Legislature(2023 - 2024)BUTROVICH 205
01/18/2024 03:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Presentation: State of Alaska Department of Health Overview | |
| 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 18, 2024
3:32 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
PRESENTATION: STATE OF ALASKA DEPARTMENT OF HEALTH OVERVIEW
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
HEIDI HEDBERG, Commissioner
Department of Health (DOH)
Anchorage, Alaska
POSITION STATEMENT: Co-presented the Department of Health
Overview.
EMILY RICCI, Deputy Commissioner
Department of Health (DOH)
Anchorage, Alaska
POSITION STATEMENT: Co-presented the Department of Health
Overview.
ACTION NARRATIVE
3:32:49 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 3:32 p.m. Present at the
call to order were Senators Tobin, Kaufman, Giessel, Dunbar, and
Chair Wilson.
^PRESENTATION: STATE OF ALASKA DEPARTMENT OF HEALTH OVERVIEW
PRESENTATION:
STATE OF ALASKA DEPARTMENT OF HEALTH OVERVIEW
3:33:28 PM
CHAIR WILSON announced the consideration of an overview by the
Department of Health.
3:34:58 PM
HEIDI HEDBERG, Commissioner, Department of Health (DOH),
Anchorage, Alaska, co-presented the Department of Health
Overview that discussed the previous and upcoming 12-month
periods. She moved to slide 2 and said July 1, 2023, marked the
one-year anniversary since the bifurcation of the Department of
Health and Social Services. DOH has focused on stakeholder
engagement, behavioral health, complex care, transformation of
care, and child care. DOH has met milestones. The five divisions
that comprise DOH are:
Public Health
Public Assistance
Behavioral Health
Senior and Disabilities Services
Health Care Services
3:36:31 PM
MS. HEDBERG moved to slide 3 and said presentation topics would
include:
[Original punctuation provided.]
SNAP Updates
Child Care Updates
Medicaid Redeterminations
Medicaid Payment Changes
Behavioral Health Updates
Home and Community Based Waiver Tool
3:36:44 PM
MS. HEDBERG moved to slide 4 and said when she became the
commissioner of DOH in November of 2022, the Supplemental
Nutrition Assistance Program (SNAP) was backlogged. The initial
backlog was eliminated with assistance from the new Division of
Public Assistance's leadership and processing design. For a
short period, the SNAP applications were processed in a timely
manner. In fall 2023 a cascade of events occurred creating a
current backlog. Events leading to the backlog included an end
to the federal government's interview waiver, the change to the
department's cloud-based document management system, and
employees missing work due to a series of severe winter storms
that closed public schools. She stated she contacted the federal
government to extend the waiver on interviews, but the request
was denied. To catch up, the department focused on training.
There were 12,098 backlogged cases in December but as of January
18, 2024, the number of cases was down to 6,233. The department
estimates the elimination of the backlog by the end of February.
3:40:14 PM
MS. HEDBERG said to prevent a backlog from occurring again the
department will have a contractor work with DOH to improve
training in the conducting of interviews. Also, through the
workflow process management system, DOH can monitor the timely
management of applications and assist eligibility technicians
according to their needs. She stated employee turnover had
decreased slightly and 22 new technicians were hired to focus on
Medicaid.
3:41:39 PM
SENATOR TOBIN said she was cautiously optimistic about
eliminating the backlog by the end of February. She stated many
municipalities were impacted by the unusually severe winter
storms. However, she opined that the state could have done more
to prevent the cascade affect. She asked if departments have
discussed how their decisions affect each other and if DOH had
established remote work policies to avoid backlogs in the
future.
MS. HEDBERG replied that DOH has telework policies. The closures
caused by the storms affected the ability of employees with
children to work. She said she did not reach out to other
departments regarding snow removal.
3:43:07 PM
MS. HEDBERG moved to slide 5 and said that in addition to staff
training, DOH is striving modernize the SNAP program by
developing a system where Information Technology (IT), workforce
support, and policy solutions work together so staff performance
can reach its highest potential. Last year the legislature
appropriated funds to update IT systems and the plans are coming
to fruition. She described IT updates and benefits.
3:45:06 PM
MS. HEDBERG said DOH launched the SNAP online application on
January 27, which is accessed through a portal on myAlaska.
People can also apply for Medicaid through the portal. In its
first week of use 500 clients applied for SNAP and the
department found no issues, so a press release was issued
informing the public of the ability to apply online. DOH has
received approximately 11,000 online applications. Preliminary
data shows the time to complete an application is short. Prompts
help ensure the applications are complete before submission.
Clerical staff have more face-to-face time with customers due to
the efficiency of the online application process.
3:47:47 PM
MS. HEDBERG stated that in the first quarter of 2024 updates
will include a self-service portal where clients can upload any
document for all public service programs. The United States
Department of Agriculture requires mid-year information checks
on SNAP clients. The system will allow clients to update their
SNAP application information online by spring. Implementation of
advanced capture / intelligent scanning will also begin in the
spring, reducing the need for the manual sorting of
applications. In July 2024, clients will have the ability to
check the status of their application through the self-service
portal and opt-in to receive electronic updates. She added that
DOH is on track to launch its integrated eligibility enrollment
system in 2025.
3:50:39 PM
SENATOR DUNBAR asked if it is possible to integrate the online
public assistance portal to assist with reducing cumbersome
administrative processes and costs associated with obtaining
approximately $7 million in federal money for the Summer
Electronic Benefits Transfer (EBT) lunch program for kids.
3:51:42 PM
MS. HEDBERG replied that the decision not to start the Summer
EBT program was intentional because it is a heavy administrative
burden. The primary focus of DOH is addressing the staff backlog
and implementing the changes necessary to become an online
system. The department can evaluate the program once current
concerns are addressed. Food Nutrition Services (FNS) concurred.
FNS and DOH continue to discuss ways to support communities and
administer the food lunch program.
3:53:24 PM
SENATOR DUNBAR opined that it makes sense that in rural areas
DOH would direct assistance to the community rather than the
individual. However, traditional implementation is better for
urban areas. He stated his concern that IT system updates will
occur without the ability to accommodate the EBT program. He
asked if DOH could build the system to receive the program
without costly changes.
MS. HEDBERG said she would follow up after evaluating current
timelines.
3:54:46 PM
CHAIR WILSON asked if clients have given feedback on their
experience with the SNAP updates.
MS. HEDBERG replied that only the SNAP online application was
launched. One client emailed correspondence regarding an error
message they received. DOH is receptive and will watch for
feedback as more system changes occur.
3:56:03 PM
MS. HEDBERG moved to slide 6 and highlighted child care updates
on funding initiatives and the governor's task force:
[Original punctuation provided.]
Grants for Child Care Providers
• Workforce stabilization:
$7.5M total, applications
closed 1/15/2024
• Innovation: Over $14M
awarded to 17 recipients
She illustrated several instances of how Alaskan communities had
made use of the funds they received. She also announced that DOH
has allocated the remaining portion of the American Rescue Plan
Act (ARPA) funds, with an estimated value of $12 and $14
million, to a non-competitive grant for all licensed child-care
workers. This grant, which is non-competitive and formula-based,
encompasses a wide array of expenses. It aims to support
licensed child-care providers with financial assistance for
necessities such as mortgage or facility payments, expenses,
health benefits, supplies, and other expenditures. The grant is
administered through Thread.
4:01:40 PM
MS. HEDBERG continued slide 6, Child Care Updates:
Task Force on Child Care
• Established under AO 346
• 33 recommendations spanning
- Background Checks
- Licensing
- Workforce
- Employers
- Tribal Authority
MS. HEDBERG stated that the governor's task force includes a
diverse array of child-care providers from across the state. The
members were tasked with determining ways to increase access to
child care. Focal points included background checks, licensing,
workforce, employers, and tribal authority. The task force
report includes 33 recommendations on these subjects. DOH has
initiated the implementation of several recommendations and will
put additional recommendations into action as funds become
available.
4:02:37 PM
MS. HEDBERG stated that the task force would focus on quality,
access, and subsidies in the second report. Discussion on the
topics would occur from January to July, and a contractor would
perform a study to identify the cost of care for Alaska.
4:03:19 PM
CHAIR WILSON referred to slide 5 and asked why only five of the
six recommendations were listed.
4:03:27 PM
MS. HEDBERG replied there were six recommended topics. The first
three included background checks, licensing, and workforce. The
task force added two more areas to the first report. The second
report would cover the other three recommended topics access,
quality, and subsidies.
4:03:43 PM
CHAIR WILSON stated his understanding that completion of the
full report would not occur until 2025. However, he wondered if
DOH would put any of the 33 recommendations into action prior to
its completion.
MS. HEDBERG replied yes.
CHAIR WILSON said he looked forward to seeing the report and
implementations. He thanked Senator Tobin for serving on the
task force.
4:04:10 PM
EMILY RICCI, Deputy Commissioner, Department of Health,
Anchorage, Alaska, moved to slide 7 and provided an update on
the Medicaid redetermination process. She said the Medicaid
redetermination process emerged in response to the public health
emergency of 2020, during which states were mandated to uphold
continuous eligibility for all Medicaid recipients. Unenrollment
was only permitted under specific circumstances. This
requirement remained in place for approximately three years,
concluding in March 2023. Subsequently, all states were tasked
with undertaking a significant and demanding endeavor to review
the eligibility determinations of all Medicaid recipients within
a defined timeframe and according to specified criteria.
4:05:05 PM
MS. RICCI spoke to the following actions taken by DOH regarding
redeterminations:
[Original punctuation provided.]
Medicaid Redeterminations
Where are we at?
• Initiated over 90,000 redeterminations
• Negotiated with CMS additional time for
redeterminations
Implemented new mitigation strategies
• New access to data for partners
4:11:06 PM
Ex Parte (Automated) Process
• Identified system errors impacting disenrollments
(Aug/Sep)
• Pause certain disenrollments until updates in place
• Working with federal data services to update and fix
system
Updates will increase successful automated renewals
4:13:59 PM
CHAIR WILSON stated that during the Health Chairs Conference he
led the Medicaid Innovation Summit for the Council of State
Governments (CSG). He learned that Alaska is one of the states
with the lowest redetermination error rates and leads in the
number of completed redeterminations. He said he wished the
media had published this information to raise the morale of
staff. He asked if the time extension to 18 months creates
separate end dates for rural and urban communities and if so,
what defines each type.
4:15:16 PM
MS. RICCI responded that the answer is complex. She explained
that DOH utilizes the rural definition employed by SNAP and the
Division of Public Assistance. To the extent possible, DOH
postponed initiating renewals through the ex parte process for
individuals in specific rural areas. However, some residents in
rural areas would have had their eligibility renewed during
summer and early fall, so DOH couldn't halt their
redeterminations. While some individuals' applications were held
until winter, others had their eligibility and renewals
processed during summer and early fall. Considering the diverse
locations and methods used by DOH to identify individuals for
renewals, the additional six months negotiated with CMS allowed
flexibility in managing the volume of redeterminations. She
stated her belief that the department has sufficient flexibility
to process the rural determinations over winter. Nevertheless,
if the process extends into spring and summer, DOH has
implemented mitigation measures such as data sharing with tribal
health organizations and extended retroactive reinstatement
periods for late renewals.
4:17:24 PM
MS. RICCI moved to slide 8 and said the bar graph shows that
over an 18-month period, DOH scheduled approximately 11,300
renewals or redeterminations per month over the nine-month
period, January to September 2024. The graph also shows renewals
from April to December 2023. The renewals vary in number
completed, ranging from 9,402 to 26,003, and were in various
stages of completion. Although DOH can plan for a static volume
of redetermination cases, the reality is the volume fluctuates
monthly.
4:18:37 PM
MS. RICCI moved to slide 9 and spoke to Medicaid savings and the
tribal reclaiming initiative. She said DOH considers it
important to effectively identify how to use general funds to
support the Medicaid program. The Division of Health Care
Services has established and leveraged opportunities to receive
a 100 percent federal match for services provided to a Medicaid
beneficiary who is also a member of a tribal health
organization. She spoke to reasons for growth in the program:
[Original punctuation provided.]
Fiscal Total State
Year GF Savings
2017 $34,781,840
2018 $45,186,960
2019 $72,647,135
2020 $95,118,333
2021 $57,467,871
2022 $74,412,331
2023 $124,551,810
Total $504,166,280
• Tribal reclaiming allows states to submit claims for
100% federal match for services outside a Tribal
facility under certain conditions.
• The Tribal Reclaiming Unit works closely with the
Alaska Tribal Health System to maximize federal
match.
4:20:56 PM
MS. RICCI moved to slide 10 and discussed Medicaid payment
changes:
• Diagnosis-Related Groups (DRG) inpatient
reimbursement
• Went live 1/1/2024
• Comprehensive Medicaid rate review RFP released
• First round to focus on:
• Behavioral health
• Long-term care services and supports
• Federally Qualified Health Centers
• Nonemergent medical transportation
4:23:52 PM
MS. RICCI moved to slide 11 and opined that the engine of the
Medicaid program is claims payment, adjudication, and
processing, therefore the Division of Health Care Services
(DHCS) is the engine since it is responsible for claims payment
and adjudication. She stated the transitions taking place in
DHCS were going well:
[Original punctuation provided.]
Medicaid Fiscal Agent and Claims System
• Fiscal agent and Medicaid Management Information
System (MMIS) are responsible for processing and
paying most Medicaid claims
• Transitioned to new fiscal agent 4/1/2023 for the
first time in a decade
• Reprocuring new contract for claims adjudication
system to be effective 1/1/2025
• New contracts focus on enhancing customer service
and vendor accountability
4:25:34 PM
CHAIR WILSON questioned whether the situation with fiscal agents
and MMIS involves genuine changes in vendors, locations, and
staff, or if it's merely a superficial transition with the same
management.
4:26:12 PM
MS. RICCI replied that the fiscal agent contract is held by
Health Management Systems (HMS) Gainwell and is a completely
different company from Conduent.
4:26:25 PM
CHAIR WILSON asked if the business location had changed or if it
is the same as the payer agent.
MS. RICCI said there were some employees who transitioned from
Conduent to Gainwell in April. Currently, like other employers,
the fiscal agent is experiencing workforce challenges. HMS
Gainwell has new locations but is largely based out of a
building in Anchorage. Filling staffing gaps is a struggle.
4:27:45 PM
CHAIR WILSON asked if HMS also has the contract for Medicaid
audits.
MS. RICCI replied that most of the audit work is done by Myers
and Stauffer.
4:27:56 PM
CHAIR WILSON asked whether HMS does any Medicaid claim work.
MS. RICCI replied she would report back to the committee.
4:28:17 PM
CHAIR WILSON requested that if the response is affirmative,
include in the response how the auditing process is managed
alongside claim processing.
4:28:30 PM
MS. RICCI stayed on slide 11 and said in relation to the
adjudication system, DOH is working to reprocure contracts.
Currently, DOH is procuring the contract for Medicaid Management
Information Services (MMIS), the actual claims adjudication
system that supports most of the Medicaid payment. She said the
procurement and results would take effect on January 1, 2025.
With both contracts, DOH is highly focused on customer service
and vendor accountability.
4:30:06 PM
MS. RICCI moved to slide 12 and said most Medicaid claims are
paid out of the MMIS and Fiscal Agent systems. However, some
claims specific to behavioral health services are paid through a
contract that is held in the Division of Behavior Health through
an administration services organization that is currently held
by Optum. She said most behavioral health claims are paid
through a single Medicaid system. By January 1, 2025, DOH wants
all payments to go through MMIS and Fiscal Agent systems as it
will standardize and centralize payments for Medicaid claims.
She opined this would result in more timely and accurate
payments to behavioral health providers. The future state of
behavioral health claims will also build out support for
behavioral health care providers.
4:33:00 PM
CHAIR WILSON asked if Optum's contract ends in 2025.
MS. RICCI replied that the contract with the current ASO Optum
would expire at the end of calendar year 2024.
CHAIR WILSON asked if DOH has seen improvements in timely
payments to contractors. He recalled some contractors are owed
millions of dollars and mentioned the state could sever its
relationship with Optum for breach of contract.
4:33:52 PM
MS. RICCI replied DOH continues to work on improving the service
behavioral health care providers receive. Ultimately moving into
the MMIS systems will address the issue faster. Claim
transitions are complex and the deputy director of Behavioral
Health is taking action to make the transition successful.
4:35:03 PM
CHAIR WILSON inquired whether DOH plans to present any 1115
Waivers during this session that the legislature should
anticipate.
4:35:12 PM
MS. RICCI responded that discussion on 1115 Waivers would occur
later in the presentation.
4:35:24 PM
MS. RICCI moved to slide 13 and said the continuum of care for
behavioral health is a huge area of focus for DOH. The
department has talked about the issue with committee members,
stakeholders, and communities statewide. There is a lot of work
happening on the topic of continuum of care. She spoke to three
programs with distinct populations.
- The Comprehensive Integrated Mental Health Program Plan is
reviewed and updated every five years. The program looks for
available services, gaps in service, and planning for the future
of all Alaskans regardless of needs or age.
- Inside of the comprehensive program resides the Behavioral
Health Roadmap for Alaska Youth. DOH again connected with
communities to learn specific needs, identify solutions, and
determine how to integrate the solutions into a statewide plan.
- The roadmap considers the Department of Justice Report issued
a year ago. The report focuses on Medicaid eligible Alaska Youth
at risk for institution.
She added DOH also focuses on complex care that spans all ages
but includes individuals who have co-occurring needs across
multiple divisions or departments.
4:37:59 PM
At ease
4:38:30 PM
CHAIR WILSON reconvened the meeting.
4:39:07 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Committee meeting at 4:39 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| DOH Department Overview 1.18.24.pdf |
SHSS 1/18/2024 3:30:00 PM |
Department of Health Overview 1.18.24 |