Bill Summary – FastDemocracy

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                         SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 16
                         IN THE LEGISLATURE OF THE STATE OF ALASKA
                           THIRTY-THIRD LEGISLATURE - FIRST SESSION
     BY REPRESENTATIVE JOSEPHSON
     Introduced: 3/8/23
     Referred: Health and Social Services, Finance
                                                     A BILL
                                          FOR AN ACT ENTITLED
 "An Act requiring the state medical assistance program to provide certain services;
 relating to cost containment measures for the state medical assistance program; relating
 to payment for adult dental services; and providing for an effective date."
 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:
   * Section 1. AS 47.07.030(b) is amended to read:
                  (b) In addition to the mandatory services specified in (a) of this section and the
         services provided under (d) of this section, the department shall [MAY] offer [ONLY]
         the following optional services: case management services for traumatic or acquired
         brain injury; case management and nutrition services for pregnant women; personal
         care services in a recipient's home; emergency hospital services; long-term care
         noninstitutional services; medical supplies and equipment; advanced practice
         registered nurse services; clinic services; rehabilitative services for children eligible
         for services under AS 47.07.063, substance abusers, and emotionally disturbed or
         chronically mentally ill adults; targeted case management services; inpatient
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       psychiatric facility services for individuals 65 years of age or older and individuals
       under 21 years of age; psychologists' services; clinical social workers' services; marital
       and family therapy services; professional counseling services; midwife services;
       prescribed drugs; physical therapy; occupational therapy; [CHIROPRACTIC
       SERVICES;] low-dose mammography screening, as defined in AS 21.42.375(e);
       hospice care; treatment of speech, hearing, and language disorders; adult dental and
       dental hygiene services; prosthetic devices and eyeglasses; optometrists' services;
       intermediate care facility services, including intermediate care facility services for
       persons with intellectual and developmental disabilities; skilled nursing facility
       services for individuals under 21 years of age; and reasonable transportation to and
       from the point of medical care.
  * Sec. 2. AS 47.07.036(b) is amended to read:
              (b) The department, in implementing this section, may not [SHALL TAKE
       ALL REASONABLE STEPS TO] implement cost containment measures that [DO
       NOT] eliminate program eligibility or reduce the scope of services required or
       authorized under AS 47.07.020 and 47.07.030 [BEFORE IMPLEMENTING COST
       CONTAINMENT MEASURES UNDER (c) OF THIS SECTION THAT DIRECTLY
       AFFECT PROGRAM ELIGIBILITY OR COVERAGE OF SERVICES]. The
       department may take cost containment measures that [TAKEN UNDER THIS
       SUBSECTION MAY] include new utilization review procedures, changes in provider
       payment rates, precertification requirements for coverage of services, or [AND]
       agreements with federal officials under which the federal government will assume
       responsibility for coverage of some individuals or some services for some individuals
       through such federal programs as the Indian Health Service or Medicare.
  * Sec. 3. AS 47.07.036(d) is amended to read:
              (d) Notwithstanding (a) and (b) [(a) - (c)] of this section, the department may
                      (1)   apply for a section 1915(i) option under 42 U.S.C. 1396n to
       improve services and care through home and community-based services to obtain, at a
       minimum, a 50 percent federal match;
                      (2) apply for a section 1915(k) option under 42 U.S.C. 1396n to
       provide home and community-based services and support to increase the federal match
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       for these programs from 50 percent to 56 percent;
                      (3)   apply for a section 1945 option under 42 U.S.C. 1396w-4 to
       provide coordinated care through health homes for individuals with chronic conditions
       and to increase the federal match for the services to 90 percent for the first eight
       quarters the required state plan amendment is in effect;
                      (4) evaluate and seek permission from the United States Department of
       Health and Human Services, Centers for Medicare and Medicaid Services, to
       participate in various demonstration projects, including payment reform, care
       management programs, workforce development and innovation, and innovative
       services delivery models; and
                      (5)    provide incentives for telehealth, including increasing the
       capability for and reimbursement of telehealth for recipients.
  * Sec. 4. AS 47.07.036(e) is amended to read:
               (e) Notwithstanding (a) and (b) [(a) - (c)] of this section, and in addition to
       the projects and services described under (d) and (f) of this section, the department
       shall apply for a section 1115 waiver under 42 U.S.C. 1315(a) to establish one or more
       demonstration projects focused on innovative payment models for one or more groups
       of medical assistance recipients in one or more specific geographic areas. The
       demonstration project or projects may include
                      (1) managed care organizations as described under 42 U.S.C. 1396u-2;
                      (2) community care organizations;
                      (3) patient-centered medical homes as described under 42 U.S.C. 256a-
       1; or
                      (4) other innovative payment models that ensure access to health care
       without reducing the quality of care.
  * Sec. 5. AS 47.07.036(f) is amended to read:
               (f) Notwithstanding (a) and (b) [(a) - (c)] of this section, and in addition to the
       projects and services described under (d) and (e) of this section, the department shall
       apply for a section 1115 waiver under 42 U.S.C. 1315(a) to establish one or more
       demonstration projects focused on improving the state's behavioral health system for
       medical assistance recipients. The department shall engage stakeholders and the
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         community in the development of a project or projects under this subsection. The
         demonstration project or projects must
                        (1) be consistent with the comprehensive and integrated behavioral
         health program described under AS 47.05.270(b); and
                        (2) include continuing cooperation with the grant-funded community
         mental health clinics and drug and alcohol treatment centers that have historically
         provided care to recipients of behavioral health services.
  * Sec. 6. AS 47.07.067(a) is amended to read:
                (a) The [SUBJECT TO APPROPRIATION, THE] department shall pay for
         minimum treatment and for preventative and restorative adult dental services provided
         under AS 47.07.030(b) and under regulations adopted by the commissioner of health
         in conformity with applicable federal requirements and this chapter. Regulations
         adopted under this section must include the following:
                        (1)    [EXCEPT AS PROVIDED IN (d) OF THIS SECTION,] a
         maximum amount of benefits for preventative and restorative adult dental services of
         $1,150 for each eligible recipient in a fiscal year; and
                        (2)    specification of the scope of coverage for preventative and
         restorative adult dental services.
  * Sec. 7. AS 47.07.067(d) is amended to read:
                (d)     The [IF THE DEPARTMENT AUTHORIZES OR APPROVES
         PAYMENT FOR COMPLETE OR PARTIAL DENTURES FOR AN ELIGIBLE
         RECIPIENT, THE] department may authorize the payment for complete or partial
         dentures for an eligible recipient in one fiscal year of the maximum payment amount
         for not more than two fiscal years. [A RECIPIENT IS NOT ELIGIBLE FOR
         ADDITIONAL BENEFITS UNDER THIS SECTION FOR A TWO-YEAR
         PERIOD.]
  * Sec. 8. AS 47.07.036(c) is repealed.
  * Sec. 9. AS 47.07.067(b) and 47.07.067(c) are repealed.
  * Sec. 10. The uncodified law of the State of Alaska is amended by adding a new section to
 read:
         MEDICAID STATE PLAN FEDERAL APPROVAL. The commissioner of health
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 shall amend and submit to the United States Department of Health and Human Services for
 approval the state plan for medical assistance coverage consistent with AS 47.07.030(b), as
 amended by sec. 1 of this Act, AS 47.07.036, as amended by secs. 2 - 5 and 8 of this Act, and
 AS 47.07.067, as amended by secs. 6, 7, and 9 of this Act.
   * Sec. 11. The uncodified law of the State of Alaska is amended by adding a new section to
  read:
         CONDITIONAL EFFECT; NOTIFICATION. (a) Section 1 of this Act takes effect
 only if, on or before January 1, 2026, the United States Department of Health and Human
 Services approves an amendment to the state plan for medical assistance coverage
 corresponding to the amendment to AS 47.07.030(b) in sec. 1 of this Act or determines that
 approval is not necessary.
         (b) Sections 2 - 5 and 8 of this Act take effect only if, on or before January 1, 2026,
 the United States Department of Health and Human Services approves an amendment to the
 state plan for medical assistance coverage corresponding to the amendments to AS 47.07.036
 in secs. 2 - 5 and 8 of this Act or determines that approval is not necessary.
         (c) Sections 6, 7, and 9 of this Act take effect only if, on or before January 1, 2026,
 the United States Department of Health and Human Services approves an amendment to the
 state plan for medical assistance coverage corresponding to the amendments to AS 47.07.067
 in secs. 6, 7, and 9 of this Act or determines that approval is not necessary.
         (d) The commissioner of health shall notify the revisor of statutes when the United
 States Department of Health and Human Services approves or disapproves an amendment to
 the state plan for medical assistance submitted under sec. 10 of this Act.
  * Sec. 12. If, under sec. 11(a) of this Act, sec. 1 of this Act takes effect, it takes effect on the
 day after the date the United States Department of Health and Human Services approves the
 corresponding amendment to the state plan or determines that approval is not necessary.
  * Sec. 13. If, under sec. 11(b) of this Act, secs. 2 - 5 and 8 of this Act take effect, they take
 effect on the day after the date the United States Department of Health and Human Services
 approves the corresponding amendment to the state plan or determines that approval is not
 necessary.
  * Sec. 14. If, under sec. 11(c) of this Act, secs. 6, 7, and 9 of this Act take effect, they take
 effect on the day after the date the United States Department of Health and Human Services
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 approves the corresponding amendment to the state plan or determines that approval is not
 necessary.
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Statutes affected: 
HB0016A, AM HB 16, introduced 01/09/2023: 47.07.030, 47.07.063, 21.42.375, 47.07.036, 47.07.020, 47.05.270, 47.07.067
HB0016B, AM SSHB 16, introduced 03/08/2023: 47.07.030, 47.07.063, 21.42.375, 47.07.036, 47.07.020, 47.05.270, 47.07.067