Legislature(2003 - 2004)
04/26/2004 09:01 AM Senate FIN
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
CS FOR SENATE BILL NO. 364(HES)
"An Act relating to liability for expenses of placement in
certain mental health facilities; relating to the mental
health treatment assistance program; and providing for an
effective date."
This was the first hearing for this bill in the Senate Finance
Committee.
Co-Chair Wilken stated this bill, sponsored by the Senate Rules
Committee at the request of the Governor, "provides a mechanism to
help contain the costs of Designated Evaluation and Treatment
program. The DET program provides psychiatric inpatient care to
certain persons enabling them to receive care close to their home
and family." He noted the Senate Health and Social Services
Committee adopted a letter of intent.
JEANNETTE GRASTO, Member, Alaska Mental Health Board and the
National Alliance for the Mentally Ill-Alaska, and the National
Alliance for the Mentally Ill-Fairbanks, testified via
teleconference from Fairbanks about her advocacy for people with
mental illness. She read her testimony into the record as follows.
SB 364 represents a major philosophical change without
discussion. It conflicts with the principles articulated in
Alaska Statute 47.36.055 and a shared vision too [of] our
current plan for mental health services. It violates the
principle that services will be provided in the least
restrictive setting and as close to the client's home as
possible. If changes in policy are going to be made, it should
be made with discussion and input from mental health
consumers, mental health courts, hospitals, the Division of
Behavioral Health and other stakeholders.
The utilization review section of this bill would allow more
efficient use of resources and appears to be a positive step,
but savings from improved management should be used for added
service capacity.
The rest of the bill represents a giant step backward. In
Fairbanks we are so grateful to have the capacity and quality
of programs that we currently have at Fairbanks Memorial
Hospital for DET beds in our mental health unit. These beds
are a critical part of the community-based services we rely
on. Before this unit was expanded to 20 beds, many Fairbankans
in acute need have spent up to three days in jail and then
were transported to API [Alaska Psychiatric Institute] in
Anchorage 300 miles away from their families and natural
support system. This was a terrible situation for both
consumers and their families and often exacerbated their
illness and symptoms. It seems like the dark ages now looking
back on it. We've come so far.
Our State is currently trying to expand DET beds so people can
access services in their community and that was a consensus
decision by the mental health community. API is downsizing and
could be reserved for the most complex people whose needs
can't be met locally. And communities would be expected to
take care of their own whenever possible.
The people we're talking about in this bill are among the most
vulnerable of Alaskans. They're either a danger to themselves
or others or they're gravely disabled and unable to take care
of themselves. They're the poorest of the poor without even
disability income or Medicaid. Alaska clearly has a
responsibility to take care of these vulnerable people. I also
think its discriminatory because we're denying them access to
a community system of care that everyone else uses. They
become second-class citizens even among an already
marginalized group.
Maybe you think it doesn't matter because it won't affect
anybody you know. But mental illness affects one in five
Alaskan families. It isn't rare and the treatment for mental
illness is more effective than heart disease or cancer. I'm
always amazed how many of my friends are struggling either
with mental illness themselves or with a family member. And it
really is a crisis when it happens to you. It isn't uncommon
when mental illness first strikes, a person is unable to work
and has no other income and is indigent until they either
return to work or qualify for disability income.
Finally, many DET patients are involuntarily committed. Is it
appropriate to take away the civil rights of an indigent
individual and then not cover their treatment? What kind of
state are we becoming if we pretend to be broke? If Alaska is
so broke we cannot take care of these most vulnerable Alaskans
then it is imperative that we have a sound fiscal plan that
guarantees we can serve their needs. Cuts to State budget must
never come from need.
Co-Chair Wilken thanked the witness for her on-going volunteer work
with the mentally disabled.
VERA JAMES, Alaska Native Health Board, testified via
teleconference from Anchorage as follows.
The ANHB is the over-arching voice representing 229 federally
recognized tribes. As part of its mission the AHNB strives to
promote the mental wellbeing and pride of Alaska Native
people. Some of these people seek mental health treatment and
not all patients of mental health facilities are covered under
insurance or other third-party resources, including Medicaid,
to pay for the cost of evaluation or treatment.
The Alaska Native Health Board therefore urges the state of
Alaska to provide financial assistance for the liability of
expenses of patient placement in certain mental health
facilities. The ANHB supports the implementation of SB 364,
which mandates that those needing mental health treatment be
eligible for financial assistance under the Act.
JEFF JESSEE, Executive Director, Alaska Mental Health Trust
Authority, testified via teleconference from an offnet location
that the Authority supports many provisions in this bill,
specifically the "management tools" the Department is seeking. He
gave examples of adequate notice and timely applications for
services provided. He spoke in favor of efforts to ensure the
Department does not pay more for treatment and evaluation than is
necessary.
Mr. Jessee however, expressed concern that in the event it appears
inadequate funds were available during a fiscal year to provide
necessary services the Department of Health and Social Services
could cease payment. He predicted this would result in the
transportation of many patients from areas of the state to the
Alaska Psychiatric Institute (API). He reminded that the new API
facility was constructed specifically upon the premise that
services would be available and would expand over time. He noted
that facilities in Fairbanks and Anchorage are equipped to provide
diagnosis.
Mr. Jessee informed that designated evaluation and treatment
facilities are expensive to operate and must have a yearlong
business plan. He furthered that hospitals must have certainty of
funding and that a hospital considering undertaking a capital
investment must consider the possibility that a major fund source
might not be guaranteed year round. He also pointed out that as the
program expands to more communities, funds would be divided
further, as is occurring with the community mental health block
grants. He warned that if a facility, such as the program operating
in Juneau were to close for a portion of the year, the State would
incur the cost of transporting patients to the API facility in
Anchorage.
SFC 04 # 94, Side B 09:48 AM
Mr. Jessee continued that this proposal would do significant damage
to the emergency system in the state. He recommended that these
sections be omitted from the bill, especially Section 2.
Mr. Jessee emphasized that other provisions of this bill are
positive, in that they would support additional management tools if
the Department found them necessary.
Senator Hoffman asked how a patient would be cared for if this bill
were implemented and the API facility was at capacity.
Mr. Jessee deferred to the Department. However, he predicted this
would be a significant problem, noting the limited number of "beds"
licensed for mental health care. He reported that in instances of
high occupancy, patients are released at the first opportunity,
which is often not advisable treatment and that many of these
patients must be readmitted.
Senator Hoffman asked if capacity limits would be reached more
often under the provisions of this legislation.
Mr. Jessee affirmed that facilities would reach capacity sooner. He
spoke to the difficulties of releasing patients from API who are
not Anchorage residents. He explained the importance of a patient's
community in outpatient treatment.
Co-Chair Wilken recalled these issues were discussed when this bill
was heard in the Senate Health and Social Services Committee. He
noted the letter of intent adopted by that committee and
recommended the Senate Finance Committee also adopt the letter to
express the intent that alternative revenue sources should be
secured so that the level of services would not be affected.
BILL HOGAN, Director, Division of Behavioral Health, Department of
Health and Social Services reaffirmed the State is responsible to
pay the cost of diagnosis, evaluation and treatment for those
individuals who are financially eligible and who need to be
involuntarily committed to non-State operated hospitals. He read
testimony into the record as follows.
The costs of these services and the related transportation
have increased dramatically over the past several years. From
FY 01 through FY 03, the costs have increased over 100
percent. The rationale for those increases has to do with an
increase in the average daily Medicaid rate as well as an
increase in the total number of beds utilized between [FY] 01
and [FY] 03.
The intent of SB 364 is to reaffirm the importance of DET as
the cornerstone our foundation of our community mental health
system, but at the same time give us a mechanism to more
adequately manage diagnosis, evaluation and treatment
services. The bill would give us the capability through a
registration process - through hospitals having to register
people who come into their facilities within 24 hours - at
least a better mechanism to manage costs. Currently it's
possible that someone might be admitted to a DET service and
the State would not be notified for up to six months after
admission. This legislation would require notification within
24 hours. It also would give us the capability of "day 8"
which is a critical day when trying to stabilize individuals
who serious psychiatric problems or symptoms. It would give us
the capability of actively working with the hospitals to
ensure that if the person needs to be in the hospital that we
would actively or proactively work with the hospital. If the
person did not need to be in the hospital, we would actively
work to develop a discharge plan to leave the hospital.
Again, as you've heard we have worked actively with our
partners, including the Alaska State Hospital and Nursing
Association, the Alaska Mental Health Board, the Alaska Mental
Health Trust [Authority], various advocates, and then members
and clients, to come up with language that is for the most
part is acceptable to all parties.
The one sticking point continues to be Section 2, which
essentially stipulates that we will only fund the service up
to the appropriation from the legislature. As Senator Wilken
has pointed out, in out letter of intent, we clearly commit to
looking at all other possible funding sources to ensure that
we are able to adequately fund this particular service.
However if we are not able to come up with additional dollars,
in the worst case scenario, an individual would have to be
sent to API. Let me also point out that we want to actively
and will continue to actively work with our community mental
health providers to find alternative community facilities or
programs for individuals before they would have to be
transferred to API.
Senator Hoffman asked the Division's intent in implementing this
legislation.
Mr. Hogan listed the first priority as locating services within the
patient's community. He stated the Department would try to locate
alternative placement if no services were available in the
patient's community and API was at capacity. He stressed the intent
to ensure patients receive hospital care if needed.
Senator Hoffman asked how services would be delivered to patients
residing in a community without a treatment facility in the event
API had no vacancies.
Mr. Hogan replied this scenario occasionally occurs. In these
instances, he stated that efforts are made to make space available
at API for that individual.
Senator Olson asked the number of licensed beds at API.
Mr. Hogan answered 92 beds.
Senator Olson asked the occupancy rate over the last year.
Mr. Hogan replied the 75-80 average daily censuses show the
facility averages 75 to 80 percent capacity.
Senator Olson expressed concern that if space were not available at
mental health facilities, patients would be admitted to a local
hospital that is not equipped for the special needs of patients
with mental illnesses. He relayed his experience that these
patients often require protection from themselves, and at times
must be restrained. He remarked that most doctors are not trained
in psychiatry and would be required to provide care they are not
qualified to administer.
Mr. Hogan responded that the intent would not be to transfer those
patients who are perceived to be a danger to themselves or others
or who have been involuntarily committed. Rather, he stated the
intent would be to stabilize patients so they could be transferred
to their community.
Senator Hoffman asked if the Department has considered the
financial risks of liability for failure to provide services.
Mr. Hogan indicated extensive discussion within the Department and
with the Department of Law has occurred. He furthered that the
procedures of other states is being researched and that he would
provide information on the findings.
Co-Chair Wilken cited the analysis in the fiscal note, which
reports that the Designated Evaluation and Treatment (DET) program
would no longer receive $724,900 federal funding beginning in FY
05. He surmised this is the impetus of this legislation.
Mr. Hogan affirmed that the program would receive a reduction of
$700,000 in FY 05, according to the Governor's proposed budget. He
expressed intent to secure alternative funding for this program and
told of options. He emphasized the need for this legislation to
improve management of the program.
VERNER STILLNER, Legislative Representative, Alaska Psychiatric
Association, read his testimony into the record as follows.
The mental health system can best be judged when it is under a
state of emergency. And such an emergency in mental health
system is covered by this piece of legislation. In other
words, when an individual, due to mental illness, is dangerous
to self or others, or gravely disabled and unable to care for
themselves, a physician or a mental health professional can
petition the court for a 72-hour hold. And an involuntary
hospitalization takes place. Currently that can take place in
Palmer, Ketchikan, Cordova, Homer, Valdez, Sitka, Bethel,
Kodiak, Juneau and Fairbanks. And then if the individual needs
to be committed for a 30-day evaluation, a longer period of
time, that individual can be hospitalized at Fairbanks
Memorial Hospital or Bartlett Regional Hospital, or the API.
My concern about this piece of legislation is that there may
be an unfunded mandate. In other words, you don't fund an
emergency system in my estimation with a letter of intent. I
predict that when the Committee of next fiscal year comes
around and the money has expired for this kind of payment for
these hospitals I've mentioned, the hospitals will start
saying "no" and pointing to the API.
The cuts in the budget that are proposed in the House and in
the Senate, cut the budget for institutional care, for
community care and for transport of patients to such
facilities. So my concern is that if these systems of
designated evaluation treatment facilities are not properly
assured of funding, they will start saying "no" and start
shifting people to the API. And the API by next year will be
downsized to a bed census of 72 capacity. And I predict that
the current census will be all that they currently will be
able to do and these hospitals will be left with individuals
to evaluate and treat and possibly not be compensated for.
I support the administrative procedures in this provision to
better manage those monies, in other words, that these
hospitals have to notify the Department when someone is
admitted. All that I think needs to be greatly improved and
there are some cost savings there. But I'm concerned that the
bill currently the way it is funded, will be a unfunded
mandate to hospitalize individuals in an emergency basis and
therefore I think the mental health of the communities and
also the public health of the community may be compromised.
Senator Hoffman understood the witness testified that the capacity
of API would be reduced in the year 2005.
Mr. Stillner affirmed the new facility would contain 72 beds.
Mr. Hogan clarified the facility would contain 74 beds with the
ability to increase to 80 beds in the event of an emergency. He
informed that the new facility is scheduled to open in July 1,
2005.
Co-Chair Wilken ordered the bill HELD in Committee.
| Document Name | Date/Time | Subjects |
|---|