Legislature(2001 - 2002)
04/17/2001 03:02 PM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
HB 174-MENTAL HEALTH INFORMATION AND RECORDS CHAIR DYSON announced that the next order of business would be HOUSE BILL NO. 174, "An Act relating to mental health information and records; and providing for an effective date." CHAIR DYSON called for an at-ease at 4:29 p.m. The meeting was called back to order at 4:31 p.m. Number 1070 REPRESENTATIVE HUGH FATE, Alaska State Legislature, came forth as sponsor on HB 174. He stated that this bill is a result of the Legislative Budget & Audit Committee's recommendation to the state auditor and the Department of Health & Social Services. House Bill 174 allows the state to better track direct grant money given to a community mental health provider. He stated that the bill does two things: it complies with the auditor's report for reporting actual consumer data, and it holds agencies harmless for being sued by the consumer for breach of confidentiality if that should ever occur. He added that this is about accountability for state grant funds. CHAIR DYSON asked whether somebody who breaks that confidentiality would not be liable for it. REPRESENTATIVE FATE responded yes, that this holds harmless an agency if a suit should occur by a consumer for a breach of confidentiality. Number 0974 ELMER LINDSTROM, Special Assistant, Office of the Commissioner, Department of Health & Social Services [DHSS], came forth and stated that there has been a requirement in regulation for a number of years for providers and community mental health centers to provide client information. Generally, they have not complied. He explained that one of the reasons they have not done so is because of a fear that without clear, explicit authority for them to share this information with the [DHSS], they would be subject to suit by a consumer. This bill gives immunity to the community mental health center that would be required to provide [DHSS] the data under this bill. CHAIR DYSON asked if there is very limited scope in this bill, which gives [the community mental health centers] immunity if they are providing this confidential information. MR. LINDSTROM replied that this is specifically for providing the information to [DHSS]. CHAIR DYSON asked if [DHSS] will treat [the information] well. MR. LINDSTROM answered that there is a lot of confidential information in his department. He stated that in his ten years working for the department he doesn't recall ever being called "on the carpet" by the legislature for disclosing confidential information. On the other hand, he said, he gets questions about why [the department] won't release confidential information. He added that this is a normal bit of his business. CHAIR DYSON asked if the information are held in electronic or paper files. MR. LINDSTROM responded that files exist in both formats. The goal in this program ultimately would be an electronic exchange of information that is encrypted. CHAIR DYSON asked if anyone has every "hacked" into [the files]. MR. LINDSTROM answered not to his knowledge. Number 0808 REPRESENTATIVE STEVENS asked whether the information being collected about people with mental health problems is by name or just includes data. MR. LINDSTROM answered that it would be client-specific. A unique identifier would be used for an individual, but it would be encrypted so [the person] would not be readily identifiable. He clarified for the committee that [DHSS] funds community mental health centers in two ways. One is the grant aid process, whereby general fund grant dollars are given to community mental health centers to provide mental health services to clients. He stated that this was the only thing that existed as recently as eight or nine years ago. In 1992 [DHSS] began allowing them to bill through Medicaid, and the costs of mental health services billed through Medicaid went from $0 to $5 million to $10 million to $20 million and are now in excess of $50 million. The Finance Committee requested the original audit, and in noting this growth in the Medicaid budget, wondered how the funding through Medicaid related to the funding of the general fund grants. The conclusion of the audit, he stated, is that they really cannot [relate the funding], because while [DHSS] gets that client-specific data very well in the Medicaid system, it has not been historically captured for persons served through those grant dollars that go to the community mental health centers. He added that this would give [DHSS] that same level of detail for those grant dollars that have been customarily received through the Medicaid program. Number 0684 REPRESENTATIVE STEVENS asked why [DHSS] would need the name. MR. LINDSTROM answered that he believes it gets to the issue of outcomes of individual clients' treatment. He stated that it is not unusual and that it is the same data received on Medicaid clients as a matter of course. REPRESENTATIVE CISSNA asked if it is possible to have numbers rather than names [in the data]. MR. LINDSTROM responded that that is the goal. [The information] would be electronically transmitted and encrypted. Number 0578 ANNE HENRY, Special Projects Coordinator, Division of Mental Health & Developmental Disabilities, Department of Health & Social Services, came forth and stated that the unique identifier used on the data that are collected from providers include the person's initials, date of birth, and the last four digits of the social security number. She added that for the grant work, [DHSS] does not collect any names. When [DHSS] receives the information from providers, it is in encrypted form, which is then decrypted [by DHSS] and stored back in an encrypted form. CHAIR DYSON asked if [DHSS] has been unable to figure out how the public money was being spent or the desired outcomes that were happening because they couldn't track individual clients. PAT DAVIDSON, Legislative Auditor, Legislative Audit Division, Alaska State Legislature, answered that he was correct. She stated that the auditors could show what the trends were in Medicaid, what services were being provided, and what clients in terms of age or location services were being provided for. After discussing it with [DHSS] they could see where the growth was. As a result of the audit, she said, one of the things that changed was the rate. There was a leveling off and, in some cases, decreased costs in certain activities. However, she said, the auditors hit a blank wall when it came to the state grants because they did not know who was being served, what services were being provided, or if some of the clients were also being billed under Medicaid or private insurance. This, she explained, comes down to the unique identifier. From an accountability standpoint it is necessary to know that the same person isn't billing insurance, Medicaid, and the state grant. She remarked that [the auditors'] conclusion was that a fee for service and a grant program are inherently incompatible, and that one way around that is to get the same data for state- funded clients as for Medicaid clients. CHAIR DYSON asked Representative Fate if he or anyone in his office has talked with any of the mental health consumers to see if they would take exception to this bill. Number 0300 REPRESENTATIVE FATE answered that they haven't. He noted that there is an ongoing lawsuit that involves a Fairbanks community mental health center. That lawsuit was brought because of the mere fact that [the mental health center] was liable because of its requirement for submissions of certain confidential client information. He stated that if this bill were to pass, this lawsuit would be dropped. CHAIR DYSON remarked that it is his sense that this is more of a legal issue than a health issue and perhaps it should be sent on to the consideration of the House Judiciary Standing Committee. He added that if that occurs then he will write a note to the chairman of the House Judiciary Standing Committee that [DHSS] should give notice to and an opportunity for any of the representatives of the mental health consumer community to weigh in on it. Number 0223 REPRESENTATIVE CISSNA made a motion to move HB 174 from committee with individual recommendations and the attached zero fiscal note. There being no objection, HB 174 moved from the House Health, Education and Social Services Standing Committee.