Afternoon everyone this hearing the Senate Health and Social Services Committee will now come to order today is Thursday January 29th
And the time is 3 31 p.m. We are in the butch of its room 205 members president are senator Myers
Senator Klayman senator Tobin vice chair Gissel and myself a chair Dunbar
Let the record reflect that we have a quorum to conduct business before I begin
I would like to thank Mary Gwen Kawakami the senate health and social services recording secretary and kyla Tupu
from the Juno LIO for staffing the committee today.
We have one item on our agenda today,
a presentation from The Department of Health
on the Rural Health Transformation Program.
With us today we have Commissioner Heidi Hedberg,
Deputy Commissioner Emily Ritchie,
Associate Director of the Office of health savings,
Betsy Wood, and Sylvan Rob is also in the room
from Department Commerce because we
have some questions that are perhaps related to licensure.
So Commissioner, would you like to come forward and begin your presentation?
I should also acknowledge we have with us representative Mina, the chair of the health and social services committee with
us today. Thank you.
For the record, my name is Heidi Hedberg, Commissioner for the Department of Health.
On slide two, so on July 4th, HR1 was signed into law that created the Rural Health Transformation Program.
It is a federal commitment to fundamentally improve how health care is delivered in Alaska.
This is one-time, five-year investment intentionally designed not to sustain the status quo, but
to transform health-care delivery, expand access, and improve outcomes.
Alaskans from across the state in developing the application.
The department had a goal that we would be transparent,
and we really wanted to ensure that Alascans saw themselves in this
application, that it reflected their challenges,
our shared realities, and our collective roles in solutions,
To that end, we used a work group that is developing into an advisory council.
And that includes the Alaska Hospital Association, the Alaskan Primary Care Association.
The Alaska Native Tribal Health Care association,
the alaskamist's colleague, and the Elaska Mental Health Trust Authority.
They have been instrumental in helping with the development of the application in a true
At its core, the application is built around three groups
who experience the system,
the healthcare system very differently,
but are deeply connected.
First, it's the patients,
it is the people as the clients that we serve.
And it really to ensure that Alaskans can have access
to care when they need it
without that unnecessary travel or delay.
It's also to strengthen care,
so they have it closer to home.
where trust, continuity, and outcomes are stronger.
For providers, too much of their time
is meant navigating avoidable systems
that are barriers rather than delivering
that whole person care and I can truly say, you know, many of them come and share that they're
entering, patient information into multiple systems because they are not connected,
that their ordering tests or reordering imaging because
they don't have access to those images and it is a very, it's a strong frustration for our
was intentionally developed to reduce those administrative frictions so that providers can
spend more time with the patients and making clinically informed timely decisions. And then
there's the payers. You know, Medicaid is within the Department of Health, but this also includes
Medicare. It includes commercial insurance. The payment structure doesn't align with
And we want to use this opportunity
to better align reimbursements with the outcomes
that we wanna see, which is to improve access, quality,
and sustainability.
At its core, this funding acknowledges
that improving rural health care in Alaska
is about collaboration, not just a single program
or single agency, but keeping the patient
at the center of the conversation.
And with that focus over the course of a very, very intensive six weeks,
we wrote the application and on October 29th is when we received our award,
which is the amounts reflected on the slide.
It's $272 million for the first year.
So before us, we truly have an opportunity.
To incorporate our lessons learned from the past on health care reform efforts
We have an opportunity work together
Differently and to come together to make the most of this one-time opportunity
We haven't thank you
If we could pause after each for questions. Thank you commissioner. We everyone from
senator diesel
Thank You commissioner commissioner the public is listening. I
take these meetings and send the recordings out to my constituent constituents.
Can you define rural?
Through the chair, Representative Giesel, there are many definitions of rural for our application.
As we defined rural, it really is the state of Alaska.
Our health care system is a hub and spoke system.
rural and frontier to delineate from our smaller villages or smallest communities to our hub
communities. But even in Anchorage, which has specialized care, that health care system is
really integrated. So for the purposes of the application, we define rural as the entire state
of Alaska. Thank you. Just follow up, Mr. Chairman. The federal government was okay with Anchorage
Through the chair representative geese. Oh, yes. Thank you
Good a good clarification. I think something that is not intuitive for a lot of folks that weren't familiar with this process
So now I thank we are on through the other questions. We're on the slide three, I believe
For the record Heidi Hedberg
So with the foundation that I had shared with you,
I think it's now important to really turn
and really discuss how was the application technically scored.
CMS outlined the criteria for the technical factors that needed to be evaluated in the notice
of funding opportunity that all states received. So think of it as a checklist. It's important to
note that we had one opportunity to make these decisions. If we have said no to any one of these
and changed the application because it was a one-time application.
And I think that's where it is imperative that we listened to Alaskans and to the associations.
And they were very clear that they wanted the Department of Health
to submit the most competitive application with that context.
It's helpful to understand there were two broad categories.
that created the technical score.
One was that qualitative.
And the qualitative was made up of the goals and the initiatives,
and we'll be discussing that slide in just a little bit.
The other broad category was the quantitative.
And that's how big is our state, the rural,
the facilities,
the policies.
There was a list of qualitative elements.
Of those qualitative elements, two of them are policies where it's going to engage the legislature
in a conversation. And that's what I want to draw your attention to on slide three.
There, one is scope of practice for pharmacists, and there are five different compact licensing
that are listed on your screen, emergency medical services, psychologist, physicians,
and nurses. It's outlined in the notice of funding opportunity that the conversation we have
between now and December 31st, 2027 states were scored if it was if that policy was implemented,
And, again, what we heard from our associations was to be competitive.
Those point values is what equated to that larger award amount that we received for year one.
Thank you, Commissioner.
We have a question from Senator Tobin.
Thank You. Thank Mr. Chairman.
And thank you for being here as Senator Giesel indicated the public is listening.
I can see you have very.
packed room behind you and so there's a lot of curiosity a little of questions and you said a few things that
Pinged questions for me. So I'm going to ask my first question
And I know we will have many more on this particular slide and hopefully I can either
Ask them here on the dais or follow up with you at a later date
But the first one is the mention of this is a one time application, this was a unique opportunity for us.
And I see here that there are legislative priorities or policies that must pass.
So I'm curious to know which legislators you talk to and who you discussed these particular pieces of policy with.
To ensure that if this one's going to be a competitive package or competitive application.
You had the votes here in the legislature to pass these particularly policies.
For the record Heidi Hedberg through the chair senator Tobin
This was outside of session clearly. This is this fall when we had to develop the application
So there was not specific targeted
Conversations with the legislature because we wanted to have equal opportunity
We were really relying on the associations and Alaskans to help kind of inform the direction that they wanted
To develop application
Do you have a follow-up, Senator Tobin?
But I want to make sure.
OK.
I have the question.
I'll wait for you to ask your follow up first,
and then I will ask my question?
Thank you.
Thank Senator Dunbar.
So with that being said, are there
legislators that are going to be prioritizing these?
Are these going be introduced by the administration?
How do we begin to discuss and have dialogue
about these particular policies?
Through the Chair, senator Toban,
this is the opportunity to have conversations
over this session and next session.
So it is open, but you do not have a prime sponsor.
You will not be sponsoring through the chair, Senator Tobin.
I think we are open.
Well, I said more directly just because in the interest of a collaborative process
is to your knowledge is the governor open to introducing these bills.
To the chair right now
We are literally having conversations to see who is interested in sponsoring or or what it looks like in terms of pathway forward
I think first is the opportunity just to educate ourselves on what the compact licensing is and is not
Very good. So my question is about
If you look at this slide sort of standing on its own,
it looks sort like the application rises and falls
on us passing these.
But I think what you've actually said,
and I have some supplementary materials to indicate,
this is only a percentage,
maybe even a relatively small percentage
of our total application.
Like you said there are other things,
how big are we, how rural in some cases are are,
what are demographics, that sorta thing.
um what percent of our score was tied to these particular reform proposals or promises to the
federal government? Through the to a chair for the record this is Emily Ricci deputy commissioner
And we don't know what the exact amount is or the score that is necessarily associated with these policies.
And part of that, is because of the way that the Rural Health Transformation Program in NOFO was developed.
And states are consistently kind of scored and ranked against each other, almost on a curve.
And that will be updated on an annual basis.
You know again, this has been a very fast process and I don't want to use that as an excuse
But that's kind of the reality of what we're working through and it's been fast for us
It's also been passed for CMS and they are working to develop kind
of answers and
Responses to the different questions we have so we don t know what that amount is if we did we would share it
So I have a document here from CMS from November 5th, the Rural Health Transformation Program
Opportunity Number. It's got a number there. I'm sure you're familiar with it.
I think it might have been distributed at some point, but it has, and we'll put it on the website,
For example, scope of practice, 1.75%,
licensure compacts 1,75%.
Short-term limited duration insurance,
1 point 75%.
Can you sort of explain to the public,
what does that 1?75% mean as you understand it?
Does it mean that licensor comp acts as a whole equate
to 1 .75 percent of the points we were to receive,
What does that mean exactly?
For the record, this is Betsy Wood,
Associate Director at the Office of Health Savings.
I think that's a really great question,
and it's honestly a difficult one to answer,
because I'd think if you look at
the Notice of Funding Opportunity,
which I believe is the document that you have,
there were multiple pieces in there that talk about
it is 1.7, without having it in front of me,
I'm hesitant to
quote from it, but there are components of scoring that were these data-driven pieces, right?
So I think some of it may be how big is your state, where you're real populations.
And then when it comes to these policy commitments, it's a percentage of a component of the score.
And I'll be honest, I've been trying to unpack too, what does that look like and what
Our understanding is that states are essentially graded on a curve against each other and they are stacked and
Regrated against Each other every time the funds are are looked at for the next year
So that's where it really does become I think a pretty tricky math problem to pinpoint what this is and again if we could say
specifically
What that percentage equates to on the dollars amount we certainly would
Okay, well, I I'd think that we've got some work
Slides here that might be more appropriate to have this discussion, but we've got a question from centers claiming
So when you talk and I'm looking at all three of you because I am not sure who's best to answer this
If we're talking about a sliding scale
Let's say you have five states and all five States in their initial score got 100%
So they all got their money and then at the end of 2027
They all didn't quite check all the boxes and and in some of them had
95% some over 90% maybe one maybe 1 of the 5 and I'm just picking 5 because you see one of
them one
of em still keeps 100% and the others you know 85% 90%, 95%, what happens
Do they do they get whatever that percentage clawed back and who gets the money?
If it gets clogged back.
For the record, through the chair, Senator Klayman, for the
record this is Emily Ritchie with the Department of Health.
Again, our understanding is that every year, right,
that kind of.
review and ranking of milestones and other elements of the application will occur and then CMS will announce,
I believe it's around October 30th of every year, what the new award amount, the updated award
amount is for future years.
And that award, our understanding, again, this will change.
We'll share with you what we know, but this can change sometimes week by week.
It can be based on whether we completed.
The milestones in our application whether we expended the funds within the time period and then again when that ranking is complete
They will compare states against each other states that maybe did not obligate all of their funds
Those funds will be taken for future years and redistributed to other States
So there is the ability to either I think be in a position where more funds are awarded
For forward years or funds or reduced for a future year's. That's our understanding now, but I will let
make. And for the record, Betsy Wood and through the chair, I think it's important to think about
when we're thinking about the funding that was allocated based off of the policy commitments
that were made. That is an area where our understanding today is that if those policy
commitments are not followed through on, then CMS can look and say here's how much money was
allocated, based of that commitment.
the state didn't meet that commitment, we would like that amount of funding back.
And then as DC Ricci mentioned, there is an annual process that the
state will go through every year, where we say, you know,
we do our reporting,
we provide information to CMS,
we work with them throughout the year throughout our cooperative agreement.
They look at our progress, they say how are you meeting your milestones,
what does this look like, and then that's where they kind of re-score
and rerank these application or re grade, I guess, on the curve against each other.
And that's where our future funding may look a little bit different than the amount that
we got today, and that is going to be based off of our progress and other states' progress.
So that�s a separate process, but this piece of we would like some�we would
like that portion of funding back, that, to my understanding,
that a process that CMS will go through December 31st, I think there's a few staggered dates
for kind of when they'd like to see these policy commitments enacted by.
There's another process, and I do think we may touch on it in a future slide, but I'll describe it now because I think it's appropriate, which is at the end of each budget period, so each year is a budget
period. You have a year to spend your fund or to allocate your funds, you have another year
spend window for each budget period, CMS will look across all states and say what funds are left unspent and then they will sweep those and they
will redistribute those across states. We don't really know a lot about how many states will receive redistributed funds, where will they go.
But those are kind of three separate pieces to be thinking about when you think about the funds may flow. I hope that's helpful.
I've got a question and then we'll, I have a questions for Senator Tobin, then hopefully
go to the next slide, but I just want to be sure, you said policy commitments and policy
commitments is not synonymous with legislative action, correct?
That is, there are policy changes that the department is going to make separate from
the request of the legislature.
Is that true?
For the record, Heidi Hedberg, yes, that's true.
policies and that's the term that is used in the notice of funding opportunity of those eight different policies
Two of them is a conversation with the legislature to make a decision. The remaining six
Can be accomplished through updating regulations and or just funding
Very good. Thank you. Senator Tobin.
Thank You, Mr. Chairman and
That is where my question is going to
To be directed to and I do want to say that
It's an incredible application.
You guys did incredible work.
I was there when you were submitting it.
The joy I felt from you was palatable.
And so I do applaud you for that work,
I also recognize the different roles that we serve.
And we are here and hopefully asking questions
so the public have the information and are aware,
but also so that
ensure that Alaska over the next five years is able to capture the most amount of resource
that will benefit the communities in which we represent.
So my question really is in this slide, as you mentioned, there are two policy areas
that need legislative action, but outside of that, for $270,000,00 million each year
for five-years, which I am not great at math, so I'm not trying to try to say what the total
amount is, that's a lot of resources that the legislature has no input in.
I'm curious about some of the dynamics that you see coming down, especially when it comes
to creating new pathways or new programs or departments and the ongoing support after
five years that may need from the legislature and yet there's very little buy-in here at
the very beginning for us.
The way that you envision that, or the way you hope that we go forward together at this point again as there was very little input from lawmakers on the initial application.
For the record, Heidi Hedberg through the Chair, Senator Tobin, I think this is a great example of building the plane as we fly, so.
I think that at the very beginning when we learned about this in July, it was like,
let's get an RFI. We are going to be committed to working with Alaskans and then it
was crafting a very competitive application and now we are looking at next steps and again,
we're looking and that's where I kind of started on the prior slide, we need to work differently
use this one-time funding to address the systemic issues that we have seen in with
patients and their patient stories, with providers, looking at our Medicaid
program and the changes that need to happen. I think this is how we're going
to work differently together. It's not written out yet, I
think. This is very much of the beginning of
the conversation. Very good. Let's move on to the next slide. We've got 15 slides
For the record. This is Emily Ritchie with the Department of Health
So when we talk about transforming the health care system, I mean that is a huge
laudable goal
But you know, what does that look like and what is our approach?
You've heard commissioner headberg earlier talk
About kind of like our north star or our vision and that as it Alaska has the best rural health
Care system of the nation and I would love to say the world and we have elements of that already
But how can we bolster that across our state?
And when we step back, we think about, you know, I think
about what do people experience?
And I I there's a lot of kind of confusion and frustration
sometimes from people trying to navigate the system.
It's fragmented.
It is complex.
And so how do we
think of increasing health care access across the full life
spectrum, right?
Starting from prenatal care all the way through to our seniors
and our elders.
What supports that?
kind of that next tier is like what enables the system.
And what will enable that access across a health care system
is our workforce, our people are our most valuable resource,
and we need to be able to support them.
And how can we leverage technology
and try innovative approaches in order to, again,
expand the ability of our work force
to provide the health-care access that we needs?
And then finally, how is that system sustained?
Again, when I step back and I think about the challenges
in the system today, I feel like people are very confused.
It can be like hard to navigate the systems frustrating
for providers because they're not able to always spend their time
focusing on patient care versus administrative duties.
And then it's very expensive.
And for the amount of money that we are paying into the
system, we think we can all agree.
We don't always feel
like we're getting the outcomes that need.
And I see providers who are not always reimbursed for the community care that they're providing or
the way that the are trying to meet their patients needs.
So how can we look at a sustainable system where kind of how we're paying for that system reflects the work that
the providers are doing and the outcomes we want to see?
So we use-
Sorry, Senator Gizarin.
Again, thank you, Mr. Chairman.
I am concerned about what we are aiming at.
So, your first bullet says,
and sure, Alaskans get affordable care.
What will that look like?
What is affordable?
Do you have data right now that says primary care
at this level of cost is
affordable and will keep
providers here in Alaska?
We used to have studies from Milliman who
Do you have a consultant now that is defining this?
Through the chair, Senator Giesle, for the record, this is Emily Ritchie.
That is part of what we need to build out, and that's some of
what can use these funds to do.
There are many, many studies,
and I know Senator, you've looked at many of those that have been underway for,
I mean, since I started in this, probably 13 years ago.
But some of those are still relevant, many are outdated, and they need to be updated.
So we've been having many conversations, I mean we have been talking with ISER.
ISer produced some pretty remarkable reports when I started in 2012 and 2013 looking at
the cost of healthcare across the system.
Is there an opportunity to update those reports?
So, we are trying to work and bring in the technical assistance we need.
Again, this came very quickly, and so this is where we need to work with stakeholders.
But quite frankly, the legislature in identifying what are some concrete goals to meet over the next five years, what're some of those metrics.
We have metrics in the application, but those were really, and they're important metrics,
but they were framed in context of specific requirements and competitiveness.
They may be a little bit different than what we as a state decide we want our healthcare system to be measured by and what want that to look like.
very quickly.
Thank you, Mr. Chairman.
Thank You.
If you want to continue, either with this slide or to the next slide.
So moving on to slide five for the record, this is Emily Ritchie.
This vision, high level vision and we try to kind of
pair that down into goals and funding initiatives
within the proposal.
We talk about three different goals.
The first is to promote the lifelong health and well-being
for Alaskans, the second is
to build sustainable outcome driven health systems
and the third is drive workforce
and technology innovations.
And this is within application.
Within those three goals,
there are six proposed funding uses
and those are represented by the multicolored boxes
Each of those proposed funding uses to me is kind of the like a core element of
the application. Those reflect the information that we received in the
feedback we receive from providers through the request for information
process and they have been heavily edited line by line
by many different stakeholders. Here on the PowerPoint slide they seem very
simple. There are actually 20 pages.
with different proposed funding uses and then some specific examples with broad language underneath.
The way that we tried to craft our approach to the application was
to almost to take an umbrella approach because, again,
we're trying to think about how to create an application
that will survive administration changes,
survive election cycles, and basically be as useful
to our healthcare community half a decade from now as it is today.
So you'll see under the proposed funding uses,
specific examples followed by broad language.
Under goal one, I think about goal 1 is focusing on the people.
And within that, we have three different proposed funding uses.
So healthy beginnings, health care access.
and healthy communities.
And so within that, some of the specific examples
under the proposed funding uses for healthy beginnings
include space renovations to support labor,
delivery, and birthing centers,
or investing in remote fetal monitoring devices,
because we know there's some organizations
that believe that could be helpful to mothers,
or enhancing maternal and child health visiting programs.
Again, those are just some
of these examples, they're many more.
Under health care access, we focused on increasing access to the full spectrum of behavioral health services.
We know that upgrading and expanding specialized EMS equipment is a need that we've heard from the communities.
We're bolstering home and community supports.
If we think about healthy communities,
we look at community programs to help manage chronic disease.
And we also heard form our tribal health partners that traditional healing is an important area of focus.
The content within these really reflects the different needs that we heard throughout the state.
Any questions?
Senator Tobin.
Thank you, Mr. Chairman.
I'm going to ask a question about capacity.
I've been given notice that some of our early learning programs have had their funding cut and our pre-K system
I'm very concerned about our parents as teachers or infant learning
These are things that we have been doing well that. We are currently poorly doing and I see here
And I know part of the rural health transformation fund is about new action new activities
And so i'm curious within the capacity of The Department
how are we going to ensure that we don't continue to backslide on evidence-based proven interventions that
we have been doing, but yet we're no longer doing as we try to stand up some of these new innovative ideas or
programs and then get them with the current burnout staff that
we are all trying to work with.
Through the Chair, Senator Tobin for the record, this is Emily Ritchie.
We went to a number of different stakeholders and we said we have to do things differently because we, the department on its own, we can provide that foundation and that support for the changes we need to see in the system, but ultimately you will be the ones that are doing the work and are implementing this.
And so to your question, We can't do it by ourselves, and were trying to make sure that we could use this funding to support our partners in building out those services.
One area that we do clarify with CMS is if we have a program that is the best practice, right?
Or is evidence-based, and we've not been able to expand it because of funding restrictions,
would that expansion be eligible for these funds?
And the answer is yes.
And so we'll talk about some of the restricted fund uses and further slides, but again,
Is not to supplant existing programs, but we can't support expansion
Especially if there are things we're doing in one area that could really be modeled in other areas and expanded, so I
Don't know if that fully answers your question, that's how we are trying to approach this
Senator Giswell and then Senator Maya
So
Commissioner or deputy commissioner are you working with the Division of Insurance?
The reason I asked this is these are great ideas. Let's get some new technology
who's going to reimburse this. Is Primera on board with this? That's one of the barriers we face.
Mr. Chairman, thank you. Through the Chair, Senator Geisel,
you know, I think it's hard to say yes and entity is on-board without knowing what
exactly it is. Specifically, we're talking about regarding the intervention, right?
Entities want to try new technologies that result in cost savings
that we build out reimbursement for that because it creates cost-savings in the future and so one area and
that we can talk about or I think is a good example is like remote patient monitoring.
So are there opportunities to support remote
patient monitor for specific types of patients, I
think about congestive heart failure, is there a way to
support them and to reduce the the readmissions that
that they may experience that results in cost savings to the health insurance
plan but ultimately and most importantly it helps the
patients stay healthier and supports the providers in that practice.
That's one area that right now is not reimbursed by Medicaid.
And I'm not sure if that's reimbursed by Primera or other third party administrators.
But you could use these funds to pilot a program like that to see if it works.
And then eventually to build that out further and build in reimbursement in something like the Medicaid program.
Other states cover it through Medicaid, we don't right now.
Partly because we want to be very thoughtful about any services we expand and
we haven't had the opportunity to test out some of these pilots.
So this fund can give us the chance to built and test those out.
Thank you, Mr. Chair.
Thank You, Senator Niner.
Thank your Mr, Chair, sir.
Kind of touched on this a little bit
in the last couple of questions,
but you've got fiscal sustainability on the slide here.
And, you know, kind of,
my biggest concern with this program moving into it,
and I've had a couple conversations with you already
about this, but is,
you we don't want to set ourselves up
for standing up new programs or expanding capacity,
and then in five years when the money's gone now,
You know, we've got these things set up and the you know now we need more money to sustain it and you
Know as the old saying goes
You Know predictions are hard especially about the future
And but I'm gonna just go out on a limb here and say in five years
We're probably not gonna have two hundred seventy million dollars laying around in the state budget to
to go back and keep doing this.
So can you give me some specifics about what you're doing
in terms of how you are talking to different providers
to make sure that what we're do with this money
is something that is sustainable in the long run
and they'll be able to wing themselves off of this
money by the end of the five years.
Through the chair, Senator Myers, for the record,
this is Emily Ritchie.
We...
We have been really thinking about that that's been a focus of ours again
We've had experience with other large amounts of money coming into the state and how do we learn from the pitfalls?
We experienced and avoid that
and so from The very beginning with the evaluation process or with any sort of funding proposals or requests from providers a
Sustainability plan has to be part of that as part Of the Evaluation Criteria and we have Been Communicating from
The Beginning that
There has
to
This is not intended to replace operating costs.
This was intended
to provide investments in the system that are necessary.
But we otherwise would not necessarily have the funding
to achieve in order to improve the System Efficiency
and ultimately allow it to
provide better care.
Commissioner.
Okay.
Very good.
I have a question.
I think you've touched on goal one, goal two.
Let's you talk to goal three first,
and then I've got a question for you.
For the record, this is Emily Ritchie.
So goal 3, again, I thing about as kind of the tools
or the methods that we have available
to achieve goal 1 and goal 2, right?
And again it is strengthening the workforce.
That is probably the number one.
challenge that we heard across the spectrum from healthcare providers and as we think
about our aging population and we about demographics in general, I think those challenges will
continue to be more acute.
So how can we focus on that and how we can leverage different programs?
And I don't think there's one solution.
I've been looking at this issue from different perspectives for a long time.
This is not a new issue, but it's become acute
And so some of the ideas that we have or that were put forward
by our different stakeholders, as well as looking at other states,
are things like expanding, grow our own programs, right?
Thinking about upskill or reskill programs.
So if you are maybe mid-career and you're interested in moving
into the healthcare field, how can we help you move
into healthcare what are some
of those paths we could create to do that?
or increase kind of the level at which you are practicing,
how can we make that available?
We know that residency programs
and expanding residency program is a key challenge
in the state and one that we would like to address
using the Rural Health Transformation Program.
We especially hear that among our family practice physicians.
So those are some examples of strengthening the workforce.
So I have a question.
It's the last bullet there, spark technology innovation.
And it's a sort of practical question going to what Senator Tobin asked about the relationship
between the department, the legislature, and this money.
So a couple of years ago, we had a crisis around SNAP and the Department of Health came
to the Legislature.
We worked together to get money so you could upgrade your sort back office IT, which was
incredibly out of date.
We all know the story.
Could that upgrade have been paid with these funds?
Could we have done that, upgrade with those funds.
And then two, does that mean we need to put a line item in our budget for it?
Or if the legislature feels that you need something in particular, can we say we're putting
it into the budget and the money is going to come from these fund?
To the chair for the record, this is Emily Ritchie.
Question about could these funds, like if we have that same need today, could
these fund be used to meet that need?
The answer is no, because those funds are available through existing funding programs like Medicaid,
whether it's a federal match available, and or SNAP.
So there is a very clear direction from the Centers for Medicare and Medicaid Services that these
funds aren't intended to supplant existing fund streams.
We are talking with other departments to understand what their needs are, because there are a number of other needs across departments that may not have available revenue streams to support some of those systems' needs, right?
children in care of the state, right, or some of
the other needs from our correction system.
So we are having those discussions.
So to your first question again, that is one of
the challenges with the funding, is that it really
cannot supplant funding that's available through
existing programs to meet needs.
In regards to the second question, you know,
I'm not a budget expert or a technician.
In general, this fund is crafted to be a grant.
And so the same way that we would use or engage with the
Centers for Medicare and Medicaid Services on other grants,
that's how this funding is coming through.
So it's not, it is very different than the funding that was
available through COVID and the ARPA periods.
It is established through a collaborative agreement.
And we have a number of like very.
comprehensive requirements that we need to meet in order to receive approval from
our team with the Centers for Medicare and Medicaid Services to actually release
the funds. And I think we're gonna talk about that a little bit later on in the
presentation. All right don't see any questions please go on to the next slide.
Moving on to slide seven for the record, this is Emily Ricci, so as I just stated,
this a federal grant, and so it is structured as a Federal Non-Construction Grant,
which will be important when we talk about limited fund uses.
So this, the funding can be used within the context of the cooperative agreement and
cooperative agreement reflects the requirements in the notice of funding opportunity as well as the purpose is approved in
the application, which again is why we tried to take an umbrella approach with the
application so that again we were specific enough to be competitive but broad enough
to give space because the time frame for responding to this was so short.
All funding must be approved and reviewed by CMS ultimately before it is released.
This is a cooperative agreement.
The Centers for Medicaid and Medicare Services works with the Department of Health throughout the project like we do with other federal grants, not just at award time.
So we have regular communication.
planning and input, they review and approve key activities,
our budget, our performance measures,
the personnel who can be funded or supported
as well as the administrative costs through this grant.
They do provide technical assistance
and evaluation support, and we actually
were part of a meeting earlier today for all states
where they kind of did their kickoff meeting.
And then we can collaborate on adjustments to the work plan if needed,
but those have to occur kind of within the confines and the boundaries of the notice
of funding award and that the boundary is of initial application.
So moving on to slide 8, there are limits on the funding that's available
through the Rural Health Transformation Program.
Again, this is considered a non-construction grant by the Centers for Medicare and Medicaid Services.
And so that prohibits the construction of new facilities or building expansions.
We understand that renovations are-
are possible with this and again we included those throughout our proposed
funding uses because we know that that is a
barrier to expanding access to care in many different communities or within
different provider types. We don't have
We don't have a lot of guidance right now on what the boundaries are for the definition of renovations.
And at different points, we've heard very wide and different definitions for what could be allowable.
Some are very narrow, some are really wide.
That is an area that we are focusing on and having conversations about.
We know that not the only state, but I want to.
Make sure I share that with the committee because that's a point of frustration that we have heard from providers as they're trying to think about what kind of projects could fit within this grant.
We are, the grant can also not be used for purchasing land or other buildings.
We've had questions about whether renting or leasing space is an option.
We also had question and we're, again, we've put this in with CMS about
whether purchasing or leasing a plane or a boat is option,
again as people think about how to bring care to rural communities.
We like to remind CMS that Alaska is different and
we have invited them to come visit.
So this third bullet talks about funding clinical services that are already covered by insurance.
And again, that can be very broad if you think about what insurance covers across the
nation.
But again I go back to the example that I used when I was describing remote patient
monitoring with Medicaid, right?
Medicaid Alaska's Medicaid program today does not cover remote-patient monitoring.
However, we do believe funds would be available to demonstrate or pilot remote
patient monitoring project using the Rural Health Transformation Program that we could
then build into coverage in the future.
to provide cost savings and what's successful.
Very important, the funds are intended
not to supplant existing funding
and we have seen a very strict line taken on that
from the Centers for Medicare and Medicaid Services.
Broadband infrastructure, including internet installation costs and certain telecommunications equipment is also prohibited.
We have some asks in about Starlink and about the actual purchase of satellites.
Especially if you're thinking about Karen or Alaska, we are not the only state with that question in, but we don't have any clear guidance yet.
Provider loan repayments are prohibited through this.
Relocation and retention incentives can be provided through the Rural Health Transformation Program.
So again, some of this is very nuanced in terms of how you would be thinking or shaping the program.
Direct payments to individuals are not allowed, so no gift cards, no cash assistance.
Again, we cannot use this to supplant the state's Medicaid match and direct food purchasing is also prohibited.
Let's see the claimant.
On this question, there seems to be a nuance in one of the early questions you testified
that a program that works, we could do more of it, that it sounds like you can't use the
money to pay for what you're already doing, but if you are doing more, which sounds
like something that may actually also be paid by Entrance but you were trying to expand.
A lot of gray area in how it fits together and I'm is that accurate or
Through the chairs senator Klayman for the record. This is Emily Ritchie. I would say that's accurate
Again, everyone is moving very quickly with this and i think the cms team
Is also working to kind of build out some of these boundaries?
I think
Good communication with them helps them consider our perspective and really the value of ideas that we may have and how those actually promote the
Object of their program and so those conversations. I think it'd be really helpful in
In clarifying like why something may be appropriate even if it's in a gray area
So there are areas in our proposed
application where we're pushing the boundaries specifically relating to child care and workforce housing.
We know that those are important needs in our communities.
We also know you are not allowed to use this for housing or for direct childcare.
But we did include some of those in proposed funding uses because there may be kind of ancillary programs or
opportunities we can develop that also help meet those needs.
What about something like, you spoke about renovation,
what about upgrading the insulation,
improving for a healthcare facility,
or even, like you said, a childcare facility.
Improving for heat retention, something
like that, would that fit in these kind of funds?
to the chair for the record, this is Emily Ritchie.
I think the extent of what renovations,
what defines renovation is still something
we're getting clarity on.
We know of several entities that really want to integrate
primary care into some of their work.
And to do that, they're looking at renovating space.
And so our ask is this aligns with system transformation,
the integration of primary-care with other services.
Can we use these funds to help renovate those spaces?
clarity quite yet on what the boundaries of those are.
And I just mentioned that because installation could be part
of what those renovations need in order to be successful.
So we're trying to get clarity on that.
All right, we'll move on to the next slide.
Okay, for the record, this is Betsy Wood.
I will be.
Kind of covering briefly the funding timeline.
I think we discussed this a little bit earlier
in the presentation, but I
think one of the key takeaways here
is that this is one-time funding.
And I thing we're all acutely aware of that.
And it's helpful to be looking into the future
to see when is the sunset date for this?
When does this program end?
So that as we start to build out programs
and our partners start build up programs,
we can be thinking about what does that sustainability
and that glide path look like towards the end of this.
And how do we leverage our dollars in between?
So, you know, I think you've heard us say multiple times that this has been a really fast and furious effort to understand what the opportunity is,
stand up an application, and then move through implementation, both on our side and on CMS's side.
I that breakneck pace may continue in that every year that we are awarded funds,
will be awarded fund annually for the next five years.
fiscal year to finish expending that kind of first bucket of funds before we move into the next.
So you can see on the screen how these pieces stack together but we'll be working really closely
with CMS and with our partners to kind distribute funds and start to make movement on progress so
Moving on to slide 10, I'll reiterate I think what we've said before which is that this is really
an Alaska-led program with a state-wide reach. Our goal is to strengthen Alaska's health care
system as a whole and that system is connected and serves the entire state. So the Rural Health
Transformation Program is built on that collaboration and those partnerships that we have across
state so organizations anywhere in Alaska may apply if their projects meet the program goals.
We need to demonstrate how their projects will meet those program roles on the state priorities and
show how that work can be sustained after funding ends.
I think one of the really, you know.
wonderful opportunities that we've seen related to partnerships with this as we
started to pull together our stakeholders and our partners across the
state through convenings. We've see organizations that have long worked
closely together realize that maybe, oh we're working on the same thing but we
've been working in parallel and new partnerships and
new opportunities have arisen where people are saying,
oh I had no idea that you had the
same concern about care coordination and referral patterns.
can we work together and make sure that we're all aligned.
So we've seen some new partnerships arise,
which is really promising.
And we have also heard that our partners are asking the state
to assist in some of that coordination and connection
and start to build out opportunities as we see,
you know, what do our community partners want to do with these funds?
What are their projects?
How does that align with each other and maybe play matchmaker in a way
where we can start connect entities together
work together in different ways.
So I have a couple of questions on this slide.
The first is, we've spoken about this before, but again, some of this is for the public
that's hearing about it for first time.
How much of the money can you use for administrative costs for your own administrative cost to
administer these funds?
And then second, how do organizations apply for these fund if they have to apply
one up. And then related to that, how would organizations even sort of find out about this?
So let's say you're the lower-class school district or something, you know, and that's
actually a very large, sophisticated organization. But a similar organization,
how are we going to push it out to them that there's this opportunity for them to apply?
Through the chair, these are great questions. First is, for the administrative piece,
predetermined caps on certain types of uses of funds
that some came from the enabling statute.
Some were articulated in the CMS notice
of funding opportunity and administrative expenses
are one of those.
There's a 10% cap overall on how
how much of that overall award can go to administrative expenses.
So that's something when we think about what does the state need in order to stand up some of this
and you'll see a lot of these on later slides too, but you know,
who do we need to partner with to help us administer these funds?
That, how do you work with subrecipients, community sub recipients who say,
I would like to do a project and I believe that this funding lies aligns.
You know, we'll use administrative dollars to help.
can make sure that this program works.
And to that end, we have 10% of the funds
that can be addressed to
that and we're, as we start to plan
and work with CMS to articulate,
here's how we see these funds being distributed
particularly in the first year.
We are classifying, you know,
planned uses of funds is this is an administrative expense.
The department needs to build capacity to run this.
We need to partner with a sub-recipient administrator
to help us with this,
those are administrative type dollars.
So there's 10 percent cap there.
Your next question is, you know, how how
how will people apply? I think you'll hear more about that on a later slide. We will be standing up
a portal, a web-based portal where entities can register. They can say here's my information,
they can provide us with a letter of intent that provides us some information about their project
so that we can help understand what's the best funding pathway for you? How can we get you
connected into the right opportunity? And again, you will see that a little bit on later slides.
is how do people find out about this?
We do have a slide on this later,
but we are using our website.
We have the Rural Health Transformation Program page
on our web site that is dedicated to this,
and we're updating it as frequently as we can.
I think you've heard that, you know,
we were building the plane as were flying it,
and as you build out new parts,
we try to tell people about those new part
and put them on the website in real time
so people can understand what are we doing,
what're these opportunities.
listserv that people can sign up for so you can be notified if we update our
website and you could get our emails that we send out to. We have
you know, just a few weeks ago, we pulled together in a very short period of time,
a statewide convening in Anchorage, where we reached out to partners and said,
we would like to come together, in person, and talk about, you
know here's what we know today, here is how,
here the program as it unfolded,
here how we built out the application,
here are how you can partner,
here you get engaged,
and we're going to continue to build out opportunities for convenings,
communities together so people can start to think about I guess at this point
it's really continued to thinking about what could this funding do in my
community and in region and how can we partner statewide. I also will say that
when the opportunity first you know kind of unfolded in July we really quickly
worked to put out a request for information to start together information
from our partners across the state and we also have been conducting many many
associations and stakeholders and entities that work with us to say here's
what we know. What are you hearing? What're your questions? And we've continued to
do that throughout the process. Any other questions on this slide? Senator Giesle.
Thank you, Mr. Chairman. Ms. Wood a few minutes ago, you said that the applicants
how what they are proposing would be sustained
after the funding ended.
And that's a great goal.
But at this point,
many providers are waiting to hear about the rebasing
of Medicaid reimbursement.
And the Division of Insurance about a year ago
removed the 80th percentile rule
without setting a minimum reimbursement
consequently contracts with
health care providers have been decimated, and they're being reimbursed at about 149 percent
or 150 percent of Medicare. Unsustainable. How? How are they to foretell how they will sustain
Through the chair senator geese will further record. This is Emily Ritchie
Speaking to the Medicaid program. We I think we presented to this committee last year
We began working on phase one of a rate methodology study to really review the rate the the underlying
Methodologies for specific types of Medicaid rates and we prioritize behavioral health long-term care services and supports
transportation, initially we started with emergent, or not emergent, but we pulled in emergen because we heard that need and federally qualified health centers.
And three of those studies are complete and posted, the fourth should be very soon, and I believe we'll be presenting that to the legislature at some time in the next few weeks.
But our intent with those study was really.
to look at, again, is what we are paying for Medicaid services?
Does that actually align with one, the outcomes we want to see,
but also the goals of the program and the costs
that providers are undertaking?
And there are recommendations within each one
of those rate methodologies that I think are going to be important
for us to review and talk about.
And we look forward to working with the legislature
to understand what are some of key changes we may want
to make now and how do we kind of phase out.
incorporating some of those other key changes in the future.
So we don't know everything now.
I can't, I have a hard time sometimes predicting five days, let alone five years.
So, we're,
we do not have perfect information today, but we know that we need to start with this process.
And we are asking entities, they may not know exactly how it will be sustained five
years from now,
but,
we want to make sure that they are thinking about that, and that that you know,
they have some thought at the very beginning for what that will look like.
Senator Giso.
Follow up, Mr. Chairman.
It is true that a third of the population benefits for Medicaid.
But two thirds do not.
Two thirds are either in private insurance or an uninsured.
And so that's the source of my previous question.
Are you working with the division of insurance?
So I would suggest there needs to be a broader discussion than just Medicaid reimbursement.
Thank you.
Senator Tobin.
Thank you, Mr. Chairman.
So I'm looking at this potential funding recipient slide,
and I know you have a follow-up slide
regarding some of your partners,
and keep thinking of something my mom
would say to me as a child, which is haste breeds holes.
When we're going quickly, we sometimes make missteps
or we forget certain pieces,
and far be it from me to cascade any group here
as doing anything in a malicious tent,
or nephariously, I knew there's
forces outside of your control, particularly with the haste dynamic, but I see all these
different groups and I'm curious of how do we as Alaskans find out what funding they received,
how they spent those funds, were their misuses of those fund, did the state provide oversight
and guidance, and in times and instances where there is missteps, what is the reclamation process,
hopefully being built into the system or already have been considered.
Because we know from the pandemic we learn lots of lessons about getting
dollars out quickly and what happens. And I've been listening to some of our
federal partners castigate our health care community and
certain folks in negative lights.
And i i would hope that we are not falling into that particular trap again.
For the record, Heidi Hedberg through the chair,
We don't know unless we partner together and we work differently together so that we can make
sure that they're making the best informed decisions with the information that
we have at this time. I would say there's a keen interest in terms of
the application process which we're going to move to and discuss but truly like what is funded.
And so that's where we keep driving people back to our website because it is our intent that we
are going be providing summaries of the projects that are happening across the state because what
we are experiencing and I think that Betsy Wood has shared this is there's some aha moments of like
But I see that you're doing it, how can we work together or take and apply what's working
in this community and applied into another community.
So our intent is that we're going to be continuing to eventually we'll have a dashboard on our
how it is being used, aligning to the initiatives,
align to goals, what are the outcomes from the funding,
looking at the return of investment,
talking a lot about sustainability.
I mean, there's a lotta conversations
about how are we going to sustain this work.
Part of that is the recognition
that we have to change the way we're working.
And so, I think that we are in the development of the evaluation.
We're going to have a contractor that will be evaluating this work, and that our intent
is that, we're gonna post it on our website.
And just as a follow-up, Senator Giesler, yes,
we were working with the Division of Insurance.
I mean, when we look at the second goal and we
look the at school sustainability of Medicaid, but also access to health insurance,
Those are conversations that we have started, but we recognize that's a year like two, three, four.
That's not a Year One, because right now we truly are just trying to build up the infrastructure and
make sure again to the chair your comment of like, is everyone aware?
We want to make that sure that were inclusive, so everyone is aware of this opportunity.
Yes, Senator Turman.
Thank you Mr. Chairman and this might be directed to you and the folks who serve on the budget subcommittee.
It would be helpful if every year the legislature was able to see the funds granted to organizations,
the projects that were funded, the expenditures that we're made.
This is public dollars and public has a right to know where every single penny is going.
Thank You.
I guess to respond to that commissioner I was going to ask a question later on about reporting requirements to CMS
But also were you planning on putting forward maybe an annual report on this and then
The contractor for evaluation the dashboard the report
Can you use these dollars for that as it as part of the administrative costs?
For the record Heidi Hedberg to the chair the answer is yes, okay very good
I would add that we are also going to be contracting with an independent evaluator over the course of the project.
So again, they can help evaluate the outcomes from the different projects and how they align with our goals.
We will also be getting their support with the compliance and the reporting requirements and all of this will be publicly available like any other public fund.
I think our intent actually is to make it more accessible.
through the dashboard than what we necessarily have right now.
I'm flashing back to our giant grant books that is published annually,
and I think we'd like to have something that's a little more interactive
and is updated more frequently.
Very good. Let's move on to slide 11.
We have a few more slides.
We've about 20 minutes left, and these are very dense
and interesting slides, I am very curious.
First of all, what a subrecipient administrator,
who that actually is, but why don't we just start on this?
on this slide.
Sure.
And for the record, this is Betsy Wood.
I think we can start with who was the sub-recepting administrator.
We were thrilled that we were able to announce that
we've partnered with the Alaska Community Foundation to help us work with community
organizations and hospitals and healthcare providers to kind of
help manage that community piece of the funding.
And I do think that it's helpful to think about
how will this money, you know,
how are we planning for it to kind of move?
And it, some of it will come into the state
that Department of Health is the lead agency for this.
We work with CMS, but we do need some
of those administrative dollars to stand up
some those pieces that we've just talked about
in order to make all of this run.
We are thinking that there are certainly opportunities
to leverage these dollars in ways to expand and to grow
into fill needs that they've identified.
But we're really thinking that the primary majority
of this money is intended for Alaskans
and is in tended to be distributed throughout the community.
And that's where, you know,
working with the Alaska Community Foundation,
they have a track record of moving,
you now.
programs that have a large amount of money to distribute and short time frames, and they've done that very well.
You know, they're deeply rooted in the community,
and it's really important to us. I think we've said this multiple times,
but it is very important for us that this program stays Alaskan-led.
You are, I believe, Alascans really know what we need,
and we know how we work well together, so that was important.
So, moving on to slide 12, I'll talk a little bit about the funding pathways that we're
building out.
You know, again, talking about understanding that Alaskans have very specific needs.
I think that all of the entities that, we envision benefiting from these funds.
comment different stages of readiness, you know, I think that we all have been talking
about, what does it look like to administer a large federal program that has a lot of
reporting requirements and has lots of strings attached and smaller entities that can be
a daunting task to look ahead and to say, am I prepared even just with my administrative
pieces to understand what it means to apply as a subrecipient, right, these are words
that mean certain things in certain places, but people are saying,
make it a reality, I think this is an opportunity for me,
but I don't know if my organization is ready for that.
We are building out an administrative readiness
kind of grant pathway so that entities can look at those
and those are administrative dollars, right,
to say, can I get myself administratively ready
in order to engage in this program?
And then the next funding pathway
that we are looking at are planning grants.
I thing of that is entities that have an idea
Maybe it's not fully fleshed out, maybe they need to build some partnerships,
maybe need put some shape around it so that they can say here's what this would look like fully packaged and ready to go.
So we're building out a planning grant pathway for organizations that need that sort of support.
Then our third pathway is looking at project implementation.
So I look at that as an entity says, I have a project that is ready to go.
It meets, you know, the, it aligns with the initiatives and the potential uses of funds
that are in the application.
And I, have, a really strong sense of what it's going to be.
I'm ready.
That's a Project Implementation Grant that would be probably a more involved application
than maybe the other pieces because we do need to communicate back to CMS.
going to look like. And I think earlier we were talking about what does it look
like to do you know renovations or infrastructure pieces and I
think that CMS has said they're prepared to work with the state and to
work potential subrecipients to really understand what's in a project and see
how it fits and that may be where we do this is within that project
implementation where you may say I have this
renovation need and part of it is upgrading the installation so that it fits the community
where I am. We may need to work with CMS so we may
need more details from applicants and that's where we're looking for project implementation.
Patho will be a little bit more robust.
We're also building out a pathway for targeted innovation projects.
I think of that as state directed or maybe prepackaged projects that are designed by the
Department of Health to address gaps that we see arise or to to
address priority areas and that allows the state to be nimble and to move
quickly and, you know, look across, we write this 20 plus pages of here's what
we all want to collectively do and we're asking our community to say, well, what
to also say let's put some shape around some of these ideas and present an opportunity that
entities can say yeah that does look like something I want to do. So that's I would say those will
maybe be more forthcoming a little bit later. Our current focus really is on building out this
our community participants to say that I would like to apply for some of these funds.
I'd like move forward, we're really building up those pieces of the program, and
then we'll fine tune as those piece has become established.
Okay, I ask sort of two related questions.
The first, can you provide any examples of those sort
of state directed or prepackaged?
projects. And then secondly, you know, we get a lot of requests from constituents and ideas from
constituents. They come to us, they come through our offices. Would you suggest us either through
our officers directly going to you or sending them to and sort of pointing them
to this source of funds for those kind of ideas?
I would say for the targeted innovation projects, yes, if there's ideas, please let us know.
We've also opened the invitation to all of the various associations, like as an association with a group of providers,
what are you seeing as the biggest pain points that apply statewide and taking those ideas?
prepackaging it and saying here's a package so it's easier for entities to
say yes I'm going to take this instead of developing my own project
implementation so I think that the ideas certainly should come to the
Department of Health so that we can definitely flush those ideas out.
To your earlier question of what are some of the examples,
I would say maternal health is an example of
what we see in communities is,
moms need to travel out earlier to deliver care.
So what some are of those projects that we can work on
to help moms stay in community longer
before they have to to have out to delivery?
Emergency medical services,
opportunity to use real health transformation funds to really look at how do we treat in
place or transport to an alternate destination so that.
We are only transporting patients to an emergency department
when it is appropriate for the emergency departments.
So I think those are different concepts
that need to be evaluated and discussed with EMS.
I Think of D.C. Richie, she had talked about
remote patient monitoring specifically around
congestive heart failure as an example.
That's another opportunity for us to look out.
I thing the ideas come from, it can come
from you, It can from associations,
from providers. We are looking at statewide impact and we also, I just want to call out,
we have this lens of equal opportunity. So from the smallest nonprofit provider to the
most robust organization that has grant writers, what's an equal
opportunity to engage in some of these targeted innovation projects that is already completed,
Very good.
Senator Giesel.
Thank you, Mr. Chairman.
Commissioner, you know, I think every person sitting at this table, and even in the legislature,
says bravo to you for the application.
And it's always exciting to have federal money.
But at the end of the day, we also have to face paying the bill for this.
And this is what I mean.
track record on reporting and tracking this money and this comes out every year and our
annual single audit.
Money wasn't reported appropriately or it wasn�t tracked and therefore we get dinged
on our federal reporting sometimes accompanied by fines which is where paying the bill comes
in.
Do you have the ability? Do have staff in place? What is your fiscal note for executing the management of this?
Thank you for that question.
I would say that we are definitely learning from our lessons learned over the past three
years since we've been in these positions first and foremost.
Second, we're creating eight new positions within the Department of Health that is funded
by the Rural Health Transformation Program.
on accounting and project implementation.
Thank you, Mr. Chair.
Thank You, Senator.
Senator Tillman.
Thank-you, thank you.
Mr Chairman, I guess that leads me to the follow-up question.
I am a former employee at the Alaska Community Foundation and I'm very well aware of what their current capacity is.
How many folks do they need to hire to be the subgrantee?
And what is their particular administrative overhead in being the administrator of these funds?
Through the chair, Senator Tobin, that's a great question.
We just were able to announce that we've contracted with them
as of yesterday morning, so I think they're still
in that staffing up capacity.
And they...
fully recognize that they will need to surge.
I think there's like an initial surge capacity
that we'll need build in order to establish this project.
And they're actively working on building out their team.
I don't know offhand how many team members they have,
but they are I also learning from past experience
and wanting to come into this prepared
and ready to move forward.
Yes, Senator Tillman. Thank you, Mr. Chairman
Will they be able to use these funds to do that and
Does that mean that there'll be less funds that go to the grantees because that they'll being using them to sustain positions?
Thank You for the question through the chair senator Tobin they will their contract will be funded with these rural health
Transformation dollars, but we look at that as part of those administrative funds
That are necessary in order to
really fully leverage and move the rest of the dollars
where they need to go, the bulk of dollars.
I think we're trying to run as lean as possible
on the administrative side while also recognizing
that if the administration gears don't turn and don't work
then it's really difficult for the programs to succeed.
Thank you.
Let's move on.
We've got two more slides.
We're running a little low on time.
Perhaps we could stay a few minutes later
if we have additional questions.
But let's moving on to slide 13.
Thank you for the record.
This is Betsy Wood.
I can be really brief with this slide.
I think this is just meant to provide an example
of the type of information that we expect to see
in those full project implementation applications.
It's really meant
to just give a sense that
we will be asking for information about the project
and the work plan pieces like that.
And a lot of this
is going to be driven by what do we need
to communicate back to CMS
so that they can have a full understanding
of how we're building up projects.
Very good.
move on to slide 14. Again, I can be brief with this. This is a high level overview of what the application review process will look like.
Again applicants will be able to register with an online portal and provide their information and ideally one time so you can say this is who I am and then start to build out those letters of intent to provide a shape of your project.
That will help us route people into what may be the most appropriate funding opportunity or funding pathway.
to work with CMS to ensure that what we'd like to fund
is aligned with what CMS's program requirements are,
and then move forward from there.
I think this is a high-level overview.
A lot of people are really interested
in the specific timeline for that.
We are working every day to build out
that timeline with specificity.
And I would say, again, to watch our website,
we'll be updating that soon as soon
as we can with more information for the public
so they can understand when and how
The money comes, presumably, over the course of these five years.
Do you intend to have a rolling application process?
Or would it be hard deadlines every year?
What do you anticipate?
To the chair, we anticipate that there will be multiple opportunities to apply for these funds, right?
We have to work in terms of budget periods, so right now we're within the first budget period.
We know how much we've been awarded for this year and able to spend through the next.
Our next budget will begin in October,
so we'll need to do some pre-planning ahead of that to start to build out our continuing application that we turn into CMS to say here's what we are thinking for next year.
recognize, you know, we're working with CMS to provide budget updates as we go to say,
okay, first we worked off of a planning number.
Now here's our actual award.
We're updating to that.
But we recognize as do they that that has to, that collaborative agreement and
cooperative agreement really does have to be a lot of cooperation and very
collaborative because we are in the position of understanding that we want to.
deploy these funds across the state, we need to receive information from potential applicants for what do they want to do, so then we can communicate that back.
So I think that there's going to be a lot of back and forth as far as what does that look like?
Where do we see those funds going?
But absolutely, there will be multiple opportunities for entities to kind of enter into that application cycle.
Again, for that kid, this is Betsy Wood, just to remind folks,
this how you can find us, how can you stay in touch with us.
We have a dedicated website on the Department of Health.
Webs are a dedicate page on
the department of health website.
We're building out frequently asked questions as we receive them.
I think I mentioned earlier we held a convening
where we brought partners together and we received over 400
individual questions that came in during that.
And so we're synthesizing those and questions
that we get from the public, from our partners,
the frequently asked questions where we can provide more information so people
understand, you know, how best to engage and what do they need to know. We have a
dedicated email box and we will be updating our website frequently with
information about different webinars, learning opportunities, and
we highly encourage people to sign up for updates. So, why don't you give the
question, Senator Myers? Yeah, when you're done. One of the questions here is who can
Do they have to be Alaskan or Alascan-based, and is there any preference given for,
for example, if you are sort of, most of the money that you're spending is here in Alaska versus an outside contractor you
are bringing in from out of state, or is that not considered?
To the chair, Senator Dunbar for the record, this is Emily Ritchie.
We are still finalizing kind of the evaluation rubric.
We worked with kind
of that key advisory group to develop that initial rubrics
that was included in the application,
but we need to finalize that.
And in future years, we plan to put that forward publicly
and update that again.
We want this process to be very public and open in terms
of how these are being evaluated.
I think right now we would expect that any application very clearly state how they are aligned with Alaska-based providers, right?
I can't imagine an entity coming in and not having an alignment with an Alaska based provider or
organization that would be competitive for funding.
Again, we are focusing on Alaska organizations and communities.
Very good. Senator Myers.
Thank you, Mr. Chair.
So it's already the end of January. You've got until October to get this money awarded and sent out.
So when is the letter of intent notifications going to come out and when will the RFP process start?
For the record Heidi Hedberg through the chair senator Myers
so on our website we are gonna the the goal that we have is
We will be announcing a webinar because we want to educate everyone in Alaska
How to apply with the registration portal and the letter of intent so that will becoming
very soon
following that we'll have a short period for the letter of intent and then we will evaluate those
and look for full proposals. So the information truly on a daily
A couple of days is continuing to be updated on our website and we would point to everyone
to our web site.
We feel the urgency in getting the information out, but to earlier questions, it's also being
about the thoughtful and making sure that we are thinking of all of the different.
We need to making many considerations as we're making these decisions on making
sure everyone's informed with the letter of intent in the process.
Very good. Senator Giesel.
Mr. Chairman, I just wanted to underscore a question that you just asked prior to Senator
Myers. You know, when you held that convening in Anchorage, it was a gold rush of outside
companies coming in, oh boy, federal money. And so I appreciate your answer that, you
will be looking at organizations already aligned with Alaskan providers. That's critical.
that the money is, in fact, used here and not simply handed out to outside entities.
Thank you.
Senator Hiesel, there are questions.
We have a couple more minutes left and I want to go back to something.
We can go to the next slide to says questions, but actually my question is based on the
Is it right to say that you're asking for?
I mean, is the Department of Health
asking you for these policy changes?
I assume yes, because it was part of the application process,
but there's been no formal sort of representation
from the governor's office by putting forward
the legislative request.
My question is, I know you can't say to us yet
sorta what percent of money hinges on which
of these policies changes.
I don't really know that yet.
Can you tell us when you might know
For the record, Heidi Hedberg, to the chair,
we have asked, every state has asked the same question,
and CMS has not provided that answer
or when they would provide that answers.
And so we don't know, but it is a question that is being asked.
Yes, I think, you know, we heard loud and clear from all of, from
Alaskans across the state to be competitive and so I
think yes,
we are looking for those policies to
be passed, but I
think that there's education,
there is evaluation that needs to happen.
And so we have two years in order to have those conversations
to evaluate,
you
know what makes sense.
And I fully respect that that is within the legislative
I know within this committee to have those conversations.
Senator Clayman, thank you, Commissioner.
Maybe to put a narrower question, and you may not answer this one either, but
what I've here repeatedly is that the timeline to get these potential policy changes on page three is two years.
And last, I counted the current governor has about ten months.
And so there's one response that one could have sitting in the legislature.
today saying hmm this sounds like a problem that's going to be the next governor's problem
not this governor is problem and the governor this Governor's happy to kind of wait and let the
next let that get dealt with in 27 not in 26 I might is that something that has been discussed
within the executive branches to whether this is a priority for 27 and not really worry about it
To the chair, Senator Clayman, yes, this is a priority and we would love to see these policies passed.
But we don't really know the policies that we're supposed to pass yet.
Through the chair, Senator Cleman. So the compact licenses four out of those five are
with the Department of Commerce and so Sylvan Rob is here and
So this is where we're all here together to make sure that they can speak to those compact
licenses EMS is within the department of health and
So yes, we would love to see the EMS compact licensure passed and there is
legislation that has been introduced
related to the scope of practice for pharmacists.
And so that is already underway.
So I think part of it is we see many legislators
that are interested in seeing legislation introduced.
I we're waiting to see who is introducing legislation.
There was another legislator that introduced
one on the psychologist.
So, I that's part just period of time
and where we are at today.
But to your earlier question,
past this session.
So I have another question.
I apologize to my colleagues, and feel
free to step out if you need to go.
But I do think this is important, because I think it drives
a lot of the conversation.
We're going to have the rest of session
if we actually want to see legislative changes.
I don't actually know if these compact licenses are sort
of an on or off switch, or if there
are different versions of this kind of legislation that
can be passed, certainly within scope of practice.
Do you have a, in the promises made to the, through the application process,
was it a certain kind of change that you need to discover practice?
Like is that defined in a way that we can put into, into legislation?
Or do you model legislation that, we could at least see?
I think that you heard the commissioner say earlier that there are very specific pieces identified that states were asked to look at, and we can share that it's within the notice of funding opportunity but it is a little bit buried in there so we could share
that with the committee and point you directly to where those pieces are.
could you drive the legislative drafting process?
So we know exactly what it is we potentially need to pass.
To conform with your application to be clear.
I mean, ordinarily we do legislating,
but certain promises have been made.
We need if we want to, we need
to know how to comply with them.
I think to the chair, I
think what we can do is we
can provide the information
that was provided by CMS.
And, you know,
I'm not a legislative
drafter, so I
think we
can say this is.
We've got reinforcements.
Court of Ann, right.
Legislative liaison
for the Department of Health.
There is model legislation
that is specifically linked
for most of the compacts,
and there's a specific link
for what exactly is looking
for in farmers.
I'll be happy to get that
specifically to you
for that committee.
I think I know the answer to this, but lastly, maybe not.
If we diverge, if we pass a version,
but we divert from the model legislation,
do we still get credit?
Do we get partial credit, how is that scored?
How we know, when will we how that is scored.
So through the chair senator Dunbar, it's pretty specific that we have to join the compact
So each compact has specifications on how much variation can be made so as long as we
Meet within the needs that each compact has and we are able to successfully join that compact
We should meet the need we haven't scoring but I defer to Betsy if there's more details. That's my understanding as well
Very good. Do we've any follow-up questions now? I've
kept everybody long enough, we're going to have more hearings on this we must if we
want to pass this legislation. So thank you Commissioner for your time. Very much appreciate
everyone's indulgence staying here a little later. The next meeting of the Senate Health
and Social Services Committee will be Tuesday, February 3rd. We will have the department back.
But this time for an overview which will include updates on SNAP and Medicaid related to the