Legislature(2001 - 2002)

04/21/2001 11:24 AM JUD

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

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