Legislature(2003 - 2004)
05/03/2004 03:23 PM House JUD
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 535 - LIMIT STATE AID FOR MENTAL HEALTH CARE Number 1260 CHAIR McGUIRE announced that the next order of business would be HOUSE BILL NO. 535, "An Act relating to liability for expenses of placement in certain mental health facilities; relating to the mental health treatment assistance program; and providing for an effective date." [Before the committee was CSHB 535(HES).] Number 1282 ROBERT HAMMAKER, Interim Treatment and Recovery Manager, Division of Behavioral Health (DBH), Department of Health and Social Services (DHSS), indicated that HB 535 will alter recently enacted statutes that fund "local psychiatric hospitalization in lieu of going to [the Alaska Psychiatric Institute (API)] alone." He went on to say: Most of the hospitalization - 98 percent of those hospitalizations - occur in Fairbanks and Juneau, and ... roughly a dozen other local hospitals are eligible to take people for local psychiatric hospitalization as well (indisc.). Now, this bill is in response to our sort [of] approaching a point where [we're] exceeding our budgets and not wanting to exceed the budget as announced. It's an important service; it's a critical service to have local hospitalization as well [the] API and local community programs. This bill will give us the ability to better manage the funding and the kind of services that are provided in the local hospitals. ... Among the stakeholders ... there's broad consensus supporting the idea of improved management that this bill gets us. There is controversy over Section 2, which limits the funding to the legislative appropriation. The [Alaska Mental Health Trust Authority (AMHTA)] and the [Alaska Mental Health Board (AMHB)] are concerned about that limitation. It's important enough to us to gather the letter of intent and modify some of the language so that we're saying that if [we] were to run out of the money, we would look across to the department to see if there was some other way we could fund this important service. ... And I've got two handouts: one is ... a number of questions and answers that have come up in previous hearings; and a second one almost might look ... like it doesn't belong here, but one of the challenges ... to this bill is that it was pretty unusual to limit an important service to the legislative appropriated amount, and this [handout lists] ... a dozen or so other bills that [contained] limitations to the legislative appropriations - it's a common part of the language - and that's its only point. Number 1404 REPRESENTATIVE GARA indicated that he would like an explanation of the bill's sections. REPRESENTATIVE GRUENBERG concurred. CHAIR McGUIRE asked why HB 535 had been referred to the House Judiciary Standing Committee, and whether the prior committee had left any contentious issues unresolved. MR. HAMMAKER reiterated that there is broad consensus for the concept of the DBH handling people who go into local hospitals; that there is controversy over Section 2 because it limits funding to the appropriated amount; that the AMHTA and the AMHB don't want that limitation; and that in an attempt at compromise, the DHSS is supplementing the bill with a letter of intent that acknowledges the importance of this service and will endeavor to fill any funding shortfalls from departmental resources. He added: The "hospital association" was okay with this if we would assist in moving people out of the local hospital to [the] API or other appropriate community programs in a timely way rather than leaving them stuck in an unfunded position in a local hospital. ... That's the most controversial part. MR. HAMMAKER turned attention to Section 3, and pointed out that the very first sentence reads in part: "The department shall provide financial assistance ...". The language in Section 2, however, makes that [mandate in Section 3] somewhat weak. He noted that CSHB 535(HES) no longer contains language to the effect that if the program ran out of money, "we would start prorating the amount we pay." With regard to the latter change, he said that the "hospital association" didn't want to get partial payment; instead, "they wanted ... all or none, and, if it's none, help move people out of our hospital." The AMHB and AMHTA didn't have any strong feelings about that provision, and it is no longer in the current version of the bill. As the bill is currently written, it's very much a matter of trying to live within the appropriations, he concluded. REPRESENTATIVE GRUENBERG asked whether the bill limits a person's right to appeal. Number 1581 MR. HAMMAKER said that issue has not been controversial, though there was concern about "how we would manage the legislation." He went on to say: This bill would register people on the first day of admission - it doesn't approve [them] - so that we have a clue to who's coming down the road. The "old legislation" said we would be the payor of last resort up to 180 [days] - they don't have to submit the bill, though, for 180 days after they've been admitted, which is a long time for us to try [to] ... figure out what bills are coming down the pike. Now [under CSHB 535(HES)] we know on the first day of admission that somebody might be coming to us, [though] that's not a final determination of whether ... we are going to make payment or not. We'll get more information to know if they meet the ... criteria - this is for people who are determined to be dangerous to themselves or others. And there's ... two levels of local designated evaluation and treatment hospitals. One level is for evaluation, and that goes up to 7 days. And there's a second level, and that's treatment, and that ... can be extended up to 40 days. At day 8, when you transition between those two, we'll make an assertive determination of whether they appear to be committable or not, and we'll set up a process whereby ..., if there's two ... apparent denials from the information that we set up ... in the normal process, ... we'll go to a physician ... discussion [with] the local hospital doctor and either the API doctor or first health [doctor] to have a conversation [about] whether the person's committed or not. It won't be a bureaucrat or a lesser medical person making that determination. That was the one area where there was some controversy about who would be determining whether somebody was eligible or not. REPRESENTATIVE GRUENBERG directed attention to language in Section 8 that read: "A denial or reduction of assistance under the is chapter due to insufficient appropriations for financial assistance under this chapter may not be appealed under this section". He surmised that this language means that if someone is denied mental health assistance simply because of insufficient appropriations, then he/she is not allowed to appeal that determination. Number 1751 MR. HAMMAKER remarked: We'll run the program full speed until we're out money, and then what happens is that there ... won't be the local hospital option but there'll still be an API option. So people will always get service. Nobody will be denied service. It's the location of the service that would change when we run out of local hospitalization money. REPRESENTATIVE GRUENBERG asked, "Might this run afoul of the constitutional right to care in the least restrictive setting?" MR. HAMMAKER replied, "That is a concern." REPRESENTATIVE GRUENBERG remarked, "That's a federal right under Donaldson v. O'Connor." MR. HAMMAKER added: It's not ideal that there isn't unlimited local hospitalization. We are trying very hard to continue this program, [and] with ... a disproportionate share [of] funding, we'll have sufficient money next year. And that's become a high priority in the process of the stakeholder discussions around this subject. But the possibility is that we would run out of money [and] ... there would be less of a local hospitalization option for some people who have no other means of paying, and they would go to [the] API instead. Four years ago we didn't have local hospitalization assertively funded with the bill, so, in some ways, it's not a brand new possibility. MR. HAMMAKER, in response to questions, relayed that the Senate companion bill has passed out of the Senate Finance Committee, and the objective is to have HB 535 move on to the House Finance Committee so that the two bills can "meet" there. REPRESENTATIVE GRUENBERG asked why the bill includes a provision stating that a person doesn't have the right to appeal, particularly given the constitutional issues raised by Donaldson v. O'Connor. He added, "It seems to me to make poor public policy ...." MR. HAMMAKER suggested that the Department of Law might be better able to address that point. In response to a question, he noted that the Senate companion bill was not referred to the Senate Judiciary Standing Committee. Number 1952 REPRESENTATIVE GARA asked whether the AMHTA opposes Sections 2 and 8. MR. HAMMAKER again reiterated that the AMHTA objects to Section 2 but is somewhat satisfied with the aforementioned letter of intent. REPRESENTATIVE GARA opined that Section 8 essentially repeats Section 2. He asked what appeal rights a patient who gets denied state funding for treatment in a private facility currently has. How does the bill change things in that regard? MR. HAMMAKER offered that nothing will change dramatically unless the program runs out of money, and then there could be challenges; in the past, when the program has run out of money, the DHSS sought supplemental appropriations. The commissioner has relayed, however, that the DHSS will no longer seek supplemental appropriations. REPRESENTATIVE GARA asked, "Has this been ... the subject of litigation in the past, where people have said they had a right to stay." "By changing the law in that regard, are you going to then, in essence, prevent litigation by people who say, 'You should fund my stay in a private facility'," he also asked. MR. HAMMAKER said he is not aware of any past litigation on this issue. REPRESENTATIVE GRUENBERG asked whether there is any danger that someone too ill to register under the provisions of the bill will fall "through the cracks." MR. HAMMAKER said that any interested party can file for such persons, including hospital staff. REPRESENTATIVE GRUENBERG offered his belief that the DHSS is well intentioned, but asked that the bill be held over for the purpose of gathering information from interested parties. REPRESENTATIVE GARA relayed that he has concerns about Sections 2 and 8 and suggested that they remove those sections from the bill, either at the bill's next hearing in the House Judiciary Standing Committee, or when the bill is heard on the House floor. Number 2131 CHAIR McGUIRE indicated that HB 535 would be held over.
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