Legislature(2003 - 2004)
02/26/2003 01:35 PM Senate HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
February 26, 2003
1:35 p.m.
TAPE(S) 03-6
MEMBERS PRESENT
Senator Fred Dyson, Chair
Senator Lyda Green, Vice Chair
Senator Gary Wilken
Senator Bettye Davis
Senator Gretchen Guess
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 25
"An Act relating to the teachers' housing loan program in the
Alaska Housing Finance Corporation; and providing for an
effective date."
[THIS BILL WAS MOVED OUT OF COMMITTEE ON 2/24/03, BUT
WAS COMMENTED ON AT THIS MEETING.]
SENATE BILL NO. 41
"An Act relating to medical care and crimes relating to medical
care, including medical care and crimes relating to the medical
assistance program."
HEARD AND HELD
SENATE BILL NO. 78
"An Act relating to an optional group of persons eligible for
medical assistance who require treatment for breast and cervical
cancer; relating to cost sharing by those recipients under the
medical assistance program; and providing for an effective
date."
MOVED SB 78 OUT OF COMMITTEE
^Overview:
^Suicide Prevention Council
Ms. Merry Carlson
Ms. Jeanine Sparks
Senator Georgianna Lincoln
Representative Mary Kapsner
Rt. Reverend Mark MacDonald
Ms. Susan Soule
Ms. Carol Seppilu
PREVIOUS ACTION
SB 41 - No previous action to consider.
SB 78 - No previous action to consider.
WITNESS REGISTER
Mr. Elmer Lindstrom, Special Assistant
Department of Health and Social Services
Box 110601
Juneau, AK 99801-0601
POSITION STATEMENT: Supported SB 41 and commented on SB 78.
Ms. Anne M. Gore, Program Director
Breast and Cervical Health Check
Department of Health &
Social Services
PO Box 110601
Juneau, AK 99801-0601
POSITION STATEMENT: Commented on SB 78.
Mr. Kevin Henderson, Eligibility Program Officer
Division of Medical Assistance
Department of Health &
Social Services
PO Box 110601
Juneau, AK 99801-0601
POSITION STATEMENT: Commented on SB 78.
Ms. Caren Robinson
Alaska Women's Lobby
PO Box 33702
Juneau AK 99803
POSITION STATEMENT: Supported SB 78.
Ms. Carla Williams
Alaska Breast Cancer Advocacy
13001 Norak Place
Anchorage AK 99516
POSITION STATEMENT: Supported SB 78.
Ms. Emily Nenon
American Cancer Society
1635 Northwester Ave.
Anchorage 99508
POSITION STATEMENT: Supported SB 78.
ACTION NARRATIVE
TAPE 03-6, SIDE A
SB 25-AHFC LOANS TO EDUCATORS
CHAIR FRED DYSON called the Senate Health, Education and Social
Services Standing Committee meeting to order at 1:35 p.m. All
members were present. He said that he wanted to correct a
statement he made regarding SB 25, which passed out of committee
on February 24. After a further look at state law he learned
that the state might not be liable for the actions of children
who are a ward of the state. Instead, the legal guardian of a
child would be liable for their activities.
SB 41-MEDICAID COSTS AND CRIMES
CHAIR FRED DYSON announced SB 41 to be up for consideration.
SENATOR LYDA GREEN, sponsor, said that because of concerns about
the increasing cost of Medicaid and the increasing number of
fraudulent claims, the administration and the Department of
Health, Education and Social Services (DHSS) want to get input
on this bill. She said she would come back to the committee with
a new committee substitute (CS) to the sponsor substitute.
CHAIR DYSON asked if there were any objections to adopting the
sponsor substitute to SB 41, version 23-LS020\A. There were no
objections and it was so ordered.
MR. ELMER LINDSTROM, Special Assistant, Department of Health and
Social Services, said this issue was a priority for the governor
and DHSS.
CHAIR DYSON said SSSB 41 would be set aside for further work and
a hearing at a later date.
SB 78-MEDICAID FOR BREAST & CERVICAL CANCER
CHAIR FRED DYSON announced SB 78 to be up for consideration and
noted that another bill on the same subject, sponsored by
Senator Davis, was referred to the Senate HESS Committee. That
bill is scheduled for a hearing next week.
SENATOR LYDA GREEN, sponsor, said SB 78 removes the sunset
provision of the 2001 legislation to allow women who have been
participating the program to continue treatment and to provide
treatment for women who will be diagnosed in the future. This
bill gives DHSS the authority to impose allowable cost sharing
under federal authority for the breast and cervical cancer
category. The state would then be able to submit an amended
state plan to the federal government that would also provide for
the implementation of a system by which these funds would be
collected. The language in the bill is the same as the language
that was used for the original Denali Kid Care program.
SENATOR GRETCHEN GUESS asked her to describe how other Medicaid
programs are dealt with and how many have the cost sharing
contribution language in section (e).
SENATOR GREEN explained that the more established Medicaid
programs have very high standards, meaning participants must
have low levels of income and very limited asset ownership to
qualify. The more recent programs have a general reference to an
income limit, but not to an asset limit. She suggested that at
some future time a co-pay requirement or client participation in
rates might allow the program to be extended to other people who
might qualify without creating a great expense to the state or
the federal government.
SENATOR GUESS asked what co-pays are in effect and would remain
in effect if this bill passes.
MR. LINDSTROM said the governor strongly supports this
legislation. He explained the current co-pay is $50 per day up
to a maximum of $200 for discharge of inpatient hospital
services, 5% of allowable charges for outpatient hospital
services, $3 per day for physicians services and $2 per day for
each prescription and [indisc.].
SENATOR GUESS asked if the language on page 1, line 11, is
problematic because it says, "to the maximum extent allowed by
federal law," but then later indicates a sliding scale by
household income.
MR. LINDSTROM replied that he didn't think so by virtue of the
permissive language on line 10, which says, "may require
premiums...."
CHAIR DYSON commented the co-pay limits are ridiculously low and
asked if federal law requires them.
MR. LINDSTROM replied that is correct and said he was speaking
to the maximum that DHSS would be allowed to implement at this
point according to federal law.
CHAIR DYSON said he understood the sponsor's comments to mean
that to qualify for this benefit a person will have to be at
200% of poverty level, the same as Denali Kid Care.
MR. LINDSTROM replied for this program, Medicaid eligibility is
tied directly to eligibility for the screening program and that
is 250 percent of the federal poverty level.
CHAIR DYSON said he understood this administration was going to
recommend altering some of the qualifying levels and asked Mr.
Lindstrom if he was saying those two will not be altered.
MR. LINDSTROM replied the administration supports the bill as
drafted and he is unaware of any suggestion to alter the federal
poverty level for this program. The point that Senator Green
made is why it's important to have this discussion about what
the committee might want to consider relative to cost sharing.
He pointed out:
It's been a long-standing desire of this
administration that if and when we are allowed to do
so by the federal government, it is perfectly fair and
very appropriate for individuals who are in these
relatively higher income categories to support the
medical costs to the extent they are able to do so in
a reasonable manner. This is language that we are very
comfortable with.
CHAIR DYSON asked how much 250 percent of annual income at the
federal poverty level amounts to.
AN UNIDENTIFIED SPEAKER said he thought the poverty level in
Alaska is about $11,000 per year, so 250 percent would be about
$25,000 for a single person.
MS. ANNE GORE, Program Director, Breast and Cervical Health
Check, said she thought the amount is about $23,000 per year for
a single individual.
CHAIR DYSON said he understood that there are no asset
limitations to qualify.
MS. GORE responded that to be eligible for the screening
program, a woman must have an income below the poverty level, be
between the ages of 18 - 64 and she may or may not have medical
insurance. She may have medical insurance that would preclude
her from receiving those screening services (i.e. if the
insurance wouldn't pay for preventative health care, such as an
annual exam or a mammogram). If she is below the income level,
has insurance and the physician submits proof that the insurance
carrier denied her claim because those services are not covered,
she is eligible to have her screening and diagnostic services
paid for. Once she undergoes treatment, even if she has an unmet
deductible of $5,000, she is considered to have creditable
coverage and is not eligible to receive treatment under
Medicaid.
CHAIR DYSON asked about the asset requirements.
MS. GORE replied there is no asset test for the screening and
diagnostic program or for the treatment program.
CHAIR DYSON asked if a person would qualify who had a home worth
$1 million that was paid for but had just lost his job and
medical coverage.
MS. GORE said technically that person could, but she thought one
would have enough assets if one owned a million dollar home to
pay for screening.
CHAIR DYSON asked Mr. Lindstrom if the preceding administration
had moved away from having an asset qualification.
MR. LINDSTROM said this program is peculiar because eligibility
is tied to the screening program. Historically, the cash
assistance programs have always had an asset test attached.
MR. KEVIN HENDERSON, Eligibility Program Officer, Division of
Medical Assistance, DHSS, said some Medicaid programs have been
around for 10-12 years that do not have an asset test. However,
most of the traditional categories do have asset tests.
CHAIR DYSON said he understood that asset requirements have been
on the books, but they have largely been ignored.
MR. HENDERSON replied:
Medicaid is pretty complicated and as you get into the
law, there are 30 some different categories of
eligibility - all of those authorized under some
federal law - some are mandatory, some are
optional....
He explained that the Denali Kid Care program and the Breast and
Cervical Program don't have an asset test under the federal
provisions. Many of the traditional Medicaid categories that
have been around a long time have always had an asset test
requirement.
CHAIR DYSON asked if federal law precludes the state from having
an asset test.
MR. HENDERSON replied it does in the breast and cervical cancer
category. He added:
It ties eligibility directly to whether they have been
screened by the Breast and Cervical Screening Program
and that program, I believe by federal law, does not
have an asset test attached to it. Adding an asset
test to it is not, to my knowledge, an option for the
state.
SENATOR BETTYE DAVIS asked if the division had been denied a
waiver once for Denali Kid Care and under what circumstances
that happened.
MR. LINDSTROM explained that DHSS petitioned the federal
government and asked for the ability to do more in the way of
co-payments and cost sharing but were told no.
SENATOR DAVIS said according to the bill, the state is already
drawing the maximum amount of money it can get based upon the
guidelines.
MR. LINDSTROM agreed.
SENATOR DAVIS thought Section 2 was redundant and asked why it
is needed.
MR. LINDSTROM replied the governor and commissioner think it is
worthwhile to reiterate the notion that with these programs,
particularly when someone is above the typical income level for
Medicaid, the state be allowed to implement a reasonable cost
sharing mechanism.
SENATOR DAVIS said she thought that language should be
clarified.
MR. LINDSTROM responded that he thought the language made that
clear and he didn't think it was inconsistent with other
language.
SENATOR DAVIS asked if Mr. Lindstrom was preparing a new plan or
waiting for the federal government to give out new guidelines.
MR. LINDSTROM said he thought allowing the state to go further
would require a change in federal law.
CHAIR DYSON said the state could change the 250% of the federal
poverty level amount if it wanted to.
MR. LINDSTROM replied that is correct, although it wouldn't be
in the context of the Medicaid program; it would refer back to
the screening program.
2:04 p.m.
MS. CAREN ROBINSON, Alaska Women's Lobby, supported SB 78.
MS. CARLA WILLIAMS, President of Alaska Breast Cancer Advocacy
and the state field coordinator for the National Breast Cancer
Coalition said that both organizations support SB 78.
CHAIR DYSON thanked her for her efforts on behalf of all
Alaskans, particularly people suffering from these devastating
maladies.
MS. EMILY NENON, American Cancer Society, stated support for SB
78 and told members, "It is unconscionable to look a woman in
the face and tell them they have cancer when you know they don't
have the means to get treatment." She said Congress recognized
this and created the 70 percent federal match to state dollars
spent on this program. This month President Bush requested a $10
million line-item increase for the screening and diagnostic side
of the program.
She also has questions about the future implications of setting
up cost sharing provisions and expressed concern about placing
an undue burden on cancer patients now or in the future. The
American Cancer Society is flatly opposed to changing the
current eligibility requirements for the treatment program. It
has to match the eligibility for the screening program otherwise
they haven't gotten around the issue of screening uninsured low-
income women, knowing that they have no means to get treatment.
SENATOR GREEN moved to pass SB 78 from committee with individual
recommendations and the accompanying fiscal note. There were no
objections and it was so ordered.
SUICIDE PREVENTION COUNCIL OVERVIEW
CHAIR FRED DYSON announced the Suicide Prevention Council
Overview to be the next item on the agenda.
MS. MERRY CARLSON began the presentation by introducing the
council members present. She then reported on the council's
accomplishments during FY02. Last year, the council:
(1) Attempted to establish a comprehensive description of the
problem of suicide in Alaska and plans to release a
"follow-back" study in March 2003.
(2) Held "listening sessions" in six Alaskan cities in which
the public, professionals, and other interested parties
informed the council about suicide-related issues,
histories, and treatment programs in those areas.
(3) Drafted a council Work Plan and by-laws.
(4) Drafted a Statewide Suicide Prevention Plan scheduled for
release and public comment in March 2003.
(5) Conducted over 20 presentations across the state designed
to inform the public about suicide.
(6) Established an accessible council office and website.
Ms. Carlson continued and said the council aims to:
(1) Continue to review the draft of the Alaska Statewide
Suicide Prevention Plan and receive public comment.
(2) Create an Advisory Group to review the draft.
(3) Finalize and distribute the Plan.
(4) Develop a specific five-year "action plan" based on the
Plan.
(5) Support three regions of the state in developing regional
suicide prevention plans.
(6) Create a Youth Advisory Group.
(7) Create and begin a suicide prevention awareness campaign.
(8) Begin a follow-back study.
MS. CARLSON went on to provide the Committee with statistics of
the suicide problem in Alaska. For the years 1991-2000, Alaska
recorded 1,264 suicides, the highest rate of suicide in the
nation. For every completed suicide, there is an average of over
four attempts that require hospitalization. In Alaska, suicide
rates are highest in Alaskans aged 15-44, while suicide attempts
are most frequent in those age 20-39. Alaska Natives have
suicide rates four times greater than the national average rate,
and Native males, in particular, have rates over six times the
national average. The majority of completed suicides involve
firearms. In response to a question from Chair Dyson, Ms.
Carlson added that suicide is a symptom; we need to examine the
underlying causes.
Ms. Carlson noted the themes of the draft Alaska Suicide
Prevention Plan are:
(1) Suicide prevention is everyone's responsibility.
(2) Successful suicide prevention requires local plans and
actions, supported by, and integrated with, regional,
state, and national resources.
(3) Suicide is related to many other problems facing Alaska's
communities and cannot be addressed alone.
(4) Suicide prevention efforts should target at-risk
populations.
(5) To prevent suicide, we need to develop healthy
communities across Alaska.
(6) Successful suicide prevention will require sufficient
resources.
MS. CARLSON concluded by making the following recommendations to
the Governor and the Legislature:
1. Educate the public about suicide, its warning signs, and
specific risk and protective factors.
2. Fund local suicide prevention plans and actions, supported
by, and integrated with, regional, state, and national
resources.
3. Continue funding research for follow-back and other studies
to determine effective prevention and intervention
strategies in Alaska.
4. We cannot delay or suspend prevention efforts.
5. Fund ongoing prevention programs and research at current
levels. Where possible, provide increased funding for
existing and new programs.
MS. JEANINE SPARKS read the testimony of CAROL SEPPILU. Ms.
Seppilu is a 20-year old resident of Savoonga, Alaska who has
lost many friends to suicide. She attempted suicide several
years ago while under the influence of alcohol. Her miracle of
survival has led her to become actively involved in suicide
prevention. She is a member of the council who attends workshops
and assists with program development, her main focus remaining
on youth. She reported that in her opinion, education is the
most effective method of suicide prevention. Developing self-
confidence and other positive personality traits are important
in this education. Her previous lack of these skills led her to
depression and a suicide attempt. She thanked the committee for
its support of the council.
In response to a question from Chair Dyson, Ms. Sparks reported
that "follow-backs" involve investigating unsuccessful suicide
attempts to learn what factors and signs contributed to the
attempt.
SENATOR GEORGIANNA LINCOLN reported that the council began with
the goals of former Senator Rick Halford. She noted the average
hospital cost of an unsuccessful suicide attempt is $7,200,
which is twice the amount of funding required to operate a
community-based prevention program for one year. In other words,
to recoup costs, a program needs only to prevent two suicide
attempts. Further, the cost for prevention programs would be
$2.40 per resident, while hospitalization costs for unsuccessful
attempts are $6.22 per resident.
REPRESENTATIVE MARY KAPSNER reiterated the council's
recommendations to the Legislature. She emphasized the
importance of educating the public about suicide warning signs
and specific risk and protective factors associated with
suicide. She stressed the need to fund local suicide prevention
plans and actions, supported by and integrated with regional,
state, and national resources. She concluded with the request to
continue funding research for follow-back and other studies to
determine effective prevention and intervention strategies in
Alaska.
RT. REVEREND MARK MACDONALD reported that the problem of suicide
is so deep and intense in our communities that we are
uncomfortable examining and studying it. He is currently hoping
and working for the creation of a common community around this
issue that can respond with all available resources.
MS. SUSAN SOULE commented on community-based prevention
programs. She reiterated that the cost of prevention is far less
than the cost of response and hospitalization.
In response to a question from Chair Dyson, Mr. MacDonald agreed
to the essential religious and spiritual component in dealing
with and preventing the problem of suicide.
MS. CARLSON concluded by reminding committee members that
suicide has many causes, which allows us many opportunities to
intervene, and points to the need for significant resources.
CHAIR DYSON thanked all participants for their presentations and
adjourned the meeting at 3:00 p.m.
| Document Name | Date/Time | Subjects |
|---|