SB 366: An Act relating to medical support for children; allowing a member of the teachers' retirement system or the public employees' retirement system to assign to a Medicaid-qualifying trust the member's right to receive a monetary benefit from the system; relating to the effect of a Medicaid-qualifying trust on the eligibility of a person for Medicaid; relating to the recovery of certain Medicaid payments from estates and trusts; requiring persons who receive Medicaid services to be liable for sharing in the cost of those services to the extent allowed under federal law and regulations; and providing for an effective date. David Skidmore, aide to Senator Frank, spoke to the bill. Jon Sherwood, Medical Assistance Adminis-trator, Division of Medical Assistance, Department of Health & Social Services, answered questions regarding the bill. Amendments 1 and 2 had been ADOPTED in a previous meeting. Amendments 5, 6, 7, and a letter of intent were ADOPTED. SB 366 was REPORTED OUT of committee with individual recommendations and three fiscal notes for the Department Health & Social Services: Claims Processing - $130.0, Medicaid Facility - $(550.0), and Medicaid Non-Facility - $(799.1). SENATE BILL NO. 366: An Act relating to medical support for children; allowing a member of the teachers' retirement system or the public employees' retirement system to assign to a Medicaid-qualifying trust the member's right to receive a monetary benefit from the system; relating to the effect of a Medicaid-qualifying trust on the eligibility of a person for Medicaid; relating to the recovery of certain Medicaid payments from estates and trusts; requiring persons who receive Medicaid services to be liable for sharing in the cost of those services to the extent allowed under federal law and regulations; and providing for an effective date. Co-chair Frank announced that SB 366 was before the committee. He noted that amendments 1 and 2 had previously been ADOPTED in a prior meeting. He invited David Skidmore, his aide, to speak to the bill and several new amendments. DAVID SKIDMORE said that amendment 5 created a new section imposing a co-payment requirement for inpatient hospital services of $50 a day, up to a maximum of $200. He said that was the same co-payment policy under Alaska's general relief medical program. Senator Sharp MOVED amendment 5. No objection being heard, it was ADOPTED. Senator Rieger said he would like to propose amendment 6 but felt it did not exactly mirror the letter of intent. In answer to Co-chair Frank, Senator Rieger said intent language read "to the maximum extent allowed under federal law." Co-chair Frank supported the amendment and felt it was not inconsistent with the intent language. JON SHERWOOD, Medical Assistance Administrator, Division of Medical Assistance, Department of Health & Social Services, said that seeking a waiver would be permissible under federal law. He felt the department would not have a problem with either the letter of intent or amendment 6. He said he would let the committee know this afternoon if the department had received any waivers. Senator Rieger MOVED amendment 6. Co-chair Frank suggested that language be added requiring a report to the legislature. Senator Rieger said it was his intent to reduce reports to the legislature. Co-chair Frank withdrew his proposed language. No further objection being heard, amendment 6 was ADOPTED. Senator Rieger said that there was a need on the part of the department to use discretion in regard to waivers. He felt the intent language would be important. Senator Rieger MOVED amendment 7. He said the utilization review the department used needed to be evaluated and this amendment authorized that. It also gave a case manager authorization to approve optional services without following the priority listing in order to design a more cost effective program. Mr. Sherwood said that presently case management ideas were being considered and evaluated. Any case management would require case managers. Senator Rieger felt that the state would be far ahead if it put $1M of general funds into fund case management and, in turn, received $3M from the feds. Mr. Sherwood agreed there was a 75 percent match when professional case management was used. End SFC-93 #59, Side 1 Begin SFC-93 #59, Side 2 Discussion was had by Senators Sharp, Rieger, and Co-chair Frank regarding pre-authorization, the priority listing and optional services. Senator Rieger informed the committee that the legislature did not determine which items were on the priority list, but was decided by the department after budget funding. In answer to Senator Sharp, Senator Rieger doubted there was any integrity to the priority list and money could be saved by being able to choose a less expensive service that appeared lower on the priority list. Hearing no objection, amendment 7 was ADOPTED. Senator Sharp MOVED the letter of intent adding language that said "a report shall be made to include a listing of waivers sought from the federal government and an indication of those granted." No objection being heard, the letter of intent as amended was ADOPTED. Senator Sharp MOVED for passage of CSSB 366(FIN) as amended from committee with individual recommendations. No objection being heard, it was REPORTED OUT of committee with individual recommendations, a zero fiscal note for the Department of Commerce & Economic Development, and fiscal notes for the Department of Health & Social Services as follows: Claims Processing-$130.0, Medicaid Facilities- $(550.0), and Medicaid Non-facilities-$(799.1). Co-chair Frank and Senator Rieger signed "do pass." Senators Sharp, Jacko, Kelly and Kerttula signed "no recommendation."