ALASKA STATE LEGISLATURE  HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  March 21, 2020 9:03 a.m. MEMBERS PRESENT Representative Tiffany Zulkosky, Chair Representative Ivy Spohnholz, Vice Chair Representative Matt Claman Representative Harriet Drummond Representative Geran Tarr Representative Sharon Jackson (via teleconference) MEMBERS ABSENT  Representative Lance Pruitt OTHER LEGISLATORS PRESENT Representative Louise Stutes COMMITTEE CALENDAR  OVERVIEW: PUBLIC ASSISTANCE & MEDICAID SERVICES COVID-19 RESPONSE - HEARD PREVIOUS COMMITTEE ACTION  No previous action to record WITNESS REGISTER ALBERT WALL, Deputy Commissioner Office of the Commissioner Department of Health and Social Services Juneau, Alaska POSITION STATEMENT: Answered questions during the informational hearing on Medicaid Services and Public Assistance programs. SHAWNDA O'BRIEN, Director Director's Office Division of Public Assistance Department of Health and Social Services (DHSS) Juneau, Alaska POSITION STATEMENT: Answered questions during the informational hearing on Medicaid services and public assistance programs. ACTION NARRATIVE 9:03:42 AM    CHAIR TIFFANY ZULKOSKY called the House Health and Social Services Standing Committee meeting to order at 9:03 a.m. Representatives Zulkosky and Claman were present at the call to order. Representatives Drummond, Tarr, Spohnholz, and Jackson (via teleconference) arrived as the meeting was in progress. Also in attendance was Representative Stutes. ^OVERVIEW: Public Assistance & Medicaid Services COVID-19 Response OVERVIEW: Public Assistance & Medicaid Services COVID-19  Response  9:04:18 AM CHAIR ZULKOSKY announced that the only order of business would be an Overview on Public Assistance & Medicaid Services COVID-19 Response by the Department of Health and Social Services. 9:05:01 AM ALBERT WALL, Deputy Commissioner, Office of the Commissioner, Department of Health and Social Services (DHSS), began the overview on Public Assistance & Medicaid Services COVID-19 Response. He said simultaneous efforts were taking place regarding safety and modification of systems while providing access to health care during [the pandemic]. The department's Emergency Operations Center (EOC) efforts were ongoing, with twice-daily meetings headed by Chief Medical Officer Anne Zink and Director of the Division of Public Health within DHSS Heidi Hedberg. He said EOC put out alerts and advisories from the Office of the Governor. Mr. Wall spoke to the department's relaxation of those policies which impeded quality of care, such as requirements around background checks in licensure for certified nursing assistants (CNAs), for the purpose of speeding up the licensure process and ensuring a supply of health care providers. While people are in isolation, telehealth is also a priority, he related: efforts by the director of the Division of Health Care Services and the director of the Division of Behavioral Health to determine from where health care originated would relax the medium through which healthcare could be provided, adding audio and visual components that had not been tested to this extent. The third policy change focused on the elderly population on Medicaid. 9:09:49 AM MR. WALL said the effort was being led by John Lee, Director of Senior and Disabilities Services. In order to implement the federal requirements for change, Mr. Wall stated, an appendix, or emergency response, to the waiver must be put together. He said an application for the waiver had been made at the time of his testimony and DHSS was waiting to hear back from the [federal] Centers for Medicare & Medicaid Services (CMS). He said he would provide changes to the committee when the waiver was accepted by CMS. The final policy change was an 1135 waiver, under a section of Medicaid that allowed for emergency regulatory change during times of pandemics and disaster. The 1135 was last activated during the earthquake, he said. The waiver was still being drafted, he stated, and it would be submitted to the committee as well. 9:13:13 AM REPRESENTATIVE SPOHNHOLZ asked about the 1915K waiver. MR. WALL replied it was an appendix to a C waiver, which is what all senior disability services were provided through Medicaid, and the K appendix is the emergency appendix that went to the C waiver. 9:14:08 AM REPRESENTATIVE TARR asked how the emergency regulatory change on the 1135 waiver would be used. MR. WALL replied that every area of service would be covered, such as allowing the use of tents in parking lots rather than requiring people receive care in a building. In response to a request for more information on the 1135 waiver services, he offered to send a summary sheet. 9:17:05 AM CHAIR ZULKOSKY reviewed considerations regarding bolstering provider workforce when looking at the federal Medicaid guidelines regarding public health crisis response: temporarily waiving screening requirements including the payment of application fees, background checks, and site visits; ceasing revalidation of providers located in state or otherwise directly impacted; temporarily waiving requirements for out-of-state providers to be licensed in-state; and allowing facilities to provide services in an alternate setting. She then asked whether the considerations were being made in Alaska because the state foresaw a possible increase in Medicaid-eligible individuals. MR. WALL confirmed that a comprehensive letter had been written including the four considerations, and a response was anticipated presently. He reiterated that "pretty much anything having to do with access to care" was included in the 1135 waiver. CHAIR ZULKOSKY asked about the intersection of Mr. Wall's work with DHSS and EOC. MR. WALL replied that until an actual state of emergency is declared, EOC is somewhat dormant and runs training missions. He added that EOC had footholds in the Department of Military & Veterans' Affairs (DMVA) as well as "homeland security," so when emergency was declared EOC worked with DHSS to respond. He added that EOC was also connected to the Federal Emergency Management Agency (FEMA) to provide protective equipment and, in some cases, personnel. 9:20:39 AM CHAIR ZULKOSKY asked Mr. Wall about his work in relation to the efforts of the EOC regarding Medicaid services in Alaska considering COVID-19. MR. WALL said they met at least twice daily to exchange information and contacts. CHAIR ZULKOSKY asked Mr. Wall to speak to DHSS's efforts regarding additional benefits currently not in the state plan, such as waiving prior authorization requirements. MR. WALL said DHSS had asked to waive various specific ongoing monthly checks so that administrative burdens could be alleviated and the focus remain on actual care. CHAIR ZULKOSKY asked for updates regarding availability of personal protective equipment (PPE) in Alaska. MR. WALL replied that many PPE manufacturers were in China, but EOC and DHSS were working on the issue. 9:24:57 AM REPRESENTATIVE TARR opined that something more aggressive should be done regarding travel, especially regarding International travelers and passengers transiting through Seattle-Tacoma International Airport, and she asked Mr. Wall whether he had any updates. MR. WALL responded that the issue was discussed by DHSS on a daily, if not hourly, basis, and he would provide the committee with a specific statement from Dr. Anne Zink on the matter. REPRESENTATIVE TARR suggested that the American Red Cross could be passing out information or doing temperature screenings at airports. She offered more suggestions on getting information to the public. MR. WALL offered to supply a specific writeup of all the efforts in that area, including "the public messaging piece" and screenings. 9:27:49 AM CHAIR ZULKOSKY expressed her agreement with Representative Tarr and implored Mr. Wall to continue to advocate within DHSS. She also mentioned recent epidemiology studies which showed Alaska had less than eight days to shut down the state before the possibility of becoming overwhelmed with hospitalizations. 9:29:08 AM REPRESENTATIVE DRUMMOND referenced a radio interview with Rorie Watt, City Manager for the City and Borough of Juneau (CBJ), during which Mr. Watt stated he was setting up volunteer screening at the Juneau International Airport, which is run by CBJ. Representative Drummond opined there also should be screening at the Ted Stevens Anchorage International Airport and at additional voluntary screening checkpoints. She said Alaska must take swifter action. 9:30:28 AM CHAIR ZULKOSKY said HB 206 had allocated $13 million to DHSS for response and mitigation efforts related to COVID-19. She related that the committee was aware some of these funds had been spent on public health nurses, epidemiologists, and microbiologists, and she asked Mr. Wall whether he knew how the remainder would be spent. MR. WALL replied that organizations that typically operated in a congregate setting were basically unfunded and would have to be modified. He said PPE would be ordered and more emergency staff would be hired. He remarked that the money would be used "in a variety of ways," and he said he would supply a list of what the expenditures would be. He added that a small amount would be a contingency fund. 9:32:50 AM REPRESENTATIVE TARR asked what additional resources needed to be provided in terms of public health education and screening, because there was still funding available. MR. WALL said he would defer to Dr. Anne Zink for the response. 9:34:00 AM REPRESENTATIVE JACKSON asked for confirmation that Mr. Wall would provide the committee with the list of important numbers he had mentioned. MR. WALL confirmed he would supply the list. REPRESENTATIVE JACKSON asked for reconfirmation that nurses licensed in other states would have their licensure requirements suspended. MR. WALL replied that it must be determined whether services would be able to be provided in Alaska and how to pay for them. Mr. Wall said DHSS was working with Occupational Licensing on the issue. He added this was all in the 1135 waiver. REPRESENTATIVE JACKSON asked whether the information available at airports had been translated. MR. WALL said Dr. Anne Zink was the appropriate person to field this question as well, and he would provide her answer. 9:36:22 AM REPRESENTATIVE TARR said she had not seen the information translated but had personally sent materials to the Center for Disease Control (CDC) to be translated. She agreed translating information should be a high priority. 9:37:31 AM REPRESENTATIVE DRUMMOND said the Anchorage School District had language experts who may be able to help translate. MR. WALL said he called in to answer questions about Medicaid services, but DHSS may be able to provide a representative from EOC to answer questions on screening and the like. CHAIR ZULKOSKY replied that the committee did not wish to take those in emergency operations away from their efforts to answer legislative questions, but if needed they would circle back. 9:39:30 AM SHAWNDA O'BRIEN, Director, Division of Public Assistance (DPA), Department of Health and Social Services, shared a list of implementation efforts. Relaxing DHSS eligibility requirements and allowing clients to give information over the phone, thus avoiding in-person contact, were two major ones. She said Medicaid cases would not be closed due to eligibility requirements. She related that state regulations would be relaxed around recertification of eligible programs; if people were required to recertify or renew in March, April, May, or June, those periods would be extended for a period of six months. She added that DPA was working to balance employees' work and childcare needs. 9:44:17 AM REPRESENTATIVE TARR asked about payment for testing and whether folks were being charged. MR. WALL replied testing was covered under Medicaid. 9:45:45 AM CHAIR ZULKOSKY asked Ms. O'Brien for a list of the suspensions. MS. O'BRIEN said DPA had more approvals pending, and she said she would provide a list that would be updated daily. In response to a follow-up question, she said there had been no end date for the relaxation of work requirements; however, DPA was monitoring the situation. 9:48:40 AM CHAIR ZULKOSKY asked whether DPA was prepared for a sustained increase in demand on public assistance programs and what preparations had been put in place. MS. O'BRIEN replied there was enough funding for meeting the most immediate needs, and it had not been indicated DPA would lose federal funding. CHAIR ZULKOSKY asked whether there had been telecommuting mandates put forward to the teams handling the processes and steps taken to address a possible bottleneck in managing applications and eligibilities. MS. O'BRIEN replied that certain levels of leadership had telework agreements, especially those with health- or childcare- related issues. She added a certain number of staff needed to work from the office and the department was working daily to find the right balance. 9:52:16 AM CHAIR ZULKOSKY asked whether, while DHSS has considered relaxing eligibility requirements, there had been evaluation or guidance to increase the permitted amount of countable assets that would allow Alaska to expand eligibility to various programs. MS. O'BRIEN replied there had not been a lot of conversation with federal partners on the topic at the time of her testimony. 9:54:02 AM REPRESENTATIVE TARR asked whether a federal government payout would be under a similar provision as the hold harmless portion of the state permanent fund dividend (PFD). MS. O'BRIEN replied she was not aware of anything at the federal level which would impact program recipients. The focus was trying to keep folks eligible and to relax as many rules as possible to keep folks enrolled in programs. REPRESENTATIVE TARR said that if the federal government did a payout, then some folks could be kicked off their programs because of money received, and she said this should be avoided. She asked whether DHSS was doing anything for those seasonal workers whose work is reduced in the summer months, especially regarding the Alaska Temporary Assistance Program (ATAP) and Temporary Assistance for Needy Families (TANF). 9:58:58 AM MS. O'BRIEN answered that DHSS was prioritizing what was more urgently needed, such as preventing any loss of benefits. REPRESENTATIVE TARR said she feared disruption in income could lead to more homelessness. MS. O'BRIEN said external communications were still being put together. 9:59:42 AM REPRESENTATIVE JACKSON related a question from a dentist as to whether medical professionals could help in terms of public health screenings. MR. WALL replied that DHSS would gladly accept a network of professionals interested in helping. He added that interested parties were welcome to contact him directly via his cell phone. In response to Chair Zulkosky, he said anyone calling would be directed to the appropriate person for assistance. REPRESENTATIVE JACKSON asked whether a direct number could be provided. MR. WALL replied his cell phone number was (907)465-1610. 10:03:47 AM REPRESENTATIVE SPOHNHOLZ remarked that taking advantage of medical professionals' expertise would be in the best interest of the public. 10:04:59 AM MS. O'BRIEN, in response to a question from Chair Zulkosky about the status of the hold harmless provision, said DHSS had full funding and no programs had been reduced. CHAIR ZULKOSKY asked, in the absence of legislation providing statutory authority to DHSS for hold harmless, and if a federal stimulus check were to be provided to Alaskans, whether DHSS had considered being proactive in holding Alaskans harmless from that as a countable asset. MS. O'BRIEN replied that DHSS had not been given guidance on how to handle funds, but traditionally the department would not be considered hold harmless-eligible, because it was not under the PFD for Alaska. 10:07:04 AM ADJOURNMENT  There being no further business before the committee, the House Health and Social Services Standing Committee meeting was adjourned at 10:07 a.m.