Legislature(2019 - 2020)ADAMS 519
03/22/2020 11:00 AM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB115 | |
| SB155 | |
| SB134 | |
| SB172 | |
| SB55 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 155 | TELECONFERENCED | |
| + | SB 55 | TELECONFERENCED | |
| + | SB 134 | TELECONFERENCED | |
| + | SB 172 | TELECONFERENCED | |
| += | SB 115 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE BILL NO. 134
"An Act relating to medical assistance reimbursement
for the services of licensed professional counselors;
and providing for an effective date."
1:42:38 PM
SENATOR DAVID WILSON, SPONSOR, indicated that SB 134 was an
act relating to medical assistance reimbursement for the
services of licensed professional counselors. The bill also
benefited all Alaskans in need of behavioral health by
expanding its capacity. The legislation would add licensed
professional counselors (LPCs) to the Medicaid optional
services. The concept of the bill was to expand behavioral
health capacity and utilization for Alaskas most
vulnerable population.
Senator Wilson continued that Medicaid clients and all
Alaskans had difficulty finding access to behavioral health
care often waiting 3 to 6 months for appointments. In a
state of crisis, they utilized the most expensive platinum
level of care there was - Alaskas emergency rooms. He
asserted that in current times, it was not where they need
to be. He reported that it cost on average about $4360 for
behavioral health assessment in Alaskas emergency rooms
versus about $200 in a clinical setting. Adding more
counselors to provide services in a clinical setting would
provide Alaska with improved health care outcomes at a
lower cost. The bill would provide the appropriate level of
care with an appropriate level of health care providers.
Costs were rising at an unsustainable rate and something
needed to be done differently to stop the trend.
Essentially, Alaska needed to retool its factories and
systems to get more productive and better outcomes for
Alaskan citizens. He asserted that SB 134 complimented
HB 290, SB 120 and many other pieces of legislation in
terms of the 1115 waiver to help provide a cost containment
reduction increasing access for Alaskans with better
outcomes of behavioral health services. He believed that
other healthcare providers in Alaska agreed, as there were
letters of support and people waiting to testify in favor
of the legislation. His staff, Mr. Zepp, would be reviewing
a PowerPoint Presentation for the committee.
1:45:16 PM
GARY ZEPP, STAFF, SENATOR DAVID WILSON, began with slide 2
of the PowerPoint presentation titled "SB 134 "An Act
relating to medical assistance reimbursement for the
services of licensed professional counselors; and providing
for an effective date" dated March 22, 2020 (copy on file).
He relayed that SB 134 would add licensed professional
counselors to the Medicaid optional services. The concept
of the bill was to expand capacity and utilization of
behavioral health care in a clinical preventative setting
versus a state of crisis in Alaska's emergency rooms.
Mr. Zepp continued that the expansion of behavioral health
care was projected to reduce waiting for services and to
improve the quality of care by providing the appropriate
care by the appropriate healthcare provider. He reported
that it would cost less than behavioral healthcare in
emergency rooms across the state. In conversations with
stakeholders, he heard about wait times for substance abuse
disorders, suicide, depression, trauma from violence, and
serious mental illness of anywhere from 3-6 months for
Medicaid clients. It was due to a workforce shortage of
behavioral healthcare professionals who were available to
see Medicaid clients.
Mr. Zepp thought everyone had seen examples of behavioral
healthcare shortages that had been revealed in peoples
daily lives and through stories in the media. Licensed
professional counselors were a valuable cost-effective part
of treatment for behavioral health care. The proposed
legislation was a piece of the behavioral health capacity
puzzle that already included marital and family therapists,
licensed social workers, PhD psychologists, prescribing
nurse practitioners, and medical doctors like psychiatrists
and primary care physicians. There were approximately 717
active licensed professional counselors available in
Alaska.
Mr. Zepp turned to slide 3 regarding behavioral health.
Many people were familiar with the term "mental health."
Mental health covered many of the same issues as behavioral
health, but the term only encompassed the biological
component of the aspect of wellness. He read from the
slide:
Behavioral health is the scientific study of the
emotions, behaviors, and biology relating to a
person's mental well-being, their ability to function
in everyday life, and their concept of self.
"Behavioral health" is the preferred term to "mental
health." A person struggling with his or her
behavioral health may face stress, depression,
anxiety, relationship problems, grief, addiction,
attention-deficit/hyperactivity disorder or learning
disabilities, mood disorders, or other psychological
concerns. Counselors, therapists, life coaches,
psychologists, nurse practitioners, or physicians can
help manage behavioral health concerns with treatments
such as therapy counseling or medication.
Representative LeBon asked what the minimum qualifications
were to become a licensed provider of mental health
services to be eligible for Medicaid reimbursement. Mr.
Zepp deferred to the various people online to address the
question. Senator Wilson thought Deputy Commissioner Wall
could answer Representative LeBons question.
1:49:11 PM
ALBERT WALL, DEPUTY COMMISSIONER, DHSS, JUNEAU (via
teleconference), responded that the requirements for
licensure rested with occupational licensing. An academic
and professional background check and a test were required.
After making application and all that was entailed a person
would become professionally licensed in the state. In the
state plan for Medicaid, the states agreement with the
federal government as to how it handled Medicaid, there
were specific definition of health care provider types. He
indicated that part of the lengthy process of getting a new
provider type into the system could be addressed with the
federal government after a bill was passed with the
provider type. He was describing a multi-step process.
First, a provider had to become an enrollable provider in
statute. Second, the state had to add the professional
licensure to Alaskas state plan with Centers for Medicare
and Medicaid Services (CMS). Third, regulations had to come
after the fact to put together the framework in which the
new license type could bill Medicaid. There was a
professional licensure board that had oversite of the
license. The definition was included in the agreement with
the federal government and the state would craft
regulations in which to bill through.
Mr. Zepp considered slide 4: "Why Medicaid clients and who
are they?" He read from a prepared statement:
"Why Medicaid clients and who are they? Medicaid
provides health coverage and long-term care services
for Alaska's most vulnerable: children, seniors,
people with disabilities, pregnant women, and very low
income or working poor.
Medicaid clients have difficulties finding access to
behavioral healthcare and often have to wait three to
six months for appointments. So, you can imagine a
person in crisis or someone who is ready to accept
behavioral healthcare services and there isn't any
access or are told it's available in three or four
months. So, what are their options? Alaska's emergency
rooms.
SB 134 would directly impact the lives of our most
vulnerable population of citizens, our poor, our
young, and our seniors. Alaska's emergency rooms have
been overwhelmed with volumes of Medicaid client's
emergency situations in need of behavioral health. The
leading cause of emergency room visit are related to
alcohol disorders and the associated aliments of
alcohol abuse.
Often Medicaid clients have nowhere else to go due to
the lack of access and the lack of capacity which
causes patients to stay much longer in the emergency
room than they should. Typically, if a Medicaid client
is in a stage of crisis and there is not access to the
appropriate care, they leave the facility and the
cycle repeats itself. They will be back at the
emergency room because they are open 24 hours a day,
seven days a week."
Mr. Zepp moved to slide 5: "Adult Untreated Behavior Health
Statistics." He indicated that the following few slides
reflected some of the statistics concerning the lack of
behavioral health care, both nationally and within Alaska.
He read from a prepared statement:
Approximately, 70 percent of American's who need
behavioral health services do not receive treatment.
For substance use disorders it's about 92 percent that
typically do not receive treatment; and adults with
serious mental health issues, approximately 66
percent, do not receive behavioral health treatment.
Without treatment in a timely manner, this often can
lead to interactions with the police, the court
systems, and the correctional facilities within our
state.
According to the "Bureau of Justice Statistics",
approximately 51.4 percent of prisoner have a serious
psychological distress and/or a history of a mental
health problem 20 percent of those are considered
"severely and persistently" mentally ill.
Mr. Zepp discussed children untreated for behavioral Health
on slide 6. He relayed that the chart showed levels of
depression, anxiety, and behavioral health disorders by age
for children. He read from a prepared statement:
"As you can see, children are very much susceptible to
behavioral health issues. Common behavioral health
issues that our children experience include
depression, anxiety, behavioral disorders, and the
most common which is attention-deficit/hyperactivity
disorder (ADHD). A child diagnosed with depression has
approximately a 74 percent chance of having a co-
disorder, like anxiety. If a child is diagnosed with
depression and anxiety disorders, if not treated, they
usually increase over time, and the child's behavioral
health condition worsens.
Boys are more likely than girls to have a mental,
behavioral, or developmental disorder and children
living below the poverty line have a 22 percent more
likelihood of a mental, behavioral, or developmental
disorder.
SB 134 can expand the capacity of behavioral
healthcare in our schools, our communities, and our
healthcare facilities."
1:54:35 PM
Mr. Zepp continued to slide 7 which discussed the Alaska
assessment of behavioral health care needs. He read from a
prepared statement:
Mental disorders among children can cause serious
changes in the way children typically learn, behave,
or handle their emotions, which causing distress and
problems throughout the day.
This is absolutely tragic, and you have probably heard
this previously, but according to the American
Foundation for Suicide Prevention, the Alaska Bureau
of Vital Statistics, and the State of Alaska, Office
of Epidemiology:
Alaska has the highest rate of suicide per capita in
the country;
In Alaska, suicide is the number one leading cause of
death for ages 10-64;
Alaska rate is 21.8 suicides per 100,000 people and in
rural Alaska it is 35.1 per 100,000;
There was a 13 percent increase in suicides between
2013-2017, as compared to 2007-2011;
Toxicology results following suicides since 2015 show
70 percent involved one or more substances, most
frequently alcohol;
More than 90 percent of people who die by suicide have
depression or diagnosable, treatable mental or
substance abuse disorder."
Mr. Zepp turned to slide 8: "Alaska assessment of
behavioral health care needs." He continued to read from a
prepared statement:
"Later in our presentation, the expert testimony will
be able to shed a light on the workforce shortage of
behavioral healthcare professional available to treat
Medicaid clients and Alaskans in general.
The 2016 Alaska Behavioral Health Systems Assessment
Report estimated that 145,790 adult Alaskans roughly
20% of the state's population - need behavioral health
services. Despite the estimated need for mental health
care in Alaska, the ratio of mental health providers
to population is low compared to national levels.
Also, most behavioral health professionals work in
urban areas and in remote areas of the state, they
have even lower provider/population ratios."
Mr. Zepp moved to the chart on slide 9: "Alaska Emergency
Room Department Super-Utilizer Facts Total Medicaid Billed
Charges." He read from his prepared statement:
"The chart above reflects the total cost that the
State of Alaska has paid to emergency rooms for
Medicaid clients throughout our state over the
previous four years.
As you can see, in 2016 the total costs were $233
million + and that amount has risen over the last four
years by $47.1 million dollars or 21.1 percent.
As an example, in 2019, the top 2.9 percent of "super-
utilizers" consumed 16.3 percent of the charges at $46
million dollars (1,301 clients at an average cost of
$35,357 annually). They had 10 visits or more per
year, some as much as 50 visits per year.
If we count the top 10.03 percent of "super-utilizers"
(6,250 Medicaid clients) costs $114.0 million or 40.67
percent of the total charges annually (6,250 clients
at an average cost of $18,240 annually). They had 5
visits or more per year.
Costs are rising at an unsustainable rate and we have
to do something different to stop this trend. We need
to improve Medicaid programs and provide increased
quality and become more cost efficient. We believe,
and other healthcare providers in Alaska agree, by
adding more LPC counseling services, we have a chance
to improve these outcomes.
1:58:31 PM
Representative Josephson asked what was typically the
reason for an appointment. Mr. Zepp responded that the
majority of Medicaid clients were seen in Alaska emergency
rooms for substance abuse disorders. Representative
Josephson assumed people were going through withdrawals.
Co-Chair Johnston indicated there were some folks online
that would likely be answering Representative Josephsons
question.
Representative Wool asked if the increase in Medicaid
billed charges for emergency room services in 2018 and 2019
was due to Medicaid expansion. He had heard from hospitals
prior to Medicaid expansion that they had several people
going to the emergency room, as it was their only option.
The hospitals were not billing because Medicaid was not
available at the time. He suspected that the increase in
charges was a result of an increase in Medicaid patients
through the expansion. Mr. Zepp deferred to Deputy
Commissioner Wall.
Representative LeBon asked how emergency room repeat
customers were intercepted and directed to providers. If
people were to continue the pattern of showing up to the
emergency room, the hospital would not refuse to treat the
patients.
Senator Wilson responded that the Mat-Su Health Foundation
had the High Utilizer Mat-Su (HUMS) Project. He indicated
members likely had an information sheet in their packets.
It reflected an intensive case management program. He
believed Providence had a similar program in place and had
seen a significant drop in expenses. In talks with the
Mat-Su Foundation and Providence, he found that they
diverted patients for which they could not bill for
services. He also noted another information sheet that
talked about Medicaid super utilizers and why they entered
emergency rooms, many of which were experiencing substance
abuse or behavioral health issues.
Mr. Zepp continued with his prepared statement regarding
slide 9:
"With the federal approval of state's 1115 waiver for
behavioral healthcare services and by adding LPCs to
the mix of behavioral healthcare professionals it
offers an opportunity to expand capacity, increase the
quality of care, lower the costs versus the crisis
mode at the platinum level costs that the state has
already paid.
I'll repeat, the amounts shown above is what the state
has already paid on behalf of Medicaid clients in
Alaska for emergency room visits over the last four
years."
2:02:29 PM
Mr. Zepp continued to slide 10: "Alaska Emergency Room
Department Super-Utilizer Facts Number of Medicaid
Clients." He read from a prepared statement:
"The chart above shows that the number of Medicaid
clients in our emergency rooms have not increased but
the costs have.
The most common diagnoses for the top 2.7 percent
super-utilizers are alcohol-related disorders and the
associated ailments;
The top 2.7 percent of "super-utilizers" are likely to
be between 20-59 years old & 61 percent are females
and 39 percent are males."
Representative Tilton posed a question about how to change
a persons behavior who was consistently going to the
emergency room because it was what they knew to do. Mr.
Zepp suggested that in a few minutes the committee would
hear from the Mat-Su Health Foundation and from Jared
Kosin, the CEO of the Alaska State Hospital and Nursing
Home Association (ASHNA). Currently, they had two programs
that had been in practice for about 2 years that were
experiencing success in rerouting patients away from the
emergency room to a clinical setting. Both programs had
achieved health improvements and cost savings.
Representative Tilton asked if the bill would increase
availability of substance abuse providers. Mr. Zepp
responded affirmatively. He noted that in 2018 the Senator
had sponsored SB 105 which added licensed, marital family
therapists to the Medicaid optional services. He thought
there was a stereo type in place regarding licensed marital
therapists and licensed professional counselors that
their scope was limited in terms of what they could
provide. However, the counselors could provide a wide
variety of services up to, but excluding, the prescription
of drugs. Licensed therapists could handle many modalities
including: substance abuse, anxiety, schizophrenia, mood
disorders, and depression.
Mr. Zepp continued to slide 11: "Preventative behavioral
health care can reduce costs." He continued reading his
prepared statement:
"There is good news however. Since the passage of SB
105, which added licensed martial and family
therapists to the Medicaid Optional Services. Several
programs aimed at diverting Medicaid clients from
emergency rooms into more comprehensive coordinated
care models are in practice right now.
As you'll hear from Mr. Jared Kosin, the President and
CEO of the Alaska State Hospital and Nursing Home
Association and hopefully from the Mat-Su Health
Foundation ladies, Ms. Elizabeth Ripley and Robin
Minard. Programs are diverting "Super-Utilizers" from
our emergency rooms in Alaska to a clinical or
coordinated care setting and it does save money. These
two are examples that are working in Alaska right now
and achieving significant results. Most importantly,
the Medicaid clients are receiving improved quality by
the appropriate healthcare professions but at
substantially reduced costs. This saves the Medicaid
program money! By adding capacity with Licensed
Professional Counselors to assist with behavioral
healthcare issues, this enhances those programs as
well as other private practice clinical settings too.
We did want to touch on the fiscal note from our
friends at the Department of Health and Social
Services. It's understood they have to provide
estimates of what programmatic changes may costs but
we believe there is more to the story."
Mr. Zepp thanked the stakeholders that supported the bill.
He revealed a list of the stakeholders on the final slide.
Co-Chair Johnston thanked the presenters and encouraged
invited testimony to begin.
2:08:52 PM
JARED KOSIN, PRESIDENT AND CHIEF EXECUTIVE OFFICER, ALASKA
STATE HOSPITAL AND NURSING HOME ASSOCIATION, ANCHORAGE (via
teleconference), indicated the association fully supported
SB 134 and thought it was smart policy and a smart use of
resources. He suggested the legislation would reduce visits
to emergency rooms. Utilization would be reduced in 2 ways.
First, it would create direct access to care in the
community. In response to Representative Tiltons question
regarding how to change behavior, he suggested that people
would have an option other than going to a high
level-of-care emergency department. He thought it was
reasonable to think people would go to another provider for
care. For those people that were hard-wired to go to an
emergency room, they could be redirected via a successful
discharge from an emergency department. He relayed that
currently in the system of care, with the capacity issues
at Alaska Psychiatric Institute (API), patients were going
to the emergency room in crisis, being converted to
Title 47 ex-parte patients, and were boarding at emergency
departments for days at a time while they waited for an
inpatient bed. Patients would then be discharged from their
inpatient bed and would show back up at emergency rooms
perpetuating a vicious cycle. The legislation would provide
emergency departments with the option of making a warm
handoff to a counselor in the community. The counselor
could then take the patient working with them on a long-
term basis. Such capacity was currently non-existent or, if
it did exist, it was on a very low level. The bill would
allow for more continuity of care. He sincerely believed
SB 134 would decrease health care costs rather than
increase them. Ultimately, the bill would save the state
money. He urged members to support the bill.
2:13:00 PM
Representative Tilton referenced Mr. Kosins statement
about the bill allowing hospitals to make successful
discharges because they would have the ability (currently
not in existence) to handoff patients to providers. She
asked if capacity of providers or the lack of the ability
to bill Medicaid influenced why behavioral health providers
were not presently used.
Mr. Kosin responded that both applied. He used the Mat-Su
Regional Medical Center as an example. It had a private
family practice as part of its network of services called
Solstice Family Care. Solstice Family Care had a licensed
clinician who could provide services for Medicaid
recipients. However, currently there was no way to bill
Medicaid for its services. He asserted that without the
ability to bill for services, the entity could not stay in
business for very long. The bill would allow for a new
avenue for discharging patients from the emergency
department to the clinician at Solstice Family Care, work
with the patient on a plan of care to help them through
episodes that would otherwise land them back in the
emergency room, and bill Medicaid. The cost for 15 visits
to the clinician would equal approximately the same as a
single visit to the emergency room. The economics were
justifiable.
Representative Carpenter asked about the likelihood the
federal government would approve professional counseling
services. He wondered if there were already other states
that include it in their services.
Mr. Zepp reported having reached out to the National
Council of State Legislatures to do some research. They
found that about 6 states including Montana, Washington,
and Oregon, had already added licensed professional
counselor services to their Medicaid optional services.
2:15:55 PM
ROBIN MINARD, MAT-SU HEALTH FOUNDATION, WASILLA (via
teleconference), relayed that the Foundation shared
ownership in the Mat-Su Regional Medical Center and
invested its profits back into the community in order to
improve the health and wellness of Alaskans living in
Mat-Su. She was testifying in strong support of SB 134. The
bill was crucial because it would help address an important
health issue facing Mat-Su residents every day - mental
health and substance use problems. Licensed professional
counselors were key behavioral health providers who could
help with the mental health and substance use issues.
Ms. Minard continued that the Foundation was aware the
issues were difficult for Mat-Su residents because they had
stated as much in the previous 3 community health needs
assessments. She reported that in 2013 residents and
professionals stated that the top 5 challenges they faced
were alcohol and substance abuse, children experiencing
trauma and violence, depression and suicide, domestic
violence and sexual assault, and lack of access to
behavioral health care. Residents with the list of issues
could be helped with access to counseling. School nurses in
the same survey were seeing waiting lists as long as
4-8 months for children and families that had Medicaid to
get into see a counselor - much too long to have to wait.
It was crucial that Alaska residents had access to
behavioral health providers for care before their problems
escalated to the state of crisis.
Ms. Minard continued that Mat-Su Regional Medical Center
and the community was inundated by residents who were in
crisis related to behavioral health issues. In 2016, 3443
residents were seen in the emergency department with a
primary behavioral health diagnosis, and those people had
8400 visits costing $43.8 million in facility charges. The
cost did not include the costs associated with law
enforcement or emergency transportation. The average cost
per visit was over $5000 and, the average cost per patient
was almost $13,000.
Ms. Minard noted the senator mentioning the HUMS Program
earlier in the meeting. She explained that HUMS was a
program supported by the Mat-Su Health Foundation, the
program was started as a way to provide care coordination
and access to community support for high utilizers. High
utilizers were defined as residents who have had 5 or more
visits to the emergency department in a year and who were
unable to independently access consistent, appropriate care
in the community. The HUMS program had already resulted in
dramatic cost savings. It had also alleviated significant
trauma for patients as well as health care providers and
families who often suffered trauma along with the patient.
She urged members, as they delved into the data, to keep in
mind that if people had access to care before their needs
became a crisis, there would be far less need for a program
such as HUMS.
Ms. Minard relayed some of the results of the HUMS Program
to-date. She reported a cost savings of $2.168 million over
2 years. In 2018, the top 3 utilizers saved $340,288 by not
making emergency department visits. In the same year, 7
patients did not visit the emergency department at all
after they enrolled in the HUMS Program. She relayed that
enrollment was voluntary for the patient. The age of the
patients ranged from 16-82, and 72 percent had Medicaid as
their health insurance. She reiterated the importance of
Medicaid clients having access to the whole continuum of
care. The program had an external evaluator and the
Foundation was still learning and tweaking the program to
make it more effective and less expensive as time passed.
Ms. Minard shared a couple of success stories from the
program thus far. The first was a young adult client that
had had 17 visits to the emergency department in the prior
year. They had poorly managed diabetes and a substance
abuse disorder. Most of their emergency department visits
lead to inpatient admission into the intensive care unit
(ICU). They had a long history of IV drug use and was non-
compliant with primary care appointments. She continued
that when the person was referred to the HUMS Program, the
outlook was poor, and HUMS staff were told the client had
little or no interest in improving their situation. With
time and a listening ear, the HUMS staff built a rapport
with the person and it quickly became obvious that the
desire for a healthier life existed. She was happy to share
that the client was currently sober; their diabetes was
well managed; they had a driver's license; they were
working a full-time job; and they had a great relationship
with the primary providers office.
Ms. Minard presented a second example. Another client had
been extremely proactive with their care and improving
their own quality of life. They had been able to maintain
sobriety for over 6 months and enrolled in parenting
classes to become a better parent in the hopes of regaining
custody of their child. The program assisted with housing,
getting them into substance use disorder treatment, and
with purchasing needed hygiene and clothing items. The
person had gained and maintained steady employment at a
restaurant in walking distance of where they lived so they
could get to work. The client was currently saving money to
get their own apartment. She concluded that the HUMS
Program showed great promise. However, even more promising
was the idea that if there was more behavioral health care
available earlier on, the HUMS program might not be needed
in the future. The hope was for people to get care in a
lower cost setting. She understood there was concern about
adding costs to the Medicaid System. She asserted that
SB 134 would do the opposite; it would allow behavioral
health care to be provided in the least costly setting,
thus, avoiding all of the more expensive care later. She
thanked members for their time.
2:22:15 PM
Co-Chair Johnston OPENED Public Testimony.
JON ZASADA, POLICY INTEGRATION DIRECTOR, ALASKA PRIMARY
CARE ASSOCIATION, ANCHORAGE (via teleconference), spoke in
support of SB 134. He read from a prepared statement:
"Alaskas 2 federally qualified health centers
actively support SB 134 adding Medicaid reimbursement
for LPCs has been a top priority in our efforts to
expand access to behavioral health services for many
years.
Community health centers are already using LPCs in
their practices to provide school-based services,
individual counseling services, substance abuse
disorder treatment, and in supporting care
coordination activities. And this does include
individual coaching on basic health and hygiene issues
such as were addressing now with the COVID epidemic.
However, these services provided by LPCs are not
currently reimbursable. They are currently paid for
through earned income, federal and private grant
funds. This is not sustainable.
Health centers have received considerable federal
funding to expand behavioral health services in the
primary care setting. They are required to provide
behavioral healthcare that is integrated with medical,
dental, pharmacy, and other services. Adding LPCs to
the roster of billable providers enables health
centers to make their services more sustainable. This
is the national best practice.
LPCs are a valuable, cost-effective component of team-
based whole-person care. This is particularly
important right now as we are doing everything that we
can to keep patients out of emergency rooms and
hospitals. Mild and moderate anxiety and depression
are co-occurring conditions with chronic conditions
including diabetes and hypertension. LPS are a vital
provider type that can typically provide short-term
counseling support that enhances the work of other
medical, dental, and pharmacy team members in
stabilizing and improving the health of emergent
patients and assisting them in managing chronic
conditions over time.
Finally, in 2017, Alaska health centers reported a
deficit of 12-18 behavioral health providers that
could expand access to 6000 to 9000 additional
patients. We support SB 134. It addresses a key need
in Alaskas response to behavioral health, lends
stability to efforts already underway, and offers
another tool in our response to improving care and
lowering the overall cost of care."
Mr. Zasada thanked the committee for its time.
2:25:24 PM
DON BLACK, EXECUTIVE DIRECTOR, BETHEL FAMILY CLINIC, BETHEL
(via teleconference), introduced himself and read a
prepared statement:
"Our clinic employs one licensed clinical worker and
one licensed professional counselor in our behavioral
health department. When I last spoke, we were
providing services to teens at the Bethel Youth
Facility in efforts to reverse destructive habits
while these students are still young. Our substance
abuse programs were embedded in the community as well
as at the Yukon-Kuskokwim Correctional Center where
our staff provided group and individualized guidance.
All that is gone while we hunker down. Although our
delivery has changed, our services continue. We
continue in more individualized services and, where
possible, by electronic medium. More individualized
services stretch our staff thin, but limited Medicaid
billable staff stretches us even thinner. Were
venturing into the unknown. We have no numbers to
support where we are going. We just know, we just all
know, we are going there.
Look around the room, or if you are meeting
electronically as I am, imagine youre looking around
the room. See not just the faces of your colleagues.
See not just the names of your colleagues. See the
person. We are all gathering on a Sunday, not as an
ordinary day but as a day to accomplish important
business in the time remaining this session Meanwhile,
there is a wave coming. We dont know how hard it will
hit. We dont know when it will hit. We just know that
it will hit, and there is nothing we can do to stop
it. And we cant even swim, just float. This stressor
just entered all of our lives.
Some of those people around the room or virtual room
will cope with this stressor better than others. It
doesnt matter how we cope or appear to cope it was a
stressor for everyone. Many of you have coping
mechanisms to help you relax a morning cup of coffee
and a newspaper at the local coffee shop. Closed.
Church closed. A relaxing dinner with loved ones or
friends after a long day closed. A trip to the gym
or local pool to work off some anxiety, relax, and re-
center all closed. We are helping our clients build
mental and emotional tools to help them address the
stressors in their own lives. Now we have a new
stressor to add to the list. We anticipate more
individualized time will be needed. We also anticipate
a potential flood in demand of these services. For
those in the Medicaid world, we may have to triage and
choose between which services are billable and which
services are not.
I just closed my dental office on Friday and am re-
purposing as many staff as possible to assist in the
increased needs in other areas of our clinic. With the
reduction in some services, the revenue to run the
clinic becomes more of a concern. When I triage a
behavioral health patient, part of that formula may
have to include the sustainability of the overall
clinic when it should be the greater need of the
patient. Passing SB 134 allows me to focus more on the
patients needs and less on the financial needs.
Passing SB 134 allows me to have access to a broader
range of billable behavioral health specialist labor
pool. It amazes me how an entire globe is pivoting all
in the same direction all at this very same point in
time. SB 134 has become something different to me in
the past few weeks. It has become our essential part
of that pivot."
2:29:15 PM
ERIC BOYER, PROGRAM OFFICER, ALASKA MENTAL HEALTH TRUST
AUTHORITY, ANCHORAGE (via teleconference), indicated he
also served as the chair for the Alaska Healthcare
Workforce Coalition. The Coalitions primary focus was to
increase the workforce in the healthcare industry across
Alaska. The Trust and the Coalition supported SB 134 to be
able to expand the number of behavioral health
practitioners who could bill for Medicaid services which
would increase the responsiveness of the healthcare
community. People experiencing behavioral health disorders
could be treated when they needed the help versus being put
on a waitlist.
Mr. Boyer continued that the Alaska Mental Health Trust
Authority (AMHTA) was concerned about Trust beneficiaries'
lives being improved. Beneficiaries included Alaskans with
mental health issues, substance use disorders,
developmental disabilities, Alzheimer's Disease and related
dementia, and traumatic brain injury. In partnership with
the Department of Health and Social Services, the Trust
ensured Alaska had a comprehensive and integrated system of
care to provide the necessary services and supports for
beneficiaries in their community of choice and in the least
restrictive setting possible. The legislation would create
a more equitable distribution of health professionals in
Alaska. It would expand options for behavioral health
treatment and care, decrease the wait times experienced by
many who were seeking behavioral health services, and
prioritize helping out the most vulnerable beneficiaries
across the state. He reiterated that the Trust fully
supported SB 134.
2:31:22 PM
SEVILLA LOVE, INTEGRATION COORDINATOR, ALASKA PRIMARY CARE
ASSOCIATION, ANCHORAGE (via teleconference), had direct
insight from her service in the healthcare field. She
alluded to the failing attempt that Alaska health centers
were currently facing because they could not meet the
behavioral health needs of their communities due to the
limitations barring them from hiring qualified behavioral
health providers known as licensed professional counselors.
She noted the bio, psycho, social, and economic impact of
COVID-19 which would only exponentiate the dire need to
prioritize the passage of SB 134.
Ms. Love continued that the behavioral health issues on the
system came at an exorbitant cost to state and federal
funding. All of the conditions were preparing to swamp an
already over-burdened emergency and acute response and
social service system in the wake of COVID-19.
Ms. Love reported there were LPCs available to go to work
presently, but health centers were not able to hire them
due to not being able to bill Medicaid. She indicated that
when patients were sick, they went to their primary care
provider. She referred to an article that reported up to 45
percent of people who died by suicide had visited their
primary care provider within a month of their death.
Additional research suggested that up to 67 percent of
individuals who attempted suicide received medical care as
a result of their attempt. She concluded that given the
statistics she provided, primary care had an enormous
potential to prevent suicide and connect people with the
needed healthcare they required.
Ms. Love continued that by capturing patients when they
presented to primary care, providers could help them. She
advocated removing all barriers between driving down costs
while meeting the increasing behavioral health issues of
individuals and families on their way into the system. She
argued that prevention was needed immediately before state
social youth and family services and psychiatric admissions
were necessary. All of the issues were most appropriately
prevented, met, and treated in primary healthcare centers.
The licensed professional counselor workforce was needed to
reduce future financial burdens and to save lives.
2:34:25 PM
PRENTICE PEMBERTON, COUNSELING SOLUTIONS OF ALASKA,
ANCHORAGE (via teleconference), spoke in support of SB 134.
He provided a brief work history. He was currently in
private practice and owned Counseling Solutions of Alaska.
He had 23 therapists who worked for him in Anchorage and
Eagle River. He was calling on behalf of all of them in
support of the bill. Changing the rule that a psychiatrist
had to supervise LPCs and licensed clinical social workers
(LCSWs) was long overdue. He responded to an earlier
question about qualifications. Licensed professional
counselors need the same qualifications to provide therapy
as those required for LCSWs and licensed marriage and
family therapists (LMFTs). The qualifications included a
graduate degree, 2 years of supervised work experience,
passing a licensing exam, and taking continuing education
credits. They were as qualified to provide therapy as any
other LPSCs, LPSWs, or LMFTs.
Mr. Pemberton conveyed that the preferred approach to
treating kids and teens was psychotherapy first, then
referral for evaluation by a psychiatrist. He thought
things were currently done in reverse order. He argued that
supporting families and kids in their community and
allowing problem solving was the way to avoid further
hospitalizations and the use of valuable emergency room
resources. He suggested that Medicaid kids were some of the
most vulnerable citizens Alaska had, yet they were denied
reasonable access to much needed mental health services for
them and their families.
Mr. Pemberton continued that as a community mental health
provider and medical social worker, one of his largest
frustrations was not being able to find quality outpatient
services. As a provider in private practice, he was
contacted frequently by doctors, pediatricians, and family
doctors looking for providers who would take their Medicaid
clients, as they could not get them in anywhere. The
emergency room was their last hope. Families were desperate
to help their kids in crisis. He surmised that the state
would pay for the care of todays children. The question
was would the investment occur in the near term by paying
for their health and wellness, or would it be in several
years by paying for their institutionalization or
incarceration. He thought much of the backlog could be
alleviated.
2:38:29 PM
Co-Chair Johnston CLOSED Public Testimony.
Co-Chair Johnston asked someone to walk through the fiscal
note.
2:39:09 PM
GENNIFER MOREAU-JOHNSON, DIRECTOR, DIVISION OF BEHAVIORAL
HEALTH, DEPARTMENT OF HEALTH AND SOCIAL SERVICES (via
teleconference), spoke in support of the bill. The bill
could expand access to care for eligible Alaskans
statewide. She also noted the potential for expanded access
for care in rural communities for individuals experiencing
mild to moderate disturbances. There was also the potential
decrease overtime of psychiatric emergency services and
acute care services. Licensed professional counselors would
also be able to provide screening, grief intervention, and
referral to treatment which was a key element of the
continuum of care.
Co-Chair Johnston interrupted Ms. Moreau-Johnson. She asked
if she could walk through the fiscal note. Ms. Moreau-
Johnson deferred to Melissa Hill.
MELISSA HILL, ADMINISTRATIVE OPERATIONS MANAGER, DIVISION
OF HEALTH CARE SERVICES, DEPARTMENT OF HEALTH AND SOCIAL
SERVICES (via teleconference), reviewed the fiscal note
[OMB Component 3234]. The fiscal note showed a $55,900
services request to complete modifications to the Medicaid
Management Information System (MMIS) that would add a new
provider type and adjust associated business rules.
Co-Chair Johnston set the bill aside. She confirmed that
the amendments for another bill had been sent out via
email.
SB 134 was HEARD and HELD in committee for further
consideration.
2:42:55 PM
AT EASE
2:56:38 PM
RECONVENED