SENATE BILL NO. 199 "An Act providing for a two-year funding cycle for medical assistance coverage for dentures." 9:28:08 AM Senator Ellis shared a story about a gentleman who visited his office and threatened to commit suicide following a negative interaction with employees at the Medicaid Dental Program. The interaction was negative because of statutes and regulations concerning dentures and the Medicaid Dental Program. The gentleman qualified for dentures under the Medicaid Dental Plan, but was told that he had to choose to have either his upper or lower dentures installed. To this person, the situation was of dire concern as he was unable to chew with only one set of dentures. The bill allows patients to forward fund the complete set of dentures versus waiting two years for the entire set of dentures. Senator Ellis explained that studies have shown that if the government helps people with dental health expenses, expensive fiscal health problems are prevented. Allowing patients to receive a full set of dentures during the same fiscal year is crucial for oral health and will reduce the impact on Medicaid patients and Alaska's dentists. The bill allows patients who are eligible for dentures under the Medicaid Adult Dental Program to forward fund the complete set of dentures. Current law limits patients to $1150 in preventative or restorative services. The bill does not increase eligibility for the total amount of benefits, it simply allows them to access the funding they would have received the next fiscal year to complete a procedure in a cost effective manner. 9:33:45 AM JON SHERWOOD, DIRECTOR, OFFICE OF PROGRAM REVIEW, DEPARTMENT OF HEALTH AND SOCIAL SERVICES (DHSS), stated that the department conceptually approves of the legislation. The department agrees that it is best for patients to receive two sets of dentures in the same appointment. If the legislation passes, patients would receive both sets of dentures in the same year. He acknowledged that the current system does not always work. The department does project that the expenditures will increase as most people will address denture needs in the first few years. The department projects costs of approximately $900 thousand in the first year, with $300 thousand from general funds. The second year projection includes $467 thousand in the second year with $200 thousand from general funds. Administrative costs include automating the two year limit. He expressed concerns about the automation prior to freezing the claims processing system, which requires one position for one year if manual tracking is required. 9:37:53 AM Co-Chair Stedman expressed concern about the fiscal note and the positions needed. Potential positive fiscal effects also exist as savings for people traveling from rural areas to receive dentures. Mr. Sherwood added that if system changes were implemented prior to the freeze, then the new position is not necessary, which would reduce the cost. He spoke about research to identify means of quantifying potential savings. He stated that the department did not see many travel expenses associated with providing a second set of dentures. Some expenses incurred are the result of emergency room visits. He stated that the department lacked data about potential savings for the state. Senator Thomas commented on the fiscal notes. He requested further estimates of state expense. He asked about contractual agreements for the department's electronic changes. Mr. Sherwood responded that the department contracts with the Affiliated Computer Systems (ACS) for the operation of the current claims processing system. Senator Thomas asked if the technical changes were made in conjunction with dental offices. Mr. Sherwood answered that the changes would happen on a technical level. The new system will track expenditures over two years, but will not affect the interaction with dental offices. Senator Thomas hoped to recruit insight from the dental practitioners about the filing of claims. Mr. Sherwood responded that the change is internal and does not affect the interface with dental offices. 9:44:26 AM Co-Chair Stedman asked if the administration has a position on the bill. Mr. Sherwood stated that SB 199 is under consideration by the administration, although a position is not currently stated. Co-Chair Stedman reviewed the fiscal notes. 9:45:42 AM DAVID LOGAN, ALASKA DENTAL SOCIETY spoke in favor of the legislation. He opined that the bill is appropriate for many reasons. The bill serves patients and dentists. He addressed the medical cost of removing damaged teeth. He explained that multiple trips are often required for the construction of dentures. He noted that travel costs often dwarf the denture expenditures. He shared a professional story. He pointed out that SB 199 allows rehabilitation for those patients in need of both upper and lower dentures. 9:50:01 AM Senator Thomas compared the dental and the billing procedures. Dr. Logan pointed out that the procedure requires molds and dentures constructed at the same time. He recalled a meeting with the Medicaid Dental Program allowing insight into the process of claims and billing. He thought that potential problems are yet unknown for the dental society. MARK PRATOR, ALASKA DENTAL SOCIETY, WASILLA, spoke in favor of the legislation. He stated that he does accept Medicaid. He pointed out that he donates approximately half of his fee for the denture procedure, in order to be able to provide the service for the fee provided by Medicaid. He acknowledged that the cost of travel increases each time a person travels for an appointment. He also saw savings in emergency room visits. In the past, he has remade entire sets of dentures as one set must fit well against the other. Co-Chair Stedman asked if the department planned to take a positive or negative position on the bill. Mr. Sherwood noted that the administration's position has not been established. Co-Chair Stedman encouraged the administration look at the bill with consideration. Senator Thomas urged the administration to address SB 199 during this session for the benefit of the patients and the state. Senator Huggins encouraged the department to consider the legislation. 9:58:37 AM Senator Ellis stated that governor Murkowski brought adult dental Medicaid. The end of the sunset led to the cost savings intention, but he opined that it was not well thought out. He expressed desire to work with the department. He opined that the cost control measure was ill advised. SB 199 was HEARD and HELD in Committee for further consideration.