SB 74-MEDICAID REFORM/PFD/HSAS/ER USE/STUDIES  1:31:12 PM CHAIR STEDMAN announced the consideration of SB 74. He noted that his staff, the sponsor's staff, and the Departments of Law and Health and Social Services have been working hard on the new CS for SB 74. REPRESENTATIVE KELLY moved to adopt the CS for SB 74, labeled 29-LS0692\I, as the working document. CHAIR STEDMAN objected for discussion. RANDY RUARO, Staff, Senator Bert Stedman, Alaska State Legislature, addressed the changes in version I of SB 74. He read from the following: The committee substitute for SB 74, version I, makes the following substantive changes: · Deletes Sections 1 and 3 of SB 74 related to health savings accounts and funding the accounts with 10% of a recipients permanent fund dividend. · As a conforming change, deletes language in Section 4 of SB 74 that would have put a sunset date on the health savings account provisions. · Adds a new Section 1 related to false claims for medical assistance and providing for a civil penalty to be imposed by either a court or an administrative agency and providing for enhanced damages to be awarded to the state. · Amends Section 2 of SB 74 to make a conforming change by deleting subparagraph (1) which related to health savings accounts and renumbering the remaining subparagraphs. · Amends Section 2, subparagraph (2) of SB 74 by adding language requiring the DHSS reform program to include referrals for career and education services. · Amends Section 2, subparagraph (4) of SB 74 by adding "behavioral health" to the list of services that telemedicine should be expanded to include. · Amends Section 2, subparagraph (9) of SB 74 by adding language providing that the payment process should be reformed by implementing fee agreements based on performance measures that include premium payments for centers of excellence and penalties for certain hospital related outcomes, such as hospital acquired infections, readmissions, and failures of outcomes. · Amends Section 2, of SB 74 by adding a new section (b) that requires the identify areas where access to telemedicine would be most effective and to coordinate with Indian Health Services providers where appropriate to gain access to telemedicine equipment. · Amends Section 2(b) of SB 74, the report section on reforms by changing the annual report due date from 10 days after session starts to October 15 of each year, and adds a number of subparagraphs in (4) - (13) that are designed to provide information to the legislature on the progress of reforms and other information relevant to management of the program. · Amends Section 2 of SB 74 by adding a new section (d) that is a definition of telemedicine. · Section 3 of version I relates to direction to the department on reducing use of emergency room services. This was Section 6 in the original version of SB 74. There was no change between the two sections other than numbering. · Section 4, the repeal section of SB 74 is deleted. It repealed the health savings account sections and the reform sections. While reform provisions are included in version I, they are not subject to sunset. · It is replaced with a new Section 4 relating to efforts at fighting fraud or waste of Medicaid funds and reporting the results to the Legislature. · Section 5 of SB 75, the section on managed care and a demonstration project using persons enrolled in Denali KidCare has been amended to be broader in scope in terms of both the types of actions the Commissioner can take and the population groups in Medicaid that can be included. This provides flexibility to the department to obtain the greatest possible coverage and savings. · The rest of the sections in the CS are not substantively different than SB 74 or are related to implementation of the bill, Section 7 (Medicaid Choice Waiver); Section 8 (Transition Regulations); Section 9 (Conditional Effect), and Sections 6, 7, 8 have an immediate effective date. 1:38:43 PM CHAIR STEDMAN withdrew his objection. There being no further objections, version I was adopted. SENATOR GIESSEL requested clarification of Section 2 on telemedicine and the cooperation with Indian Health Service (IHS) providers. She understood that IHS has been using telemedicine for several years. She asked if the bill suggests providing private sector access to the IHS structure and if non- beneficiaries would be charged for the service. MR. RUARO explained that the intent is more general than that. The IHS facilities have been building up telemedicine capacity over the years, whereas the state doesn't have it in some areas. The idea in Section 2 is to urge the department to work with IHS and take advantage of opportunities of sharing equipment and working together. 1:40:41 PM SENATOR GIESSEL summarized that it is more of a philosophical statement of working together, rather than a contract. MR. RUARO said that is correct; they anticipate that the department and IHS will work together. SENATOR GIESSEL thought that was realistic. She appreciated not duplicating services and costs. 1:41:57 PM SENATOR GIESSEL asked about new subsection (d) which includes a definition of telemedicine. She asked about other definitions of telemedicine in statute. MR. RUARO did not know of any other definitions of telemedicine. SENATOR GIESSEL said there are other definitions and she offered to compare them so they coincide. CHAIR STEDMAN held SB 74 in committee.