ALASKA STATE LEGISLATURE  HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  March 5, 2024 3:03 p.m. MEMBERS PRESENT Representative Mike Prax, Chair Representative Justin Ruffridge, Vice Chair Representative CJ McCormick Representative Dan Saddler Representative Jesse Sumner Representative Zack Fields Representative Genevieve Mina MEMBERS ABSENT  All members present COMMITTEE CALENDAR    HOUSE BILL NO. 343 "An Act relating to medical assistance coverage for rehabilitative, mandatory, and optional services furnished or paid for by a school district on behalf of certain children." - MOVED HB 343 OUT OF COMMITTEE HOUSE BILL NO. 344 "An Act relating to medical assistance demonstration projects established by the Department of Health." - MOVED HB 344 OUT OF COMMITTEE HOUSE BILL NO. 371 "An Act relating to medical review organizations; relating to the definitions of 'health care provider' and 'review organization'; and relating to the duties of the chief medical officer in the Department of Health." - MOVED HB 371 OUT OF COMMITTEE SENATE SPECIAL CONCURRENT RESOLUTION NO. 2 Disapproving Executive Order No. 125. - CONSIDERED HOUSE BILL NO. 196 "An Act relating to the supplemental nutrition assistance program; and providing for an effective date." - MOVED HB 196 OUT OF COMMITTEE PREVIOUS COMMITTEE ACTION  BILL: HB 343 SHORT TITLE: SCHOOL DISTRICT MEDICAL ASSISTANCE SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR 02/20/24 (H) READ THE FIRST TIME - REFERRALS 02/20/24 (H) HSS 02/27/24 (H) HSS AT 3:00 PM DAVIS 106 02/27/24 (H) 02/29/24 (H) HSS AT 3:00 PM DAVIS 106 02/29/24 (H) Heard & Held 02/29/24 (H) MINUTE(HSS) 03/05/24 (H) HSS AT 3:00 PM DAVIS 106 BILL: HB 344 SHORT TITLE: MEDICAL ASSIST. DEMONSTRATION PROJECTS SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR 02/20/24 (H) READ THE FIRST TIME - REFERRALS 02/20/24 (H) HSS 02/29/24 (H) HSS AT 3:00 PM DAVIS 106 02/29/24 (H) Heard & Held 02/29/24 (H) MINUTE(HSS) 03/05/24 (H) HSS AT 3:00 PM DAVIS 106 BILL: HB 371 SHORT TITLE: MEDICAL REVIEW ORGANIZATIONS SPONSOR(s): RUFFRIDGE BY REQUEST 02/20/24 (H) READ THE FIRST TIME - REFERRALS 02/20/24 (H) HSS 02/29/24 (H) HSS AT 3:00 PM DAVIS 106 02/29/24 (H) Heard & Held 02/29/24 (H) MINUTE(HSS) 03/05/24 (H) HSS AT 3:00 PM DAVIS 106 BILL: SSCR 2 SHORT TITLE: DISAPPROVE EO 125 SPONSOR(s): RULES 02/12/24 (S) READ THE FIRST TIME - REFERRALS 02/12/24 (S) HSS 02/15/24 (S) HSS AT 3:30 PM BUTROVICH 205 02/15/24 (S) Moved SSCR 2 Out of Committee 02/15/24 (S) MINUTE(HSS) 02/19/24 (S) HSS RPT 3DNP 2NR 02/19/24 (S) DNP: WILSON, DUNBAR, GIESSEL 02/19/24 (S) NR: TOBIN, KAUFMAN 02/19/24 (S) TRANSMITTED TO (H) 02/19/24 (S) VERSION: SSCR 2 02/20/24 (H) READ THE FIRST TIME - REFERRALS 02/20/24 (H) HSS 03/05/24 (H) HSS AT 3:00 PM DAVIS 106 BILL: HB 196 SHORT TITLE: FOOD STAMP PROGRAM ELIGIBILTY SPONSOR(s): MINA 05/08/23 (H) READ THE FIRST TIME - REFERRALS 05/08/23 (H) HSS, FIN 02/22/24 (H) HSS AT 3:00 PM DAVIS 106 02/22/24 (H) 02/24/24 (H) HSS AT 3:00 PM DAVIS 106 02/24/24 (H) Heard & Held 02/24/24 (H) MINUTE(HSS) 03/05/24 (H) HSS AT 3:00 PM DAVIS 106 WITNESS REGISTER EMILY RICCI, Deputy Commissioner Department of Health Juneau, Alaska POSITION STATEMENT: Answered committee questions on HB 343. LEAH VAN KIRK, Health Care Policy Advisor Department of Health Juneau, Alaska POSITION STATEMENT: Answered committee questions on HB 343. EMILY RICCI, Deputy Commissioner Department of Health Juneau, Alaska POSITION STATEMENT: Gave invited testimony during the hearing on HB 344. REPRESENTATIVE JUSTIN RUFFRIDGE Alaska State Legislature Juneau, Alaska POSITION STATEMENT: As prime sponsor, introduced HB 371 to the committee. HEIDI HEDBERG, Commissioner Department of Health Juneau, Alaska POSITION STATEMENT: Gave invited testimony on SSCR 2. GENE WISEMAN, Section Chief Rural Community Health Department of Health Anchorage, Alaska POSITION STATEMENT: Gave invited testimony on SSCR 2. REPRESENTATIVE GENEVIEVE MINA Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Reviewed HB 196 before the committee. KATY GIORGIO, Staff Representative Genevieve Mina Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Answered committee questions on HB 196. DEB ETHERIDGE, Director Division of Public Assistance Department of Health Juneau, Alaska POSITION STATEMENT: Answered committee questions on HB 196. ACTION NARRATIVE 3:03:42 PM CHAIR PRAX called the House Health and Social Services Standing Committee meeting to order at 3:03 p.m. Representatives Sumner, Fields, Saddler, Mina, Ruffridge, and Prax were present at the call to order. Representative McCormick arrived as the meeting was in progress. HB 343-SCHOOL DISTRICT MEDICAL ASSISTANCE  3:06:24 PM CHAIR PRAX announced that the first order of business would be HOUSE BILL NO. 343, "An Act relating to medical assistance coverage for rehabilitative, mandatory, and optional services furnished or paid for by a school district on behalf of certain children." 3:07:31 PM REPRESENTATIVE SADDLER asked a clarifying question related to the fiscal note for HB 343. EMILY RICCI, Deputy Commissioner, Department of Health, answered committee questions on HB 343. She said the Department of Health (DOH) does not anticipate a need for an increase in funding for any services outlined under HB 343 that utilize Medicaid. 3:09:11 PM CHAIR PRAX asked whether medical services given to a child would still require parental consent if HB 343 were to become law. LEAH VAN KIRK, Health Care Policy Advisor, Department of Health, answered committee questions on HB 343. She said that parental consent is always required to give care to a child and emphasized that HB 343 wouldn't change that requirement. 3:09:59 PM CO-CHAIR RUFFRIDGE moved to report HB 343 out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, HB 343 was reported out of the House Health and Social Services Standing Committee. 3:10:27 PM The committee took an at-ease from 3:10 p.m. to 3:13 p.m. HB 344-MEDICAL ASSIST. DEMONSTRATION PROJECTS  3:13:16 PM CHAIR PRAX announced that the next order of business would be HOUSE BILL NO. 344, "An Act relating to medical assistance demonstration projects established by the Department of Health." 3:13:52 PM EMILY RICCI, Deputy Commissioner, Department of Health, gave invited testimony on HB 344. She said HB 344 would provide authorization to the DOH to apply for an 1115 demonstration project and added that HB 344 supports the DOH's goal of moving from patient's acute healthcare needs to prevention and stabilization of patients chronic or ongoing healthcare needs. 3:15:37 PM REPRESENTATIVE MINA asked if the DOH had considered the Department of Housing and Urban Development (DHUD)'s recent unveiling of the Housing and Services Partnership Accelerator (HSPA) and its implications for a piece of legislation like HB 344. MS. RICCI responded that the DOH has not directly considered the DHUD's new HSPA program but said that the department is in conversation with multiple national groups to identify opportunities to leverage. REPRESENTATIVE MINA asked for clarification as to how a 1115 waiver works and how it correlates to health-related needs in Alaska. MS. RICCI explained that the 1115 waiver is a tool used by the DOH to achieve specific policy/programmatic goals and said that there is ample statutory language to currently to explore federal opportunities related to federal re-entry care. She emphasized that any budgetary impacts must be approved by the legislature. REPRESENTATIVE MINA asked why there is a focus on the re-entry provision of HB 344. MS. RICCI answered that the focus on the re-entry provision is largely in areas of healthcare, behavioral health, and substance use disorders. 3:19:54 PM CHAIR PRAX asked when the legislature could expect to see the application of the re-entry provision of HB 344. MS. RICCI explained that the DOH would first need contractors to complete the technical developmental work and said the DOH would anticipate substantial community engagement and tribal consultation 3:21:55 PM CO-CHAIR RUFFRIDGE moved to report HB 344 out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, HB 344 was reported from the House Health and Social Services Standing Committee. 3:22:28 PM The committee took an at-ease from 3:22 p.m. to 3:24 p.m. HB 371-MEDICAL REVIEW ORGANIZATIONS  3:24:54 PM CHAIR PRAX announced that the next order of business would be HOUSE BILL NO. 371, "An Act relating to medical review organizations; relating to the definitions of 'health care provider' and 'review organization'; and relating to the duties of the chief medical officer in the Department of Health." REPRESENTATIVE JUSTIN RUFFRIDGE, Alaska State Legislature, as prime sponsor, introduced HB 371 to the committee. He explained that HB 371 would seek to update older statutory language to allow medical review organizations to obtain multiple different personnel types to review medical data. 3:26:48 PM CHAIR PRAX asked about the rationale behind HB 371. REPRESENTATIVE RUFFRIDGE explained that HB 371 would allow an individual chief medical officer in DOH to make a decision on the capacity of a medical review organization quicker than the Alaska Board of Medicine could. CHAIR PRAX asked whether medical review organizations have any regulatory authority. REPRESENTATIVE RUFFRIDGE replied that medical review organizations do not have any regulatory authority and said that those organizations exist primarily to bring forward recommendations to other entities that perform regulatory procedures. 3:29:07 PM REPRESENTATIVE RUFFRIDGE moved to report HB 371 out of committee with individual recommendations and the accompanying fiscal notes. REPRESENTATIVE SUMNER objected, then withdrew his objection. There being no further objection, HB 371 was reported from the House Health and Social Services Standing Committee. 3:29:52 PM The committee took an at-ease from 3:29 p.m. to 3:33 p.m. SSCR 2-DISAPPROVE EO 125  3:33:24 PM CHAIR PRAX announced that the next order of business would be SSCR 2, "Disapproving Executive Order No. 125." 3:34:18 PM HEIDI HEDBERG, Commissioner, Department of Health, gave invited testimony on SSCR 2. She explained that Executive Order 125 would remove the Alaska Council for Emergency Medical Services (ACEMS) and transfer its statutory authority to DOH. She said even though there would be new advisory committees formed within DOH, there would still be a need for ACEMS to provide recommendations to DOH. 3:35:57 PM CHAIR PRAX asked how council members are appointed to ACEMS. 3:36:35 PM MS. HEDBERG answered that individuals can submit an application to the Office of Boards and Commissions. CHAIR PRAX asked how DOH would gather the individuals needed to serve on the committee. MS. HEDBERG gave multiple examples of professions not represented on the council and explained how the vetting process would work. CHAIR PRAX asked whether regulatory changes could be made by ACEMS. MS. HEDBERG replied that ACEMS provides only recommendations to DOH. 3:38:00 PM REPRESENTATIVE MINA asked what the timeline of creating a new council would look like. MS. HEDBERG answered that the State Emergency Medical Services Office has the administrative support to provide the services and functions of setting up new emergency medical service (EMS) advisory committees in a timely manner. 3:38:53 PM GENE WISEMAN, Section Chief, Rural Community Health, Department of Health, gave invited testimony on SSCR 2. He explained that there are many underrepresented professions related to emergency medical services and said that Executive Order 125 would allow DOH to expand and contract advisory boards as necessary. CHAIR PRAX asked whether there has been general public participation in DOH advisory board hearings. MR. WISEMAN said that there isn't a lot of public activity or interest in advisory board meetings and ACEMS has "been struggling to find its place" since its inception in 1977. 3:42:16 PM CHAIR PRAX opened public testimony on SSCR 2. After ascertaining there was no one who wished to testify, he closed public testimony. CHAIR PRAX explained the implications of legislator's votes towards SSCR 2 and how they would affect Executive Order 125. REPRESENTATIVE SADDLER asked whether SSCR 2 could move to the House floor if it was not passed in committee. REPRESENTATIVE FIELDS explained that it would move to the House floor regardless of whether it was passed out of committee. 3:44:58 PM The committee took an at-ease from 3:44 p.m. to 3:45 p.m. 3:45:24 PM CHAIR PRAX announced that the House Health and Social Services Standing Committee had reviewed SSCR 2 and sent it to the full legislature for consideration. HB 196-FOOD STAMP PROGRAM ELIGIBILTY  3:46:28 PM CHAIR PRAX announced that the final order of business would be HOUSE BILL NO. 196, "An Act relating to the supplemental nutrition assistance program; and providing for an effective date." 3:47:07 PM REPRESENTATIVE GENEVIEVE MINA, Alaska State Legislature, reviewed HB 196 before the committee. She explained that the goal of HB 196 is to improve food security in Alaska by focusing on improving the Supplemental Nutrition Assistance Program (SNAP) in Alaska. She explained that HB 196 would pursue a federal flexibility known as broad base categorical eligibility (BBCE) that would allow the Department of Health (DOH) to increase the federal poverty income limit for SNAP benefits from 100 percent to 200 percent of the federal limit and to allow DOH to waive the asset requirement of SNAP. 3:49:03 PM REPRESENTATIVE SADDLER asked for an estimation of the increase of people that would utilize SNAP benefits due to the increase in the federal poverty income limit. KATY GIORGIO, Staff, Representative Genevieve Mina, Alaska State Legislature, on behalf of Representative Mina, prime sponsor of HB 196, said that the Congressional Budget Office's has data related to the expansion of SNAP recipients. REPRESENTATIVE SADDLER asked how many recipients of SNAP benefits are individual versus family recipients. 3:50:57 PM DEB ETHERIDGE, Director, Division of Public Assistance (DPA), Department of Health, answered that DPA measures the definition of a family recipient as a group with 2.5 individuals per household and said that she does not have current data on the difference between individuals and families utilizing SNAP benefits. 3:52:24 PM CHAIR PRAX asked whether there is any data as to how successful raising the federal poverty income limit would be. MS. ETHERIDGE answered that other states that have utilized the same strategy to increase SNAP benefit qualification have seen increased self-sufficiency and job security. 3:54:33 PM REPRESENTATIVE SADDLER asked when the 60-month enrollment limit on SNAP begins. MS. ETHERIDGE said she would get back to the committee with answers later. 3:55:06 PM REPRESENTATIVE MINA gave closing remarks regarding the efficacy of BBCE and said that it encourages work and relieves many families of basic living expenses to allow them to save and move forward financially. She explained that currently, there are many people who can't accept a 50-cent raise because they would no longer qualify for benefits and lose more in the long run. She explained how SNAP benefits are determined and said that most states have pursued BBCE because it encourages and allows people to progress in their careers. She elaborated further on the intricacies of federal assistance programs and how recipients are chosen. She noted that there is a lot of work being done in Alaska to address food insecurity and expressed her gratitude to DPA for its interest in HB 196. 4:00:46 PM REPRESENTATIVE RUFFRIDGE moved to report HB 196 from committee with individual recommendations and the accompanying fiscal notes. There being no objection, HB 196 was reported from the House Health and Social Services Standing Committee. 4:01:19 PM ADJOURNMENT  There being no further business before the committee, the House Health and Social Services Standing Committee meeting was adjourned at 4:01.