Legislature(2001 - 2002)
04/21/2001 11:24 AM House JUD
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* first hearing in first committee of referral
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HB 174 - MENTAL HEALTH INFORMATION AND RECORDS [Contains discussion of CSSB 135(HES), the companion bill to HB 174.] Number 2354 CHAIR ROKEBERG 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." [HB 174 is sponsored by the House Rules Standing Committee by request of the Legislative Budget and Audit Committee] Number 2330 REPRESENTATIVE HUGH "BUD" FATE, Alaska State Legislature, speaking on behalf of the Joint Committee on Legislative Budget and Audit (LB&A), noted that HB 174 is a companion bill to SB 135. He explained that the state auditor and the Department of Health & Social Services (DHSS) recommend the changes encompassed by HB 174 in order to allow the state to better track direct grant moneys that are given to community mental heath providers. He said HB 174 does two things: It complies with the auditor's report, which recommends reporting actual consumer data, and it holds agencies harmless for being sued by the consumer for breach of confidentiality if such should ever occur. He added that HB 174 is really about accountability for state grant funds. REPRESENTATIVE FATE noted that Amendment 1, [22-LS0684\A.1, Lauterbach, 4/20/02] will make HB 174 identical to CSSB 135(HES), the current version that is advancing in the Senate. Amendment 1 reads as follows: Page 4, following line 26: Insert a new bill section to read: "* Sec. 7. The uncodified law of the State of Alaska is amended by adding a new section to read: DATA FROM PRIOR YEARS. (a) As a condition of receiving state money for state fiscal year 2002 under AS 47.30.520 - 47.30.620, 47.30.660 - 47.30.915, or AS 47.31, the entity eligible for the state money shall agree to furnish the Department of Health and Social Services with confidential and other information about recipients of services paid for, in whole or part, with state money during state fiscal years 2000 and 2001 under AS 47.30.520 - 47.30.620, 47.30.660 - 47.30.915, or AS 47.31. The entities governed by this subsection shall comply with regulations of the department regarding the submission of the information required under this subsection. (b) The department may review, obtain, and copy the information submitted under (a) of this section. The department may also obtain information of the type described in (a) of this section from the patient who received the services described in (a) of this section and review or copy that information. (c) Records and information obtained by the department under this section are medical records, shall be handled confidentially, and are exempt from public inspection and copying under AS 40.25.110 - 40.25.120. The records and information may be copied and disclosed under regulations established by the department only under the same circumstances as provided for confidential records under AS 47.30.845, as amended by sec. 4 of this Act. (d) The department may review the information obtained under this section to evaluate compliance with the applicable statutes and grant contracts. However, the department may not use the information furnished under this section to impose civil or administrative penalties for failure to comply with applicable statutes and contracts. The department may use the information to establish a database on which to base future management practices and to impose restrictions and conditions on use of state money in fiscal year 2002 and later. (e) In this section, "department" means the Department of Health and Social Services." Renumber the following bill section accordingly. Number 2252 ELMER LINDSTROM, Special Assistant, Office of the Commissioner, Department of Health & Social Services (DHSS), explained that Amendment 1 will allow [the DHSS] to collect data for fiscal years (FYs) 2000 and 2001 in order to build a "baseline." After noting that HB 174 will be effective the next fiscal year, he said that [the DHSS] concurs with the legislative auditor that without Amendment 1, it would in fact be two or three years before [the DHSS] would have the kind of baseline and accountability information that the auditor recommends. CHAIR ROKEBERG asked Mr. Lindstrom whether he was aware of the Health Care Financing Administration's (HCFA) "deadline on confidentiality and the privacy of medical records." MR. LINDSTROM, after noting that he is not an expert on that federal law, assured the committee that [the DHSS] is acutely aware of it, and that anything [the DHSS] does via HB 174 will be consistent with [the HCFA] requirements. He explained that a past legislative audit as well as the most recent one have taken [the DHSS] to task for not being able to collect this data. The prior audit was requested by the Senate Finance Committee when it noticed that Medicaid expenditures for community mental health services had grown exponentially; prior to 1991 or 1992 there was no Medicaid funding going into mental health centers, but once that was allowed, expenditures grew from nothing to $5 million to $10 million to $20 million, and are now in excess of $50 million. MR. LINDSTROM added that [the DHSS] has excellent client data on the Medicaid program, but the same entities that are beginning to aggressively bill Medicaid are also grantees of the Division of Mental Health & Developmental Disabilities. [The DHSS], however, does not have the management information - the client data - that would enable it to monitor how those general fund (GF) grants are being spent. He concurred with Representative Fate that HB 174 resolves an accountability issue. CHAIR ROKEBERG mentioned that the provisions of HB 211, what he calls the "Alaska patients' bill of rights", will take effect July 1, 2001 for managed care entities; [HB 211] will cover most health insurers in Alaska, and contains a strict confidentiality provision, which goes well beyond any "opt in" requirements and requires the consent of the patient in order to release of any information. MR. LINDSTROM, after noting that he has been with the department for ten years, remarked that he has no recollection of [the DHSS] ever breaching patient confidentiality; [the DHSS] has patient records, medical records, and confidential information in virtually "every bit of book of business that we have in the department and we ... are acutely sensitive to [confidentiality]." Number 2036 CHAIR ROKEBERG said he only brings up the topic because: We have the HCFA privacy regulations; we've got the Alaska patients' bill of rights; we have the GLBA (the Gramm-Leach-Bliley Act), where the private sector is going to go through ... mandated "opt in" medical records provisions for all medical information from insurance companies; to say nothing of our own privacy provisions of our constitution. REPRESENTATIVE BERKOWITZ asked for an example of the type of confidential information that [the DHSS] will be reporting. Number 1992 ANNE HENRY, Special Projects Coordinator, Central Office, Division of Mental Health & Developmental Disabilities, Department of Health and Social Services, explained that the kind of information that the division is trying to gather is found on what is called the "Aurora" form - the admission form. A unique identifier (which consists of the client's initials, date of birth, and the last four digits of his/her social security number) is created from that information; the division does not use the client's full name or full social security number. Attached to the identifier will be information such as the client's diagnosis, living situation data, legal situation, and his/her general function level. The identifier will later be used to link that client to what is called the "encounter," which is when the person comes in for treatment on any given day; that information will be matched up with that service, the cost of that service, and the amount of time that service took, so that the division can build a profile detailing how much each individual is using certain services. This information will then be used to make program decisions. MS. HENRY added that all of the information gathered is encrypted at the mental health center before it is sent into the department, where it is then handled by two different individuals who will be the only people in the state that have the code to decrypt and access that information. She said that as far as the division is able to discern at this time, the deadline established for the privacy portion of the federal Health Insurance Portability and Accountability Act (HIPAA) will be about two years. She said that the division believes it has established the same standards as the federal regulations. In response to questions, she said that HB 174 will enable the division to provide the legislature as well as the Alaska Mental Health Trust with performance measures. In defense of Amendment 1, she explained that it will enable the division to gather two years' worth information to form a baseline; then, via HB 174, the division can require mental health providers to continue to submit data, and thus the division will be able to track expenditures and patterns of mental health problems in different locations. Number 1791 PAT DAVIDSON, Legislative Auditor, Legislative Audit Division, Legislative Agencies & Offices, mentioned that the impetus for HB 174 was the result of a couple of audit reports detailing the escalating cost of community mental health programs. Between 1992 and 1997 the numbers went from zero Medicaid dollars up to $15 million; the state's share went from $31 million to $39 million. The questions asked as a result of this growth were: "What's going on?" and, "Is this being well managed?" What the Legislative Audit Division found is that with regard to Medicaid, sufficient information was being collected so that the [DHSS] could analyze its regulatory efficiency, but when it came to state grants, the Legislative Audit Division ran into a wall because, while Medicaid is a fee for service, state grants were going out without any identification of who was being served or what services were being provided. She said she believes that HB 174 will allow such information to be collected, and that it will enhance the [DHSS's] ability to account for those millions of dollars that go out in state grants. REPRESENTATIVE FATE mentioned that HB 174 is accompanied by a zero fiscal note from [the DHSS]. He added that HB 174 will allow [the DHSS] to comply with the Legislative Audit Report. CHAIR ROKEBERG asked whether any state [grant] funds go to private providers of mental health services. MS. HENRY replied that to her knowledge, all of [the entities that receive state grant funds] are "community mental health nonprofits." She pointed out that HB 174 speaks specifically to community mental health centers. Number 1572 REPRESENTATIVE BERKOWITZ made a motion to adopt Amendment 1 [text provided previously]. Number 1570 REPRESENTATIVE COGHILL objected for the purpose of reviewing Amendment 1. After doing so, he withdrew his objection. Number 1540 CHAIR ROKEBERG noted that there were no further objections to Amendment 1. Therefore, Amendment 1 was adopted. Number 1532 REPRESENTATIVE MEYER moved to report HB 174, as amended, out of committee with individual recommendations and the accompanying zero fiscal note. There being no objection, CSHB 174(JUD) was reported from the House Judiciary Standing Committee.
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