HOUSE BILL NO. 127 "An Act relating to the practice of dental hygiene; establishing an advanced practice permit; prohibiting unfair discrimination under group health insurance against a dental hygienist who holds an advanced practice permit; relating to medical assistance for dental hygiene services; and providing for an effective date." 1:36:59 PM Co-Chair Johnston invited the bill sponsor to the table. REPRESENTATIVE IVY SPOHNHOLZ, SPONSOR, reported that the bill created an advanced practice permit which would allow dental hygienists to provide care for underserved populations at senior centers, healthcare facilities, day cares and schools. Dental hygienists would be allowed to provide care to Alaskans who were eligible for Public Assistance, home bound, or lived in an underserved community. The permit would be available for dental hygienists who had a minimum of 4000 hours of clinical experience and who were approved by the Alaska Board of Dental Examiners. Alaska would not be the first state to make such changes. Dental hygienists practiced under advanced practice permits or similar permits in six other states. She reported that 40 other states were considered "direct access" states meaning that dental hygienists could initiate treatment based on their assessment of a patient's need without the authorization or the presence of a dentist. 1:38:31 PM Co-Chair Johnston OPENED Public Testimony. 1:38:45 PM DOMINIC WENZELL, DENTIST AND BOARD MEMBER, ALASKA BOARD OF DENTAL EXAMINERS, ANCHORAGE (via teleconference), reported that the board agreed the bill addressed the concerns it initially had with the original Senate version. Members of the board supported HB 127 in its current form. 1:39:55 PM KATRINA VIRGIN, PRESIDENT, ALASKA DENTAL HYGIENISTS ASSOCIATION, KODIAK (via teleconference), supported the advanced practice permit. The association had seen a great demand across the state that needed to be filled. The dental hygienists would like to be able to practice to the extent of their licensure and abilities. 1:40:38 PM Co-Chair Johnston CLOSED Public Testimony on the bill. She indicated individuals from the Department of Health and Social Services (DHSS) were available online to address questions regarding the fiscal note. Representative Tilton referenced the fiscal note with an OMB component number of 3234 and cited the cost related to the implementation into the Alaska Health Enterprise System of $250,000. She asked for an explanation of the cost. MELISSA HILL, ADMINISTRATIVE OPERATIONS MANAGER, DIVISION OF HEALTH CARE SERVICES, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, ANCHORAGE, reported that a portion of the costs were related to hours needed to work on the adjudication and payment process. The division needed to add the billing provider, as it was new to the system. The cost was approximately $187,000. Once the billing provider was added to the system, a provider change would be necessary and would take about 600 hours to complete and cost approximately $63,000. Co-Chair Johnston asked about the fiscal note for HB 127 in comparison to the fiscal notes for SB 105 related to the Marital and Family Therapist (LMFT) licenses and SB 134 for licensed professional counselors. The fiscal notes for both Senate bills were $50,000 compared to $63,000 for HB 127. She queried the difference. Ms. Hill responded that the current legislation created a brand-new provider type. The previous programs could be billed under a health group. If the division was only doing a provider type change it took about 600 hours to do the work which cost about $50,000 previously. However, the contractor's cost per hour increased. 1:44:17 PM RENEE GAYHART, DIVISION DIRECTOR, HEALTHCARE SERVICES, DEPARTMENT OF HEALTH AND SOCIAL SERVICES (via teleconference), reported that there was a price increase on the modification hours with the contractor which was the difference between the cost in the previous year of $50,000 with the LMFTs and the cost of $63,000 for licensed professional counselors. The claims related to both would be adjudicated through the newly established ASO with Optum, their behavioral health claims. The only cost to and through the Healthcare Services fiscal agent was the enrollment component. The division would not be doing the adjudication, so the price was not included. However, the division would be doing the claims adjudication for the dental hygienists under their new provider type. Representative Wool asked if 600 hours of programming was the standard every time a provider type was added into the system. Ms. Hill responded affirmatively. Representative Wool asked if it was an industry standard, or whether the software was particularly cumbersome. Ms. Gayhart replied that the division had the system in place with Conduent, the division' fiscal agent since 2013. New provider types were rarely added to the system. Often, they were added as rendering providers affiliated to a provider. She confirmed that the cost was an industry standard for implementing a new provider type or I.D. She confirmed that $63,000 was standard for adding the enrollment component. The work included completing all of the related hard coding for the system to accept a new provider type. Representative Wool asked about the additional amount of $180,000. Ms. Gayhart responded that the amount was related to claims adjudication. She explained further that the dental hygienists were currently paid under a dental provider's number. They had a subset of codes they could provide for cleaning and other services. Claims adjudication ensured that as claims came through the system, they edited to ensure that the particular provider type was able to bill for the codes and were paid correctly. Claims adjudication built logic into the system to pay claims appropriately and to deny claims that should not be paid. Representative Wool asked if behavioral health was easier to enter into the system because it had fewer codes. He asked if he was accurate. Ms. Gayhart indicated that was because the particular claims would be run through the administrative service organization or Optum. They were not paid through the MMIAS which was Conduent, the fiscal agent that the dental hygienists would be under. She continued to explain that the LMFTs and the licensed professional counselors were being paid through a different system. 1:49:34 PM Vice-Chair Ortiz was aware the bill was for the purpose of better-serving underserved folks. He wondered about driving down other costs. Representative Spohnholz reported it was difficult to predict cost savings that would result from the bill. However, with folks getting more preventative care, they would likely need less surgeries and removals and have fewer cavities which would, in turn, lead to a savings for the state in the future. There was a value in preventative dental care verses only urgent and treatment related dental. Looking at preventative dental as a whole saved the state money. She hypothesized that by increasing access to preventative dental care, the state would save money down the road. Vice-Chair Ortiz asked his question because of the communities on the list that he was aware already had dentists providing care including the Ketchikan Indian Community Tribal Health Clinic. Representative Spohnholz indicated that the practitioner would be paid less and cost the state less. Representative Wool noted Representative Spohnholz asserting that the state would save money in the long run. He asked, in an underserved area without basic dental hygiene care, if hygienists would find several problems in patients that would require a dentist's intervention. He spoke of his personal experience discovering larger problems during routine dental services. He wondered if the sponsor had anticipated or accounted for such scenarios. Representative Spohnholz suspected there might be an initial short-term upswing in care from a dentist. However, in the end it would likely cost the state less. Co-Chair Foster commented that he supported the bill. He relayed that the local hospital in Nome, Norton Sound Health Corporation, served 15 villages in the region and supported the bill. Co-Chair Johnston indicated amendments were due on March 9, 2020 by 5:00 p.m. HB 127 was HEARD and HELD in committee for further consideration.