HB 343-SCHOOL DISTRICT MEDICAL ASSISTANCE  3:30:57 PM CHAIR PRAX announced that the next order of business would be HOUSE BILL NO. 343, "An Act relating to medical assistance coverage for rehabilitative, mandatory, and optional services furnished or paid for by a school district on behalf of certain children." 3:31:39 PM HEIDI HEDBERG, Commissioner, Department of Health, on behalf of the bill sponsor, House Rules by request of the governor, introduced HB 343. She said the proposed legislation would improve access to school-based services "for all eligible Medicaid children." It would remove statutory [language] that limits access to those services. She said HB 343 would provide more convenient choices for parents seeking care for their children and increase flexibility for schools seeking Medicaid reimbursement for eligible children. She turned to Emily Ricci and Leah Van Kirk to offer a presentation. 3:32:45 PM EMILY RICCI, Deputy Commissioner, Department of Health, on behalf of the bill sponsor, House Rules by request of the governor, co-offered a PowerPoint presentation [hard copy included in the committee packet] during the hearing on HB 343. She began on slide 3, which read as follows [original punctuation provided, with some formatting changes]: Medicaid can only reimburse for school-based services if the child has a disability and the services are included in the student's individualized education plan (IEP). Only 6 out of 54 school districts currently submit claims for Medicaid reimbursement. Speech, Occupational, and Physical Therapy make up 96 percent of reimbursed services. MS. RICCI explained that within the federal umbrella are state- supported services for children in a school-based setting. She noted that the services that districts can bill Medicaid for to receive reimbursement are limited within the smaller set of services outlined in the state plan. They are limited to services available through a student's individualized educational plan (IEP). She said this creates challenges for school districts. She said HB 343 addresses one administrative barrier; others are being addressed by the department with stakeholders. She named the districts currently submitting claims for Medicaid reimbursement: Anchorage, Delta/Greely, Fairbanks, Juneau, Ketchikan, and Matanuska-Susitna (Mat-Su). MS. RICCI turned to slide 4, "Healthy Families Initiative" - the governor's initiative - which focuses on "Healthy Beginnings," "Health Care Access," and "Health Care Communities." She said HB 343 focuses on improving and increasing access to care for students. She turned the presentation over to Leah Van Kirk. 3:36:49 PM LEAH VAN KIRK, Healthcare Policy Advisor, Department of Health, on behalf of the bill sponsor, House Rules by request of the governor, co-offered a PowerPoint presentation [hard copy included in the committee packet] during the hearing on HB 343. She touched upon slide 5, regarding what HB 343 would do, and she echoed that it would improve access for students that can receive school-based services. It would allow schools to bill for Medicaid services without having those services included in the IEP. She said the bill would create opportunities to provide services to children that may not need an IEP. Further, HB 343 would provide an option, not a mandate. She said if a parent cannot find services in the community, they may be able to access those services in the school. 3:39:38 PM MS. RICCI continued with slide 8, "Benefits to Alaskans," and talked about early intervention and prevention and avoiding emergency room visits or acute level of care. She said the department sees HB 343 as reducing administrative burden and maximizing the federal Medicaid match. MS. VAN KIRK drew attention to slide 9, "Why now?," and said that by reducing the administrative burden on schools, they would be more likely to deliver school-based services. She said 25 states thus far have "reduced the requirement" and provide services to those who do not have a disability or have an IEP. She indicated that after removing statutory barriers via HB 343, the next step would be to engage stakeholders and identify methodologies that work for school districts. She made note of letters of support that had been received. She stated that DOH is applying for a grant to support efforts. MS. RICCI added that the process of speaking with stakeholders is beginning, and removing the statutory provision is essential to that process. 3:45:00 PM MS. RICCI, in response to a question from Chair Prax, said she is not certain how many of the six aforementioned districts utilize school staff to provide services, but she has seen them contract with outside providers "to come in and offer services in the school setting." 3:47:49 PM MS. RICCI, in response to a question from Representative Mina about the second paragraph of one of the fiscal notes, offered her understanding that the reference to an increase of 50 percent refers to current participation. She added that the department sees this as a long process with incremental growth. In response to Representative Saddler, she further clarified that 50 percent pertains to the number of children in school districts. 3:49:35 PM MS. RICCI, in response to Chair Prax, indicated that a work group would figure out a flexible system that includes the needs of smaller school districts. 3:50:28 PM MS. RICCI next covered the sectional analysis of HB 343, on slide 11, which read as follows [original punctuation provided]: Sectional Analysis Section 1 This section removes the requirement that Medicaid services provided in a school setting are limited to those covered under an Individual Education Plan (IEP) 3:51:10 PM CHAIR PRAX open public testimony on HB 343. 3:51:35 PM TREVOR STORRS, President & CEO, Alaska Children's Trust (ACT), testified in support of HB 343. He thanked the governor and DOH leadership for taking this step to increase health care access for children. He explained that ACT supports policies that promote the health and wellbeing of Alaska's children. He talked about the importance of ensuring that families have access to the knowledge, skill, support, and resources to thrive. He echoed the statements of the presenters about the current status for reimbursement and said HB 343 would allow schools to be reimbursed for services provided to all students eligible for Medicaid. He emphasized that the expansion of school-based Medicaid services would support families by providing opportunities for parents to access health services for their children, increase the convenience for the families seeking that care, and promote parent-directed services within the school setting. Further, he echoed that increasing services would encourage early intervention and prevention. He spoke about the flexibility and support for Alaska communities that would result from HB 343. 3:54:17 PM CHAIR PRAX, after ascertaining there was no one else who wished to testify, close public testimony on HB 343. 3:55:22 PM MS. RICCI, in response to a question from Representative Saddler regarding whether there would be an increase in positions such as therapists in each school rather than one that travels from school to school indicated that would be up to each school to decide based on the needs of students and what the community can support. In response to follow-up question regarding the cost to the state, she said the services will be built up over time, and she noted these are not additional services but an additional setting in which existing services can be provided. Overall, she said, the department does not believe that HB 343 would result in additional cost to the Medicaid component. She explained that the department thinks of this as a cost shift, not an expansion of services. 3:58:46 PM REPRESENTATIVE FIELDS gave his interpretation of the presentation that instead of a parent taking their child to a Medicaid covered appointment after school, they could take them to the appointment at the school, and this could be a more efficient system but is not necessarily "more care." CHAIR PRAX announced that HB 343 was held over.