delete "three"
Insert "two"
Page 26, line 20, following "governor":
Insert "for staggered three-year terms"
Page 26, lines 27 - 29:
Delete "A contract shall provide for a fee based on a
per capita expense that is fair and economical."
Page 26, line 29:
Following "structure":
Insert "for a contract under this subsection"
Following the second occurrence of "payments,":
Insert "capitated payments,"
Page 26, line 30, following "structures.":
Insert "The department shall work with the division of
insurance, Department of Commerce, Community, and
Economic Development, to streamline the application
process for a company to obtain a certificate of
authority required under AS 2 l .09.010 as necessary
to participate in a demonstration project under this
section."
Co-Chair MacKinnon OBJECTED for discussion.
Ms. Shadduck explained Amendment 18. She stated that
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, There being NO OBJECTION, and Amendment 18 was
adopted.
Senator Olson MOVED to ADOPT Amendment 19, 29-LS0692\ V.25,
Glover, 2/29/16 (copy on file):
Page 22, line 27, following "the":
Insert "unnecessary"
Co-Chair MacKinnon OBJECTED for discussion.
Senator Olson explained Amendment 19. He felt that the
change would ensure that there was not undue burden on the
entities.
Co-Chair MacKinnon wondered if the department accepted the
amendment.
Mr. Sherwood responded that the department felt the
amendment was reasonable clarifying language.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
further OBJECTION, Amendment 19 was adopted.
9:55:02 AM
AT EASE
9:57:18 AM
RECONVENED
Senator Bishop WITHDREW Amendment 20.
Co-Chair MacKinnon appreciated that the offices had
submitted amendments.
Vice-Chair Micciche MOVED to ADOPT Amendment 21, 29-
LS0692\V.30, Glover, 3/1/16 (copy on file).
Co-Chair MacKinnon OBJECTED for discussion.
Vice-Chair Micciche explained Amendment 21. The amendment
was a response to the recommendation of the 2015 DHSS
performance review, which estimated that the change would
provide an annual savings of approximately $927,000. The
amendment would require Pioneer Home Seniors applying for
payment assistance to submit to the department proof of
Medicaid application documentation of Medicaid acceptance.
He shared that the department agreed that this could be a
cost-saving measure, as long as it was tied to the
application for payment assistance rather than the
application for admittance to the Pioneer Home wait list.
He noted that the amendment clearly stated that it was
simply a condition for receipt of payment assistance.
Co-Chair MacKinnon detailed the amendment.
Vice-Chair Micciche felt that the amendment was adequately
covered. The remaining pages were renumbering the other
sections accordingly.
Senator Olson looked at the inserted language on page 29,
and wondered what would occur without the decision letter.
10:00:10 AM
AT EASE
10:08:16 AM
RECONVENED
10:08:49 AM
Vice-Chair Micciche replied that in order for the state to
realize the $927,000, there was the hope to use federally
sponsored programs. He stressed that the intent was to
initially utilize federal programs.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 21 was adopted.
Vice-Chair Micciche MOVED to ADOPT Amendment 22, 29-LS0692\
V.45, Glover, 3/2/16 (copy on file).
Co-Chair MacKinnon OBJECTED for discussion.
BECKY HULTBERG, PRESIDENT, AK STATE HOSPITAL AND NURSING
HOME ASSOCIATION, ANCHORAGE (via teleconference), explained
the amendment. She shared that the amendment clarified that
it was a "team approach" to the project with the goal of
minimizing the number of frequent users of the emergency
department services. The amendment also removed unnecessary
language, and more clearly defined the information that
would be shared through the electronic data interchange.
Co-Chair MacKinnon queried additional comments. Ms.
Hultberg thanked the committee.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 22 was adopted.
10:14:40 AM
Co-Chair Kelly MOVED to ADOPT Amendment 26, 29-LS0692\V.49,
Glover, 3/2/16 (copy on file).
Co-Chair MacKinnon OBJECTED for discussion.
Co-Chair MacKinnon explained that most of the amendment was
on page 31, lines 19 through 21.
Ms. Shadduck explained Amendment 26. She noted that the
first section of the amendment was the title change to
reflect the remaining changes in the amendment.
Co-Chair MacKinnon wondered if the amendment addressed
Senator Bishop's concerns. Senator Bishop replied in the
affirmative. He appreciated that there were several
references to the private marketplace.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 26 was adopted.
10:18:27 AM
Vice-Chair Micciche MOVED to ADOPT Amendment 23, 29-
LS0692\V.42, Glover, 3/2/16 (copy on file).
Co-Chair MacKinnon OBJECTED for discussion.
10:18:32 AM
AT EASE
10:19:06 AM
RECONVENED
Ms. Shine explained Amendment 23. She stressed that there
were many changes within the amendment.
10:21:26 AM
Co-Chair MacKinnon shared that Senator Giessel would be
available at 10:30 am.
10:21:49 AM
AT EASE
10:23:02 AM
RECONVENED
10:23:34 AM
SENATOR CATHY GIESSEL, SPONSOR announced that the term
"telehealth" was a more modern term than the word
"telemedicine." She stressed that telehealth encompassed
the word, telemedicine. She shared that most state programs
used the word, "telehealth.
Senator Olson queried the definition of AS 47.05270(e) Ms.
Shine replied that the definition was on page 22, line 15,
which was a new definition that would be inserted into
statute. She noted that there were two definitions that
were exactly the same, so referencing later in the
amendment addressed back to statute. She stated that
telehealth was the practice of health care delivery,
evaluation, diagnosis, consultation, or treatment using the
transfer of health care data through audio, visual, or data
communications that were performed over two or more
locations between providers who were physically separated
for the recipient; from each other; or between a provider
and a recipient who were physically separated from each
other.
Senator Olson queried the definition of "telehealth" under
statute. Ms. Shine replied that she did not believe it was
in existing statute.
Ms. Glover stated that there was no definition of either
telehealth or telemedicine currently in statute. The
definitions in the bill would be new definitions.
Senator Olson queried AS 47.05.270(e). Ms. Shine replied
that it would be a new statute.
Co-Chair MacKinnon queried the department's position of the
use of telehealth. Mr. Sherwood responded that the
department was supportive of the use of the word
"telehealth."
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, There being NO OBJECTION, and Amendment 23 was
adopted.
10:28:32 AM
AT EASE
10:33:11 AM
RECONVENED
10:33:22 AM
Vice-Chair Micciche MOVED to ADOPT Amendment 27, 29-
LS0692\V.48, Glover, 3/2/16 (copy on file).
Co-Chair MacKinnon OBJECTED for discussion.
Vice-Chair Micciche explained Amendment 27.
Co-Chair MacKinnon shared that the amendment would
incorporate SB 98 into the legislation.
10:34:16 AM
CHUCK KOPP, STAFF, SENATOR PETER MICCICHE, explained the
amendment. He remarked that a recent report showed that the
use of tele psychiatry had saved API over $1 million in
physician fees; $600,000 in hospitalization; and $70,000 in
travel in FY 15. He noted that one of the challenges was a
prohibition of out-of-state physicians who were licensed in
Alaska from being able to provide health care. He shared
that there was a similar problem with the Department of
Corrections (DOC) being able to stabilize patients in
psychotic episodes; and the short supply of psychiatrists.
Mr. Kopp noted that Sections 6 and 7 of the amendment
referred to the Board of Professional Counselors; the Board
of Marital and Family Therapists; the Board of
Psychologists and Psychological Associate Examiners; and
the Board of Social Work Examiners. The amendment was
offered by Senator Giessel to incorporate the behavioral
health therapists who work in teams at different locations
with the same client.
10:39:26 AM
Co-Chair MacKinnon wondered if the remarks referred to page
5, line 21.
Mr. Kopp clarified that the telemedicine business directory
was created through Department of Commerce, Community and
Economic Development (DCCED). He remarked that the name and
contact information of each business must be included in
the directory.
Co-Chair MacKinnon hoped that a forthcoming committee
substitute would incorporate the changes. She remarked that
the final version may not move from committee until the
following Monday.
Senator Olson noted that there was a comment related to the
Alaska State Medical Association, but that association did
not have regulatory authority. He queried the opinion of
the Alaska Medical Board on the amendment. Mr. Kopp replied
that the State Medical Board was not in favor of the build
out of telemedicine.
Senator Olson queried the opposition to telemedicine. He
wondered if there was merely a resistance to change. Mr.
Kopp replied that that he agreed with that assertions
proposed by Senator Olson. He stressed that there was a
still an in state licensing requirement.
10:42:39 AM
Vice-Chair Micciche remarked that the board had a list of
requests. He felt that the bill may make providers
uncomfortable, but wanted to move past the resistance. He
stressed that the amendment would address the high cost of
health care. He felt that the board may not oppose the
current version
Senator Hoffman wondered why the definition of telemedicine
was different from the definition on page 22 of the bill.
10:44:24 AM
AT EASE
10:44:50 AM
RECONVENED
10:44:52 AM
Ms. Shine explained that the definition in the bill was
previously amended.
Co-Chair MacKinnon queried the previously adopted
amendment. Ms. Shine replied that she believed it was
Amendment 23.
Vice-Chair Micciche felt that the amendment would
significantly reduce travel costs for lower level of health
care. He thanked various members of the legislature and
legislative personnel.
Co-Chair MacKinnon WITHDREW her OBJECTION. There being NO
OBJECTION, Amendment 27 was adopted.
10:47:09 AM
AT EASE
10:48:09 AM
RECONVENED
10:48:18 AM
Co-Chair MacKinnon shared that Legislative Legal would
incorporate the amendments into a new committee substitute.
She shared that she did not know when the committee
substitute would be available. She hoped that the fiscal
notes would be available.
SB 74 was HEARD and HELD in committee for further
consideration.
ADJOURNMENT
10:49:47 AM
The meeting was adjourned at 10:49 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 74 DCCED SFC Committee Followup 030216.pdf |
SFIN 3/3/2016 9:00:00 AM |
SB 74 |
| SB 74 ABHA Testimony letter re-Grant Req.pdf |
SFIN 3/3/2016 9:00:00 AM |
SB 74 |
| SB 74 GCDSE Support Testimony.pdf |
SFIN 3/3/2016 9:00:00 AM |
SB 74 |
| SB 74 Public Testimony Geneva Woods Medical.pdf |
SFIN 3/3/2016 9:00:00 AM |
SB 74 |
| SB 74 Amendment Packet 1-26.pdf |
SFIN 3/3/2016 9:00:00 AM |
SB 74 |
| SB 74 Amendment 27 - Micciche D.pdf |
SFIN 3/3/2016 9:00:00 AM |
SB 74 |