SENATE BILL NO. 285                                                                                                        
     "An Act  relating to medical  assistance coverage for  targeted                                                            
     case  management  services  and  for  rehabilitative   services                                                            
     furnished  or  paid  for by  a  school district  on  behalf  of                                                            
      certain children; and providing for an effective date."                                                                   
                                                                                                                                
                                                                                                                                
This  was the first  hearing  for this  bill in  the Senate  Finance                                                            
Committee.                                                                                                                      
                                                                                                                                
Co-Chair  Wilken explained  that this legislation  would expand  the                                                            
definition  of  the  Department  of  Health   and Social   Services'                                                            
Targeted  Case  Management  services  as  they  relate  to  Medicaid                                                            
payments.  He noted  that the  proposed  changes could  result  in a                                                            
general funds savings of $270,000.                                                                                              
                                                                                                                                
JACQUELINE TUPOU,  Staff to Senator Lyda Green, the  bill's sponsor,                                                            
specified that  this bill would address two things:  first, it would                                                            
expand   the  Department's   authority  to   expand  Targeted   Case                                                            
Management  Services beyond the currently  specified three  targeted                                                            
groups;  and  second,  it would  align  the  State's  definition  of                                                            
school-based  rehabilitative services  with the federal definition.                                                             
These changes, she continued  would allow the State to be reimbursed                                                            
for expenditures associated with those services.                                                                                
                                                                                                                                
Co-Chair Green reminded  the Committee that separate legislation has                                                            
been  adopted  that  allowed  school  districts   to  be  registered                                                            
Medicaid  vendors. Continuing,  she  stated that  in the process  of                                                            
implementing that  legislation, the Department of  Health and Social                                                            
Services  was  informed  by the  federal  program  that one  of  its                                                            
definitions  "was  weak." This  legislation,  she  continued,  would                                                            
strengthen that [unspecified]  definition so that, in the future, "a                                                            
great deal  of income" could  be provided  to school districts  that                                                            
choose to participate.                                                                                                          
                                                                                                                                
Co-Chair  Wilken   stated  that  this  legislation  could   generate                                                            
millions of dollars.                                                                                                            
                                                                                                                                
Senator  Bunde  noted  that  a zero  fiscal  note  accompanies  this                                                            
legislation because the  savings were calculated with the previously                                                            
adopted legislation.  He declared  that the program could  result in                                                            
the receipt of several hundred million dollars.                                                                                 
                                                                                                                                
Co-Chair  Wilken recalled  that the  amount would  be approximately                                                             
$4.5 million.  He asked for confirmation  that the federal  money in                                                            
question would  remain in the school districts' budgets  rather than                                                            
being provided to the State.                                                                                                    
                                                                                                                                
Co-Chair Green stated that  the funds would result in a net increase                                                            
to  school  districts'   budgets.  She  specified   that  while  the                                                            
Department  of Health  and  Social Services  and  the Department  of                                                            
Education  and Early Development  would assist  school districts  in                                                            
the process,  this legislation  would strengthen  the targeted  case                                                            
management definition  so that districts' could receive  the federal                                                            
cooperation.                                                                                                                    
                                                                                                                                
JON SHERWOOD,  Department of Health  and Social Services,  concurred                                                            
that  the   school-based  services   legislation  would   result  in                                                            
approximately  $4.5 million in new federal funding  once the program                                                            
is fully operational. This  legislation, he continued, would resolve                                                            
the problem  with  the Statute  definition involving  Targeted  Case                                                            
Management   to  include  additional   targeted  groups,   which  he                                                            
attested, would include groups already being served.                                                                            
                                                                                                                                
Co-Chair  Wilken  asked when  the  corresponding  State regulations                                                             
would be completed  as, he pointed out, that is required  before the                                                            
school districts could move forward.                                                                                            
                                                                                                                                
Mr. Sherwood understood  that the regulations should be available by                                                            
the start of  the upcoming school  year. However, he clarified  that                                                            
not all school districts  would be ready at that time as development                                                            
of  program  support  such  as  billing  systems,  could  take  some                                                            
districts additional  time. He also  noted that federal approval  of                                                            
the State plan is also required.                                                                                                
                                                                                                                                
Co-Chair Wilken asked for examples of Targeted Case Management.                                                                 
                                                                                                                                
Mr.  Sherwood  exampled  that,  in  addition  to  the  school  based                                                            
services,  other qualifying  services  include:  families  receiving                                                            
Family and  Preservation Services  through the Office of  Children's                                                            
Services;  some  of the  work  conducted  by public  health  nurses;                                                            
people in  the Infant Learning  Program; and  some of the people  in                                                            
Juvenile Justice who are  in community placement as opposed to being                                                            
housed  in a State  facility which  would make  them ineligible  for                                                            
Medicaid.                                                                                                                       
                                                                                                                                
Co-Chair  Green   moved  to  report  SB  285  from  Committee   with                                                            
individual recommendations and accompanying fiscal notes.                                                                       
                                                                                                                                
There being  no objection, SB 285  was REPORTED from Committee  with                                                            
zero  fiscal notes  #1  and #2,  dated January  28,  2004, from  the                                                            
Department of Health and Social Services.