Legislature(2021 - 2022)GRUENBERG 120

02/21/2022 01:00 PM House JUDICIARY

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01:02:34 PM Start
01:03:19 PM HB172
02:42:05 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 172 MENTAL HEALTH FACILITIES & MEDS TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
             HB 172-MENTAL HEALTH FACILITIES & MEDS                                                                         
                                                                                                                                
1:03:19 PM                                                                                                                    
                                                                                                                                
CHAIR CLAMAN announced  that the only order of  business would be                                                               
HOUSE  BILL  NO.  172,  "An  Act relating  to  admission  to  and                                                               
detention at  a subacute mental  health facility;  establishing a                                                               
definition for 'subacute mental  health facility'; establishing a                                                               
definition  for  'crisis  residential center';  relating  to  the                                                               
definitions for  'crisis stabilization  center'; relating  to the                                                               
administration of psychotropic medication  in a crisis situation;                                                               
relating to  licensed facilities; and providing  for an effective                                                               
date."  [Before  the committee, adopted as a  working document on                                                               
2/16/22, was the  proposed committee substitute (CS)  for HB 172,                                                               
32-GH1730\W, Foote, 2/16/22 ("Version W").]                                                                                     
                                                                                                                                
1:04:28 PM                                                                                                                    
                                                                                                                                
MARK  REGAN, Legal  Director, Disability  Law  Center of  Alaska,                                                               
provided invited testimony during the  hearing on HB 172, Version                                                               
W.    He  explained  that  the  Disability  Law  Center  was  the                                                               
plaintiff  in a  lawsuit  against the  Department  of Health  and                                                               
Social  Services  (DHSS)  regarding  the  system  of  involuntary                                                               
evaluation and treatment  of patients.  The lawsuit  was based on                                                               
people  "stacking up"  in [police]  custody and  emergency rooms.                                                               
The  lawsuit was  settled based  on the  recommendation that  the                                                               
state implement  the Crisis  Now model,  which would  provide for                                                               
short-term treatment.   He expressed  the opinion that  Version W                                                               
would  aid  individuals  with  two   major  improvements  on  the                                                               
original bill.   He  stated that the  first improvement  would be                                                               
when  an  individual is  taken  into  custody on  an  involuntary                                                               
basis,  it would  provide for  an ex  parte order  to appoint  an                                                               
attorney  for  the  individual.     He  stated  that  the  second                                                               
improvement would  be that when  an individual is being  held for                                                               
more than  three days, the  individual would  have a right  to an                                                               
attorney and  a judicial  hearing.  He  concluded that  Version W                                                               
would remedy previously held concerns.   He expressed support for                                                               
the proposed legislation on behalf of the Disability Law Center.                                                                
                                                                                                                                
1:08:47 PM                                                                                                                    
                                                                                                                                
MR.  REGAN,  in  response  to   a  question  from  Representative                                                               
Eastman, stated  that the lawsuit had  been settled in 2020.   He                                                               
added that one of the terms  of the settlement is the state would                                                               
introduce legislation to implement the Crisis Now model of care.                                                                
                                                                                                                                
CHAIR CLAMAN pointed  to a letter from the  Disability Law Center                                                               
[included in  the committee packet] entitled,  "HB 172 Supporting                                                               
Document  - Disability  Law  Center  Letter 2.21.2022.pdf"  which                                                               
contains additional information on the lawsuit.                                                                                 
                                                                                                                                
REPRESENTATIVE   EASTMAN   asked   whether  there   existed   any                                                               
exceptions to the 72-hour rule,  such as inclement weather events                                                               
in rural communities.                                                                                                           
                                                                                                                                
1:11:57 PM                                                                                                                    
                                                                                                                                
STEVEN   BOOKMAN,  Senior   Assistant  Attorney   General,  Civil                                                               
Division (Anchorage), Human Services  Section, Department of Law,                                                               
answered questions during  the hearing on HB 172, Version  W.  In                                                               
reference to  Representative Eastman's  question, he  stated that                                                               
the  72-hour  timeframe would  begin  upon  arrival at  a  crisis                                                               
stabilization  center  or  a  crisis   residential  center.    He                                                               
reminded the committee that an  individual would have an attorney                                                               
appointed.  Responding to a  follow-up question, he stated that a                                                               
weather delay  could increase  the amount  of time  an individual                                                               
was in custody, beyond the 72-hour  limit.  He added that the 72-                                                               
hour period would be based on actual clinical time.                                                                             
                                                                                                                                
CHAIR CLAMAN  questioned whether  the proposed  legislation would                                                               
create changes to how or when guardians would be contacted.                                                                     
                                                                                                                                
MR. BOOKMAN  offered that there  exists a statute  which requires                                                               
notice to be  given to guardians.  He referred  to his experience                                                               
in  dealing  with civil  commitments  at  the Alaska  Psychiatric                                                               
Institute (API) and pointed out, if  the API had knowledge of the                                                               
existence of  a guardian, efforts  would be made to  contact this                                                               
person.   He characterized the  process as  an informal one.   He                                                               
expressed the  opinion that Version  W would improve  the quality                                                               
of  notification  requirements  by   the  court  of  a  scheduled                                                               
hearing.                                                                                                                        
                                                                                                                                
CHAIR CLAMAN added that the  court system had provided an updated                                                               
fiscal note.                                                                                                                    
                                                                                                                                
1:17:09 PM                                                                                                                    
                                                                                                                                
HEATHER CARPENTER,  Senior Policy  Advisor, Department  of Health                                                               
and Social Services, answered questions  during the hearing on HB
172,  Version  W.   She  stated  that  current statute  does  not                                                               
formally  mandate the  contact  of a  guardian,  while Version  W                                                               
would codify this requirement.                                                                                                  
                                                                                                                                
CHAIR  CLAMAN  invited  the  court  system  to  answer  questions                                                               
regarding guardian contact and the fiscal note.                                                                                 
                                                                                                                                
1:18:23 PM                                                                                                                    
                                                                                                                                
NANCY  MEADE,  General  Counsel,  Office  of  the  Administrative                                                               
Director,  Alaska Court  System,  answered  questions during  the                                                               
hearing on HB  172, Version W.  She stated  that the court system                                                               
had  conducted  research  in  CourtView  to  ascertain  how  many                                                               
guardians  are private  versus those  provided by  the Office  of                                                               
Public Advocacy (OPA).   The conclusion had been  that most known                                                               
guardians  are private.    She  added the  caveat  that the  data                                                               
source  for  guardians  is  not   ordinarily  tracked  for  this;                                                               
nevertheless, she expressed her opinion this was useful.                                                                        
                                                                                                                                
MS. MEADE,  responding to Chair Claman's  request for information                                                               
regarding the  fiscal note,  stated that there  is not  a current                                                               
statutory requirement  for the court  system to  notify guardians                                                               
in the case  of an involuntary commitment proceeding.   She noted                                                               
that, per page  6, line 3 of the proposed  legislation, the court                                                               
would be obligated to notify  the guardian when the individual in                                                               
crisis is admitted to a  crisis residential center, and again, on                                                               
page  9, line  28, the  court would  be obligated  to notify  the                                                               
guardian when an  involuntary mental commitment is  ordered.  She                                                               
noted that CourtView is a  confidential source of information for                                                               
parties  to the  case, so  other entities  would likely  not have                                                               
complete information.   She stated that the  fiscal note includes                                                               
2,  range  12,  clerk  positions.     These  positions  would  be                                                               
responsible  for the  increased notification  requirement to  the                                                               
court.   Because the probate  office is currently very  busy, she                                                               
explained   that  the   court   is  not   able   to  absorb   the                                                               
responsibilities  with its  current  resources.   She added  that                                                               
mental commitment  cases are  likely to be  filed with  the court                                                               
after  [business] hours,  and currently  no  staff are  available                                                               
during this time.                                                                                                               
                                                                                                                                
CHAIR  CLAMAN asked  whether Crisis  Now would  be accessible  to                                                               
minor children.                                                                                                                 
                                                                                                                                
MS.  CARPENTER answered  that the  proposed crisis  stabilization                                                               
process  would   be  available   to  minors   in  the   same  way                                                               
intervention  services are  currently  available  for minors  and                                                               
adults.   She noted that  some providers are  currently providing                                                               
such services to minors via  the [1115 Behavioral Health Medicaid                                                               
Waiver].  She  noted that, currently, when  there are involuntary                                                               
commitment  proceedings  against  a  minor, a  guardian  must  be                                                               
notified.                                                                                                                       
                                                                                                                                
1:24:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SNYDER  asked whether  currently an  attempt would                                                               
be made to contact a guardian.                                                                                                  
                                                                                                                                
MS. CARPENTER answered  yes.  She noted a "guardian  ad litem" is                                                               
appointed in  such cases,  and an attorney  is appointed  to both                                                               
the youth and the guardian.                                                                                                     
                                                                                                                                
MR.  BOOKMAN added  that existing  law  would permit  a minor  to                                                               
provide  consent  to services  in  case  the guardian  cannot  be                                                               
contacted.  He  stated that parents and guardians  are likely the                                                               
individuals who would bring minors to facilities for treatment.                                                                 
                                                                                                                                
MR.  BOOKMAN,  in  response to  a  question  from  Representative                                                               
Snyder, stated that  should API have knowledge of  a guardian for                                                               
an adult,  it will attempt  to make contact.   He pointed  out AS                                                               
7.25 directs that a guardian  shall be notified of a respondent's                                                               
rights;  however, in  AS 7.15  there  is no  mention of  guardian                                                               
notification.    He pointed  out  Version  W would  address  this                                                               
inconsistency.                                                                                                                  
                                                                                                                                
1:28:41 PM                                                                                                                    
                                                                                                                                
STEVE  WILLIAMS, Chief  Executive Officer,  Alaska Mental  Health                                                               
Trust Authority, in response  to Representative Eastman, answered                                                               
that  the  intention of  Version  W  would  be to  transform  the                                                               
current  system,  along with  the  new  components developed  and                                                               
implemented.  He noted that first,  a crisis call center would be                                                               
contacted, and  there would be  an attempt to resolve  the crisis                                                               
with de-escalation and no additional  intervention.  He explained                                                               
that, should  the call  center determine  additional intervention                                                               
is necessary, a mobile crisis  intervention team, consisting of a                                                               
medical professional  and a peer,  would be dispatched  to assess                                                               
the  situation and  make  decisions regarding  the  need for  any                                                               
additional  intervention.   He  noted that  this  is the  current                                                               
practice in Anchorage  and Fairbanks.  He  explained that, should                                                               
the crisis  intervention team determine  the situation  cannot be                                                               
resolved,  the  individual  would  be  transported  to  a  crisis                                                               
stabilization facility  in the community.   He  further explained                                                               
that, should  the individual [remain  unstable for] more  than 23                                                               
hours, 59  minutes, the individual  would be referred for  7 days                                                               
at  a  crisis  residential  center.   He  added  that  not  every                                                               
community would have the ability  to implement all the components                                                               
as described, such as in rural  Alaska.  He stated that Version W                                                               
would  allow  for  each  of  the  components  to  be  implemented                                                               
according to resources available in each community.                                                                             
                                                                                                                                
REPRESENTATIVE  EASTMAN  asked  whether  the  scenario  described                                                               
would  apply in  a  case  where someone  other  than the  patient                                                               
should call the crisis center.                                                                                                  
                                                                                                                                
MR. WILLIAMS cautioned that he  did not have direct experience as                                                               
an emergency  dispatcher and  offered that  trained professionals                                                               
would receive  and assess  the initial call  for assistance.   In                                                               
response to a follow-up question,  he stated that a peace officer                                                               
or  law enforcement  officer  could refer  an  individual [to  an                                                               
escalated level of care].  He  continued that Version W would not                                                               
remove  the   authority  of  law   enforcement  or   other  first                                                               
responders to respond  to an emergency; rather,  the intent would                                                               
be  to deter  this  level  of intervention  unless  it is  deemed                                                               
necessary.    He  offered  that  health  care  professionals  are                                                               
trained  and equipped  to deal  with  mental health  crises.   He                                                               
noted that a  uniformed responder, or the  potential for flashing                                                               
lights,  may unintentionally  escalate a  [mental health  crisis]                                                               
situation.                                                                                                                      
                                                                                                                                
1:34:46 PM                                                                                                                    
                                                                                                                                
CHAIR CLAMAN,  in response to Representative  Eastman, offered to                                                               
clarify his  question into two parts.   He stated that  the first                                                               
question  is whether  an individual  may be  brought to  a crisis                                                               
center by law  enforcement, and second, how soon  would a medical                                                               
professional evaluate the  individual.  In other  words, how long                                                               
until a diagnosis is made.                                                                                                      
                                                                                                                                
REPRESENTATIVE  EASTMAN clarified  that his  line of  questioning                                                               
concerns when the individual could elect to leave.                                                                              
                                                                                                                                
MR. WILLIAMS answered that, when a  person is brought to a crisis                                                               
stabilization  center  or  to a  crisis  residential  center,  an                                                               
evaluation would take place within three hours.                                                                                 
                                                                                                                                
MS.  CARPENTER explained  that,  once at  the  crisis center,  an                                                               
individual would  receive an evaluation within  three hours, then                                                               
a determination would  be made as soon as  possible regarding the                                                               
resolution of  the crisis.   However, she  stated that  she would                                                               
not offer  the DHSS's judgment  in lieu of  professional clinical                                                               
judgment,   as   each  case   would   be   based  on   individual                                                               
circumstances.    She  stated  that the  current  law  permits  a                                                               
patient to be held involuntarily,  while the proposed legislation                                                               
would  direct  a  72-hour  timeframe   within  which  a  clinical                                                               
determination   could  be   made.     She  added   that  clinical                                                               
considerations, such  as the administration of  medication, would                                                               
need to be considered by a  professional.  She added that, should                                                               
no  treatment  be  required,  the  individual  may  not  be  held                                                               
involuntarily.                                                                                                                  
                                                                                                                                
1:39:35 PM                                                                                                                    
                                                                                                                                
MS.  CARPENTER, in  response to  a  question from  Representative                                                               
Eastman, stated that a mental  health professional, as defined in                                                               
AS 47.39.15, in cooperation with  the individual in charge, would                                                               
determine  when  a  patient  no   longer  meets  the  involuntary                                                               
detention criteria.                                                                                                             
                                                                                                                                
REPRESENTATIVE EASTMAN questioned  that, if there is  a delay for                                                               
crisis intervention, and an enforcement  officer is on the scene,                                                               
could  the officer  offer professional  judgment  on whether  the                                                               
individual may no longer require crisis care.                                                                                   
                                                                                                                                
MS. CARPENTER  offered that, per  the terms of the  settlement of                                                               
the  lawsuit brought  by  the Disability  Law  Center, the  state                                                               
would  be required  to enact  a re-evaluation  after 48  hours to                                                               
ensure an individual is not held without cause.                                                                                 
                                                                                                                                
CHAIR  CLAMAN  interjected  that the  information  Ms.  Carpenter                                                               
provided is not a component of Version W.                                                                                       
                                                                                                                                
REPRESENTATIVE  EASTMAN asked  whether the  48-hour re-evaluation                                                               
could occur over the phone or by other remote technologies.                                                                     
                                                                                                                                
MS. CARPENTER  answered that the  re-evaluations could  occur via                                                               
telehealth  and offered  to follow  up with  the committee  after                                                               
consulting with the contractor who conducts the evaluations.                                                                    
                                                                                                                                
1:43:06 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VANCE   asked  what  percentage   of  individuals                                                               
experiencing  a crisis  are self-reporting.    She expressed  the                                                               
understanding that  the intent of  the proposed bill would  be to                                                               
limit  the  role  of  law enforcement  in  mental  health  crisis                                                               
intervention.                                                                                                                   
                                                                                                                                
MR.  WILLIAMS  answered that  the  percentage  of patients  self-                                                               
reporting is not  readily available.  He explained  that, for the                                                               
communities where the system has  been implemented, national data                                                               
reflects  90 percent  of cases  are resolved  during the  initial                                                               
phone call and, of the remaining  10 cases, 7 are resolved by the                                                               
mobile  crisis  intervention  team.     He  noted  that  for  the                                                               
remaining 3  unresolved cases, the  patient would  be transported                                                               
to a  crisis intervention center  or a crisis  residential center                                                               
for 5 to 7 days.                                                                                                                
                                                                                                                                
REPRESENTATIVE VANCE  referred to the definitions  listed on page                                                               
11 of  the bill and  asked what the scope  of the authority  of a                                                               
health officer.                                                                                                                 
                                                                                                                                
MR.  BOOKMAN answered  that  the current  definition  of a  peace                                                               
officer  includes professionals  such as  a public  health nurse.                                                               
He  stated   that  Version  W   would  define   "health  officer"                                                               
consistently to draw  a distinction between a  health officer and                                                               
a peace officer.  He noted  that a health officer would include a                                                               
paramedic or a firefighter.  He  stated that, should HB 172 pass,                                                               
a peace officer or health officer  would be the one authorized to                                                               
initiate a formal involuntary hold process.                                                                                     
                                                                                                                                
REPRESENTATIVE  VANCE questioned  the  health officers'  training                                                               
which would enable them to make these decisions.                                                                                
                                                                                                                                
MR. BOOKMAN answered that Version W  would not create a change to                                                               
any  required training;  however, it  would add  firefighters and                                                               
paramedics who would have professional  licensing.  He added that                                                               
the  health or  peace officer  would transport  an individual  in                                                               
crisis to a center for an evaluation by a medical professional.                                                                 
                                                                                                                                
1:48:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KURKA questioned  the provision  in the  proposed                                                               
legislation  which  gives  the criteria  to  hold  an  individual                                                               
against the individual's will.                                                                                                  
                                                                                                                                
MR. BOOKMAN  answered that  the criteria  would be  that probable                                                               
cause exists when  an individual is likely to cause  harm to self                                                               
or others,  or is  gravely disabled, as  defined in  current law.                                                               
In response to a series  of follow-up questions, he answered that                                                               
the definition of  "likely to cause harm"  and "gravely disabled"                                                               
is  in AS  47.30.915.   He explained  that a  peace officer  or a                                                               
health  officer   would  have  the  authority   to  transport  an                                                               
individual to  a crisis center  and a mental  health professional                                                               
would have the  authority to keep the individual in  custody.  He                                                               
stated  that  mental  health  professionals  include  a  licensed                                                               
clinical   social    worker,   a   professional    counselor,   a                                                               
psychiatrist,  or an  advanced nurse  practitioner.   He answered                                                               
that, once an  individual has been taken to a  crisis center, the                                                               
same  criteria would  apply to  determine whether  the individual                                                               
stays.   He  added that  a  mental health  professional would  be                                                               
required to  petition the court  and attest  to the need  for the                                                               
recommended treatment.                                                                                                          
                                                                                                                                
CHAIR  CLAMAN,  for  a  list  of  definitions,  referred  to  the                                                               
committee packet  item, titled "Version  W Additional  Document -                                                               
Definitions  for  Alaska   Involuntary  Commitment  Statutes  (AS                                                               
47.30.915) 2.21.2022.pdf."                                                                                                      
                                                                                                                                
1:54:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VANCE   questioned  the  required   evidence  for                                                               
probable cause.                                                                                                                 
                                                                                                                                
MR. BOOKMAN  answered that  an application would  be made  to the                                                               
court for an  involuntary hold, and an explanation  of the events                                                               
leading to the  professional's conclusion would be  required.  In                                                               
relation   to  the   individual   in  crisis,   he  stated   that                                                               
considerations may  be made based  on the ability  to communicate                                                               
logically,  personal   hygiene  or   wound  care,   and  actions,                                                               
including catatonia or involuntary movements.                                                                                   
                                                                                                                                
REPRESENTATIVE VANCE  asked whether a mobile  crisis team, health                                                               
officer, or  first responder would  be required to  provide proof                                                               
for the reason for detention.                                                                                                   
                                                                                                                                
MR.  BOOKMAN  answered that  an  emergency  24-hour hold  may  be                                                               
determined necessary by a police  officer or medical professional                                                               
without  judicial  review based  on  professional  judgment.   He                                                               
stated  that a  mobile  crisis  team would  be  required to  keep                                                               
records  for  Medicaid waivers  and  case  management, which  are                                                               
subject  to  review  by  regulatory bodies  but  not  subject  to                                                               
judicial review.                                                                                                                
                                                                                                                                
CHAIR  CLAMAN pointed  out the  current practice  where a  police                                                               
officer may complete  an ex parte order for a  72-hour hold based                                                               
on  the officer's  professionally trained  judgment, and  this is                                                               
subject to judicial review.                                                                                                     
                                                                                                                                
REPRESENTATIVE   VANCE  expressed   concern  that   the  proposed                                                               
legislation would expand authority  for health officers and peace                                                               
officers to initiate an involuntary hold.                                                                                       
                                                                                                                                
CHAIR CLAMAN  offered that, in current  practice, individuals may                                                               
be subject to  ex parte orders despite not being  in custody.  He                                                               
deferred to Mr. Bookman.                                                                                                        
                                                                                                                                
MR.  BOOKMAN  offered  clarification that  the  "health  officer"                                                               
reference  would not  be an  expansion  of additional  authority;                                                               
moreover,  it would  be a  clarification of  the definition.   He                                                               
stated that firefighters and paramedics  would be included in the                                                               
definition  as  well.   He  stated  that  in Anchorage  the  fire                                                               
department is the designated mobile crisis team.                                                                                
                                                                                                                                
2:01:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN questioned  whether, following the initial                                                               
assessment and  prior to  transport to a  crisis center,  would a                                                               
[mobile crisis team] have the discretion to stop the process.                                                                   
                                                                                                                                
MR. BOOKMAN offered  that Version W is not intended  to limit the                                                               
discretion of law enforcement.  He  stated that there may exist a                                                               
scenario when a law enforcement  officer determines an individual                                                               
may need to be transported to  jail, an emergency room, or mental                                                               
health facility.   He  stated that the proposed legislation would                                                               
expand the  officer's options,  while maintaining  the discretion                                                               
to reassess the situation according to police standards.                                                                        
                                                                                                                                
CHAIR  CLAMAN offered  the example  of an  individual with  known                                                               
mental health issues  who lives with his mother.   The individual                                                               
became convinced the  mother left the country, when  she had only                                                               
left for  the store,  and then this  person experiences  a mental                                                               
health crisis  because of this belief.   He explained that  a law                                                               
enforcement  officer  with no  prior  knowledge  of the  person's                                                               
mental health  situation could transport  the person to  a crisis                                                               
center.   Once  the crisis  center becomes  involved, the  mother                                                               
would be contacted, and the crisis  averted.  He offered that, if                                                               
the officer  had been familiar  with the individual,  the officer                                                               
could contact the mother instead  of transporting the person to a                                                               
crisis center.                                                                                                                  
                                                                                                                                
2:05:48 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN  asked  whether a  police  officer  could                                                               
offer a crisis center as an alternative to arrest.                                                                              
                                                                                                                                
MR.  WILLIAMS   stated  that  law   enforcement  has   the  first                                                               
discretion to assess  for safety and risk  assessment and whether                                                               
a  crime has  been  committed.   He added  that  Version W  would                                                               
establish  a  system wherein  a  police  officer or  other  first                                                               
responder  may determine  whether an  individual requires  mental                                                               
health  care  rather than  solely  placing  the respondent  under                                                               
arrest.  He  referred to the example offered by  Chair Claman and                                                               
characterized it as a good  example of the extent of coordination                                                               
between law     enforcement, first responders,  and mental health                                                               
professionals to determine  the best course of action.   He noted                                                               
that  the role  of law  enforcement  is not  to act  as a  social                                                               
worker but to facilitate care and resume law enforcement duties.                                                                
                                                                                                                                
2:09:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN asked  what safeguards  exist to  prevent                                                               
the abuse of  the process, including the  [unjustified] threat of                                                               
arrest.                                                                                                                         
                                                                                                                                
MS.  CARPENTER   answered  that   there  exist   patient  rights,                                                               
including the right to counsel.   She added that the Medicare and                                                               
Medicaid offices  have oversight of hospitals,  which have crisis                                                               
care facilities.   She stated that DHSS has  licensing and review                                                               
staff to ensure the treatment  plans and grievance procedures are                                                               
compliant.   She  noted that  each  facility should  also have  a                                                               
grievance procedure.   She added that the  Alaska State Ombudsman                                                               
and the Police Standards Council could handle complaints.                                                                       
                                                                                                                                
MR.  BOOKMAN   stated  that  mental  health   professionals  have                                                               
expressed a  preference to avoid involuntary  commitments because                                                               
it  leads  to  better  patient   outcomes,  and  law  enforcement                                                               
professionals  have  expressed   a  preference  that  individuals                                                               
receive necessary care  so officers can focus  on law enforcement                                                               
duties.                                                                                                                         
                                                                                                                                
2:13:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN suggested  that the  proposed legislation                                                               
would create a third alternative  to either arrest or involuntary                                                               
commitment and asked what safeguards exist to prevent coercion.                                                                 
                                                                                                                                
MS. CARPENTER  offered to  clarify that no  new process  would be                                                               
created, and this pertains to  individuals who have not committed                                                               
any  crime.   She  stated that  an  involuntary commitment  would                                                               
occur  when  an  individual  meets   the  definition  of  gravely                                                               
disabled or a  danger to self or others.   She stated that crisis                                                               
centers are necessary  to prevent individuals from  sitting in an                                                               
emergency room  under observation only, or  in protective custody                                                               
at a community jail.                                                                                                            
                                                                                                                                
CHAIR CLAMAN  added that a  civil commitment may be  either court                                                               
ordered, involuntary, or voluntary,  and the proposed legislation                                                               
would  allow an  individual to  be held  at a  crisis residential                                                               
center for a period of less than 30 days.                                                                                       
                                                                                                                                
REPRESENTATIVE  EASTMAN asked  what safeguards  exist to  prevent                                                               
abuse of the proposed process.                                                                                                  
                                                                                                                                
MS. CARPENTER restated  that patient rights exist  and added that                                                               
professionals,   such  as   emergency  medical   technicians  and                                                               
firefighters,  are required  to  be  professionally licensed  and                                                               
overseen by the State Licensing Board.                                                                                          
                                                                                                                                
CHAIR  CLAMAN added  that an  essential protection  would be  the                                                               
proposed  judicial hearings  prior to  a 72-hour  hold.   Another                                                               
protection would be  the appointed attorney who  may advocate for                                                               
a patient's release.                                                                                                            
                                                                                                                                
2:18:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN  noted  that   the  definition  of  peace                                                               
officer would include Village Public  Safety Officers (VPSOs) and                                                               
others.    He  questioned  the  protections  to  safeguard  first                                                               
responders concerning individuals who  are taken into custody and                                                               
not vaccinated.                                                                                                                 
                                                                                                                                
MS.  CARPENTER  answered  that VPSOs  have  oversight  via  their                                                               
licensure.   She added  that the settlement  in the  lawsuit with                                                               
the Disability  Law Center included  a provision that  DHSS shall                                                               
offer  training   to  law  enforcement   to  recognize   when  an                                                               
individual may  be experiencing a  mental health crisis,  and the                                                               
appropriate action which should be  taken.  She stated that there                                                               
had been a previously proposed  bill which would have allowed for                                                               
a voluntary designation  of a disability on  the driver's license                                                               
of a mentally disabled person.                                                                                                  
                                                                                                                                
2:21:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  DRUMMOND asked  how many  beds in  the state  are                                                               
available  for  treatment  in  a   subacute  mental  health  care                                                               
facility.                                                                                                                       
                                                                                                                                
MS. CARPENTER  answered that the facilities  which currently meet                                                               
the criteria to qualify as  a designated treatment and evaluation                                                               
facility are the  API; Fairbanks Memorial Hospital,  which has 20                                                               
beds;  Mat-Su Regional  Medical Center,  which has  16 beds;  and                                                               
Bartlett Regional Hospital, which has 12  beds.  In response to a                                                               
series  of   follow-up  questions,  she  answered   that  API  is                                                               
currently at  its maximum capacity  of 80  beds, 10 of  which are                                                               
for forensic care for those  deemed incompetent to stand trial in                                                               
a criminal case.  She answered  that the facilities are maxed out                                                               
and  waitlists exist,  which are  reviewed  by DHSS  daily.   She                                                               
responded,  per the  proposed  legislation, the  48  beds at  the                                                               
listed facilities are where  respondents would receive treatment.                                                               
She continued that  Version W would allow  for crisis residential                                                               
centers to  provide care, including  72-hour holds, which  is the                                                               
shortest  effective  treatment  period.   She  advised  that  the                                                               
current system does not meet current needs.                                                                                     
                                                                                                                                
2:25:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  DRUMMOND  asked  whether there  exist  sufficient                                                               
beds in residential  centers in addition to those at  the API and                                                               
the other hospitals.                                                                                                            
                                                                                                                                
MS. CARPENTER offered  to follow up to the committee  with a list                                                               
of facilities  which have requested  the [1115  Behavioral Health                                                               
Medicaid  Waiver].     She  estimated  that   15  facilities  had                                                               
requested such waivers.                                                                                                         
                                                                                                                                
CHAIR CLAMAN offered  that Version W would  provide the licensing                                                               
structure for  additional residential facilities.   He noted that                                                               
previous legislation had  permitted crisis stabilization centers;                                                               
however, these were limited to 23-hour treatments.                                                                              
                                                                                                                                
2:28:50 PM                                                                                                                    
                                                                                                                                
MR.  REGAN,  in  response  to  Representative  Eastman's  earlier                                                               
question regarding the  existence of any legal  protections for a                                                               
potential  mistake,   or  worse.    He   recalled  Representative                                                               
Eastman's  suggestion  that  a peace  officer  may  determine  an                                                               
unvaccinated individual  posed a  danger to self  or others.   He                                                               
stated that  training exists which  would ensure  intervention is                                                               
based  on the  existence of  mental illness  and not  based on  a                                                               
difference of opinion.   He stated that, should  an individual be                                                               
brought for  emergency evaluation, the health  officer would seek                                                               
evidence of  mental illness.   If  it is  determined there  is no                                                               
evidence, the individual will be released.                                                                                      
                                                                                                                                
REPRESENTATIVE  VANCE  asked for  an  explanation  of the  fiscal                                                               
notes  concerning  the  Alaska Mental  Health  Trust  Authority's                                                               
(AMHTA's) funding  and general  funding.   She drew  attention to                                                               
the  fiscal note  from  the Department  of  Family and  Community                                                               
Services, which  would begin with  a smaller increment,  and then                                                               
this  increment would  dramatically increase  over the  next five                                                               
years.                                                                                                                          
                                                                                                                                
MS. CARPENTER  answered that the  reason for the  growth depicted                                                               
in the  fiscal note  is because  of the  estimated growth  in the                                                               
number of  facilities.  She  added that, if no  alternate funding                                                               
exists,  a   statutory  requirement   determines  the   state  is                                                               
obligated  to   cover  the  costs   for  an  individual   who  is                                                               
involuntarily  committed.   She  explained that  Disproportionate                                                               
Share Hospital  (DSH) funds within  the federal  Medicaid program                                                               
are  available only  to hospitals  and not  to tribal  hospitals.                                                               
She  noted that  several DSH  qualifying facilities  may be  paid                                                               
with federal and general matching funds.                                                                                        
                                                                                                                                
2:34:42 PM                                                                                                                    
                                                                                                                                
MR.  WILLIAMS offered  that a  partnership exists  between AMHTA,                                                               
community  partners, and  DHSS.   He stated  that in  fiscal year                                                               
(FY)  2023 AMHTA  had approved  $4.5  million of  AMHTA funds  to                                                               
coordinate  with communities  and the  department to  develop and                                                               
implement the  components of the  proposed model.  He  added that                                                               
in FY 22 and  FY 21, AMHTA invested roughly the  same amount.  He                                                               
stated that  the role of AMHTA  is to effect positive  changes to                                                               
the behavioral crisis care system.                                                                                              
                                                                                                                                
REPRESENTATIVE VANCE  asked whether  the state and  tribal health                                                               
organizations  are  partnering  to  leverage  additional  federal                                                               
resources to meet the needs in rural parts of the state.                                                                        
                                                                                                                                
MS. CARPENTER answered that the  Division of Behavioral Health is                                                               
in communication  with tribal partners  weekly.  She  stated that                                                               
partners  providing   these  services  include   Maniilaq  Health                                                               
Services,  Norton Sound  Health Corporation,  and Yukon-Kuskokwim                                                               
Health  Corporation.   She stated  that, when  a tribal  provider                                                               
uses the [1115 Behavioral Health  Medicaid Waiver] when serving a                                                               
tribal  beneficiary, the  state  can obtain  100 percent  federal                                                               
Medicaid funding.   She noted that tribal providers  are the only                                                               
providers in  certain areas  in rural  Alaska locations,  such as                                                               
Kotzebue, Nome, and Bethel.                                                                                                     
                                                                                                                                
2:38:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  asked whether detention,  evaluation, and                                                               
treatment (DET)  facilities would be subject  to local ordinances                                                               
or policies.                                                                                                                    
                                                                                                                                
CHAIR  CLAMAN asked  the  pertinence of  the  question to  crisis                                                               
residential centers.                                                                                                            
                                                                                                                                
REPRESENTATIVE EASTMAN stated he  was inquiring on which entities                                                               
would prescribe policies, such as mandatory masking.                                                                            
                                                                                                                                
CHAIR  CLAMAN   asked  Representative  Eastman  to   explain  the                                                               
relevance of his line of questioning.                                                                                           
                                                                                                                                
REPRESENTATIVE  EASTMAN stated  that  he was  inquiring to  learn                                                               
about the authority responsible for running the facilities.                                                                     
                                                                                                                                
2:39:58 PM                                                                                                                    
                                                                                                                                
MS. CARPENTER  answered that  each hospital  operating DET  has a                                                               
unique  ownership  structure.    She noted  that  hospitals  with                                                               
Medicaid  and Medicare  programs are  subject to  case management                                                               
system  rules, the  Joint Commission,  and oversight  with health                                                               
care  facility  licensing  by  the state.    She  explained  that                                                               
Fairbanks  Memorial  Hospital  is  a  community  foundation-owned                                                               
facility, Mat-Su Regional Medical Center  is jointly owned by the                                                               
Mat-Su  Health  Foundation  and  its  co-operator,  and  Bartlett                                                               
Regional Hospital is owned by the City and Borough of Juneau.                                                                   
                                                                                                                                
2:41:32 PM                                                                                                                    
                                                                                                                                
CHAIR CLAMAN announced that HB 172 was held over.                                                                               

Document Name Date/Time Subjects
HB 172 Work Draft Committee Substitute v. W 2.16.2022.pdf HJUD 2/16/2022 1:30:00 PM
HJUD 2/21/2022 1:00:00 PM
HJUD 2/23/2022 1:30:00 PM
HJUD 2/25/2022 1:30:00 PM
HB 172
HB 172 Transmittal Letter 4.9.2021.pdf HJUD 5/14/2021 1:00:00 PM
HJUD 2/16/2022 1:30:00 PM
HJUD 2/21/2022 1:00:00 PM
HJUD 2/23/2022 1:30:00 PM
HB 172
HB 172 Sectional Analysis v. W 2.16.2022.pdf HJUD 2/16/2022 1:30:00 PM
HJUD 2/21/2022 1:00:00 PM
HJUD 2/23/2022 1:30:00 PM
HB 172
HB 172 Additional Document - Introduction Presentation to HJUD Committee 5.14.2021.pdf HJUD 5/14/2021 1:00:00 PM
HJUD 2/16/2022 1:30:00 PM
HJUD 2/21/2022 1:00:00 PM
HJUD 2/23/2022 1:30:00 PM
HB 172
HB 172 Additional Document - Definitions for Alaska Involuntary Commitment Statutes (AS 47.30.915) 2.21.2022.pdf HJUD 2/21/2022 1:00:00 PM
HJUD 2/23/2022 1:30:00 PM
HB 172
HB 172 Supporting Document - Letters Received by 5.14.2021.pdf HJUD 5/14/2021 1:00:00 PM
HJUD 2/16/2022 1:30:00 PM
HJUD 2/21/2022 1:00:00 PM
HJUD 2/23/2022 1:30:00 PM
HB 172
HB 172 Supporting Document - Disability Law Center Letter 2.21.2022.pdf HJUD 2/21/2022 1:00:00 PM
HJUD 2/23/2022 1:30:00 PM
HB 172
HB 172 Opposing and Amend Letters and Testimony Received by 2.15.2022.pdf HJUD 2/16/2022 1:30:00 PM
HJUD 2/21/2022 1:00:00 PM
HB 172
HB 172 Fiscal Note DPS-AST 4.7.2021.pdf HJUD 5/14/2021 1:00:00 PM
HJUD 2/21/2022 1:00:00 PM
HJUD 2/23/2022 1:30:00 PM
HB 172
HB 172 Fiscal Note DFCS-IMH 2.11.2022.pdf HJUD 2/16/2022 1:30:00 PM
HJUD 2/21/2022 1:00:00 PM
HJUD 2/23/2022 1:30:00 PM
HB 172
HB 172 Fiscal Note DOH-MS 2.11.2022.pdf HJUD 2/16/2022 1:30:00 PM
HJUD 2/21/2022 1:00:00 PM
HJUD 2/23/2022 1:30:00 PM
HB 172
HB 172 Fiscal Note JUD-ACS 2.17.2022.pdf HJUD 2/21/2022 1:00:00 PM
HJUD 2/23/2022 1:30:00 PM
HB 172