Legislature(2019 - 2020)ADAMS ROOM 519
05/21/2019 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB1001 | |
| SB19 | |
| Presentation: Substance Use and Mental Health Response in Anchorage | |
| Presentation: Southcentral Foundation | |
| Presentation: Mat-su Health Foundation | |
| HB1001 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB1001 | TELECONFERENCED | |
| += | SB 19 | TELECONFERENCED | |
CS FOR SPONSOR SUBSTITUTE FOR SENATE BILL NO. 19(FIN)
"An Act making appropriations, including capital
appropriations, supplemental appropriations,
reappropriations, and other appropriations; amending
appropriations; making appropriations to capitalize
funds; and providing for an effective date."
1:32:04 PM
REPRESENTATIVE CHUCK KOPP had been asked to provide some
opening comments. He noted that the legislature had adopted
public safety legislation to toughen the laws on crime. He
spoke to drug treatment. He addressed the underlying
reasons for crime and noted that substance abuse and mental
health issues were the drivers of over 80 percent of the
state's incarcerated population. He stressed the importance
of addressing the issues that were tearing apart families
and communities. He related that the governor's drug
advisor, Andy Jones, had recently testified to the House
Heath and Social Service Committee. He recounted that in
the prior 4 years the legislature began to seriously
address the issue via funding in recognition of the crisis.
Recently, the legislature supplemented Medicaid grants by a
ratio of 1 to 3. He indicated that in 2015 the state had
$62.5 million in grants and $38.4 in leveraged funding
amounting to $101 million that served approximately 20
thousand Alaskans. In 2018, Alaska had $54 million in
grants and $150 million in Medicaid billing totaling $205
million that served approximately 38 thousand Alaskans. The
state was currently serving twice as many people but still
had a huge demand for services. He provided statistics for
a Department of Health and Social Services (DHSS) in-
treatment waitlist. He reported that the waitlist in
Fairbanks was 60 days, in Juneau the waitlist amounted to
30 days, on the Kenai the wait time was 2 weeks, in
Dillingham the wait period was 1 month, and in Wasilla the
waitlist was up to 2 months. He delineated that DHSS was
currently completing a gap analysis of services necessary
for addiction treatment. The 1115 Medicaid Waiver
application to the Center for Medicaid Services (CMS)
stated that the state needed another 200 treatment beds in
addition to the 325 already established representing a 62
percent increase. The same document stated that Alaska
needed 23 withdrawal management programs and 28 out-patient
treatment programs. He believed that the programs served in
the interest of public safety and offender rehabilitation
and that early intervention could prevent incarceration. He
announced that the following presentation would reveal that
addiction was fueling crime and the state lacked treatment
options. The state had shovel ready projects with matching
grants to incentivize communities to invest in treatment
centers. He maintained that accessible treatment was
necessary in order to "get though on crime."
Co-Chair Wilson explained that she intended to include
treatment funding in the capital budget and the reason the
issue was presently under discussion.
^PRESENTATION: SUBSTANCE USE and MENTAL HEALTH RESPONSE IN
ANCHORAGE
1:37:07 PM
NANCY BURKE, HOUSING SERVICES COORDINATOR, MUNICIPALITY OF
ANCHORAGE, introduced herself. She shared that she was a
clinically trained social worker and previously helped with
the development of the Alaska Mental Health Trust Authority
(AMHTA) predevelopment program that examined the
infrastructure needs of treatment services across the
state.
NATASHA PINEDA, DIRECTOR, ANCHORAGE HEALTH DEPARTMENT (via
teleconference), provided her background information in
public health prevention. She had worked on health policy
with the Department of Administration (DOA), served as a
program officer for AMHTA for substance abuse, and worked
for the Department of Health and Social Services (DHSS),
Division of Behavioral Health as a grant manager and Chair
of the Alaska Committee to prevent underage drinking.
SEAN CASE, CAPTAIN, ANCHORAGE POLICE DEPARTMENT, introduced
the PowerPoint presentation: "Substance Use and Mental
Health Response in Anchorage."
Captain Case began with slide 2: Drug Impact on Police
Services." He reported that the Anchorage Police Department
(APD) made 1700 arrests with drug seizures annually and 650
drug only arrests. He noted that roughly 6.5 arrests per
day were associated with drugs. The department responded to
over 30 overdose deaths, which did not represent the total
number of overdoses in Anchorage.
Vice-Chair Johnston asked whether Narcan was helpful.
Captain Case reported that APD did not use Narcan because
they could quickly respond along with the Alaska Fire
Department (AFD) and employ other readily available and
effective methods.
Vice-Chair Johnston asked whether the fire department used
Narcan. Captain Case responded in the affirmative. Vice-
Chair Johnston deduced that the concerted efforts of the
police and fire department saved lives but HIPPA [Health
Insurance Portability and Accountability Act] prevented the
statistical data collection regarding the number of lives
saved. Captain Case replied that he was unable to answer
the HIPPA question but concurred that the combined effort
saved more lives. Vice-Chair Johnston suggested that if the
Anchorage Fire Department did not use NARCAN the number of
overdose deaths could be higher. Captain Case answered in
the affirmative.
Representative Merrick asked Captain Case how many total
arrests the APD had in one year. Captain Case did not know
the answer to her question but could provide it.
1:41:48 PM
Captain Case pointed to the graph on the far right of slide
2. He indicated that the graph showed clearly what the
police department was up against daily. The graph included
three types of drug categories: Amphetamines and
Methamphetamines, Heroin, and Prescription Drugs. He
delineated that prescription drugs that were illegally
obtained or possessed were the most commonly seized drugs
and the numbers were on the rise over the last 5 years
except for 2018. Methamphetamines was the second largest
seizure and rose steadily over the last 5 years. He added
that other jurisdictions reported that Methamphetamines had
played a substantial role in bush communities more so than
heroine. He noted that heroine seizure was on the rise over
the last 5 years. He related that the APD had started a
criminal diversion process. However, due to drug addiction
problems and the lack of availability of drug treatment the
diversion process proved challenging.
1:44:23 PM
Representative Sullivan-Leonard asked about the statistic
regarding the various arrests. She was aware that SB 91
"created an open-door policy." She hoped that with the
passage of HB 49 - Crimes; Sentencing; Drugs; Theft;
Reports [2019] it would provide additional tools for the
law enforcement community. Captain Case responded in the
affirmative. He believed that tougher sentencing forced
treatment, which had been effective.
Co-Chair Wilson remarked that imposing stiffer sentences
without treatment availability created the open door. She
noted that some offenders were unable to get the treatment
they sought. Captain Case confirmed that stricter
sentencing without treatment created a criminal justice
cycle. He concurred that not only did the law enforcement
system need the additional tools of HB 49, treatment was
necessary for a holistic approach. Co-Chair Wilson asked
whether there were other states that had examples of
treating the offender on the "front side" early on in their
sentence versus the "back side," which took place before
release but after a length of incarceration. She wondered
if data was available regarding which option was more
successful. Captain Case relayed that the answer was not in
his area of expertise but acknowledged that the point in
the criminal justice process when treatment was more
efficacious was prior to incarceration. Co-Chair Wilson
surmised that treatment could be part of a plea deal.
1:48:01 PM
Representative Carpenter wanted to better understand the
use of the term, "forced treatment." Captain Case explained
that he was referring to treatment that was part of a plea
deal for a reduced sentence or treatment that occurred
during custody.
Captain Case moved to slide 3: "Mobile Response (March
2019)." He explained that the table applied to the number
of mental health clients the APD had been involved with. He
noted that out of 821 total police reports related to
mental health issues the department had provided 173
transports to hospitals. He reported that out of the 173
people, approximately 40 needed emergency mental health
care. He ascertained that transporting roughly 143
individuals with mental health issue and no other support
or options was problematic for the APD and emergency rooms
(ER). He thought that delivering people to the ER did not
provide "an affordable early response" and offered that
approximately 60 to 65 of the individuals would respond to
"street level intervention."
Co-Chair Wilson asked what reasons the 173 individuals were
picked up by the APD under Title 47. Captain Case explained
that the 173 individuals were not under arrest but were
being transported from a Department of Corrections DOC
facility. The problem in the policing world where a loved
one or friend threatened suicide, required the APD to place
the suicidal person in a safe environment such as a
hospital.
Representative Carpenter asked for an explanation of the
"No Action" line on the table that numbered 84. Captain
Case replied that 84 mental health related calls lead to no
arrest or action of any kind by the APD.
1:52:27 PM
Ms. Pineda continued with slide 4: "Substance Misuse
Summary of Findings."
? Alcohol is the substance of highest use and misuse
in Anchorage
Compared to all other substances, alcohol
contributes to the most deaths, EMS ambulance
transports, hospitalizations, OCS intakes
Ms. Pineda relayed that over the past year the Anchorage
Health Department (AHD) conducted a substance misuse
assessment. She highlighted the findings. She reported that
initially, the AHD assessed opioid and prescription drug
misuse but discovered that a much broader assessment was
necessary. She elaborated that alcohol was the most common
form of substance use and abuse and contributed to many AFD
emergency transports and hospitalizations. Alaska's rate of
consumption and binge drinking was in line with the
national average. However, the age adjusted mortality rate
was twice as high as the rest of the country. The AHD saw a
serge in polly substance use, which involved the use of two
or more substances concurrently. She noted that polly
substance use was particularly dangerous because of the
possibility of drug interaction leading to overdose.
Sometimes substance users were unaware that one of the
drugs was mixed with another drug that users might not be
aware of i.e. fentanyl. She reported that in response to
Rep. Johnston's query, Anchorage had 51 opioid overdose
deaths in 2017 that dropped to 25 in 2018. The number of
Narcan kits distributed in Anchorage in 2017 was 1,510 and
in 2018 the number was 3,511.
Representative Sullivan-Leonard wanted to know how AHD had
compiled her data. She asserted that the statistic on the
table on the right side of slide 4 showed heroin use at 0.5
percent of Alaskans 18 plus years old who used or misused
in the past year or month. She thought it was confusing
when the opioid epidemic was widely reported. She asked how
the data was compiled. Ms. Pineda responded that the data
was derived from the National Survey on Drug Use and Health
2016-2017 and was self-reported. She admitted that the data
could be an underreporting error and was not AHD data.
1:57:02 PM
Representative Sullivan-Leonard asked whether Anchorage had
undertaken its own polling. Ms. Pineda answered that the
national survey had included a variety of different data
sources that included state and local data that provided
more complete data on how substance abuse was impacting
Anchorage; however, she was unable to include additional
information in the slide.
Ms. Pineda advanced to slide 5: "Substance Misuse Summary
of Findings."
? Methamphetamine use is increasing
? 2013-2018: methamphetamine-related overdose
mortality rate increased 233%. All other drug
mortality rates declined in this period.
Ms. Pineda revealed that methadone use was increasing in
Anchorage and it was expected to be the next epidemic. The
number of AFD Emergency Services (EMS) Methamphetamine
Transports steadily increased from 2016 to 2018. She
discerned that some of the increase in meth use may be due
to polly substance use or the use of opioids can lead to
use of methamphetamine. She reported that 3.5 percent of
Anchorage high school students reported ever using meth
versus 2.5 percent nationwide. The reported use is higher
in female students than male students and from 2015 to 2017
she noted a 153 percent increase in the percent of lifetime
use in female students compared to a 24 percent increase
among male students. She reported that the second graph on
the slide depicted the number of "AFD EMS: Total Calls by
Primary Impression." The graph highlighted that Behavioral
Health Disorder was the most common primary impression
followed by alcohol. The category that included
"Poisoning/Drug Ingestion and Substance/Drug Abuse" was
less predictable and increased or decreased over 4 years.
She pointed that that the categories were not mutually
exclusive and could co-occur. She elaborated that the graph
illuminated that alcohol misuse was a consistent problem
and behavioral health disorders were present with greater
frequency at acute emergency levels. She surmised that the
increase could represent a lack of "more comprehensive
systems of care." The AFD thought that the alcohol numbers
could be higher if the data included EMS response to
alcohol related injuries and the number would likely be
staggering. She added that Alaska had one of the highest
rates of traumatic brain injuries in the country. She
recommended solutions that helped the vulnerable population
through treatment and recovery and through a focus on
prevention.
Ms. Burke advanced to slide 6: "Filling Treatment Gaps in
Alaska."
Projected capacity to serve up to 250 people annually
Residential (In-patient) Treatment Program:
Program capacity: 18 individuals with 9 double
double occupancy bedrooms
Length of stay: 90 days
Population served: adult males
Ambulatory Withdrawal Management Capacity: 8
Length of Stay: 15 days
Transitional Housing: Capacity: 44 individuals
Length of Stay: Average 6 months
Out-patient Treatment Program:
Program capacity: Variable based on staffing capacity
Length of program: 60 days
Days per week operated: 4
Ms. Burke indicated that Anchorage had a treatment facility
located near the Anchorage airport that fell into disrepair
and needed replacement. The building housed a successful
treatment program for individuals with co-occurring mental
illness and substance use. She discussed that Anchorage was
a place where people had higher needs, and many were
reflected in the homeless population. She offered that 70
percent of the homeless population experienced mental
illness or substance abuse issues and 53 percent of the 70
percent had traumatic brain injuries. She suggested that to
fill the gap, Anchorage was proposing a new treatment
facility with a mix of services that mirrored new treatment
options available under the 1115 Medicaid Waiver that
allowed step up and step down services and ensured people
were stable before they left the treatment facility. In
addition to offering specific treatment for individuals
with cognitive disorders along with mental illness and
substance abuse issues. The city was hoping to begin
construction by the spring of 2020.
Representative Merrick asked how the municipality
determined that the current treatment center was
successful. Ms. Burke answered that the facility was run by
a non-profit via a service contract with the state of
Alaska and was located on municipal land. The transition
out of the program was reportedly successful but she did
not have the data and would provide it later.
2:06:10 PM
Representative Knopp had heard her mention the 1115 waiver
and asked for more information about the waiver. Ms. Burke
explained that the 1115 waiver was a mechanism to utilize
Medicaid that allowed more flexibility to provide for
different levels of need for those with substance abuse
issues. The waiver was a tool used by many communities
across the country to stabilize people in residential
services and provide further services upon release.
Representative Knopp asked if the waiver was part of
Medicaid expansion. Ms. Burke responded in the affirmative.
2:07:25 PM
REPRESENTATIVE IVY SPOHNHOLZ, CHAIR, HEALTH AND SOCIAL
SERVICES COMMITTEE, explained the 1115 waiver. She reported
that the 1115 was a "state innovation waiver" that the
state applied for with the federal government. She detailed
that the state had strict guidelines for the kinds of
services that was covered under Medicaid. The state found
that the allowable services were not meeting the needs in
Alaska. The waiver allowed the state to experiment and
offer more lower cost more effective strategies for
delivering care in Alaska. The strategies were employed in
other areas of healthcare but were restricted in the
substance abuse arena.
Representative Josephson asked whether the current facility
was due to close in the following month. Ms. Burke answered
the facility was damaged by the earthquake and the city was
indefinitely extending its lease to allow the program to
remain in the building. Representative Josephson asked if
the state were to invest in the new treatment facility what
the cities portion of the investment was. Ms. Burke
responded that municipal funds were included in the
anticipated bond package for the following year. The
Municipality of Anchorage recognized the need for the more
costly services. Representative Josephson wondered whether
the people of Anchorage were willing to make the investment
at a cost of $4.5 million.
2:10:44 PM
Ms. Burke moved to slide 7: "Construction and
Infrastructure Costs" in order to answer the question.
Design Costs and Timeline
Design cost estimate - ~$1.2 million
? Current timeline:
? August September 2019 RFP released and
Contract awarded
? September January 2020 Design completed
? Design includes:
? Residential (in-patient) treatment
? Out-patient treatment
? Transitional Supportive Housing
? Administrative office space
Construction Costs and Timeline
Infrastructure improvement cost - ~$2.85 million
? Improvements will be made to the road, water,
sewer, and gas utilities.
Funding will come from 2020 MOA bond
proposition.
? Timeline:
? Improvements will coincide with construction of
treatment center.
? Total Treatment Center construction estimate
~$17.9 million
? Proposed timeline:
? March 2020 Construction permit issued
? May 2020 Construction begins
? Outstanding amount to complete construction
$14.5 million
Representative Josephson asked Captain Case whether an
individual was compelled to treatment due to an active
criminal case, or if individuals just wanted to "get off
the street." Captain Case observed that he had seen both
scenarios.
Vice-Chair Ortiz asked if alcohol abuse treatment was
offered in the treatment facility. Ms. Burke answered in
the affirmative and confirmed that alcohol was the largest
substance abused. Vice-Chair Ortiz asked whether treatment
for alcohol abuse was sought voluntarily. Captain Case
responded that the criminal cases could require alcohol
treatment such as domestic violence.
Representative Sullivan-Leonard asked about the inception
of the project. She noted that it appeared much planning
had been done. Ms. Burke responded that the current phase
of the project began in 2015. Representative Sullivan-
Leonard asked if the people of Anchorage would support the
bond package in 2020. She assumed the bond would cover much
of the construction costs and design work. Ms. Burke
replied that $1.2 million depicted on the slide was grant
funding currently in the city's possession and would move
forward with design work. She reported that the $2.85
million of bond funds would be used for the necessary
infrastructure upgrades. The $14.5 million was the
outstanding balance needed to complete construction.
Representative Sullivan-Leonard asked where the
municipality was expecting to obtain the remaining funds.
Ms. Burke responded that all avenues of funding would be
considered to meet the construction expense.
2:16:04 PM
Representative Sullivan-Leonard was aware that other
entities would be involved in the funding process. She
requested a list of potential investors. She pointed to the
state's fiscal crisis and advised that garnering state
support would be challenging. She encouraged the
municipality to take on the brunt of the costs.
Co-Chair Wilson pointed out that the cost of incarceration
was $178. per day per prisoner without treatment. She asked
for a breakdown of the costs associated with individuals
receiving treatment depending on the level of treatment.
Ms. Pineda was unable to answer the question. She indicated
that the Salvation Army operated the current facility and
they could provide the costs. She was waiting for final
numbers related to rates under the 1115 waiver and would
provide exact amounts for the services associated with
slide 5. Co-Chair Wilson asked about the success rate of
treatment and whether "further intense treatment" was
necessary. Ms. Pineda deferred the question to a behavioral
health expert. She acknowledged that some people need
treatment multiple times, but most ultimately achieved
recovery.
Co-Chair Wilson asked about the possibility for the
facility to provide treatment beds to individuals under the
custody of DOC. Ms. Burke thought that it was a beneficial
option worth exploring. She expounded that the facility was
designed to fill in the gaps existing in treatment and stop
the cycle of incarceration or homelessness.
Ms. Burke transitioned into slide 8: "Aftercare and
Community Supports."
? Many people will stabilize in housing with
supportive services appropriate for their needs
? Community integration through housing (Pay for
Success) = Reductions in emergency and first responder
resources
Ms. Burke spoke of the importance of "syncing up the
systems" that offered resources and had proven success with
recovery and assisting the transitions back into the
community. She addressed the facilities step up or step
down approach of either intensifying or reducing service
according to need.
Co-Chair Wilson reminded the committee that 80 percent of
incarcerated individuals had mental health issues. She did
not know how the state could not afford treatment and
expect change.
Representative Merrick asked whether the facility would be
a municipal or a statewide project. Ms. Burke replied that
the project was statewide. Representative Merrick asked how
residential space would be prioritized. Ms. Burke replied
that space was determined through a "funding
configuration." She exemplified that a contract with DOC
would provide prioritization. She suggested that partnering
with other communities that could not offer the facility's
level of care was the best approach for Anchorage.
2:22:54 PM
Representative Josephson reiterated that he had been told
that there was an "ample supply" of transitional treatment
but residential treatment was still lacking. He wondered
how the scenario impacted treatment systems. Ms. Burke
deferred the answer to other professionals.
Representative Carpenter asked whether the facility would
include sex offenders. Ms. Burke replied in the
affirmative.
^PRESENTATION: SOUTHCENTRAL FOUNDATION
2:24:53 PM
APRIL KYLE, VICE PRESIDENT, DIVISION OF BEHAVIORAL
SERVICES, SOUTHCENTRAL FOUNDATION, introduced herself and
discussed the Southcentral Foundation services. The
foundation was a regional native healthcare organization
serving 65 thousand Alaska native and American Indian
people in the region. The system of care employed was
called the "NUKA System of Care," which was a relationship
based primary care focused system that included an
extensive array of behavioral health services. She
elaborated that the foundation operated the detox program,
which they were expanding to 22 beds through support by the
state. The program served roughly 600 admissions per year
and they expected to exceed 800 upon expansion. She asked
the committee to consider how the service would provide
treatment after detox. She noted that the program served
the entire state and strove to find treatment post detox.
The gold standard in a detox program was to offer a "bed to
bed transfer" from detox to treatment. Most individuals
leaving detox needed a clinical level of treatment
appropriate for residential treatment. The program operated
one program in Anchorage, which was a 16 bed women's detox
program that allowed children to accompany their mothers.
She spoke to the lengthy waitlist of up to 2 months to
participate in the program. She furthered that residential
placement for elders with medical needs was difficult, as
well as access to medically assisted treatment for
substance use disorder.
2:28:52 PM
She addressed the 1115 waiver that originally had three
portions: substance abuse disorder, adult, and children.
The CMS approved the substance abuse disorder portion of
the waiver first and the state created an implementation
plan. The state planned for 110 new treatment beds; 90
adult beds and 24 youth beds. In addition, the state
planned 24 new beds specifically for traumatic brain injury
and cognitive impairment with a statewide focus and 66
high-intensity adult beds or medium-intensity youth beds.
She communicated that the state received an exemption to
allow residential treatment beyond 16 beds, which made
treatment more economical. The exemption allowed existing
or new programs to grow. Treatment centers would still
require start-up funds and facility costs. In addition to
one-time money needed to launch a program, it took multiple
years to reach full capacity, and subsidies were needed in
the ramp up years. The exemption provided opportunity, but
upfront money was still necessary to launch a program.
Ms. Kyle continued that in 2017, $6 million of capital
funding was awarded to three providers: The Sober Center in
Fairbanks operated by Tanana Chiefs, the detox program at
Central Peninsula Hospital, and Set Free women's
residential treatment center in the Mat-Su. She emphasized
that treatment and recovery changed people into functioning
adults. She observed the reverse for people on waitlists.
She reported having a difficult time sleeping knowing there
were people out there waiting for treatment. She reported
that it was costlier for the state not to expend funds for
treatment than the cost of treatment itself.
Co-Chair Wilson requested the range of costs per individual
including Medicaid funding. Ms. Kyle agreed to provide the
information.
2:36:49 PM
Representative Knopp asked why CMS had a 16-bed limit. He
asked whether the exemption had a cap or if the number was
unlimited. Ms. Kyle answered that the 16-bed limit was
established at a time when mental health services were
institutionalized and served a great number of patients.
The idea behind the limits was to eliminate the need for
large institutions. She noted that the state was working to
move beyond the limit and was unaware of a new cap.
Representative Carpenter asked how many beds across the
state were designated for alcohol treatment. Ms. Kyle was
uncertain of the answer and relayed that typically most
treatment programs employed a multiple substance approach.
Representative Spohnholz interjected that the state
currently had 325 in-patient beds. The 1115 waiver process
estimated that Alaska needed approximately 200 more beds at
a more intense level of treatment than currently offered in
the state. Representative Carpenter was looking at previous
slides that showed the number of people discharged for
alcohol related treatment was over 9,000 in 2017. He
thought that 9,000 occurrences with a total of 525
treatment beds in the state would not solve the problem.
Co-Chair Wilson thought it was important to know what the
beds were for.
Representative Spohnholz noted a document "Number of New
Services by Region According to Appendix 1 of 1115 SUD
Waiver Implementation Plan" (copy on file) that described
the range of services the Division of Behavioral Heath
determined were needed. She agreed that an additional 200
beds were not enough. However, additional non-residential
treatment programs were included in the plan. She expounded
that not everyone needed residential treatment. The
division estimated that an additional 23 withdrawal
management programs were necessary throughout the state
along with 28 additional intensive out-patient treatment
centers. She surmised that the state needed to increase
access to treatment.
Co-Chair Wilson asked Ms. Kyle to explain her relationship
with the state. Ms. Kyle answered the foundation had a
variety of programs and one program; the Family Wellness
Warriors Initiative provided services within the Department
of Corrections.
2:42:40 PM
LANCE JOHNSON, BEHAVIORAL HEALTH SERVICES DIRECTOR, NORTON
SOUND HEALTH CORPORATION (via teleconference), was the
administrative director of the corporation and served in
the capacity since 2012. He expounded that Norton Sound
served approximately 9,800 people. He had appreciated the
previous comments. He wanted to emphasize the need for beds
and treatment facilities in rural areas. He was aware of
the large population in Alaska that was addicted to
substances. He acknowledged that the most abused substance
remained alcohol. He had observed the effects of limited
treatment resources for people wanting treatment. The
effects were further complicated by care that was only
available out of the region; i.e., residential treatment
centers and psychiatric hospitals. He requested that the
committee reflect upon how to build rural treatment
infrastructure.
Mr. Johnson provided information about what the Norton
Sound Health Corporation (NSHC) provided. He reported that
the corporation provided out-patient substance misuse and
mental health treatment services. The corporation also
provided intensive out-patient substance misuse services of
up to 9 hours a week per individual. The corporation had an
onsite psychiatry program available 7 days a week. In
addition, the corporation provided telehealth and itinerant
clinicians for the 15 surrounding villages. He elaborated
that each community had a village based highly experienced
counselor and by October 2019 all would become a certified
behavioral health aide. Norton Sound decided to act on
their own out of the need to change the narrative that
rural areas were "stuck", and people had to leave the area
to get better. He believed that more could be done in
partnership with the state to provide higher levels of care
that was culturally reflective to keep people in the
region. He emphasized that local treatment was cost
effective and relieved "the burden of a stressed system."
2:49:32 PM
Vice-Chair Johnston asked whether NSHC worked with the Nome
Youth Facility and other correctional facilities in the
region. Mr. Johnson answered in the affirmative but
explained that the Nome facility recently hired its own
clinician and NSHC currently participated in an ancillary
role. The corporation had a contract with DOC for the Anvil
Mountain Correctional Center and the Seaside Residential
Community [half-way house] in Nome that provided a full
time clinician that offered individual and group services
for mental health and substance misuse. He reported that
the Correctional Center had a waitlist for services.
Vice-Chair Johnston understood that inmates did not qualify
for Medicaid. She wondered whether DOC and HSHC could build
a continuum of care to eliminate the prison waitlist for
services. She asked whether Mr. Johnson thought that the
in-house clinician was providing and adequate level of care
at the youth facility. Mr. Johnson voiced that NSHC was
already providing a continuum of care at Anvil Mountain and
Seaside facilities but indicated that the need was greater
than the number of providers available. He acknowledged
that inmates had to wait to apply for Medicaid once they
were released and he noted that services would be available
to instruct newly released prisoners in how to apply for
Medicaid and other life skills. He relayed that the NSHC
opened a day center in Nome for homeless, substance users
from 8:30 AM until 7:30 PM and hired recovery coaches that
were peer support coaches to help people recover. In
addition, behavioral health providers worked in the center
for 4 hour per day to engage in relationships and build
trust. He communicated that the day center was really a way
to gain access to treatment other than entering the
criminal justice system. He stressed that rural treatment
infrastructure would mitigate the demands for treatment
beds in other parts of the state.
Mr. Johnson continued to address Vice-Chair Johnston's
question regarding the Nome treatment facility. He informed
the committee that by adding treatment beds, the facility
served the youth well. He was aware that the Nome Youth
Facility was slated for closure in the future. He viewed it
as an opportunity for transitional housing for inmates
released from jail. He used his prior scenario as "an
interesting example on a way to build treatment
infrastructure."
Co-Chair Wilson asked why the youth facility hired its own
clinician. He reported that the goal of the facility was to
develop treatment beds and provide services they wanted.
Co-Chair Wilson wondered whether the Seaside residents
qualified for Medicaid. She noted that the center was a
Community Residential Center (CRC). Mr. Johnson understood
that the residents' Medicaid was still suspended in a CRC
because the residents were still in DOC custody. The
corporation provided services to the residents through a
contract due to the lack of Medicaid. Co-Chair Wilson asked
whether the residents could leave for treatment or work.
Mr. Johnson responded that Seaside housed roughly 50
residents, and some received furlough status to work or
participate in treatment. Co-Chair Wilson informed the
committee that if the residents had freedom of movement,
they were Medicaid eligible and DOC was supposed to help
the residents fill out the Medicaid application. She
remarked that the facility currently housed 23 individuals
and was disappointed that the state did not utilize all 50
beds.
Representative Carpenter asked how many communities in the
Norton Sound area were dry. He wondered whether Mr. Johnson
observed alcohol addiction in the dry communities. Mr.
Johnson responded that 14 out of the 15 outlying
communities were dry. He reported that there were alcohol
abuse issues in the communities. He noted that there was a
"significant issue with boot-legging."
Co-Chair Wilson asked what would be accomplished by
offering treatment versus longer jailtime. Mr. Johnson did
not believe that longer sentencing was the answer and that
a certain level of substance abuse treatment should be
provided in prisons. He related that 90 percent of the
inmates at Anvil Mountain were in jail due to substance
misuse. He wanted to mitigate the numbers by attempting to
offer a full continuum of care for treatment services in
Nome. He revealed that NSHC was working on such a project,
the Wellness Center in Nome, in partnership with the Alaska
Mental Health Trust Authority (AMHTA) offered a full
continuum of care including intensive out-patient, out-
patient, day treatment, and a sober center in the facility.
He furthered that the facility had sober housing attached
as well. He noted that the project was shovel ready. The
corporation contributed $8 million and was seeking $5
million more in funding. Construction would commence in the
summer of 2019. He reminded the committee that relapse was
part of treatment for some before recovery holds and
offering a regional full continuum of care offered the wrap
around services, cultural relevancy, family support and
unification, and levels of services necessary for the
individual. He commented that treatment in prison was still
necessary, but the numbers of incarcerated individuals
would drop over time.
Vice-Chair Johnston asked how many beds the Wellness Center
would provide. Mr. Johnson characterized the facility as
"pseudo-residential," which offered a residential level of
care, but the patients would live in the sober housing. He
shared that 52 slots were available in total. Vice-Chair
Johnston asked about the number of beds in the sober
housing. Mr. Johnson responded that a total of 48 beds
would be available.
Co-Chair Wilson thanked Mr. Johnson for his presentation.
^PRESENTATION: MAT-SU HEALTH FOUNDATION
3:07:28 PM
ELIZABETH RIPLEY, CHIEF EXECUTIVE OFFICER, MAT-SU HEALTH
FOUNDATION, introduced herself and the PowerPoint
presentation: "Mat-Su Health Foundation.". She reminded
committee members that the Mat-Su Foundation was originally
the Valley Hospital Association that operated the preceding
Valley Hospital in Palmer. The association wanted to build
a new hospital to accommodate the growing valley population
and entered into a partnership with a "for-profit
proprietary company" to build the Mat-Su Regional Medical
Center. She reviewed untitled slide 2 titled:
The Mat-Su Health Foundation shares ownership in Mat-
Su Regional Medical Center and invests its profits
from that partnership back into the community to
improve the health and wellness of Alaskans living in
the Mat-Su.
Ms. Ripley turned to slide 3:
Theory of Change
• Community-driven
• Data-driven and strategic
• Capacity-builder
Ms. Ripley emphasized that the foundations priorities were
community driven. She related that the community's
priorities were focused on mental health substance use and
child maltreatment and were asking for more treatment and
recovery supports.
Ms. Ripley advanced to slide 4:
Good News!
New Mat-Su BH Services Fill Gaps in the Continuum of
Care:
? Set Free residential SUD Treatment for women*
? Peer Treatment Services
? Outpatient SUD treatment
? SUD treatment in a local high school
Ms. Ripley indicated that all the services on the slide
were started with a state appropriation in 2018.
Ms. Ripley continued to slide 5:
Our Role As A Funder
? Support data and research efforts
? Convene and advocate to make systems'
improvements and build a complete continuum of
care
? Provide local match funding for start-up and
scholarships to develop workforce
Ms. Ripley related that the foundation worked closely with
DHSS to continually improve its operating systems. They
used data to find problems and provide match funding for
identified "gaps in the continuum of care." She explained
that the photo on the slide housed the Set Free Alaska
program that received a grant from the state and the
foundation to add residential treatment beds for women and
pregnant women. The funding was sustained by billing
Medicaid or other insurers. She thanked the state for the
initial funding and hoped the state would offer $20 million
in additional funding support.
Ms. Ripley advance to slide 6:
More Good News! BH Systems Improvements in Mat-Su
Crisis Intervention/Mental Health First Aid Training
for first responders
High Utilizer Mat-Su (HUMS) Program
Peer support services in the emergency department
Planned psychiatric emergency department and
behavioral health beds
Ms. Ripley wanted to ensure the committee that any state
funding was used "prudently with maximum administrative
efficiency" and obtained desired health outcomes. The
projects on slide 6 were invested in to maximize the
returns to the state and improved behavioral health
services in the Mat-Su. She highlighted the second bullet
item: High Utilizer Mat-Su (HUMS). She shared that the
foundation invested half of $1 million into the program and
reduced emergency room (ER) use by 61.7 percent within the
first year of the pilot project, which saved the state over
$1.1 million. The programs success was due to the ability
to fill gaps in the continuum of care.
3:12:41 PM
Ms. Ripley turned to slide 7: "The Mat-Su Health Foundation
Uses a Systems Approach." She indicated that the graphic
depicted the Substance Abuse and Mental Health Services
Administration (SAMHSA) model for a "good and modern
addiction mental health service system." The foundation had
been working on creating the model continuum of care for
about 5 years and was still in progress. The foundation
worked at a systems level to provide its continuum of care.
She reported that the 1115 waiver drove the system and
would pay for services in the long run. The slide provided
a wholistic picture of how services should work in the
state.
Ms. Ripley moved to slide 8:
"Prevention is Key."
WELLNESS
EARLY SIGNS &
SYMPTOMS
DISORDER
CRISIS
3:14:40 PM
Ms. Ripley turned to slide 9:
Mat-Su Regional Medical Center Emergency Department.
? 2013: 2,391 patients w/BH diagnoses = $23M
[increase] in charges
? 2016: 3,443 patients w/BH diagnosis = $43.8M
[increase] in charges
? Additional costs borne by law enforcement, or
Mat-Su Borough EMS for dispatch and ambulance
services
Ms. Ripley indicated the slide showed "where and how" the
foundation was investing the state's dollars downstream.
She noted that the increase in ER costs was largely due to
the opioid crisis and lack of out-patient treatment access.
She stressed that if treatment was available prior to the
point of crisis the citizens and the state would benefit.
Additional funding was needed in other areas of the
continuum of care. She asserted that when they first
compiled the data on the slide it proved that the ER was
the most utilized service for those in a behavioral health
crisis and represented a downstream investment that did not
offer a return.
Representative Merrick asked about the $20 million
appropriation Ms. Ripley had referred to earlier. Ms.
Ripley indicated that Representative Spohnholz was hoping
for a $20 million appropriation in the capital budget for
treatment services. Representative Merrick asked how much
of the amount Ms. Ripley expected to receive. Ms. Ripley
replied that the Division of Behavioral Health (DHSS) would
issue an RFP (request for proposal) as part of a
competitive process. She expounded that the foundation
would assist a local provider produce a competitive
application and would not receive any funding directly.
Funding was not guaranteed with a competitive bidding
process and needs all over the state.
Co-Chair Wilson asked whether the foundation was looking at
capital funding or funding for existing programs. Ms.
Ripley deferred the answer to a later slide.
Ms. Ripley turned to that the list on untitled slide 10:
Alcohol-related disorders: 438 visits costing on
average $4,246/visit
? Substance Use disorders: 218 visits costing on
average $5,274/visit
? Anxiety-related disorders: 195 visits costing on
average $3,895/visit
? Suicide and self-harm disorders: 315 visits
costing on average $3,161/visit
? Mood Disorders: 172 visits costing on average
$3,846/visit
Ms. Ripley reported that the slide data reflected the
number one visits and average cost per visit in 2016. The
information came from a 2016 McDowell Group study of Mat-Su
Regional ER charges. She reminded the committee that the ER
was not providing mental health or substance abuse
treatment and believed that treatment offered a more cost
effective way to address the crisis.
3:20:06 PM
Ms. Ripley detailed slide 11:
"Statewide, substance use disorders are costly."
? 39,000 Alaskans - alcohol dependent or abuse in the
past year
? 13,000 Alaskans were dependent on illicit drugs
(2017)
? Cost of alcohol abuse was $1.84 billion (2015)-
42.9% paid by government
? Cost of drug abuse was $1.22 billion (2015)
Ms. Ripley voiced that the slide data was extracted from
two reports (Economic Cost of Alcohol Abuse published in
2017 and the Economic Cost of Drug Abuse in Alaska
published in 2016) funded by the AMHTA prepared by the
McDowell Group. She offered to provide a breakdown of
costs.
3:21:03 PM
Ms. Ripley moved to slide 12:
Two areas supported by the Medicaid waiver where
we can save money by having the right services:
? Substance Use Disorder Treatment
? Crisis prevention and care
Ms. Ripley detailed that the foundation would direct any
additional state funding to the areas reflected on the
slide.
DR. MELISSA KEMBERLING, VICE PRESIDENT OF PROGRAMS, MAT-SU
HEALTH FOUNDATION, offered that she had a master's degree
in public health and a PhD in Sociology and previously
worked for the Alaska Native Tribal Health Epidemiology
Center.
3:22:45 PM
Dr. Kemberling skipped to slide 14:
Crisis Prevention and Treatment Gaps
? Crisis Call center
? Mobile Crisis Unit*
? Crisis Stabilization and Respite*
? Supportive housing
* Medicaid 1115 Waiver application includes these
services.
Dr. Kemberling offered that Ms. Riplely illustrated the
huge cost associated with the lack of crisis prevention and
treatment resulting in individuals turning to the ER for
care. She explained that a model called "Crisis Now" was
identified on the slide. The model prevented or shortened
the crisis. The call center coordinated the type of care
data and adhered to the Suicide Prevention Lifeline model
to help channel the caller to the appropriate care. The
Mobil Crisis Unit offered a "rapid response to assess an
individual and resolve a crisis" for both children and
adults. The focus of the team was to link people with
services and coupled with the Crisis Stabilization and
Respite Center, reduce the acute symptoms and stabilize the
individual within 24 hours to avoid hospitalization.
Dr. Kemberling advanced to slide 15:
"The right continuum of crisis services in Phoenix,
Arizona"
? 37 FTE Police Officers engaged in public safety
instead of mental health transport/security
? Drastic reduction in psychiatric boarding in
emergency departments ($37 million in cost savings)
? Reduced potential state acute care inpatient expense
by $260 million (net savings of $100 million)
Dr. Kemberling reported that the AMHTA was examining the
approach for Alaska. The Medicaid waiver could provide the
operating dollars.
3:27:09 PM
Dr. Kemberling reported the list of capital needs that were
reflected on slide 16:
"Moving Towards a Complete Behavioral Health Continuum
of Care in Mat-Su."
Capital Needs
? Detox: ambulatory and residential
? Residential Treatment for Individuals with
Substance Use Disorder
? Crisis Call Center
? Mobile Crisis Program
? Sub-acute Stabilization (crisis prevention and
step-down)
Supportive Housing
Dr. Kemberling pointed out the list reflected the needs of
the borough and the foundation's approach. She concluded
with untitled slide 17:
Investment in capital funding with a "systems
approach" to start these services is crucial for
saving lives, saving dollars and improving the
health of Mat-Su and Alaska.
Co-Chair Wilson asked whether the foundation had a contract
to provide services for behavioral health with the Mat-Su
Pretrial Facility. Dr. Kemberling responded that the
foundation did not directly provide behavioral health
services but provided grants to non-profits and community
agencies and had not provided a grant to the pretrial
facility. Co-Chair Wilson asked if she was aware of other
organizations providing behavioral health to the Mat-Su
Pretrial Facility. Dr. Kemberling acknowledged that the
Prisoner Reentry Coalition and Mat-Su Pretrial was involved
in community coalitions and the foundation's Crisis
Intervention Team Coalition as well.
Co-Chair Wilson commented that the facility was different
from a long-term facility and she wondered whether any
reentry services were available.
Representative Sullivan-Leonard was sorry she was unaware
of the capital grant by the Mat-Su Foundation. She asked
for an update on the foundation's attempt to increase
behavioral health beds and how the capital grant may help
if the hospital was unable to move forward. Ms. Ripley
responded that the hospital was in a holding pattern
waiting for the legislature to pass a budget and the
available funding from Medicaid. The foundation created a
business plan. The construction had proceeded, and a
director had been hired. The goal was to have available
beds by the fall of 2019.
3:31:43 PM
Co-Chair Wilson informed everyone that there were no grants
in the capital budget. She furthered that the idea was to
look at how additional capital budget funds could be used
for treatment and to fill in the gaps. She reiterated that
currently the $20 million was not available in the budget.
Representative Sullivan-Leonard thanked the chair and noted
that it was "apparent" organizations were informed of the
possible additional funding and she wanted to learn how the
funds would be utilized.
Ms. Ripley was trying to demonstrate that, although they
had worked with the state to fill the gaps in the care
continuum still many remained. She indicated that if
capital funding was available the foundation would be able
to assist a non-profit as a local partner.
3:33:55 PM
AT EASE
3:35:05 PM
RECONVENED
PHILIP LICHT, EXECUTIVE DIRECTOR, SET FREE ALASKA (via
teleconference), introduced himself. He recounted that
several years ago a client showed up at Set Free Alaska
after his fourth DUI while his children were in the car.
The offender faced an additional charge of endangering the
welfare of a child. The thought of losing custody of two
children sparked the motivation to change. No one had
considered the individual's horrific backstory of physical
and sexual abuse as a child that set the path of shame and
addiction. He declared that at Set Free Alaska everyone was
valued as a unique individual. The individual was initially
very guarded, but overtime completed treatment, regained
custody of the children, and gained employment. After a few
years of sobriety, the person applied and was hired by the
program. He believed the person's life had changed forever
and he no longer cost the state money under incarceration.
He informed the committee members that treatment did work.
The goal was to help people stop offending and stop
charging people and start changing them. He noted the many
success stories under the program's partnership with the
criminal justice system. He cited the lack of treatment
beds and access to treatment. He relayed that most criminal
justice cases and social ills were connected to addiction.
Often, court ordered treatment helped people break the
cycle of addiction and incarceration, but lack of treatment
kept offenders in the cycle. He was pleased that the
legislature was considering capital funding for addiction
treatment. The cost of launching new treatment centers was
a major barrier to providing enough treatment. He remarked
that the Valley Oaks program was one of the only
residential treatment facilities that was opened in the
last ten years. He revealed that Set Free Alaska was in the
process of opening another residential treatment center in
Homer for men where children could accompany the men to
treatment. The new programs would not have been possible
without substantial capital and operational funding support
during the initial phase of the projects. The programs were
sustained long-term through earned revenue. The proposed
funding could help start other similar projects around the
state. He indicated that increased funding meant increased
capacity which helped more people. He emphasized that
criminal justice reform must go "hand in hand with
treatment and rehabilitation." He opined that people must
be treated as persons rather than just locking them up. He
relayed a personal story about his brother's journey with
addiction and incarceration.
3:42:06 PM
Mr. Licht spoke of the accomplishments by his younger
brother after his treatment, education, and job training
while in prison in Arizona and support upon release. His
brother was a success story with over three years sobriety.
He concluded that treatment does work, and people do get
better. He thought the collaborative efforts between the
criminal justice system and treatment providers was
powerfully effective.
Representative Sullivan-Leonard thanked Mr. Licht. She was
happy to hear about the program's expansion in other areas
of the state. She asked if the current Alaska congressional
delegation in Washington had offered to assist in any way.
Mr. Licht reported that he had asked Senator Dan Sullivan
about funding for addiction treatment. He confirmed that
funding for opioid and other treatment would continue but
he did not mention specific funding for the state.
Co-Chair Wilson asked whether Set Free Alaska had a
relationship with DOC. Mr. Licht reported that the entity
was on the list of DHSS approved providers for criminal
justice system that included OCS and DOC. The organization
had a contract with DOC through the Wellness Courts in Mat-
Su to provide treatment services for Wellness Court and
Family Infant/Toddler Court. In addition, the organization
worked closely with the probation officers for felons and
Mat-Su ASAP treatment services for misdemeanants.
3:47:15 PM
Co-Chair Wilson asked if it was accurate to say that
without treatment crime would continue. Mr. Licht answered
in the affirmative.
Co-Chair Wilson thanked the committee. She believed that
providing more treatment was an urgent need.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 19 MOA Substance Abuse .pdf |
HFIN 5/21/2019 1:30:00 PM |
SB 19 |
| SB 19 New Services for 1115 SUD Waiver Implementation Plan.pdf |
HFIN 5/21/2019 1:30:00 PM |
SB 19 |
| SB 19 MSHF HFIN Capital Budget Pres FINAL.pdf |
HFIN 5/21/2019 1:30:00 PM |
SB 19 |