Legislature(2017 - 2018)SENATE FINANCE 532
04/11/2018 01:30 PM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB215 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 285 | TELECONFERENCED | |
| += | HB 286 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 215 | TELECONFERENCED | |
SENATE FINANCE COMMITTEE
April 11, 2018
1:51 p.m.
1:51:52 PM
CALL TO ORDER
Co-Chair MacKinnon called the Senate Finance Committee
meeting to order at 1:51 p.m.
MEMBERS PRESENT
Senator Lyman Hoffman, Co-Chair
Senator Anna MacKinnon, Co-Chair
Senator Click Bishop, Vice-Chair
Senator Peter Micciche
Senator Donny Olson
Senator Gary Stevens
Senator Natasha von Imhof
MEMBERS ABSENT
None
ALSO PRESENT
Elizabeth Diament, Staff, Representative Paul Seaton; Jill
Lewis, Deputy Director, Division of Public Health.
SUMMARY
CSHB 215(FIN)
DHSS: PUBLIC HEALTH FEES
CSHB 215 was HEARD and HELD in committee for
further consideration.
CS FOR HOUSE BILL NO. 215(FIN)
"An Act relating to program receipts; and relating to
fees for services provided by the Department of Health
and Social Services."
1:52:34 PM
Co-Chair MacKinnon introduced the bill.
1:53:09 PM
AT EASE
1:53:32 PM
RECONVENED
ELIZABETH DIAMENT, STAFF, REPRESENTATIVE PAUL SEATON,
discussed the bill. She explained the process of the bill.
She stated that during the subcommittee process, Public
Health was identified as a division that could be charging
additional fees to help sustain its mission. She shared
that the constitutional mission of the division was
protecting and promoting the health of Alaskans. She
announced that, currently, the Department of Health and
Social Services (DHSS) charged for some public health
services, however, the department could only charge what
was listed in AS 44.29.022a. She shared that the list of
duties that were currently fee-eligible were mostly
clinical. The fees included maternal and child health
services; nutrition services; and preventative medical
health services. The division lacked fee authority such as
administrative and professional services. The bill would
amend AS 44.29.022 to grant DHSS the authority to establish
reasonable fees for the support of administration of public
health programs. The bill gave statutory authority to DHSS
to charge fees for any public health related services under
AS 18, and tobacco control programs under AS 44.29.022. The
bill also added the fees created to the list of program
receipts separately accounted under AS 37.05.146c. The bill
allowed DHSS to decide what fees it would establish through
regulation and a public process. The fees already must be
in the public interest and economically feasible to
collect; and could not undermine the division's mission.
The fees were limited to the actual cost of services, and
any regulation would be required for each new fee.
Co-Chair MacKinnon wondered whether the fees would be used
for public health, and not the Medicaid program. She felt
that public health was sometimes shadowed by Medicaid
services.
Ms. Diament replied that the intent of the legislation was
that the fees would pay for public health services. She
deferred to Ms. Lewis for more information.
JILL LEWIS, DEPUTY DIRECTOR, DIVISION OF PUBLIC HEALTH,
agreed with Ms. Diament. She stated that the listed fees
would be in the list of designated program receipts in
statute, which would clarify the intent of the legislature.
The fees would support the specific program that generated
the fees.
Co-Chair MacKinnon asked if there was anything to consider
inside the bill language that would bolster the intent. She
felt that the bill should support the areas which the funds
were generated and overall public health.
Vice-Chair Bishop asked if the committee would discuss the
fiscal note.
Co-Chair MacKinnon replied that the fiscal note would be
covered by DHSS.
Vice-Chair Bishop thought the fiscal note answered many
questions regarding the designation of the receipts.
2:00:01 PM
Ms. Diament addressed the Sectional Analysis for the bill
(copy on file):
Section 1
(page 1, line 4)
Adds a new paragraph (90) to the list in AS
37.05.146(c) of designated general fund program
receipts and non-general fund program receipts that
are accounted for separately, and appropriations from
these program receipts are not made from the
unrestricted general fund.
Paragraph (90) does 2 things:
1) Consolidates all current public health fees listed
in AS 37.05.146(c) that are collected by the
Department of Health and Social Services into one
subsection.
Note: It was determined that the statute could be made
clearer by consolidating other DHSS programs and
services along with public health under (90). From the
current list of 89 program receipts in AS 37.05.146(c)
the following would move under (90):
Current AS 37.05.146 (c) 42 becomes (90) (A)
59 - (B)
60 - (C)
61 - (90) (D)
62,63,65,66 (E)
64 (F)
67 (90) (G)
71 (H)
88 ( I)
2) Adds language in subsection 90(e), other public
health programs and services
Note: The specific public health programs and services
for which DHSS may establish fees are
specified under AS 44.29.022(a), which is explained in
the next section.
Section 2
(page 2, line 14)
Adds AS 44.29.020(a) (14) tobacco control programs
administered by the Department and public health
programs the department administers under AS18 to the
list of services in AS 44.29.022(a) for which the
Commissioner of the Department of Health & Social
Services can establish reasonable fees.
Note: While there are other departments also listed
within AS 18, language under AS 44.29.022(a) states
that the commissioner of DHSS may only establish fees
for services listed under this statute that are
provided by DHSS.
Section 3
(page 2, line 26)
Adds a new sub section to AS 44.29.022 requiring the
commissioner of health and social services to consult
with stakeholders, including at least one public
meeting, before a notice of proposed action is made
regarding the development of new fees under AS
44.29.020(a) (14) or AS 18.
Section 4
(page 3, line 5)
Repeals statutes that have been consolidated under
subsection (90) in section 1 of this bill.
Co-Chair MacKinnon asked if there was a reason there was no
effective date for the bill.
Ms. Diament replied that there was no fiscal impact for FY
19, because it would take time for the regulations to go
into effect.
Senator von Imhof noted that there was a presentation, so
she would aske a question during the presentation.
Ms. Lewis discussed the presentation "HB 215 DHSS: Public
Health Fees," (copy on file).
Ms. Lewis showed slide 2, "HB215 DHSS: Public Health Fees":
? Public Health is able to charge fees for certain
clinical services:
? Maternal and child health services
? Nutrition services
? Preventive medical services
? Health education
? Public health nursing services
? Laboratories
Ms. Lewis turned to slide 3, "HB215 DHSS: Public Health
Fees," which showed a pie chart entitled 'Division of
Public Health Funding Sources - FY2019 Governor's Budget."
She remarked that the FY 16 and FY 17 budgets included
intent language that the Division of Public Health evaluate
and implement strategies to maximize billable services. She
recalled that the Legislative Audit's performance review of
the department included similar recommendations. She stated
that the graph showed that the budget already included
nearly $7 million in general fund program receipts, which
made up approximately 6 percent of the total receipts. The
receipts came from individuals who paid for the clinical
services listed on slide 2.
Ms. Lewis showed slide 4, "HB215 DHSS: Public Health Fees":
? Public health lacks fee authority for other services
and functions:
o Professional services
o Data extraction and analysis
o Training and expert consultation
o Administrative functions
o Inspections and
certifications
o Program administration
2:06:54 PM
Ms. Lewis displayed slide 5, "HB215 DHSS: Public Health
Fees":
? Fees waived if
? not in the public interest
? not economically feasible to collect
? the public health is best served by the waiver
of the fee
? Services not denied because of inability to pay
? Sliding fee schedules
? Fees limited to the actual cost
? Regulations required for each new fee
Ms. Lewis spoke to slide 6, "HB215 DHSS: Public Health Fees
? Fees for public health services will
o Keep us safe
o Help communities be healthy
o Provide access to primary care
o Inform decision makers where resources are most
needed
Co-Chair MacKinnon stated that the presentation was
available online.
Senator Micciche asked about the success of sliding fee
schedules, and wondered if there was a significant
administrative burden.
Ms. Lewis replied that the slide fee schedule was mostly
used the public health nursing centers. She stated that
each client filled out information about their income to
determine where they fit in the sliding fee scale. She
remarked that the burden was minimized, because it was a
standardized process. She emphasized that it was, however,
a manual process.
Senator Micciche asked if there was documentation required
or if the process relied on the honor system.
Ms. Lewis stated that it was mostly the honor system.
2:12:10 PM
Senator von Imhof asked if the data being referred to was
already collected or if it was a new data set.
Ms. Lewis stated that the data sets were made available as
was reasonable under state privacy and confidentiality
laws.
Senator von Imhof wondered about a potential charge for
providing raw data.
Ms. Lewis stated that the fee structure for every type of
service provided varied. In general, most likely raw data
would be based on the record count or the size of the file.
Co-Chair MacKinnon OPENED public testimony.
Co-Chair MacKinnon CLOSED public testimony.
Ms. Lewis discussed the fiscal note.
Co-Chair MacKinnon asked whether the regulation cost would
be absorbed.
Ms. Lewis replied in the affirmative.
2:18:53 PM
Ms. Lewis addressed page 2 of FN 2. She noted that the fees
would be used to support public operations. In the
narrative portion there were four examples given for
different types of fees:
* Registration, certification, and inspection of
radiological device fees are needed to support a
second radiological health physicist for magnetic
resonance imaging (MRI), computed tomography (CT),
mammography, and ultraviolet devices.
Currently only fees for X-ray devices are authorized
and only X-ray devices are registered, certified and
inspected. No new position are needed; the division
will utilize an existing vacant position. ($100.0 DGF)
* An administration fee for the healthcare
practitioner loan repayment program, Supporting
Healthcare Access through
Loan Repayment Program (SHARP), would cover the cost
of operating the program, which is currently supported
with unrestricted general funds. Similar loan
repayment programs charge an administrative fee.
($200.0 DGF/-200.0 UGF)
* Allowing a reasonable fee for custom statistical and
epidemiological analyses on public health data sets
would greatly enhance the usefulness of the datasets.
The division is frequently asked for ad hoc analyses;
however, our resources are consumed in collecting the
data, leaving little capacity for analysis. Other
states charge annual or per-hour fees for analytical
work. ($175.0 DGF)
* The division has turned away requests to assist with
community health assessments and community action plan
development. The division lost the capacity for this
service when the position funded with unrestricted
general funds was eliminated in recent budget cuts.
The ability to charge fees would enable us to once
again support local efforts for healthier communities.
No new positions are needed; the division will utilize
existing positions. ($125.0 DGF)
Vice-Chair Bishop asked for clarification about the
inspection of radiological devices.
Ms. Lewis replied that the division visited all the
different facilities to inspect the radiological devices.
She remarked that the current focus was on the x-ray
devices.
Vice-Chair Bishop wondered if there was a timeline
associated with the inspection, or if a major hospital
would bring on a contractor. He wondered about the
liability associated with inspection.
Ms. Lewis thought the matter was a gap in public health
coverage. She remarked that there were stories about
diagnostic machines that were not properly calibrated. She
stressed that facilities were making their best efforts to
ensure that the machines and procedures were good practice.
She stated that there was no one to ensure that those
efforts were happening for the public safety.
Vice-Chair Bishop felt that examining the machines was
important to save money downstream.
Senator Micciche asked whether the department was
certifying x-ray machines.
Ms. Lewis replied in the affirmative.
Senator Micciche wondered whether there was a fee for each
inspection.
Ms. Lewis thought the fee would be similar to that of the
x-ray fee, which was a per unit fee. She noted that the fee
was $80 per x-ray tube.
2:25:01 PM
Co-Chair MacKinnon observed that the fiscal note provided
funding for an existing vacant position.
Ms. Lewis stated that the department was asking the funding
to be applied to the personal services line. She stated
that the existing vacant position would be repurposed.
Co-Chair MacKinnon felt that there was a focus on
eliminating all positions. She noted that there was a cost
to putting positions in the system. She remarked that there
were positions that were unfilled in the books. She
wondered whether the fee would be used to cover the cost of
the position.
Ms. Lewis stated that the Division of Public Health had
approximately 430 employees, and there was turnover that
generated 30 to 40 current vacant positions. Those
vacancies were evaluated and prioritized based on the
highest need at the time.
Vice-Chair Bishop remarked that there was not a criticism,
but there was an examination of the turnover of employees.
Co-Chair MacKinnon shared her gratitude for those that
worked in public health.
Co-Chair MacKinnon referenced x-rays and technology and
asked how it related to scans in airports. She wondered
whether there was a verification of the output on those
machines.
Ms. Lewis stated that DHSS had no authority over the
devices used in airports by the federal government.
Co-Chair MacKinnon asked if there was a way for Division of
Public Health to make an inquiry related to the possibility
of unhealthy output of the machines.
Ms. Lewis stated she would look into the matter.
Co-Chair MacKinnon stated she was willing to cosign a
letter related to that concern.
Co-Chair MacKinnon asked for an update on the SHARP
supportive care access repayment program.
CSHB 215 was HEARD and HELD in committee for further
consideration.
Co-Chair MacKinnon discussed the agenda for the following
day.
2:32:00 PM
AT EASE
2:32:11 PM
RECONVENED
Co-Chair MacKinnon clarified items about the agenda for the
following day.
ADJOURNMENT
2:33:32 PM
The meeting was adjourned at 2:33 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 215 Additional Documents-Public Health Briefing Paper 2.20.2018.pdf |
SFIN 4/11/2018 1:30:00 PM |
HB 215 |
| HB 215 Explanation of changes Ver D to Ver O.pdf |
SFIN 4/11/2018 1:30:00 PM |
HB 215 |
| HB 215 DHSS Slide Presentation 2-20-2018.pdf |
SFIN 4/11/2018 1:30:00 PM |
HB 215 |
| HB 215 Letters of Support 3.27.18.pdf |
SFIN 4/11/2018 1:30:00 PM |
HB 215 |
| HB215 Sectional Analysis ver O 2.20.18.pdf |
SFIN 4/11/2018 1:30:00 PM |
HB 215 |
| HB215 Sponsor Statement ver O 3.27.18.pdf |
SFIN 4/11/2018 1:30:00 PM |
HB 215 |