Legislature(2019 - 2020)CAPITOL 106
04/16/2019 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB89 | |
| HB114 | |
| Confirmation Hearing(s):|| Mental Health Trust Authority Board of Trustees | |
| Commissioner, Department of Health and Social Services | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 89 | TELECONFERENCED | |
| += | HB 114 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
[Includes discussion of HB 135.]
4:07:47 PM
CO-CHAIR SPOHNHOLZ announced that the final order of business
would be continuation of the confirmation hearing of Mr. Adam
Crum, designee for commissioner of the Department of Health and
Social Services.
4:08:21 PM
CO-CHAIR ZULKOSKY recalled that during the 4/13/19 confirmation
hearing for Mr. Crum, the commissioner designee stated that
there was no intention to change any support for the
continuation of Medicaid expansion. Introduced yesterday by the
governor was HB 135, which would turn back the authorizations
and support for Medicaid expansion. She asked the commissioner
designee to reconcile this change in position.
4:08:58 PM
ADAM CRUM, Commissioner Designee, Department of Health and
Social Services (DHSS), replied HB 135 would provide tools to
grow and provide for the expansion population so they can
actually increase their economic prosperity and we can provide
for them, so they don't have to face the fiscal cliff. ... The
idea ... behind this was open transparency to align with the
[Alaska Supreme Court] decision so that the legislature
understood where this stood on this process." He said he looks
forward to discussing this further throughout the subcommittee
process. The Department of Law (DOL) is drawing up a statement
for legislators that will provide further explanation. It is
not the intent to cancel out the eligibility for the Medicaid
expansion population.
4:09:59 PM
CO-CHAIR ZULKOSKY observed that [Section 2, subsection (a)] of
HB 135 states that the department is not required to cover
individuals who are eligible for medical assistance under this
section as a result of the expansion authorized by the Patient
Protection and Affordable Care Act, which the committee often
refers to as Medicaid expansion. She recalled that the
commissioner designee's comments on 4/13/19 were in support of
continuing Medicaid expansion because of the recognition of the
federal funding and investment and how that propels Alaska's
economy and how that protects the health of Alaskans. She asked
how the commissioner designee feels such a stark turn of
position within a matter of days from his testimony on 4/13/19
to yesterday's introduction of this bill can be rectified.
COMMISSIONER CRUM responded that the intent of HB 135 is not to
actually remove any care or treatment for the Medicaid expansion
population. The particular line referenced is a clarification
to show that it matches the [Alaska] Supreme Court as being an
option. There will be some more discussion to ensure there are
no legal issues or unintended consequences through this. The
main idea through this is to make sure that opportunities are
had for these individuals. [For example,] he has previously had
employees who turned down a raise because they would no longer
qualify for benefits with the raise, which is a rational
economic thought. In his talks with legislators there has been
a lot of concern for this fiscal cliff. So how could a glide
path be provided for these individuals? This bill would provide
tools so options could be explored to move forward so if this
population does grow [DHSS] can still provide care and the
Medicaid would be a secondary payer for services like substance
use disorder (SUD) training, behavioral health, and other things
now provided in the private marketplace.
4:12:15 PM
CO-CHAIR ZULKOSKY said she didn't hear an answer but appreciates
the commissioner designee's attempt. She stated that Medicaid
expansion has provided a significant amount of investment in
Alaska as it relates to behavioral health services and Medicaid
is the lead funder of addiction treatment in a time of opioid
crisis. Given Medicaid expansion could potentially be
destabilized through HB 135, she asked the commissioner designee
to talk about what he sees as Medicaid's role in addressing the
opioid epidemic or other behavioral health issues.
COMMISSIONER CRUM answered that it would continue the exact same
way as it is now, proceeding with the Medicaid Section 1115
Behavioral Health Waiver Demonstration Project ("Section 1115
Waiver") that DHSS has approved for the SUD treatment. As well,
funding mechanisms would continue for the Section 1115 Waiver
for behavioral health so that mild and moderate issues can be
treated upfront. The Medicaid would act as a secondary payer
for that process. This is going to be a long process of working
together to make sure. The department's full intent in
discussions with the Centers for Medicare & Medicaid Services
(CMS) is to ensure that that level of stability is maintained.
4:13:53 PM
CO-CHAIR ZULKOSKY related that an analysis of the cost savings
to Alaska's general fund as a result of Medicaid expansion shows
that between fiscal years 2016 and 2019 behavioral health
services within the division have seen an offset of $23 million
with an additional $10.5 million projected through 2020. She
stated she is disappointed to see that within a matter of days
of having a conversation with the commissioner designee about
his support of Medicaid expansion that there would be such a
significant policy shift without any collaboration in terms of
moving forward. It gives her pause about his ability and
readiness to advocate to the governor to uphold the mission of
the department given all of the complex health policies that are
in front of the division. She said she would leave conversation
about the policy of HB 135 to a future date.
COMMISSIONER CRUM replied that this is going to be a long
process. He said his intent has not changed since 4/13/19; [the
bill] is to maintain the Medicaid population, to allow a tool in
the mechanism for growth, and to maintain available assets so
[DHSS] can actually treat using the waiver system that it is
working towards. Bringing forth HB 135 provides an opportunity
to have open discussions on this and he looks forward to working
with the co-chair on this to address these issues to make sure
it is the right path for Alaska.
CO-CHAIR SPOHNHOLZ maintained that HB 135 suggests restructuring
the way Alaska provides care to the Medicaid expansion
population. She said it doesn't describe how a step down would
be provided for people who would be moving out of eligibility
for Medicaid expansion. She thinks of a glide path as being
something that prevents a person from falling off the cliff of
losing all health insurance when he/she no longer qualifies for
Medicaid expansion. She doesn't think of a glide path as taking
out the supports from underneath someone before he/she even gets
to the cliff.
COMMISSIONER CRUM responded he agrees 100 percent on that. He
said the main intent of this and some of the tools is to ask for
permission for DHSS to continue to go after these waivers to
build this program to make sure that these individuals are
supported before they actually lose these benefits.
CO-CHAIR SPOHNHOLZ related that she and Co-Chair Zulkosky were
surprised to see something as expansive as HB 135 dropped
without getting any heads up. She noted the bill includes a
provision that would allow the department to implement emergency
regulations to cut rates without the opportunity for provider
comment. She inquired whether the commissioner designee has
consulted with the provider community and community partners
about how these proposals would impact them.
COMMISSIONER CRUM answered that [DHSS] has not yet started the
consulting process. This is the opening, the information is now
out, and these issues can now be addressed. The emergency
regulations in the bill are related specifically to this act,
which is an order for [DHSS] to speed up this process. If these
waivers are received, the intent is any regulatory changes
necessary on the side [of DHSS].
CO-CHAIR SPOHNHOLZ noted that the nurse hotline is included in
HB 135. She related that when presenting the [proposed]
Medicaid Phase One reductions to the Health & Social Services
Finance Subcommittee this year, DHSS staff said that the
department did not need legislation to implement the proposed
Phase One changes. She asked what changed the minds of [the
commissioner designee and his staff].
COMMISSIONER CRUM replied that depending on the budget received
from the legislature and the savings areas involved, DHSS could
use dollar savings in order to save some of this. If the full
proposal that DHSS presented moving forward were to be approved,
then DHSS would need this budgetary ask to implement those
items.
CO-CHAIR SPOHNHOLZ advised that, typically, dropping a piece of
legislation on roughly day 92 of the legislative session without
any consultation is a recipe for not getting the bill passed
because there is no way to get through this level of substantive
content in this amount of time. She said she does not take
lightly the kinds of proposals made in this bill as they are
going to have broad sweeping changes. If the proposals are
good, then they warrant the time to engage with the provider
community to understand properly how to implement them. For
example, earlier today she decided to set aside a fairly small
bill for a couple of days to ensure she addressed a concern that
the provider community had. She further advised that the scope
of what HB 135 proposes is not even technically possible to get
done in this amount of time unless the whole provider community
was lined up in lockstep behind the department.
4:19:20 PM
CO-CHAIR ZULKOSKY asked what the largest number of employees is
that the commissioner designee has personally supervised.
COMMISSIONER CRUM responded he has directly supervised 20
employees.
CO-CHAIR ZULKOSKY noted that a person might directly supervise a
certain number of employees and that those employees might
directly supervise other individuals. She asked whether there
is a broader team that the commissioner designee can speak to on
a total number of people that he has lead in an organization.
COMMISSIONER CRUM answered 75 employees and said the company had
offices in a couple states.
CO-CHAIR ZULKOSKY pointed out that the Department of Health and
Social Services has more than 3,000 employees across the state.
She noted there is a big need to travel around, as was
previously mentioned by the commissioner designee, because many
of these employees are working in diverse communities and
handling diverse programs. She requested the commissioner
designee to explain how his management experience qualifies him
to lead a department of this size and scope.
COMMISSIONER CRUM replied that coming from a background of doing
organizational development strategic leadership, a manager knows
that not much more than eight individuals can be effectively
managed unless they are incredibly high functioning individuals.
So, he said, the goal is to set up an organization in which a
manager has great deputies that manage the tier below them, and
that tier manages the tier below them. The organizational
leadership comes from the top. It's the vision a manager works
through, creating the employee buy-in, and the inspiration
aspect, so it is a scalable function across the board. He ran
and worked large projects with 20 direct employees, but if
talking large-scale projects it added up into the thousands; it
is a matter of semantics when it comes towards that. What the
leadership ability comes from is management at that scalable
aspect.
4:21:29 PM
REPRESENTATIVE TARR stated that this is hard for her because
clearly the commissioner designee would bring a lot of energy to
the position, but he doesn't really have a public health
background or a direct health care or health policy background.
While she is trying to be open minded, she is challenged because
this is coming during an administration that she believes is
going in the wrong direction regarding the health of Alaskans.
She cannot separate the commissioner designee from what she sees
as heading in the wrong direction. She is troubled that these
conversations start with just looking for every opportunity to
cut costs when her vision is about how to improve health. While
it happens more slowly than is wanted, successfully improving
health always reduces cost and she would be more comfortable if
that was the view [of the administration]. [Legislators and
state employees] get to benefit from state paid insurance and
she doesn't see anyone in the room giving up their health
insurance. Yet needy Alaskans who also have state covered
health insurance have much more difficulty in actually finding
access to that service and it seems as if these people are being
beaten down like they've done something wrong while they really
haven't. It is the fact that health care costs are astronomical
and barely anyone can afford them, unless lucky enough to have a
job with good health insurance [as do the people in this room].
Going in the direction of only seeing people by dollar signs is
troubling because she is so motivated to improve the health of
Alaskans. The commissioner designee is a hard worker, but the
direction and the vision are challenging for her.
4:24:14 PM
COMMISSIONER CRUM responded he 100 percent agrees, which is why
any solution that is put forward will continue to work with the
department's current ongoing Section 1115 Waivers. The goal of
the waivers is to shift the dollar spend from one end of the
spectrum to the other to provide mechanisms to treat the mild
and moderate and not always just pay for the severe. The goal
is to do family resiliency. A DHSS employee is being sent for
the federal Family First Prevention Services Act and how can
Title IV-E dollars be spent for getting some mental health
training and for licensed marriage family therapists to address
family issues. The timing of HB 135 is unfortunate, but it is
going to be a long-term process of addressing this together and
always keeping in mind that [DHSS] is going to continue working
down this path of providing this access. Other items proposed
by DHSS, like diagnosis-related groups (DRGs), are a move
towards a value-based system to make sure there are improved
health outcomes for the dollars spent.
4:25:19 PM
REPRESENTATIVE TARR offered her appreciation to the commissioner
designee for saying that, but said she doesn't hear that coming
from the third floor. Frequently heard is the term "able-bodied
individuals," but many people work really hard and yet cannot
get ahead because of the economics. Therefore that philosophy
troubles her.
COMMISSIONER CRUM said he looks forward to sharing with the
committee the information about how this would work for those
able-bodied people, so they have a chance to actually get ahead
if possible; if not, this is no means of removing them from the
program. This is so that as they do grow, they don't have to
make that hard decision and [DHSS] can grow along with them.
CO-CHAIR SPOHNHOLZ maintained that that is not what HB 135 says.
4:26:46 PM
CO-CHAIR ZULKOSKY recognized that the committee asks many hard
questions, but said it is because the committee cares a lot
about what it is doing. While the committee might be on the
opposite side of the table and push forward a lot of hard
questions, it is because the committee might have a difference
of opinion on how to get from Point A to Point B. Clearly there
is a difference of opinion on what HB 135 is actually going to
do and how it will impact the Medicaid expansion population in
Alaska. Alaska is in a time of challenging and lean budgets.
Medicaid expansion brings in $27 of federal funds for every $1
of state funds that are spent. She requested the commissioner
designee to talk about his plan and vision for ensuring that
health coverage for Alaskans continues in a time of challenging
budgets.
COMMISSIONER CRUM answered, Part of our initial discussions
with CMS with a plan like this would actually to be to maintain
that 90 percent match for that Medicaid expansion population for
the paying of their premiums through the individual market as
well as the secondary payer aspect.
CO-CHAIR ZULKOSKY commented that if a state match is not put
forward to leverage those federal resources, there might not be
sustainability of a system at all. She said this appears to be
a way to destabilize the Medicaid program as a whole. It is
hard to understand how moving along this path is going to, in
the long run, preserve the sustainability of this program.
4:28:36 PM
REPRESENTATIVE JACKSON commended the co-chairs for being on top
of the recently introduced HB 135 and noted she has not yet had
the opportunity to review the bill. She said Representative
Tarr really cares that everyone needing care is taken care of.
Representative Jackson cautioned, however, that she doesn't want
to make it look like the people in the administration have
anything against a better tomorrow for all Alaska. Noting that
Co-Chair Spohnholz put forth a bill that would try to curb the
opioid crisis, she asked what is being done with Medicaid to
curb the prescriptions that go out.
COMMISSIONER CRUM replied DHSS has a lot of processes through
the Medicaid program, such as the Prescription Drug Monitoring
Program (PDMP) and working with providers. He said DHSS is
working with the pharmacy board about the professional standards
because it is this very fine line of individuals in need in pain
that have to be managed to over-prescription and how to deal
with those issues. The Department of Public Safety, the Office
of Drug Control Policy in the governor's office, and DHSS are
addressing this ongoing issue to make sure that individuals who
do need it can get the proper supply, and that it is controlled
thereafter. Providing an alternative means is something that
could be explored in the future.
REPRESENTATIVE JACKSON expressed her concern about people having
to turn down raises in order to stay on Medicaid benefits and
said it goes hand in hand with the step down. Hopefully there
is a process for empowering people to grow, while at the same
time not dropping overnight the medical benefits that they have.
She inquired whether the commissioner designee has any foresight
on how to do that or working with businesses in this regard.
COMMISSIONER CRUM responded DHSS is working on that through the
levers that it controls. Through this process, part of this
waiver would be to find ways to expand the federal poverty level
(FPL) so that as they grow, they get a little bit of a subsidy
as opposed to just binary yes or no. The department wants to
make sure that it can expand along with them. One of the
primary goals through this is to make sure that the able-bodied
in this population can work, have the opportunity to better
themselves, and can take advantage of other programs, such as
vocational training or vocational rehabilitation, to improve
their economic lot. That also helps everything across the board
with family resiliency to social determinacy of health.
4:32:26 PM
CO-CHAIR ZULKOSKY reviewed the questions and answers between the
committee and the commissioner designee on 4/13/19 in regard to
the Alaska Psychiatric Institute (API) and the sole-source
contract that the commissioner designee awarded to Wellpath
Recovery Solutions ("Wellpath") during the time he had invoked
statutory authority for the no bid process. She inquired
whether the commissioner designee, in his role as commissioner,
would be issuing a competitive request for proposals (RFPs) for
Phase Two or the long-term management of API.
COMMISSIONER CRUM responded that when it comes to patient safety
and the stability of the facility, options are on the table and
[a competitive RFP] could be worth evaluating. As far as his
direct answer on Saturday, he said he believes it is actually in
procurements hands at this point, given where it is at in the
contract process.
CO-CHAIR ZULKOSKY asked whether the commissioner designee has a
plan to return API back to state management once the initial
contract term with the private company for this initial phase is
over, or whether this move is intended to be a permanent move to
privatize API.
COMMISSIONER CRUM answered that at this point there is no plan
to move it back into state control if Wellpath meets the key
performance metrics; however, it is something worth evaluating.
CO-CHAIR ZULKOSKY stated that that feels a bit oppositional in
terms of the commissioner designee being willing to consider a
competitive RFP, however there is not an intention to bring it
back to state management. But, she added, she also understands
that if a competitive RFP were put forward it wouldn't be coming
back under state management. She urged that Mr. Crum, in his
role as commissioner, use his leadership for such a big
complicated issue to put forth a competitive RFP for Phase Two
because there are a lot of stakeholders in the state and in the
community that are very concerned with how this initial part of
the contract came forward.
4:35:19 PM
CO-CHAIR SPOHNHOLZ opened public testimony on the confirmation
of Mr. Adam Crum as commissioner of DHSS.
4:36:02 PM
LIN DAVIS testified in opposition to the confirmation of Mr.
Adam Crum as commissioner of DHSS. She said she is a retired
state worker and spoke as follows:
Quietly coiling under the governor's chair, a venomous
philosophy swells. Human needs as burdens. Common
good too burdensome. Under Commissioner Crum's chair
quietly coiling. Cuts to Medicaid through block
grants. Cuts to senior benefits and no benefits at
all for May or June. Cuts to Alaskans who experience
chronic mental illness. Cuts to those so ill they
need API. Human needs and common good too burdensome.
Cut the funds for domestic violence programs for
opioid recovery, for dental cleanings and cavity
repair. Human needs and common good too burdensome.
Cut all social services. Let PTSD and suicide ride
the land. Less of this and less of that might make us
more the venom says. Mr. Crum in my view has tried,
but too many unhealthy results have rolled out of his
office. I encourage you not to confirm him.
4:38:25 PM
TINA WILLIAMS testified in opposition to the confirmation of Mr.
Adam Crum as commissioner of DHSS. She said she has 31 years
of state service and was chief financial officer for over eight
years at API. She returned June 2018 based on an offer
requesting that she assist the hospital to re-establish
financial infrastructure due to an ever degrading administrative
and financial situation of the last several years. Placed under
her supervision were business office operations, financial
processes, structure, reporting, and after approximately one
week on the job the Human Resource Section at API. She was told
her last day with API would be 3/1/19, with no explanation. She
asked then-Acting CEO Gavin Carmichael if she could use leave to
achieve her final high three years. He had to check, but the
answer was no, and she retired with three days' notice.
MS. WILLIAMS said Governor Dunleavy and Commissioner Designee
Crum rely on a team of people to help steer the ship. After
watching much of the House Finance Committee presentation, as
well as court testimony, the story unfolding by DHSS Deputy
Commissioner Wall over several weeks involved some changes
seemingly just as a changing narrative. Was there an emergency?
Was there an emergent issue? Was there a reason to bring a
vendor from outside of Alaska to manage the hospital? Neither
the commissioner nor the deputy commissioner has had experience
with running a hospital. It is a complicated department to run
even without API. While she applauds Mr. Crum's business acumen
and willingness to take on the commissioner position, she is
concerned about Mr. Crum as the commissioner and Mr. Al Wall as
deputy commissioner as they continue to allow the degradation of
services at the hospital and support increased fees for
vulnerable senior citizens in Alaska's Pioneer Homes based on
the governor's 2020 budget request to the legislature.
MS. WILLIAMS related that the [API] hospital census was around
36 or 37 when she left in March. According to testimony the
numbers last week were 26 for an 80-bed hospital. She said
continued pressure to open beds to 80 exists throughout the
community and is also demonstrated by the commissioner's office
with the Wellpath contract having this as one of the milestones,
even though that is a clinical decision. The hospital must
operate safely and not bow to executive pressure to open beds
when nursing staff, psychiatric nursing assistants,
psychiatrists, physicians, and other licensed practitioners are
not available while issues are investigated regarding
allegations of abuse or neglect from the patient population.
MS. WILLIAMS recalled that according to the commissioner
designee's 4/13/19 testimony before the committee, Wellpath was
vetted and the commissioner designee was aware of Wellpath's
litigation. She said this vetting appears not to follow good
business practice and also sets the state up for additional
litigation regarding the procurement practices that led up to
the approximately $44 million contract with Wellpath.
Administrative and financial infrastructure of the hospital,
additional direct patient care positions of psychologists and
social workers, and nursing vacancies still exist at the
hospital. Recruitment for positions has been off and on since
January 2019 where managers have been confused if they were
allowed to recruit or not. Recruitment for positions at the
hospital has been difficult and to find people interested and
not be able to hire or proceed with the recruitment process
ensured that the hospital would not have the resources needed on
site to resolve some of the issues. The place continues to be a
stressful environment for those who work in direct care and
supportive positions. Wellpath's message is that the jobs must
be competed for and Wellpath's infrastructure is still not in
place or transparent.
MS. WILLIAMS said decisions were made at the commissioner's
office level without API staff awareness or involvement. She
stated that the contract terms, amount, and milestones were not
provided to the entire executive team at the hospital, much less
to her as the CFO prior to execution. They actually should have
been on file at the hospital, which is a requirement for
surveys. Failure to provide updated contract information was
previously cited and yet Deputy Commissioner Wall proceeded to
keep it hidden until the week that the first payment for $1
million was necessary. Unless a person watches legislative
testimony, one wouldn't have known that this contract was
coming. The Department of Health and Social Services has been
managing a hospital from afar for several years and has not
understood the complexities, regulations, and general processes
to serve a diverse and vulnerable in-patient population. Every
time there is new leadership education must start all over
versus taking action to resolve. The department's leadership
takes credit for work that started prior to the administration
change. There was just no concurrence from DHSS leadership or
funding to allow the hospital to proceed with this contract that
would have helped staff and patients before the Wellpath
contract. Shouldn't the goal be to provide the best level of
care for the most vulnerable mentally ill patients? This will
be a milestone that DHSS will use to celebrate achievement and
make a case that Wellpath is working.
MS. WILLIAMS stated that many of the day-to-day decisions needed
DHSS commissioner office leadership because there was lack of
funding to be able to manage and run the hospital daily
operations. When she left the hospital she put out yet another
plea for additional funds to be moved to the contractual
services and grant lines to pay for vendors that had been
providing services, but the commissioner's office made sure that
$5 million was moved from the API personal services line to pay
for a new contract with Wellpath, ignoring the rest of the
pending obligations.
MS. WILLIAMS related that Deputy Commissioner Wall testified
during Judge Morse's court hearing with the Disability Law
Center. She said the lawsuit continues to have a changing
narrative about immediate jeopardy, Wellpath, and milestones
without a plan to relieve the backlog of people waiting for some
type of care or evaluation services at the hospital. When
Deputy Commissioner Wall was director of the Division of
Behavioral Health, he did nothing to resolve issues with the
continuum of care that would make a positive and lasting impact
so the mentally ill would not languish in jails or emergency
rooms. The backlog existed when Mr. Wall was in his previous
position and the hospital reported directly to the Division of
Behavioral Health, whose agenda then and now is to privatize the
hospital.
MS. WILLIAMS concluded by saying that the confirmation of Mr.
Crum would not be in the state's best interest with his
selection of Mr. Wall for deputy commissioner.
4:45:56 PM
REPRESENTATIVE DRUMMOND thanked Ms. Williams for her testimony
and requested a written copy.
4:46:32 PM
KEN HELANDER, Advocacy Director, American Association of Retired
Persons (AARP) Alaska, testified in opposition to the
confirmation of Mr. Adam Crum as commissioner of DHSS. He
stated it isn't customary for his organization to comment on
administrative appointments, but this was changed by the recent
abrupt action by DHSS that directly affects low income older
Alaskans who will not receive a May or June senior benefits
payment. This action, without forewarning, raised numerous
questions of its necessity, management of the process, and
concern for the wellbeing of those affected. The position of
commissioner is a position of public trust that brings with it
the necessary burden of concern for people in need and in pain.
The job of committee members is to vote whether to advance Mr.
Crum's confirmation. His job as an advocate for older Alaskans
is to always hold the commissioner accountable.
MR. HELANDER stated that every action taken by the department,
like the unfortunate one taken against senior beneficiaries last
week, has an impact on real lives in real situations being
played out all over Alaska every day. It is not enough for the
commissioner to execute the agenda of the administration to
reduce spending. It is at least equally important to ensure,
regardless of the cut, that the wellbeing of every Alaskan is
protected and supported. Each cut affects persons in some kind
of need. Every cut affects the job of someone helping that
person in need. Without well-managed public services, who will
tend to those in need? Will the commissioner? Will the people
in the department? Will the governor? Those Alaskans will be
tended by families, friends, neighbors, and by scores of public
and private organizations established to ensure that no one
falls through a hole in the safety net.
MR. HELANDER said AARP Alaska will be watching the commissioner
and his department in the execution of their responsibilities to
Alaskans. The commissioner's salary comes from the same coffers
as do the funds that support Alaskans in need. On behalf of
those in need and on behalf of those who help those in need and
on behalf of AARP's 85,000 members, AARP Alaska pledges to hold
Mr. Crum accountable for every action. AARP Alaska urges Mr.
Crum to listen as intently for the real human needs and to look
as closely at the human dignity displayed as he does to the
administration that has nominated him for this position. Only
then can the commissioner warrant the public trust that is
essential for the health and wellbeing of all Alaskans.
4:49:49 PM
VINCE BELTRAMI, President, American Federation of Labor and
Congress of Industrial Organizations (AFL-CIO), testified in
opposition to the confirmation of Mr. Adam Crum as commissioner
of DHSS. He noted that his organization represents over 50,000
members in the state. During his 12 years at this job he has
never before felt compelled to testify against the nomination of
any commissioner because generally he thinks the governor should
get to choose his people. However, this governor has made some
odd choices in commissioners that did not stand the scrutiny of
a process and that is the job of legislators. He is here today
because standing up for collective bargaining rights and
contracts is his job.
MR. BELTRAMI said this commissioner designee has made himself a
target by engaging in some very dubious actions. If a
commissioner designee cannot abide by the law, he or she should
not be confirmed. Yesterday, the Alaska State Employees
Association, an AFL-CIO affiliated union, filed a request for a
temporary restraining order on the illegal contract entered into
by the commissioner designee with Wellpath. This contract
violates long-standing provisions of [the state's] contracts
that clearly lay out how any efforts to privatize state services
must be conducted. [The state's] contracts, these rules, are
the law. It doesn't matter if the law is broken through
incompetence or intent. Mr. Crum doesn't even officially have
the job and already the rules are being disregarded. If this
commissioner designee will violate the collective bargaining
agreement, what other provisions of law would he disregard?
MR. BELTRAMI stated that legally and competently managing the
largest department in Alaska government is the charge of this
position and it is off to a very bad start. Dealing with
employment and contracts should be the easiest part of this very
complicated job. Complying with the myriad of federal laws and
rules that govern the department is more complicated, but also
not negotiable. This violation of collective bargaining
agreements should give everyone pause and cause reflection about
whether a violation on the least complicated aspect of the job
doesn't foreshadow future problems. He urged committee members
to oppose the confirmation of Mr. Crum.
4:52:28 PM
DAWN BUNDICK, testified in opposition to the confirmation of Mr.
Adam Crum as commissioner of DHSS. She said she has been a
public servant for many years working for Alaskans. She stated
that Mr. Crum is not a person who is looking to protect the
health and human services of Alaskans. He has allowed the
Senior Benefits Program funding to expire without legislative or
public notice. He is committing a crisis to support budgetary
plans to eliminate senior benefits altogether. Her mother
received a letter saying that her senior benefits would be cut,
and this has affected her making ends meet. The public elected
the committee members as stewards for Alaskans and protecting
in-state jobs and families. She asked the committee members to
oppose the confirmation of Mr. Crum and stated, "people, not
profits.
4:53:54 PM
JAN CAROLINE-HARDY testified in opposition to the confirmation
of Mr. Adam Crum as commissioner of DHSS. She said she works
for the Department of Transportation & Public Facilities and is
testifying for herself and seven DHSS employees who are unable
to testify for fear of retribution. She opposes Mr. Crum's
confirmation for at least three reasons. First, Mr. Crum
initiated a sole-source privatization contract with API that
disregards current employee rights, future Alaskan employment,
and patient rights. Outsourcing steals Alaskan jobs. Second,
Mr. Crum does not have the best interests of Alaska's elders and
vulnerable populations. He broke faith with them by rejecting
Medicaid block grant funds, which would help alleviate some of
the extraordinarily high costs of health care. How should
Alaska's most vulnerable citizens be entrusted to someone who
has only shown a pattern of cutting and privatization? The
third reason strikes her personally. She is a 70-year-old woman
with no family. Her retirement income plus Social Security was
insufficient to live on without making sacrifices, so she
returned to work at age 70. With no family and no one to take
care of her when she becomes incapacitated, she will have to go
to the Pioneer Home for her final years, months, or days. She
could afford to reside there at the current level of cost, but
with the fees now being raised to 140 percent of today's costs
it will be impossible. Is this how to treat Alaska's pioneers?
Outsourcing and cutting benefits for Alaska's most vulnerable
population is criminal, immoral, and vicious.
4:56:15 PM
BEV GAJARING testified she opposes the confirmation of Mr. Adam
Crum as commissioner of DHSS because he supports the outsourcing
privatization of API. She said she has family and friends who
are at risk of losing their jobs at API if Mr. Crum is confirmed
because he will privatize the facility. Privatization will
cause them to lose their homes, benefits, take other positions,
or relocate. Mr. Crum has no vested interest in the persons of
the public sector and its employees because he has no real
experience in the Department of Health and Social Services. How
can an individual be relied upon to run DHSS who is unable to
relate to its employees or patients? Alaskan's health and
social services should not be up for profit or privatization.
Someone is needed who is willing to put his or her best foot
forward in securing DHSS in the right direction and by finding
ways that will benefit and protect employees, patients, and the
vulnerable population. Mr. Crum is not the person. She urged
the committee to stand by her and those in the communities whose
lives are in jeopardy and cast a no vote for Mr. Crum's
confirmation.
4:58:09 PM
REPRESENTATIVE JACKSON asked whether Ms. Gajaring works for API.
MS. GAJARING replied no, family and friends.
REPRESENTATIVE JACKSON pointed out the threat of API closing and
asked whether those people would have lost their jobs either
way.
MS. GAJARING responded they would end up losing their jobs. If
it is no longer API and Wellpath takes over, who is to say that
Wellpath will hire them? There are also others who are of age
and how can they be guaranteed job security?
4:58:51 PM
JENNIFER CUNNINGHAM testified she opposes the confirmation of
Mr. Adam Crum as commissioner of DHSS because he has zero
experience in health and human services or working in the public
sector. She stated she has worked at API for three years, and
in this job, she has been assaulted twice. She has a traumatic
brain injury and these assaults have had a deleterious effect on
her life, including headaches, post-traumatic stress (PTS)
episodes, short-term memory loss, and panic attacks, which makes
her feel overwhelmed with her family and in the community. She
has increased her current medication because of the brain
injury. She loves her job and further assaults could make her a
quadriplegic or dead. She fears that supporting Mr. Crum would
lead to job losses and increased risk of danger to API staff and
patients. She does not believe that Mr. Crum has the knowledge,
interest, or skills in protecting her or her co-workers. She
urged the committee to vote no on Mr. Crum's confirmation.
5:00:34 PM
MARK NELSON testified in opposition to the confirmation of Mr.
Adam Crum as commissioner of DHSS. He addressed Representative
Pruitt's statement that was made during the 4/13/19 confirmation
hearing that Mr. Crum's politics shouldn't have anything to do
with whether he is confirmed as commissioner since politics are
not involved in any of the decision making process. Mr. Nelson
therefore looked at Mr. Crum's qualifications related to API as
a sample of the commissioner designee's work, knowledge, skills,
and abilities. He recalled that according to an earlier hearing
there was some sort of jeopardy at API in early February [2019]
at which time the commissioner designee invoked a statute where
he was "stepping in," so it appears the commissioner designee
didn't even realize that he is in charge of API. Stepping in
and having a private company come to facilitate the hospital
means Mr. Crum doesn't have the ability to do it himself. The
CEO and staff of API answer to the commissioner. The
commissioner designee has been in charge since early December
[2018]. Since that time, the API CEO and all six doctors have
left their positions. According to the hearings this is
unprecedented. This should be a red flag. The commissioner
designee appointed dozens of people into positions within the
division, yet for the number one sore spot under his command,
API, the commissioner designee failed to appoint a CEO, which by
his own testimony was the reason why API was having
difficulties.
MR. NELSON recalled that the commissioner designee testified on
4/13/19 that having a workweek of 60 hours would be wonderful.
He maintained that this indicates Mr. Crum is over his head. He
further maintained that Mr. Crum doesn't understand that as
commissioner of DHSS he is dealing with life and death. This is
not sitting across from a teenager as a volunteer. Mr. Crum is
taking money away from elderly people who die if they don't get
their medications. An elderly person who doesn't get money
cannot afford heat and gets pneumonia and dies. This is not
appointing the CEO at API and a person kills themselves. Mr.
Crum is not qualified and should not be confirmed.
5:03:45 PM
MAUREEN SUTTMAN testified in opposition to the confirmation of
Mr. Adam Crum as commissioner of DHSS. She stated she is a
retired licensed professional counselor and, surprisingly, she
is also a Medicaid recipient because she wasn't making much
money when she got a diagnosis of stage four cancer two years
ago. While Mr. Crum has sparkling good college degrees, he has
absolutely no work experience in the health field, which is of
concern for someone who is heading up the Department of Health
and Social Services. There is so much to know and when a person
doesn't have the work experience to know, that is when the
person runs into legal concerns, which Mr. Crum has done. She
noted she has a master's degree and has worked in mental health
with a variety of populations across the state, and the
populations are a concern because she hasn't heard anything
about stakeholders. Rather, she is hearing business ideology by
a political placement from a governor who has a certain way of
looking at things. Alaska has high cultural needs, high
transition needs in and out of treatment, and high ongoing
treatment needs. These are not being attacked from a health
perspective but from a business and money perspective, which
concerns her. Mr. Crum is not qualified.
5:06:27 PM
BECKY SEWELL testified in opposition to the confirmation of Mr.
Adam Crum as commissioner of DHSS. She stated she has her own
business working out of her home. She shared a story of a
friend working for API that began in late December [2018]. The
story started with API requesting that the State of Alaska fund
API appropriately to cover the salaries of nurses and to cover
the hiring of more staff to keep staff safe around patients. It
all started with staff safety because the patients were
physically aggressive and there wasn't enough staff to cover
that. Her friend states that the nurses salaries are $10 an
hour less than the other hospitals in Anchorage, along with API
being the only hospital in Anchorage where staff gets hurt on a
regular basis. These are really dedicated people. In a
previous legislative hearing Mr. Crum said there were six deaths
at API in 2018. But, she maintained, that is untrue - there
were no deaths at API. Both Mr. Crum and Deputy Commissioner
Wall have done a lot of things in secret. She doesn't trust Mr.
Crum and thinks he should not become commissioner.
5:09:07 PM
KAREN CAMERON testified in opposition to the confirmation of Mr.
Adam Crum as commissioner of DHSS. She said her opposition is
based on lack of integrity and not having the professional
experience and expertise to do the job as a health commissioner.
Mr. Crum has misstated his education and work experience. He
doesn't have a degree in health services or hospital
administration. The degree is in something called industrial
hygiene and his work experience, self-described, was a truck
driver and he was working for his father at that time at
Northern Industrial Training. Neither of these qualifies him to
be a hospital administrator or health systems administrator.
Regarding lack of integrity, one of the first things Mr. Crum
did was to award a contract of $1 billion contract to Wellpath,
a Nashville, Tennessee, company with massive financial and legal
problems. Wellpath's experience is not in psychiatric hospitals
but in prisons, jails, and detention centers. This contract is
a giveaway while Governor Dunleavy is trying to restrain
spending it looks like a quarter of a billion dollars was
given away in one day without any public testimony or
transparency. There are so many very real problems in the state
in terms of health and nothing has been heard about revenue
generation or coming up with contracts and grants that are
available to the state. Mr. Crum and Mr. Wall feel it doesn't
make any difference what they do as long as they cut DHSS 40
percent. The people, patients, and employees deserve better.
5:12:30 PM
CO-CHAIR SPOHNHOLZ closed public testimony.
5:13:09 PM
CO-CHAIR SPOHNHOLZ noted that since the committee's last meeting
a lawsuit was filed against the state by the Alaska State
Employees Association alleging that DHSS violated its bargaining
agreement, state law, and the state constitution as the
department seeks to privatize operations at API. Lawmakers
cautioned the commissioner designee that privatization of a
public facility must be done with the utmost care and due
diligence to prevent lawsuits as well as to ensure safety. Yet
the commissioner designee proceeded and now the state is being
sued. The inadequate process and lack of complying with the
contracts in state law now jeopardizes the facility and its
ability to do what it needs to do and has created new liability
for the state on which resources are now being spent to defend
against a lawsuit that was preventable if this same process had
been conducted in a slower, more deliberative way. She asked
what the commissioner designee's plan is for moving forward in
regard to this lawsuit.
COMMISSIONER CRUM replied that the department is evaluating the
lawsuit and he cannot comment on pending litigation. He said
that throughout this process his primary concern was patient
safety, which led to where things are now. It was faster than
the department would have liked, but DHSS believes the process
was upheld and that it had everyone involved and it was done in
the correct way.
CO-CHAIR SPOHNHOLZ stated she respectfully disagrees.
CO-CHAIR SPOHNHOLZ recounted that on [4/12/19] DHSS announced it
would not be paying out senior benefits to the highest tier of
recipients for [the months of May and June]. On 4/13/19 the
committee asked the commissioner designee whether he would ask
for a supplemental or be able to move funds between allocations,
which the commissioner has the authority to do. At that point
the commissioner designee hadn't had time to figure this out.
She asked whether the commissioner designee would like to
comment now that he has had two additional business days to
research the issue.
COMMISSIONER CRUM responded that the issue of senior benefits is
frustrating, particularly for those involved knowing that it is
a very vulnerable population and how much they depend upon those
funds. The department followed a process based on previous
years precedence in how the payments had either been cut or
stopped, as well as following legislative guidance. The
department is evaluating this and still trying to see if there
are available funds amongst programs. It is not an easy ask to
see who has extra funds that could be moved over as the other
programs must still be projected for the rest of the year. All
programs deal with a vulnerable and needy population. It is
unfortunate the way the guidance went out on that, but the
department was trying to do that in advance. One thing DHSS has
control over is that perhaps with these populations the
department can do an expedited review process, and perhaps if
they do qualify, DHSS can mitigate it a bit by having enhanced
Supplemental Nutrition Assistance Program (SNAP) benefits.
CO-CHAIR SPOHNHOLZ offered her understanding that the Senior
Benefits Program only needs $800,000 to fully fund the top tier
benefits for the rest of the [fiscal] year. She surmised the
commissioner designee is saying that with a $3.4 billion budget
he cannot find $800,000.
COMMISSIONER CRUM answered DHSS does not have discretion to
transfer any funds away from the Medicaid side, so the entire
dollar amount must be extracted out of that. To continue the
process to make sure, DHSS must do projections throughout the
end of the fiscal year to see how that program would be affected
if dollars are found and there are no unintended consequences.
CO-CHAIR SPOHNHOLZ remarked that for someone who has been making
the pitch that his qualifications, while not based on experience
in the health care arena, health care policy, or public sector,
include organizational development and business expertise, it
would seem a small matter to find $800,000 in a budget that is
this large when talking about seniors who count on this money to
pay for heating, food, and prescription medications.
COMMISSIONER CRUM replied that the situation is not an easy one.
He said this was the budget given to the department last year
and DHSS has followed its guidelines to manage within the
appropriations. His goal through next year is to have more open
dialogue so that this doesn't sneak up on the department.
CO-CHAIR SPOHNHOLZ concurred that that would be wise.
5:18:21 PM
REPRESENTATIVE TARR said she is struck that a supplemental bill
hasn't come out to cover this. Given the amount of discussion
with legislators, it seems this alternative would have support
and so she doesn't understand why the problem wouldn't be
resolved this way. Under these circumstances it seems the
commissioner designee, as the leader, would want to have
supplemental legislation dropped tomorrow to resolve this short-
term problem and then move forward with looking at a long-term
solution.
COMMISSIONER CRUM responded DHSS is still trying to find out if
there are possible dollars. If the legislature wants to
expedite the process with a supplemental, the department would
use that accordingly.
REPRESENTATIVE TARR stated she is one of about 635,000 permanent
fund dividend (PFD) recipients. This would be under $1.50 per
person to cover and she is willing to contribute the $1.50
necessary to support the state's seniors.
5:20:16 PM
CO-CHAIR ZULKOSKY said the commissioner of DHSS should ensure
that every legislative tool in the toolbox is leveraged to
resolve relatively small fixes in the grand scheme of things
within the department. Making sure that any individual who is
carrying the mantle for seniors and people with disabilities and
those who don't have the resources to benefit from systems that
many others have been privileged to benefit from is where the
challenge is. She echoed the concerns of her colleagues on the
committee.
CO-CHAIR SPOHNHOLZ thanked the commissioner designee for his
testimony and engaging in a rigorous conversation. She offered
her understanding that this was not easy, but said this is a big
job that Mr. Crum is applying for and sometimes a big job has a
tough interview process.
5:21:43 PM
CO-CHAIR ZULKOSKY moved to advance the confirmation of Adam
Crum, designee as Commissioner of the Department of Health and
Social Services, to a joint session for consideration. She
reminded the committee that signing the reports regarding
appointments to boards and commissions in no way reflects
individual members' approval or disapproval of the appointees,
and the nominations are merely forwarded to the full legislature
for confirmation or rejection. There being no objection, the
confirmation was advanced.
5:22:39 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:22 p.m.
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