Legislature(2003 - 2004)
04/25/2003 09:06 AM Senate FIN
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* first hearing in first committee of referral
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= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
CS FOR SENATE BILL NO. 157(HES)
"An Act relating to inpatient psychiatric services for persons
who are under 21 years of age and are either eligible for
medical assistance or are in the custody of the Department of
Health and Social Services."
This was the first hearing for this bill in the Senate Finance
Committee.
Co-Chair Green, the bill's sponsor, explained that this bill would
require the Department of Health and Social Services to provide,
when available, in-State psychiatric services to individuals under
the age of 21, who are in State care and require or need those
services. She stated that, while this requirement is currently in
regulation, it is not being implemented. She expounded on the
benefits of providing in-State care as: it "would stabilize the
environment so that the State can attract and assure care providers
in this field that in-State providers would be considered first"
before a person would be sent out-of-State for treatment; would
reduce the demand on the State to pay for expensive out-of-State
treatment; and would keep individuals closer to family. She noted
that the Denali KidCare program has contributed to the growth in
the numbers of individuals identified as requiring treatment.
JOHN DUFFY Borough Manager, Mat-Su Borough, testified via
teleconference from Mat-Su in support of this legislation, and he
urged the Committee to support it. He stated that allowing children
to receive treatment close to home and to family members would
"increase the probability of treatment success." In addition, he
noted that provisions of this legislation would remove "uncertainty
from the private sector" and allow for more in-State treatment
centers. This, he asserted, would benefit individuals, positively
impact the economy, and provide jobs. He affirmed that in-State
treatment is less expensive than out-of-State treatment, and that
"it makes sense that Alaskan dollars remain in Alaska" to support
the State's economy.
KATHY CRONEN, Chief Executive Officer, Fairbanks NorthStar
Hospital, testified via teleconference from an offnet site in
support of bringing Alaskan children "home for treatment.' She
informed that 300-plus children were treated out-of-state last
year, and she opined that this "has devastating impact of these
children and their families, as well as on the State because we are
not supporting our kids." She stressed that mental health care
should be provided closer to home, that follow-up care is critical
to a child's long-term success, and, she asserted, treatment should
involve a child's family.
Ms. Cronen furthered that this legislation would be good for the
State as it would allow in-State treatment programs to expand,
would create hundreds of new jobs, and would keep Medicaid dollars
in the State. She urged the Committee to pass this legislation.
Senator Olson asked the staffing situation at the Northstar
Hospital, particularly whether the hospital is able to attract
board-certified psychiatrists and other support staff as, he
understands, there is a shortage of personnel in these fields of
practice.
Ms. Cronen confirmed that "staffing and recruitment is always a
challenge for any health care provider;" however, she informed
that, while the hospital has at times experienced nursing and
psychiatrist staff shortages, the hospital has been successful in
the long-term. She voiced the need to provide job security, and she
contended that legislation of this nature would provide the
foundation.
Senator Taylor moved to adopt CS SB 157 (HES) as the working
document.
There being no objection, the (HES) committee substitute was
adopted as the working document.
JODY SIMPSON, Member Mat-Su Borough Assembly, testified via
teleconference from Mat-Su and voiced that the Mat-Su Borough
supports this bill. She voiced that out-of-state treatment removes
Alaskan children from their families as well as sends Alaska
dollars elsewhere thereby resulting in a loss of in-State job
opportunities.
ROBERT BUTTCANE, Programs/Administration, Division of Juvenile
Justice, Department of Health and Social Services informed that the
Department supports this legislation and its goal of establishing
"adequate in-State resources to meet the treatment needs of young
people." He informed that the Division is committed to working with
providers to develop the needed capabilities. However, he noted
that some complicating factors must be addressed to include the
fact that parents of children who are not in the State's custody
have the right to decide whether their child would receive in-State
or out-of-State treatment. He furthered that another factor is that
few Alaskan facilities provide "secured, locked care" which is
required in some situations. However, he attested that the
provision requiring an assessment to be conducted on each child is
an appropriate one as it would enable the Division to compile a
facility needs list that would propel the State's system to evolve
as necessary with the goal that eventually the State's resources
would meet all needs.
Co-Chair Green asserted that even though a child might not be in
State custody, the fact that the child might be a Medicaid
recipient would provide the State with the right to determine where
the child might receive treatment.
Mr. Buttcane concurred.
Co-Chair Green furthered that a recent Medicaid audit [copy not
provided] recommended that requests for out-of-state and in-state
travel for medical necessities should be accompanied by written
justification. She reiterated that this legislation is taking what
is currently in regulation and putting it into statute to assure
that the regulations would be implemented.
Senator Hoffman asked how rural children would benefit from this
legislation as, he communicated, and they would still be removed
from their small communities and their families to receive care.
Mr. Buttcane responded that this is a valid concern as individuals
from rural areas would continue to experience upheaval, and he
stated that "there is no easy answer" to the situation. He
suggested that, "the next step" to address this scenario would be
to provide more in-state care options to keep the "children at
least that much closer to their communities." He stated that
further action from Native Health organizations, State, federal,
and private, non-profit entities could assist in providing better
service to young people.
Senator Hoffman allowed that this bill would enable rural children
to be one step closer to home; however, he concluded that the needs
of rural children are still being addressed.
Co-Chair Green agreed that Senator Hoffman has a good point. She
stated that this bill would allow for small, private care
facilities with perhaps as few as eight employees to locate in
rural areas where there is a need. She stressed that through
legislation such as this, the emphasis would be to keep youth in-
State "to create the synergy and the energy and the numbers"
required to encourage the private sector to service smaller
communities. She predicted that there would be "a gradual growth"
in this direction.
Senator Olson asserted that mental health treatment is a
complicated process, and he asked how the decision regarding the
proper course of treatment and whether the State has adequate
facilities to provide that treatment would be determined.
Mr. Buttcane told of "a shared process of review by a
interdisciplinary team" comprised of medical and psychology
doctors, social workers, and care providers who would conduct an
inventory of State's programs and the needs of child, before
rendering a recommendation, and he furthered that funding would be
determined by Medicaid. He stated that were someone to determine
that the outcome of the review was improperly derived at; there
would be an opportunity for a review.
Senator Olson asked whether a physician or psychiatrist would be on
the staff of the review board.
Mr. Buttcane clarified that there is a psychiatrist on staff.
SFC 03 # 65, Side B 09:54 AM
Co-Chair Green responded that the current regulations specify that
a licensed psychiatrist, a physician, a clinical social worker, a
registered nurse, an occupational therapist, a psychological
associate, and representatives from the Division of Family & Youth
Services and the Division of Juvenile Justice would comprise the
members of the review board.
Co-Chair Wilken informed the Committee that a question arose in the
Senate Health Education and Social Services Committee hearing as to
whether bringing children who are currently being treated out-of-
state back to the State would increase the State's Medicaid
expenses. He stated that the answer is no, it would not. He noted
that this information is provided in fiscal note #1.
Co-Chair Green moved to report the bill from Committee with
individual recommendations and accompanying fiscal note.
There being no objection, CS SB 157 (HES) was REPORTED from
Committee with previous fiscal note #1 from the Department of
Health and Social Services.
RECESS TO THE CALL OF THE CHAIR 9:55 AM / 1:25 PM
Co-Chair Green chaired the remaining portion of the meeting.
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