Legislature(2015 - 2016)BUTROVICH 205
03/16/2015 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearings: | |
| Confirmation Hearing: Commissioner of the Department of Health and Social Services That Includes Discussion Related to Medicaid | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 16, 2015
1:32 p.m.
MEMBERS PRESENT
Senator Bert Stedman, Chair
Senator Cathy Giessel, Vice Chair
Senator Bill Stoltze
Senator Johnny Ellis
MEMBERS ABSENT
Senator Pete Kelly
COMMITTEE CALENDAR
CONFIRMATION HEARINGS
Commissioner - Department of Health and Social Services
Valerie Davidson
- CONFIRMATION ADVANCED
Board of Dental Examiners
Dr. Thomas Kovaleski
Paula Emswiler Ross
Dr. Paul Silveira
- CONFIRMATIONS ADVANCED
Alaska Mental Health Trust Authority Board of Trustees
Christopher Cooke
Mary Jane Michael
Carlton Smith
- CONFIRMATIONS ADVANCED
Board of Nursing
Julie Gillette
Sharyl Toscano
- CONFIRMATIONS ADVANCED
Board of Examiners in Optometry
Paul Barney
Dr. Stephen Stralka
- CONFIRMATIONS ADVANCED
Board of Pharmacy
Leif Holm
- CONFIRMATION ADVANCED
Board of Massage Therapists
David Edwards-Smith
Amanda Unser
Traci Gilmour
Ron Gibbs
Shirley Nelson
- CONFIRMATIONS ADVANCED
State Medical Board
Dr. Steven Humphreys
- CONFIRMATION ADVANCED
Violent Crimes Compensation Board
Dr. George Brown
- CONFIRMATION ADVANCED
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
VALERIE DAVIDSON, Commissioner-designee
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Provided information related to her
confirmation hearing.
JOHN SHERWOOD, Deputy Commissioner
Department of Health and Social Services
Anchorage, Alaska,
POSITION STATEMENT: Answered questions related to Medicaid
claims.
ACTION NARRATIVE
1:32:27 PM
CHAIR BERT STEDMAN called the Senate Health and Social Services
Standing Committee meeting to order at 1:32 p.m. Present at the
call to order were Senators Ellis, Giessel, and Chair Stedman.
He said today's work is to review some of the governor's
appointments. Senator Stoltze arrived shortly thereafter.
^CONFIRMATION HEARINGS:
CONFIRMATION HEARINGS:
Commissioner - Department of Health and Social Services
Valerie Davidson
Board of Dental Examiners
Dr. Thomas Kovaleski
Paula Emswiler Ross
Dr. Paul Silveira
Alaska Mental Health Trust Authority Board of Trustees
Christopher Cooke
Mary Jane Michael
Carlton Smith
Board of Nursing
Julie Gillette
Sharyl Toscano
Board of Examiners in Optometry
Paul Barney
Dr. Stephen Stralka
Board of Pharmacy
Leif Holm
Board of Massage Therapists
David Edwards-Smith
Amanda Unser
Traci Gilmour
Ron Gibbs
Shirley Nelson
State Medical Board
Dr. Steven Humphreys
Violent Crimes Compensation Board
Dr. George Brown
1:33:19 PM
CHAIR STEDMAN announced the list of confirmations.
1:36:08 PM
SENATOR STOLTZE said positive things about the Alaska Mental
Health Trust Authority Board of Trustees. He noted their
importance in developing resources to benefit trustees.
SENATOR STOLTZE moved to forward the names of the appointees to
the full legislature sitting in joint session for a vote.
CHAIR STEDMAN reminded members that signing the report in no way
reflects individual members' approval or disapproval of the
appointees, and that the nominations are merely forwarded to the
full legislature for confirmation or rejection. There being no
objection, it was so ordered.
He introduced Commissioner-designee, Valerie Davidson, noting
that Department of Health and Social Services (DHSS) is one of
the largest departments in the state with a billion-plus budget.
^Confirmation Hearing: Commissioner of the Department of Health
and Social Services That Includes Discussion Related To Medicaid
1:38:44 PM
VALERIE DAVIDSON, Commissioner-designee, Department of Health
and Social Services, provided information related to her
confirmation hearing. She shared that she was born in Bethel and
lived there and in Aniak. She said she was a Head Start kid and
received health care from Clara Morgan whom she credited with
many of her values. She recalled persons who influenced her
growing up. [This confirmation hearing contains discussion
related to Medicaid.]
She said she moved to Salcha, Alaska, and attended Salcha
Elementary School and then Eielson Air Force Base Junior High. A
family expectation was to rise to the occasion and thrive. She
said she attended University of Alaska - Fairbanks, and
University of Alaska Southeast. She worked as an intern and
staff for John Binkley. She said her undergraduate degree is in
Elementary Education with a specialty in Early Childhood and a
minor in Bilingual Education. She said she is a strong believer
in early childhood education.
She said she attended graduate school at the University of New
Mexico School of Law and then worked in Anchorage for a year.
She then moved back to Bethel and began a career in Tribal
Health. She worked for the Yukon-Kuskokwim Health Corporation
for seven years, three of the years as general counsel and four
of the years as executive vice president. She then moved to the
Alaska Native Tribal Health Consortium in Anchorage where she
worked for eight years.
1:43:45 PM
CHAIR STEDMAN asked what motivated Ms. Davidson to become
commissioner, especially during this time of lack of funding.
COMMISSIONER DAVIDSON responded that it is a big job in a big
department with a complicated budget, but said she has never
turned away from a tough job. She shared a personal story about
health care. She spoke of her interest in improving health care
systems. She stated that some of her particular passions are
child welfare cases and the fact that what the state is doing
now is not working. She said she has a goal of developing a
better partnerships between the state, tribes, and the federal
government to solve problems together, especially in light of
the budget situation.
1:46:54 PM
COMMISSIONER DAVIDSON said her style is straightforward and
collaborative, and she welcomes a diversity of opinions.
She said she has four priorities for the department. The first
is to create a sustainable health care delivery system. She
opined that expansion and reform go hand in hand. The Governor
requested every department to describe what it would look like
in four years with a 25 percent reduction. Of DHSS's budget of
$2.7 billion, $1.7 billion is Medicaid and $700 million of that
is from general funds. She stated that reform is the opportunity
to meet budget challenges. She said the second priority is child
welfare matters and she is planning meetings to bring tribal and
federal partners together to work with the state. The third
priority is to work with federal partners to reduce costs. The
fourth priority is improving wellness and prevention
opportunities in order to save costs further down the road.
1:50:13 PM
SENATOR STOLTZE mentioned stakeholders as a subject from the
last meeting. He spoke strongly of honoring all points of view.
He noted a combativeness in a Lunch and Learn presentation on
Medicaid against some stakeholders. He requested comments on
differing policies.
COMMISSION DAVIDSON said she does welcome differing opinions,
but does not necessarily agree with them. She noted a
discrepancy in the presentation regarding years of Medicaid
expansion in a couple of states before the current expansion of
Medicaid was offered. She suggested it would be better to
compare data from the same years. She emphasized that looking at
various perspectives does not mean she is going to agree 100
percent of the time, but she hoped stakeholders could have
honest conversations out in the open. She noted there is another
Lunch and Learn coming up.
1:54:17 PM
SENATOR GIESSEL asked for examples of Ms. Davidson's work with
private sector providers outside of tribal or federal programs.
COMMISSIONER DAVIDSON provided an example of when she worked
under Commissioner Gilbertson with the Yukon-Kuskokwim Health
Corporation as way to maximize federal contributions. She noted
five non-profit organizations they worked with. She discussed
ways to develop partnerships to transition services. She said
they held community meetings which were difficult. Bethel
Community Services provided services not provided by the tribe.
She concluded that the solution was to think of the clients and
provide services that made sense. The transition of the five
programs took place within ten months.
2:00:09 PM
SENATOR GIESSEL recalled Commissioner Gilbertson believed that
health care would transition from the small provider to a
hospital environment in the future. She asked how Commissioner
Davidson plans to go forward working with the diverse types of
health care providers.
COMMISSIONER DAVIDSON stated that she has not worked for a non-
tribal health provider. She shared that the department has
written an RFP and the successful bidder will look at health
care reform opportunities and waiver programs in other states
and seek what is right for Alaska. Then the department will
engage stakeholders to see what Alaska has to do to move
forward. She stressed that the state has to have that
conversation in order to redesign the Medicaid system. She
commented that there are large providers in tribal health, but
also very small ones, and everyone had a seat at the table.
There were necessary and tough conversations.
2:03:59 PM
SENATOR ELLIS addressed a different topic regarding two
constituents who want to change and improve the Psychiatric
Patients Grievance Process. He asked that the department meet
with the constituents and address their concerns.
2:05:53 PM
SENATOR GIESSEL asked about the Medicaid payment system, which
is not working very well. She asked for the status of Xerox's
MMIS payments and the timeframe for getting health care
providers paid.
CHAIR STEDMAN inquired when the "bugs would be fumigated."
COMMISSIONER DAVIDSON explained that there have been significant
challenges with the MMIS system. Xerox was awarded the contract
in 2007 and the original "go live" date was in 2010, but the
actual go live date was October of 2013. One of the biggest
challenges was that the system that was to be tested was not
rigorously tested. The department knows there is a need to
improve the accuracy and timeliness of the claims.
She related that there have been some improvements. The Division
of Health Care System has been working to get providers paid,
but the backloads are still there. Going forward, the claims are
paying more timely and Director Brody has said that 97 percent
of new claims are paid in a timely manner. She emphasized that
under the new administration, the department has done its best
to be as transparent as possible and has posted the backlogs to
a website. The department sued Xerox and there was a hearing in
February. The vendor has indicated that all problems have been
solved, but she said she does not agree.
2:10:53 PM
She said providers are contacting the Division of Health Care
Services to set up repayment for the advances they received. In
the past, some providers had to have advance payments in order
to stay in business.
2:12:21 PM
SENATOR GIESSEL asked how many are in the backlog and what the
timeframe is.
JOHN SHERWOOD, Deputy Commissioner, Department of Health and
Social Services, answered questions related to Medicaid claims.
He said that currently all of the suspended Medicaid claims
amount to a little over $100,000 and $68,000 of those are mass
adjustments that did not process correctly.
CHAIR STEDMAN asked for the projected timeframe for clearing up
the claims.
MR. SHERWOOD said there is not a fixed schedule for reprocessing
claims, but he thought it might be August, if Xerox stays on
track with the progress they've been making.
SENATOR GIESSEL stated she was reluctant to see 40,000
beneficiaries added to Medicaid in light of the backlog.
COMMISSIONER DAVIDSON replied that the department expects to be
back on track by about August. Of the 40,000 beneficiaries that
would be eligible for Medicaid expansion, the department expects
about 20,000 to actually enroll. They are working with Xerox to
ensure that new claims are paid. The providers have up to one
year to meet timely filings. The department expects to be ready
for the expansion population.
2:16:35 PM
SENATOR GIESSEL provided a scenario where providers agree to
wait for payment, but now there are 20,000 more beneficiaries.
She asked if the providers can absorb that many new
beneficiaries.
COMMISSIONER DAVIDSON emphasized that the providers welcome
Medicaid expansion as an opportunity to provide services. Many
of the individuals who are in the expansion population are
getting care already through emergency rooms. The providers have
said they would like to see these patients in a primary care
setting, such as with a community health practitioner or
behavioral health practitioner. Other providers are ready and
able to provide additional services to new beneficiaries.
Providers are not mandated to take on any more Medicaid
patients.
SENATOR GIESSEL asked if community health aids are all part of
the Native Health Care System. She noted that not all Medicaid
beneficiaries fall under that system; there are people outside
the system. She asked if Commissioner Davidson thought the new
beneficiaries could be absorbed.
COMMISSIONER DAVIDSON pointed out that many non-Natives use the
Tribal Health System because there is no other provider
available. The state does not receive a 100 percent federal
match for a non-IHS patient. Veterans in rural communities also
receive services from the Tribal Health System and those costs
are billed to the Veterans Administration. Tribal Health is in
larger communities, as well in rural communities.
She noted that there are opportunities for nurse practitioners
and physician assistants to provide services, that before had
been provided by physicians. Every time the state has the
opportunity to look at alternative providers, additional people
can be served.
2:21:25 PM
SENATOR GIESSEL said Medicaid will not change how nurse
practitioners can practice. She said 50 percent of Medicaid
beneficiary's live in Anchorage. She asked if the Railbelt
providers can absorb the new beneficiaries.
COMMISSIONER DAVIDSON reiterated that the department has heard
from providers that they support Medicaid expansion.
SENATOR STOLTZE inquired about cost containment and asked if
Medicaid expansion and reform still go hand in hand.
COMMISSIONER DAVIDSON stated that the department believes that
Medicaid expansion and reform go hand in hand. She said, "We are
building upon the reform efforts that the department has already
undertaken and we see there are more opportunities for reform."
SENATOR STOLTZE said, "Can go hand in hand or must go hand in
hand?"
COMMISSIONER DAVIDSON said "must" given the current budget
scenario. She reiterated how much the department must cut in
order to meet the Governor's request. She said the department
has to look at reform in order to address the current budget
situation.
2:24:28 PM
SENATOR STOLTZE questioned what is enforceable by the federal
government. He wondered if the state has the ability to pass
reform.
COMMISSIONER DAVIDSON said the department is in active
negotiations with the Centers for Medicaid and Medicare Service
(CMS) about the reform efforts already under way, regardless of
expansion. For example, utilizing a waiver to be able to work
with the Tribal Health System to take advantage of 100 percent
federal match. Also, the department is working with CMS on
waivers to be able to finance services already provided. She
said Medicaid reform is tough, but the state has to keep moving
forward. The department believes that by doing expansion,
leveraging federal resources and opportunities, and redesigning
the way the state provides health care, will allows the state to
provide health care more efficiently and to provide services to
those who are without health care, in a way that is cost
effective.
2:28:31 PM
CHAIR STEDMAN noted a forthcoming bill regarding cost
containment.
SENATOR STOLTZE asked if he could provide a list of issues to
see where there is agreement.
CHAIR STEDMAN said that opportunity would come during a bill
discussion.
SENATOR GIESSEL asked for the RFP timeframe.
COMMISSIONER DAVIDSON said the RFP report about key reform
efforts in Medicaid will be delivered to the legislature next
January 2016.
SENATOR GIESSEL noted there is a RFP to audit the Department of
Health and Social Services (DHSS).
2:31:53 PM
SENATOR GIESSEL said in accordance with AS 39.05.080 the Senate
Health and Social Services Committee has reviewed the following
appointment and forwards the name of Valerie Davidson to joint
session for confirmation. This action does not denote support or
non-support of the appointee. There being no objection, it was
so ordered.
CHAIR STEDMAN congratulated Commissioner Davidson.
SENATOR STOLTZE acknowledged the presence of Dr. George Brown.
2:33:55 PM
There being nothing further to come before the committee,
Chair Stedman adjourned the Senate Health and Social Services
Standing Committee at 2:33 p.m.