Legislature(2023 - 2024)BUTROVICH 205
01/31/2023 03:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Overview State of Alaska Department of Health | |
| 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
January 31, 2023
3:30 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator James Kaufman, Vice Chair
Senator Löki Tobin
Senator Forrest Dunbar
Senator Cathy Giessel
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
OVERVIEW STATE OF ALASKA DEPARTMENT OF HEALTH
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
HEIDI HEDBERG, Commissioner Designee
Department of Health
Juneau, Alaska
POSITION STATEMENT: Co-presented an overview of the State of
Alaska Department of Health (DOH).
EMILY RICCI, Deputy Commissioner
Department of Health
Juneau, Alaska
POSITION STATEMENT: Co-presented an overview of the State of
Alaska Department of Health (DOH).
JOSIE STERN, Assistant Commissioner
Division of Finance and Management Services
Department of Health
Juneau, Alaska
POSITION STATEMENT: Co-presented an overview of the State of
Alaska Department of Health (DOH).
ACTION NARRATIVE
3:30:31 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 3:30 p.m. Present at the
call to order were Senators Giessel, Dunbar, Tobin and Chair
Wilson. Senator Kaufman arrived thereafter.
^OVERVIEW STATE OF ALASKA DEPARTMENT OF HEALTH
OVERVIEW
STATE OF ALASKA DEPARTMENT OF HEALTH
3:31:07 PM
CHAIR WILSON announced the committee would hear the continuation
of the overview of the Department of Health (DOH).
3:31:50 PM
HEIDI HEDBERG, Commissioner Designee, Department of Health,
Juneau, Alaska, said that the department would present the
second half of its overview.
3:32:12 PM
EMILY RICCI, Deputy Commissioner, Department of Health, Juneau,
Alaska, advanced to slide 23 and highlighted important changes
relative to federal requirements during the pandemic. She spoke
to the following points regarding continuous Medicaid
enrollment:
• In March 2020, the federal government put continuous
enrollment requirements in place. States were required to
maintain eligibility status for Medicaid beneficiaries.
• Acceptable reasons for disenrollment were personal request,
move out of state, and death.
• State annual redetermination processes were suspended.
• A 6.2 percent federal funding increase was given for
increased enrollment.
• In December 2022 a federal omnibus bill was passed,
separating the continuous enrollment requirement from the
federal public health emergency.
• On May 11 the federal public health emergency ends.
3:35:00 PM
MS. RICCI stated that the federal government continues to issue
guidance for ending continuous enrollment and noted:
• Alaska will begin its pre-pandemic Medicaid
redeterminations for eligibility on April 1.
• Alaska has 12 months to complete redeterminations for all
active Medicaid cases.
• Alaska has 14 months to finalize terminations.
• The earliest expected termination date is May 31.
• Redetermination plans will be submitted to the Centers for
Medicaid Services (CMS) on February 15.
• DOH and stakeholders begin maximizing public communication
in February.
• There would be a phase down of federal medical assistance
percentages (FMAPs) and gave reasons for working closely
with CMS.
3:40:54 PM
SENATOR GIESSEL said the Department of Election's communication
plan used multiple languages and public events. She suggested it
would be an excellent model to follow since informing the public
will be challenging.
3:41:53 PM
CHAIR WILSON stated that DOH recently filled its Communications
Officer position, which will benefit the department.
3:42:01 PM
SENATOR TOBIN asked if additional communication positions would
be needed to accomplish the magnitude of the task.
3:42:17 PM
COMMISSIONER-DESIGNEE HEDBERG stated that DOH had signed a
contract with a communications company to support the
department's public information team. The communications manager
will begin the position on Monday. DOH and the consultant will
develop a robust communication plan with assistance from partner
organizations. The plan will include multiple languages and
venues so Alaskans can respond to the change on time.
3:43:42 PM
SENATOR DUNBAR said he understands that under federal
guidelines, redetermination must begin on April 1. He asked if
DOH had started preliminary work to avoid backlogs and what the
appeal process would be.
3:44:32 PM
MS. RICCI replied that the first preliminary step was to ensure
programming was in place for Alaska's Resource for Integrated
Eligibility Services (ARIES). Programming will be completed by
February 28, allowing time to discover programming issues. The
programming process has provoked thoughtfulness in how the
distribution of redeterminations will occur over 12 months.
Ideally, the distributions would be even. Redeterminations in
the Eligibility Information System (EIS) will be manually
enrolled. Most of the enrollment in the ARIES system will be
automatic. DOH is uncertain how many in the ARIES system must be
manually enrolled. There is a standard appeal process for
redeterminations, which can involve peer hearings. She said she
would provide an outline of the process to the committee.
3:46:45 PM
CHAIR WILSON asked approximately how many Alaskans are on
Medicaid.
3:46:53 PM
MS. RICCI replied that there are about 263,000 Alaskans.
3:47:07 PM
CHAIR WILSON asked Ms. Ricci to expound briefly on the
department's redetermination plan.
3:47:19 PM
MS. RICCI replied that not all redeterminations would occur on
April 1. The department will have 12 months to work through the
263,000 redeterminations. Some redeterminations will occur as
people apply for different benefits or programs. DOH will
schedule other redeterminations based on the month of the
beneficiaries enrollment.
3:48:21 PM
SENATOR DUNBAR suggested that DOH should send the outline for
the appeal process to every Senator since there are 260,000
people on Medicaid.
MS. RICCI responded that legislators could assist in the change
by asking constituents to update their contact information.
3:49:45 PM
CHAIR WILSON asked if DOH plans to use Medicaid enrollment
specialists to assist with contact information or help with
enrollment issues.
3:50:07 PM
MS. RICCI replied that the department would be relying on that
partnership. Provider groups are one of the most important
stakeholders to connect with. The goal is to use connections
within all of the divisions in the department and provide
consistent messaging.
3:51:07 PM
CHAIR WILSON asked whether the department has anticipated the
number of enrollees that may fall from the rolls.
3:51:43 PM
MS. RICCI replied that she had heard estimates ranging from 3 -
6.6 percent. From the Spring of 2020 to the present, there has
been a 30,000-enrollee increase. She stated she did not
anticipate dropping all 30,000 enrollees, but the number
provides an idea of the increased volume the department has
experienced. She said the department has considered the impact
that ending continuous enrollment will have on the budget
because not all enrollees were previously utilizing services.
3:52:01 PM
SENATOR KAUFMAN joined the meeting.
3:53:33 PM
SENATOR TOBIN stated she is concerned about employee attrition
and the health of employees. She asked for suggestions on ways
the legislature can help DOH retain employees.
3:54:14 PM
COMMISSIONER-DESIGNEE HEDBERG replied that she has been working
with the new director of public assistance. DOH has filled
fourteen recruitment positions. Eligibility technician training
takes time, so information on turnover is being gathered. Staff
have been working through a backlog of applications and are
under stress. The department is also evaluating whether
additional long-term non-permanent positions are needed. Staff
morale is focused on ensuring they feel heard and have the
resources to do their work.
3:56:18 PM
CHAIR WILSON asked if the redetermination process must start on
April 1 or if DOH can push it back.
3:56:33 PM
MS. RICCI replied that the department must start on April 1 at
the latest.
3:57:03 PM
JOSIE STERN, Assistant Commissioner, Division of Finance and
Management Services, Department of Health, Juneau, Alaska, said
the Department of Health includes the following divisions:
• Behavioral Health
• Healthcare Services
• Public Health
• Public Assistance
• Senior and Disability Services
• Departmental Support Services
• Medicaid Services
MS. Sterns turned to slide 24 and said the chart and graph
compare the FY 22 actuals, FY 23 Management Plan, and FY 24
Governor's budget introduced on December 15. She excluded
Departmental Support Services, the Human Services Community
Matching Grant, and Community Initiative Matching Grants from
the comparison; these grants and services usually appear
consolidated. However, many of the changes associated with the
Department of Health and Social Services bifurcation occurred
within Departmental Support Services, making a similar
comparison from FY 22 to FY 24 difficult. DOH currently has
1,453 full-time positions. Medicaid Services is the largest
portion of the budget at $2.5 billion. Notable increments in the
FY 24 budget are:
• $1 million Departmental Support Services, Commissioner's
Office increment split equally between federal and
undesignated general funds to create the Office of Health
Savings. The Office of Health Savings aims to address
healthcare costs, maximize existing contracts' value, and
secure additional recoveries through reclaiming.
• $150,000 Commissioner's Office increment to the
undesignated general fund for recruiting and retaining
health professionals in Alaska. DOH anticipates that the
healthcare sector will grow about 6.7 percent in the next
12 years, equating to about 5,000 new jobs.
• $1.5 million Information Technology Services increment for
ten full-time positions to invest in business information
technology.
• $2.6 million Medicaid Services increment to undesignated
general funds to extend post-partum Medicaid coverage from
60 days to 12 months.
• $18.1 million Medicaid Services increment to undesignated
general funds due to Medicaid cost increases, which include
the cost to provide services, inflation, utilization and
other CMS plan changes.
• $2.8 million Public Health increment to undesignated
general funds to adopt recommendations in the Alaska
Tuberculosis Plan.
• $4.2 million Public Health increment to undesignated
general funds to eliminate congenital syphilis.
• $1.5 million Senior and Disability Services to undesignated
general funds to support senior and disability community-
based grants and independent learning community base
centers.
4:00:57 PM
CHAIR WILSON asked if the legislation for 12-month post-partum
care was forthcoming.
4:01:10 PM
COMMISSIONER-DESIGNEE HEDBERG replied that it was forthcoming.
4:01:19 PM
SENATOR GIESSEL stated that Alaska Regional's Senior Medicare
Clinic was closing. She asked if Ms. Hedberg had any solutions.
4:01:41 PM
MS. HEDBERG deferred to Ms. Ricci.
4:01:54 PM
MS. RICCI said she has seen seniors become eligible for Medicare
and suddenly be unable to receive care from their long-standing
provider. Ultimately, Medicare is a solely federal program. It
is unlike Medicaid, having a partnership with states. Time needs
to be spent understanding how rates are determined and looking
for modifiers, specifically for primary care. She opined that
people nationwide would be happy if Medicare paid more. However,
in Alaska, Medicare and providers have an acute problem. There
is no easy fix that the state can offer to address the
underpayment, but collectively Alaska can have a strong voice in
saying the rates impede seniors' access to critical care.
4:04:45 PM
SENATOR GIESSEL stated that the Biden administration is
considering reducing Medicare reimbursement, which magnifies the
problem. She said that Alaska had a Health Care Commission for
several years before the state defunded it. The commission did
comprehensive work on healthcare cost savings and system
improvements. She asked what the chance would be of DOH
expanding the Office of Health Savings to the formula of the
Health Care Commission.
4:06:12 PM
MS. RICCI replied that she and her colleagues have become hyper-
focused on administering programs and ensuring service to
beneficiaries. The concept of an Office of Health Savings is to
leverage immediate short-term savings through subrogation and
additional pharmacy rebates. The office would also focus on some
bigger vision goals.
4:08:09 PM
SENATOR GIESSEL said that the Office of Health Savings would
look at how the bureaucracy could improve its function. She
stated that she would like to discuss the health commission
elsewhere because it took on big-picture issues and was
comprised of clinicians, public health officials, and the
bureaucracy to avoid missteps.
4:08:58 PM
SENATOR DUNBAR referred to the operating budget (slide 24) and
said a line called "Other" jumped from $35 million in 2022 to
$73 million in 2023 and stayed at an elevated rate of $75
million. He asked for an explanation of "Other" and the $40
million increase in the revenue source.
4:09:36 PM
MS. STERN replied that "Other" refers to fund sources that are
generally inter-agency receipts. They are agreements that the
Department of Health may have with other departments or
divisions. It appears because it is both a revenue and
expenditure source. The underlying fund for the inter-agency
(IA) receipts would be either undesignated general fund (UGF),
designated general fund (DGF), or federal funding.
SENATOR DUNBAR asked for an explanation of the increase.
4:10:20 PM
MS. STERN replied that she was uncertain and would report back
to the committee.
4:10:32 PM
SENATOR KAUFMAN questioned how a battleship would be rebuilt as
it steams across an ocean. DOH has a budget of $3 billion. He
opined that it is a big operation and deserves an embedded
continuous improvement process with resources to focus solely on
improvement. The benefit to performance and the economy will
make money. Quality is free because it pays for itself when
implemented. He opined that improvement programs are valid and
should be avidly pursued. It takes an organized, concerted,
resourced effort to drive improvement in a complex and expensive
organization.
4:12:49 PM
CHAIR WILSON asked Ms. Ricci and Commissioner Designee Hedberg
to introduce themselves.
4:13:13 PM
COMMISSIONER DESIGNEE HEDBERG said she moved to Alaska in 1995.
She received a degree from Pacific University and described how
her degree in outdoor studies allowed her to work for non-profit
organizations and meet people throughout Alaska. She said she
was asked to apply for a position with DOH while working for the
Blood Bank of Alaska in 2009 and has worked in various positions
within the Division of Public Health for 13 years. For the past
four years, she has been the director of public health. She
gained valuable experience and relationships as part of the
collective COVID-19 response team. She expressed appreciation
for the team she works with.
4:15:44 PM
MS. RICCI stated she was born and raised in Juneau. She has a
broadcast journalism degree and a master's in public health. In
2004 she began her career in public health following a tsunami
in Sri Lanka. She stated she worked for the Red Cross, entered
the Peace Corps, and discovered she enjoys public health and
public service. For the past 12 years, her work has focused on
the private sector, mainly with the Division of Retirement and
Benefits. She described several projects she has worked on, such
as issues related to Medicaid. She stated that her passion is
improving the health care system and thinking about it from a
payer perspective. Understanding and being thoughtful about how
society pays for services is essential. Insurance and payment
methods are critical to supporting the overall health of
Alaska's population.
4:18:17 PM
CHAIR WILSON said that Alaska is one of three states with higher
Medicaid rates than Medicare. Yet, providers say Medicare rates
are not high enough. He asked if Alaska's Medicaid is too high
compared to other states.
4:19:14 PM
MS. RICCI replied that there are circumstances where Medicaid
does pay higher rates than Medicare, specifically for
professional services. If you were to look at facility costs,
Medicaid does not pay higher than Medicare. The healthcare
system has post-pandemic changes, and the impact of those
changes is just beginning to be understood. She said she
consistently hears about the effects of the pandemic, supply
change disruption, inflation, and workforce shortages. She
opined that it all ties into the payment financing system and
how to support it. She stated that she does not feel prepared to
say the rates are too high or low unilaterally. The system needs
to be looked at to ensure the pay rates achieve the outcomes
Alaskans want, such as healthy individuals, strong primary care,
and robust prevention.
4:21:10 PM
CHAIR WILSON asked if Optum's medical and behavioral health
provider payments are backlogged.
MS. RICCI stated that Optum is the department's Administrative
Services Organization (ASO) that adjudicates claims for the
services provided under the 115 Waiver in the Division of
Behavioral Health. There have been challenges with Optum's
adjudication system. Some providers struggle to understand how
payments are adjudicated and why they are not paid timely. The
division is aware of the issue and has implemented steps for
improvement. The challenges have been foundational to the
Administrative Services Organization (ASO) beginning its
operations.
4:22:51 PM
CHAIR WILSON stated he finds the issue concerning because there
is only one provider in his district that offers critical care
services and that provider has not been paid for over a year. He
asked if Optum was making payments.
4:23:12 PM
MS. RICCI stated that foundational claims must be paid timely
and accurately. She said she does have concerns with Optum's
ability to do so consistently. Not paying critical providers is
unacceptable, and the department must ensure reimbursement. She
asked that Chair Wilson put the provider in contact with the
department to investigate the issue.
4:23:42 PM
CHAIR WILSON thanked the presenters.
4:24:36 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee meeting at 4:24 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| DOH Department Overview - DRP 01.23.2023.pdf |
SHSS 1/24/2023 3:30:00 PM SHSS 1/31/2023 3:30:00 PM |
SHSS Dept of Health Overview |
| Dept of Health Org Chart.pdf |
SHSS 1/31/2023 3:30:00 PM |
SHSS Dept of Health Org Chart |