Legislature(2001 - 2002)

04/17/2001 03:02 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= 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                                                               
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                                                               
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                                                               
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.                                                                 

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