02/16/2005 01:30 PM Senate HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB82 | |
| SB78 | |
| SB79 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 82 | TELECONFERENCED | |
| *+ | SB 78 | TELECONFERENCED | |
| *+ | SB 79 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
February 16, 2005
1:33 p.m.
MEMBERS PRESENT
Senator Fred Dyson, Chair
Senator Gary Wilken, Vice Chair
Senator Lyda Green
Senator Kim Elton
Senator Donny Olson
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 82
"An Act relating to child protection, including forensic
interviews and transportation of children; and providing for an
effective date."
MOVED CSSB 82(HES) OUT OF COMMITTEE
SENATE BILL NO. 78
"An Act establishing the SeniorCare program and relating to that
program; creating a fund for the provision of the SeniorCare
program; repealing ch. 3, SLA 2004; and providing for an
effective date."
HEARD AND HELD
SENATE BILL NO. 79
"An Act relating to coverage for adult dental services under
Medicaid; and providing for an effective date."
MOVED CSSB 79(HES) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: SB 82
SHORT TITLE: CHILD PROTECTION INTERVIEW/TRANSPORT
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
01/26/05 (S) READ THE FIRST TIME - REFERRALS
01/26/05 (S) HES, JUD
02/14/05 (S) HES AT 1:30 PM BUTROVICH 205
02/14/05 (S) Heard & Held
02/14/05 (S) MINUTE(HES)
02/16/05 (S) HES AT 1:30 PM BUTROVICH 205
BILL: SB 78
SHORT TITLE: SENIOR CARE PROGRAM
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
01/24/05 (S) READ THE FIRST TIME - REFERRALS
01/24/05 (S) HES, FIN
02/16/05 (S) HES AT 1:30 PM BUTROVICH 205
BILL: SB 79
SHORT TITLE: MEDICAID FOR ADULT DENTAL SERVICES
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
01/24/05 (S) READ THE FIRST TIME - REFERRALS
01/24/05 (S) HES, FIN
02/16/05 (S) HES AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
Stacie Kraly, Senior Assistant Attorney General
Department of Law
PO Box 110300
Juneau, AK 99811-0300
POSITION STATEMENT: Supports SB 82.
Marcie Kennai, Deputy Commissioner
Office of Children's Services
Department of Health &
Social Services
PO Box 110601
Juneau, AK 99801-0601
POSITION STATEMENT: Supports SB 82.
Linda Wilson, Deputy Director
Public Defender Agency
Department of Administration
PO Box 110200
Juneau, AK 99811-0200
POSITION STATEMENT: Opposed SB 82 if not amended
Joel Gilbertson, Commissioner
Department of Health & Social Services
PO Box 110601
Juneau, AK 99801-0601
POSITION STATEMENT: Introduced SB 78
Jon Sherwood, Medicaid Specialist
Department of Health & Social Services
PO Box 110601
Juneau, AK 99801-0601
POSITION STATEMENT: Answered questions on SB 78
Pat Luby
AARP Representative
Anchorage, AK
POSITION STATEMENT: Testified in strong support of SB 79
Rosemary Hagevig
Catholic Community Services
Juneau, AK 99801
POSITION STATEMENT: Testified in support of SB 79
ACTION NARRATIVE
CHAIR FRED DYSON called the Senate Health, Education and Social
Services Standing Committee meeting to order at 1:33:56 PM.
Present were Senators Gary Wilken, Kim Elton, and Chair Fred
Dyson.
SB 82-CHILD PROTECTION INTERVIEW/TRANSPORT
CHAIR FRED DYSON announced SB 82 to be up for consideration and
asked for a motion to adopt proposed Amendment 1.
1:35:14 PM
SENATOR WILKEN moved Amendment 1 and objected for discussion
purposes.
STACIE KRALY, senior assistant attorney general, Department of
Law (DOL), explained the reason the DOL proposed the amendment
stemmed from the fact that "forensic interview" was not defined
in the original bill. Amendment 1 provides that it is a
specialized kind of interview that is employed by advocacy
centers to elicit information for use in criminal or civil court
proceedings.
24G-1
A M E N D M E N T 1
HEALTH EDUCATION AND SOCIAL SERVICES COMMITTEE
TO: SB 82
Page 1, line 8, following "cause":
Insert ", as documented by the department, "
Page 2, following line 14:
Insert the following new material:
"(2) "forensic interview" means a structured
interview that employs objective and age-appropriate
questioning techniques to elicit accurate and reliable
facts that may be used in court proceedings;"
Page 2, line 15:
Delete "(2)"
Insert "(3)"
CHAIR DYSON read the proposed change on page 1, line 8, and
commented that the wording needed further clarification so the
amendment would be conceptual.
1:36:25 PM
CHAIR DYSON noted the objection was withdrawn and [conceptual]
Amendment 1 was adopted.
CHAIR DYSON recalled a question about the immunity section on
page 2, paragraph (e), and asked Ms. Kraly to comment.
MS KRALY recapped saying the discussion on Monday related to the
scope of the immunity provision stated on page 2, lines 5-8.
After much discussion, the Department of Law (DOL) and the
Office of Children's Services (OCS) decided that the entire
paragraph could be removed.
CHAIR DYSON remarked it would revert to the standards in Title
9.
MS. KRALY agreed that it reverts to the general immunity
provisions under Title 9.
1:38:20 PM
CHAIR DYSON moved to remove paragraph (e) from page 2, line 5
and subsequently renumber the paragraphs. Hearing no objection,
Amendment 2 was adopted.
CHAIR DYSON referenced the amendment concerning findings and
noted Senator Green's concern is that the language implies a
duty for the state to provide child advocacy center (CAC) type
services. He noted the last line in the first (a) subsection
says that no child shall be denied comprehensive services
because of inability to pay.
CHAIR DYSON recalled several years ago sexual assault victims
were required to pay for their own investigation. Although that
issue had been addressed, he was concerned about the possibility
of the state failing to gather admissible evidence because a
victim wasn't able pay for the investigation. He asked Senator
Green whether she was concerned that the implication was that
the state would provide CAC type services everywhere.
1:40:29 PM
SENATOR GREEN said she didn't want to create an entitlement.
CHAIR DYSON said this section of statute isn't the place to
imply the use of remedial services.
MARCIA KENNAI, deputy commissioner, Office of Children's
Services (OCS), Department of Health and Social Services (DHSS),
expressed agreement and said if the final sentence is read in
entirety, it appears the intent is that the issue be related to
the ability to pay in those circumstances where OCS engages in
an investigative circumstance and not remedial services.
CHAIR DYSON asked whether the intent would be clarified if
"forensic services" or "investigative services" were inserted
and "therapeutic" removed from the paragraph.
MS. KRALY said since forensic interview is defined, the phrase
should say:
No child in Alaska should be denied access to a
forensic interview during a child abuse investigation
including a medical assessment because of inability to
pay.
1:43:01 PM
CHAIR DYSON recapped saying delete, "comprehensive services" and
insert, "forensic interview" to the phrase "during a child abuse
investigation including medical assessment".
SENATOR ELTON said it wouldn't work to strike "comprehensive
services" and insert "forensic interview" and also include,
"including medical assessment" because medical assessment
wouldn't be included in a forensic interview.
MS. KRALY concurred with the interpretation. If the purpose of
the limitation is to create a forensic interview, then the
medical assessment is a separate issue from the forensic
interview as it is defined.
1:44:05 PM
CHAIR DYSON asked if it should read:
No child in Alaska should be denied access to a
forensic interview and medical assessment during a
child abuse investigation because of inability to pay.
SENATOR GREEN asked whether he intended to include legislative
intent in the findings amendment.
CHAIR DYSON responded that was yet to be determined.
1:44:52 PM
MS. KRALY said used as legislative intent, she would suggest
changing the medical assessment language to match the language
in AS.47.17.064. Because "medical assessment" isn't defined, the
phrase should read:
No child in Alaska should be denied access to a
forensic interview or a medical or radiological
examination [during a child abuse investigation
because of inability to pay.]
1:46:24 PM
CHAIR DYSON drew attention to subsections (b) and (c) and asked
Senator Green if a duty or an obligation was still inferred.
SENATOR GREEN opined it implies a huge obligation and emphasized
the danger in being too specific with entitlements.
CHAIR DYSON acknowledged his history is different than hers. He
asked where she sees the entitlement language.
SENATOR GREEN replied it's the "No child shall be denied..."
language.
CHAIR DYSON said that phrase is qualified with the phrase
"because of inability to pay for an investigation."
SENATOR GREEN pointed out it's subject to the interpretation.
1:47:40 PM
CHAIR DYSON said this doesn't refer to someone with a need; it
refers to a victim of a crime. He intended this to be a
narrowing to include investigation of the crime and recording of
the evidence rather than treatment of the person.
SENATOR ELTON said he would like to assume that a criminal
investigation wouldn't be interrupted because someone couldn't
pay for the interview. Rather, he'd like to think that the
language is a restatement of current department practices, which
is that an investigation wouldn't stop because a victim couldn't
pay.
MS. KRALY agreed with the statement and reminded members that
the advocacy center proposed the amendment. Nevertheless, she
didn't believe that criminal or child abuse investigations are
held at bay to determine who might pay for the service.
CHAIR DYSON moved, as Amendment 3, a new Section 1, with
subsequent renumbering. He said it's the legislative intent
findings and it changes just the last sentence in subsection
(a). It would read:
No child in Alaska should be denied access
to forensic interview or medical assessment
or radiological examination because of
inability to pay.
CHAIR DYSON asked whether there was objection to Amendment 3.
SENATOR GREEN objected.
SENATOR ELTON asked whether he moved the entire page and
suggested the findings component be one amendment and the
language change on community partnership be a second amendment.
CHAIR DYSON acknowledged the two paragraphs were separated on
his sheet and he announced the motion to adopt Amendment 3
included just the findings.
CHAIR DYSON asked for a roll call on proposed Amendment 3.
Amendment 3 failed 2-2 with Senator Elton and Chair Dyson voting
yea and Senators Green and Wilken voting nay.
1:52:26 PM
CHAIR DYSON asked for a motion to adopt the definition language.
SENATOR ELTON moved to accept the definition language on page 2
lines 10 - 14.
A M E N D M E N T 4
Page 2, lines 10, delete "-based program"
Add, "partnership committed to a multidisciplinary team
approach".
CHAIR DYSON questioned whether it was worthwhile voting on a
definition since the amendment talking about child advocacy
failed.
SENATOR ELTON suggested it replaces similar language already in
the bill on page 2, subsection (f)(1) and is purely
definitional. Instead of saying "community-based program" as it
does in the bill, it would say, "...community partnership
committed to a multi-disciplinary team approach..."
CHAIR DYSON asked whether there was objection.
SENATOR GREEN objected to discuss the definition further. She
asked if the use of the term "multi-disciplinary team" might
commit the state to certain standards and expectations regarding
the function of child advocacy centers.
SENATOR OLSON joined the committee at 1:56 PM.
MS. KENNAI said the term is also used in places that don't have
child advocacy centers. When child sexual abuse cases are
reported the multi-disciplinary team meets.
SENATOR GREEN asked if a standard and expectation is established
that may not exist some places in the state.
MS. KENNAI replied her understanding is that the fields of law
enforcement, child protection, criminal prosecution, victim
advocacy, and medical and mental health helped develop the
protocols and those fields are available in the communities
where child advocacy centers are in place.
SENATOR GREEN asked whether the definition of a child advocacy
center is in the new language.
CHAIR DYSON pointed to page 2, line 10.
SENATOR GREEN asked where the primary reference to child
advocacy center resides in statute.
MS. KENNAI pointed to Section 1, lines 10-11.
CHAIR DYSON asked whether there was objection to Senator Elton's
motion. Hearing none, Amendment 4 was adopted.
SENATOR WILKEN moved Amendment 5.
Strike the sentence in Section 1, line 5 that begins: "No
child in Alaska..." and ends in "...because of an ability
to pay." The balance of the section would remain.
He explained he agrees with Senator Green about not creating an
entitlement, but he didn't want to lose the entire findings.
CHAIR DYSON clarified the proposed amendment offers a modified
Section 1. He asked whether there was objection to Amendment 5.
SENATOR DONNY OLSON apologized for his late arrival and asked
what would happen if a child was abused physically or sexually
and didn't have the ability to pay.
SENATOR WILKEN replied: "I'm not in this business, but I can't
imagine how we would turn someone away without saying it in the
law." Furthermore, he didn't believe a child would be turned
away because of an inability to pay.
2:01:53 PM
SENATOR OLSON said his interpretation is different. The sentence
doesn't turn someone away as much as it denies access.
CHAIR DYSON asked whether there was objection to Amendment 5.
SENATOR OLSON objected.
SENATOR ELTON summarized the previous discussion for Senator
Olson.
2:04:15 PM
SENATOR OLSON asked the department to comment on the proposed
amendment.
MS. KENNAI clarified the department would never deny a child a
medical exam or an investigation because they weren't able to
pay.
CHAIR DYSON added there is no impediment in law and the
department has the authorization to do what is needed during a
criminal investigation. He asked Senator Olson if he maintained
his objection.
SENATOR OLSON replied just to further the discussion. He asked
about the procedure for getting a child to a facility from a
remote area.
MS. KENNAI replied if a disclosure happened in a village school
and a child needed to fly to a child advocacy center, DHSS would
fly the child in at department expense as part of the
investigation.
SENATOR OLSON withdrew his objection to Amendment 5.
2:06:29 PM
SENATOR GREEN objected to Amendment 5 and stated, "I'm not going
to support this because I still think this totally changes the
focus of what this legislation is. It's become a definition of a
child advocacy center in my mind. And for the record, I object."
CHAIR DYSON asked for a roll call vote.
Amendment 5 passed 4-1 with Senators Elton, Wilken, Olson and
Chair Dyson voting yea and Senator Green voting nay.
2:07:17 PM
LINDA WILSON, deputy director, Alaska Public Defender Agency
(APDA), Department of Administration reported that the agency
handles the representation of parent and child protective
proceedings and children in juvenile delinquency proceedings.
Furthermore, APDA has participated in the Children's Justice
Task Force with members of OCS and is familiar with the child
advocacy centers.
Although she looks forward to working toward a resolution, APDA
wants to put their concerns on the record. The following is
verbatim:
I was able to listen in to most of the testimony on
Monday and so while I'm not going to be specifically
addressing the amendments that you discussed today, I
did want to just share some of our concerns about what
the purpose of this bill does and maybe look to ways
that we could possible shore up some of it so that
some of those concerns might go away.
I think what you have to start out with is
understanding the importance of parental rights - that
parents have a right to custody of their children and
to parent their children. We have to understand that
that's a given. And I think there was testimony Monday
also about our right against unreasonable searches and
seizures.
What this bill does is grant an extraordinary power to
OCS that is not something that is typically done. What
it's allowing OCS to do is to seize a child - to take
physical control of a child and take them somewhere
without notifying the parent. And it does this without
any judicial oversight at all. The parts of the bill
that do that are in Section 1 - again I'm looking at
the version without those recent amendments done. So
it's [subsection] (c) and (d) that are going to be
added to [AS] 47.17.064.
Wanting to do this without officially taking the child
into emergency - that was the goal - not requiring
them to take emergency custody but yet to physically
transport children to have either a forensic interview
that may or may not include a very invasive
gynecological exam. This is very concerning, I think,
to parents out there that they're not notified about
this type of thing.
What we would like to see at least in here is some
judicial oversight. When you don't take official
custody - and we can call that emergency custody
that's provided for in [AS] 47.10.142 - in 47.10.142
when you do take official emergency custody, within 24
hours you have to file something with the courts. Let
the court know if you decided during that 24 hours to
release the children. You at least have to report to
the court what you did, why and what your reasons
were.
In this bill, there's no requirement to do that. So if
you were to take the children and go have them do this
forensic interview - which may or may not include an
invasive genealogical exam - if they return the
children, there's no reporting, no accounting, no
judicial process, no oversight by the courts and
that's very concerning.
In criminal cases, if somebody wants to
[indiscernible] or do a glass warrant, all they have
to is call the on-duty magistrate, present their case
to them and the magistrate gives their blessing to it.
Why wouldn't we want them to be doing that? Why
wouldn't we want some sort of judicial oversight
before they're taking this drastic measure? If there's
reasonable cause, why shouldn't they be willing to
present that to an on-duty magistrate? All it would
take is a telephone call; it could be done in a matter
of minutes. It's not that onerous of a hoop to jump
through.
2:13:09 PM
So those are our concerns. We would certainly like to
see some sort of judicial oversight component in this
bill for this type of drastic action.
SENATOR OLSON asked Ms. Wilson whether she favored the
legislation or not.
MS. WILSON replied she didn't support the legislation without
amendment because there is no judicial oversight. Referencing
the end of subsection (d) she read: "Transportation of a child
under this section does not constitute the child being taken
into emergency custody of the state under AS 47.10.142." Without
SENATOR GREEN asked whether DOL might be available to respond to
Ms. Wilson's testimony because in the previous hearing it was
stated that troopers already have this authority.
MS. KRALY responded she and Ms. Wilson had a detailed
conversation earlier regarding the fact that "this was not a
vast departure from current practice." She said Ms. Wilson
remained concerned and they agreed to continue the discussion to
try and find common ground.
SENATOR ELTON noted Ms. Wilson identified this as an
extraordinary step and he was curious if other states require
some sort of judicial oversight before removing and/or
transporting a child.
2:15:47 PM
MS. KENNAI replied some states do require temporary custody. The
primary goal here is to take children who disclose for a
forensic interview before they go home and get coached.
Certainly, the parent would be notified so that they could meet
at the child advocacy center if possible. Current emergency
custody statutes do not allow it, but current statute does
authorize transport of children to a hospital or examination
without parental permission when there is evidence of physical
abuse. SB 82 adds sexual abuse to statute.
SENATOR ELTON mentioned a phone call could be made to a
magistrate or judge and he questioned whether that would create
difficulty for either the child or the department.
MS. KENNAI replied it has caused some difficulty. Although they
certainly have the authority to contact a judge to obtain
emergency custody, on many occasions permission has been denied
based on the fact that the disclosure may not be sufficient
evidence. "If you look at the research, most children who
disclose sexual abuse are telling the truth. There's a very
small percentage that are false allegations." If a child is sent
home and a parent begins to coach or intimidate, the child
becomes afraid to speak up by the time they reach the advocacy
center.
CHAIR DYSON expressed concern and asked if DHSS or a peace
officer is currently authorized to take custody.
MS. KRALY replied the standard for taking emergency custody is
under AS 47.10.142. She read:
(a) The Department of Health and Social Services
may take emergency custody of a child upon discovering
any of the following circumstances:
(1) the child has been abandoned as abandonment
is described in AS 47.10.013;
(2) the child has been neglected by the child's
parents or guardian, as "neglect" is described in AS
47.10.014, and the department determines that
immediate removal from the child's surroundings is
necessary to protect the child's life or provide
immediate necessary medical attention;
(3) the child has been subjected to physical harm
by a person responsible for the child's welfare, and
the department determines that immediate removal from
the child's surroundings is necessary to protect the
child's life or that immediate medical attention is
necessary; or
(4) the child or a sibling has been sexually
abused under circumstances listed in AS 47.10.011(7).
MS. KRALY said the distinction is that it's a heightened
standard to take emergency custody. As Ms. Kennai indicated,
mere disclosure isn't always sufficient to establish discovery
to support an emergency custody. The standard should be
heightened to be able to remove a child from a parent's home
without notifying the parent or without getting pre-judicial
approval. Under the emergency custodies statutes, you must
either file a petition or release within 24 hours.
SENATOR DYSON questioned the reason a child's disclosure of
sexual abuse wouldn't be enough to take emergency custody.
2:21:02 PM
MS. KRALY replied it's certainly a complicated question, but a
disclosure alone might not be sufficient depending on what
disclosure is made, how it is made, and to whom it is made.
"That's when we want to get more information before we make a
mistake."
CHAIR DYSON said he was uncomfortable with that and perhaps the
issue ought to be addressed in the Senate Judiciary Standing
Committee.
2:23:13 PM
CHAIR DYSON stated his preference to send the bill to the Senate
Judiciary Standing Committee then return it to this committee
for review.
SENATOR WILKEN moved CSSB 82(HES) out of committee with
individual recommendations and attached fiscal notes.
SENATOR OLSON said the point Ms. Wilson brought forward is cause
for concern, but he was curious whether those concerns had ever
been legitimized.
MS. WILSON responded Ms. Kraly mentioned they haven't always
gotten a writ of assistance when requested. "But I can guarantee
you that the majority of the time, if there are allegations of
sexual abuse, the state takes emergency custody." She assured
members that this happens on a regular basis.
What the bill does not provide, she said, is judicial oversight.
Physically taking control of a child is emergency custody and
most states don't have that extraordinary power without judicial
oversight. What about the instances of false findings, she
asked. "Don't we at least want there to be some judicial hoops
that they have to jump through at some point in the process -
especially if it results in no findings?"
SENATOR OLSON remarked getting a 48-hour hold or a Title 47
commitment from a magistrate in the middle of the night is one
of the last things he wants to worry about as a doctor. On the
other hand, it's extremely invasive for a young child to have a
gynecological examination when it isn't justified.
2:26:25 PM
SENATOR ELTON said it would seem that the fiscal note would be
greater than zero to reflect additional transportation expenses.
MS. KENNAI said they would have to do an analysis on that but
DHSS doesn't see there would be a large increase in the number
of interviews. In some areas of the state it is a problem while
in other areas they can call a judge and get permission to take
the child for an interview.
She explained once the child gets to the child advocacy center,
the physical exam isn't conducted without parental consent so
some checks and balances already exist even though they aren't
in statute.
2:29:14 PM
CHAIR DYSON asked whether there was objection to Senator
Wilken's motion to move CSSB 82(HES) out of committee. Hearing
none, the motion carried.
SB 78-SENIOR CARE PROGRAM
2:30:06 PM
SENATOR DYSON announced SB 78 to be up for consideration.
COMMISSIONER JOEL GILBERTSON, Department of Health and Social
Services, advised he was addressing his comments to the
committee substitute (CS). The bill deals with extending
SeniorCare benefits to Alaska seniors - particularly around
prescription drug coverage. The Legislature passed a bill last
session that established a $120.00 per month cash assistance
program for low-income seniors living below 135 percent of
poverty and a prescription drug subsidy for seniors that are
between 135 and 150 percent of poverty.
That benefit program expires on January 1, 2006 at which time
the new, Part D, federal Medicare drug benefit will become
effective and provide seniors with prescription drug benefits.
Parts A and B are what most Alaska seniors have. Part A relates
to in-patient hospital services for seniors; Part B relates to
out-patient physician reimbursements; Part C deals with managed
care plans under Medicare but isn't used in Alaska; and Part D
is the new prescription drug benefit.
Each part has associated costs. Part A has its own deductible;
Part B has its own premium and deductible for seniors to pay;
and Part D will have a premium deductible. Therefore, as seniors
enroll in Medicare Part D, those above 135 percent of poverty
will be responsible for some premium and deductible costs. Those
are first dollar costs, which means they must satisfy those
before they may receive benefits under the prescription drug
benefit.
SB 78 is a proposal under SeniorCare. He emphasized that:
First and foremost this legislation states that for
seniors above 135 percent of poverty and below 300
percent of poverty, the State of Alaska will cover the
premium and deductible costs for those seniors to
ensure that there is no senior in this state ... that
will not be able to enroll in a comprehensive
prescription benefit plan beginning next year.
Prescription drugs represent a sizeable part of health care and
many seniors in the state are forced to choose between food,
rent or prescription drugs. By itself the Medicare drug benefit
won't ease that decision for many low-income seniors, but the
extension of the $120 per month cash assistance for low-income
seniors below 135 percent of poverty will help some.
He referenced a chart that looks at what the qualifications and
benefits mean in real dollars, and said it's important when
talking about income levels. The cash assistance benefit
continues at $120 per month or for seniors below 135 percent of
poverty. Those individuals won't get state help with
prescription drug expenses because the federal government will
cover the costs for them. Instead the state acknowledges they
have other costs and recognizes that cash is much more flexible.
Therefore, seniors below 135 percent of poverty, which is just
under $16,000 per individual and about $21,000 per couple, will
continue to receive the $120 per month cash assistance. They
will receive the Medicare drug benefit with no premium and no
deductible. The state expects to serve about 7,000 seniors,
which is about the same as the cash assistance program under
SeniorCare.
The new benefit under SB 78 deals with prescription drug
assistance for seniors above 135 percent of poverty and up to
300 percent of poverty. That amounts to just less than $35,000
for an individual and just under $47,000 for a couple. Following
an asset test, the state will step in and cover monthly premium
and deductible costs, but individuals will still have out of
pocket expenses for coinsurance and prescription drugs. Under
this proposal, DHSS expects to serve about 10,000 seniors.
2:36:31 PM
Comparing old and new SeniorCare prescription drug benefits, he
pointed out the considerable savings that seniors would enjoy
under the new proposal.
2:38:20 PM
As previously stated, DHSS expects to serve about 7,000 people
with cash assistance. For the original SeniorCare program, the
estimates were accurate for the cash assistance benefit in the
135 percent of poverty bracket, but were somewhat inaccurate
between 135 and 150 percent of poverty, which means there is a
surplus in the SeniorCare Trust Fund. The surplus will be used
to pay for start up and a portion of the first year costs.
The fiscal notes indicate increased expenses for the first year
because the Medicare drug benefit doesn't begin until the second
half of the next state fiscal year.
2:40:00 PM
SENATOR KIM ELTON asked the reason the old program didn't
eliminate residents in the Pioneer/Veteran Homes while the new
proposal does.
JON SHERWOOD, Medicaid specialist, Department of Health and
Social Services, said both the current program and SB 78 contain
provisions for temporary stay in the home. Since the original
bill, other statutes have defined public institutions to exclude
Pioneer/Veteran Homes. Prior to last session they were included
in some definitions so that's why they decided to specify them
separately.
COMMISSIONER GILBERTSON said the justification for excluding
those residents is that this would be a redundant benefit since
there is already a Pioneer Home Assistance Program.
2:41:44 PM
SENATOR ELTON said he was working from Version \A even though
Version \G was under consideration so some of his questions
might have already been answered.
He noted seniors are limited to 30-day out of state trips with
exceptions for out of state medical treatment or to accompany a
family member who is receiving medical treatment outside the
state. However, it isn't an exception to leave the state to care
for an ill family member that lives out of state because the
senior isn't accompanying the family member outside.
COMMISSIONER GILBERTSON agreed with the interpretation and said
the point is legitimate. He recalled working on the issue last
year and acknowledged it would be advantageous to use the
language they settled on at that time. He thought there was a
waiver process that was established for the department to have
discretion on a case-by-case basis.
2:44:38 PM
SENATOR ELTON suggested the committee look at the exception
language for Permanent Fund dividends to accommodate medical
treatment for an immediate family member. He then questioned the
effective date.
MR. SHERWOOD explained the committee substitute (CS) simplifies
the language to have the bill take effect when Medicare Part D
becomes available in Alaska.
SENATOR ELTON remarked in five years the program would be more
expensive than the Longevity Bonus Program.
MR. SHERWOOD replied he didn't have five-year numbers, but the
projection is to serve about 17,000 seniors in the first year
for about $17 million and the Longevity Bonus Program was to
serve 15,000 seniors for $38 million.
2:47:43 PM
SENATOR ELTON acknowledged that because of the phase out, no one
would have been served without this program.
CHAIR DYSON asked for an explanation of the differences between
Versions \A and \G.
MR. SHERWOOD described four changes: conforming language
changes; clarifying reference to the Medicare Modernization Act;
adding SeniorCare Benefit to the statutory list of items that
can not be garnished; and changing effective date to eliminate
reference to January 1.
2:49:52 PM
SENATOR ELTON moved to adopt Version \G as the working document.
There being no objection, the motion carried.
CHAIR DYSON suggested the committee entertain a conceptual
amendment to make eligibility the same as for the Permanent Fund
Dividend as far as traveling out of state.
SENATOR ELTON said he would like to review that before moving
the bill since he didn't remember the language precisely.
CHAIR DYSON expressed agreement and said he is uncomfortable
that seniors must go through a waiver process to go outside for
medical reasons. He added the department would have an
opportunity to speak against the change here and in the Senate
Finance Standing Committee.
COMMISSIONER GILBERTSON said the department really doesn't
monitor senior travel patterns and that particular change in the
program management might be minimal. Acknowledging that it is
within Legislature's purview to change, he said the current
language has proved to be adequate to address the issue in the
last year.
SENATOR WILKEN suggested it is important for the committee to
know how many other states have this type of program and how
other states are treating the federal drug prescription program.
He suggested that western states were of particular interest.
COMMISSIONER GILBERTSON said he would make the information
available at the next hearing, but other states haven't begun to
respond to the integration between the state pharmacy assisted
plan and Medicare drug benefits. The Medicare, Part D, drug
benefit would be delivered in a different way than Medicare Part
A and Part B. Part D would essentially be delivered through
private insurance - pharmacy benefit management firms. At least
two firms would bid on each region after which the region is
assigned an actuarial value per life of individuals that would
be served. Then the actuarial/cash value is converted to a
benefit for the consumers.
He suggested many states are digesting the information and
deciding how to convert what used to be a Medicaid benefit to a
supplement to Medicare.
2:56:05 PM
SENATOR WILKEN said he would prefer not to move the bill from
committee in order to provide time for further clarification.
CHAIR DYSON asked the process used to decide that 300 percent of
the federal poverty level was the right number to use.
COMMISSIONER GILBERTSON replied he would provide information
regarding what the various income threshold options mean. To
some extent, he said, the line is discretionary and there is
nothing to peg it to in the private market place. Governor
Murkowski has taken the position that the threshold should be
low enough so that seniors in need are served. He doesn't want
any senior in the state not to be enrolled in a prescription
drug benefit next year because they aren't able to afford the
premium or deductible, which is sizeable. The out of pocket
expense before the first benefit is received is around $700.
After reviewing the income levels, the governor decided that for
a senior who makes less than $35,000 per year a $670 deductible
is high so that's where he drew the line.
CHAIR DYSON asked whether the poverty level is $10,000 per year
for a single person.
COMMISSIONER GILBERTSON replied the Alaska poverty level is
higher than the national average by 25 percent and in Alaska,
100 percent of poverty is between $11,000 and $12,000 per year.
Where you draw the poverty line is the discretion of policy
makers, he emphasized.
2:59:56 PM
CHAIR DYSON asked whether there is an asset test.
COMMISSIONER GILBERTSON said yes, for the seniors who receive
the $120 cash assistance benefit, the liquid asset limit per
individual is $6,000. The secondary benefit, the prescription
drug subsidy liquid asset level is $50,000.
CHAIR DYSON asked about non-liquid assets.
COMMISSIONER GILBERTSON replied there is none.
CHAIR DYSON noted the in state advertisements for restructuring
assets to qualify for different programs and remarked that some
of it looks like scam.
COMMISSIONER GILBERTSON agreed and said it has been a constant
struggle for states and the federal government to keep up with
lawyers that work to reduce senior's assets. The fiscal crisis
in Medicaid is largely associated with senior and disability
services. Middle and upper middle income Americans are spending
down parents and transferring assets when they need long-term
care. Although both federal and state look-backs have become
stricter, a great number of lawyers are still helping seniors
become eligible for programs such as this.
3:02:39 PM
CHAIR DYSON said if 40 percent of the senior population would
qualify that means that that 40 percent of seniors are living
under the 300 percent of federal poverty level.
COMMISSIONER GILBERTSON replied it's a rough estimate, but if
17,000 seniors are served it's about 40 percent.
CHAIR DYSON announced he would hold the bill and would be
interested in the department looking into the qualifications for
being out of state and whether the permanent fund is a good
model.
SENATOR WILKEN said he would like to know what other states are
doing with regard to the federal program.
3:04:33 PM
CHAIR DYSON said he would be interested in comparisons with
Colorado and Idaho.
SENATOR DONNY OLSON asked for information on the distribution of
rural participants.
COMMISSIONER GILBERTSON agreed to do so.
CHAIR DYSON asked for information about what additional benefits
people might qualify for.
COMMISSIONER GILBERTSON said he would get the information and
clarified there would be some dual eligibility so the program
would be available to Alaska Natives who are eligible for Indian
Health Service (IHS) benefits. He would provide information on
the number of dual eligibilities and the benefits they have
access to, but it is well established in law that benefits will
be provided to all individuals regardless of whether or not they
are eligible under IHS or a Native health corporation.
3:07:00 PM
CHAIR DYSON said he could appreciate that, but doesn't want
someone to receive payment twice for the same drug.
SENATOR ELTON expressed interest in whether the previous program
had pro rata language and also in departmental discussions about
inserting pro rata language in this bill.
3:08:24 PM
CHAIR DYSON held SB 78 in committee.
SB 79-MEDICAID FOR ADULT DENTAL SERVICES
CHAIR FRED DYSON announced SB 79 to be up for consideration.
3:08:43 PM
BRAD WHISTLER, dental officer, Department of Health and Social
Services (DHSS), introduced himself.
COMMISSIONER JOEL GILBERTSON, Department of Health and Social
Services (DHSS), explained this is a Governor proposal under
Medicaid. It would provide capped preventative dental healthcare
benefit to all low-income adults in Alaska.
Currently, Medicaid dental coverage for people over age 21 is
restricted to emergency dental services, which basically means
pulling a tooth if a problem arises. SB 79 proposes to enhance
the emergency dental Medicaid services for adults to include
preventative and/or restorative care. Because of the lack of
preventative Medicaid dental services in years past, a backlog
exists, which justifies the proposed annual benefit cap for
preventative services to $1,150 per client. The annual limit
amounts to what it would cost to replace an upper or lower
denture so that a senior could replace a full denture over a
two-year period.
He noted currently there are about 41,000 Medicaid beneficiaries
in Alaska.
3:11:09 PM
COMMISSIONER GILBERTSON said the Mendenhall Trust Authority is a
partner in the proposal and has allocated some of its money to
pay part of the state match. Recent studies have shown a link
between oral health and chronic diseases and the trust
recognizes the trustees have a pressing need for oral health
care. "This transition will allow us to position the Medicaid
program around preventative services, which is a good investment
for the state."
He noted the associated fiscal note and explained the general
fund match is augmented with Mental Health Trust money for the
next six years. There are a number of optional services under
Medicaid and this proposal is to include preventative dental
services.
3:13:06 PM
SENATOR KIM ELTON asked the number of Alaska dentists that do
Medicaid services.
COMMISSIONER GILBERTSON acknowledged access has been an issue.
MR. WHISTLER said access varies across the state but overall,
about 85 percent of Alaska dentists are enrolled in the Medicaid
program. Although he didn't know how many dentists are accepting
new Medicaid clients he did acknowledge the real access issue is
when new clients who are enrolled in Medicaid go for care. With
regard to the adult program, the proposal would augment the
tribal dental programs that are already serving adults.
3:15:32 PM
SENATOR ELTON referenced the fee information in the fiscal note
and said it would be helpful to have a list of the Juneau
dentists that provide two cleanings a year for $250 because he
pays considerably more.
MR. WHISTLER replied the fiscal note is based on Medicaid
reimbursement rates and private rates would be higher.
CHAIR DYSON commented most medical practitioners aren't happy
with the Medicaid reimbursement rates. He was curious about the
view dentists might have.
MR. WHISTLER replied most dental practices wouldn't have more
than 5 to 10 percent of its clients in the Medicaid program so
dentists don't typically rely on those clients for practice
income. He suggested it might make dentists more vocal about
reimbursement rates. The program has tried to maintain
reimbursement at between 70 and 80 percent of usual customary
reasonable fees.
COMMISSIONER GILBERTSON added the department has always been
concerned about provider participation in the Medicaid program.
Across the board, between 55 and 60 percent of the licensed
providers in the state accept Medicaid as a portion of the
insurance they accept.
3:18:04 PM
SENATOR DONNY OLSON noted chronic diseases were addressed, but
he saw no mention of acute diseases such as gingivitis and
resultant septicemia. He was curious how the bill would address
those issues.
MR. WHISTLER said that sort of case would fit an emergency
dental service, which would be covered in the current program.
This bill proposes to cover preventive and restorative dental
services in addition to the emergency services. Hopefully this
would augment existing services so fewer people would get into
an acute condition.
COMMISSIONER GILBERTSON restated Mr. Whistler's response.
3:19:22 PM
CHAIR DYSON recognized Mr. Jessie and asked whether he was
testifying that the Mental Health Board agrees with the bill and
the funding provided by the Mental Health Trust.
JEFF JESSIE said that is correct. He informed members the trust
issues over $1 million per year in mini grants paid directly to
beneficiaries and nearly 70 percent of the requests are for
dental needs that aren't covered by Medicaid. It's clear there
is need in this area.
PAT LUBY, AARP representative, testified in of SB 79.
ROSEMARY HAGEVIG, executive director, Catholic Community
Services, testified in strong support of SB 79. She pointed out
that providing dental care would help many people get back into
the workforce so they see this as a workplace issue.
3:23:26 PM
CHAIR DYSON asked for the will of the committee.
SENATOR ELTON moved CSSB 79(HES) \G version, and attached fiscal
note from committee with individual recommendations. There being
no objection, it was so ordered.
There being no further business to come before the committee,
Chair Dyson adjourned the meeting at 3:23:56 PM.
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