Legislature(2021 - 2022)SENATE FINANCE 532

05/12/2022 01:00 PM Senate FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Bills Previously Heard/Scheduled TELECONFERENCED
+ HB 265 HEALTH CARE SERVICES BY TELEHEALTH TELECONFERENCED
Heard & Held
+ SB 124 MENTAL HEALTH FACILITIES & MEDS TELECONFERENCED
Heard & Held
*+ HB 172 MENTAL HEALTH FACILITIES & MEDS TELECONFERENCED
Heard & Held
SENATE BILL NO. 124                                                                                                           
                                                                                                                                
     "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."                                                                                                           
                                                                                                                                
CS FOR HOUSE BILL NO. 172(FIN) am                                                                                             
                                                                                                                                
     "An  Act  relating  to  crisis  stabilization  centers,                                                                    
     crisis residential centers,  and subacute mental health                                                                    
     facilities; relating to  representation by an attorney;                                                                    
     relating   to   the  administration   of   psychotropic                                                                    
     medication   in  a   crisis   situation;  relating   to                                                                    
     hospitalizations   for    mental   health   evaluation;                                                                    
     relating to  licensed facilities; relating to  a report                                                                    
     to the legislature on  psychiatric patients and patient                                                                    
     rights; and providing for an effective date."                                                                              
                                                                                                                                
1:38:55 PM                                                                                                                    
                                                                                                                                
Co-Chair Stedman relayed  that it was the  first hearing for                                                                    
SB  124. It  was the  committees  intention  to hear  a bill                                                                    
introduction, consider  a sectional analysis  and comparison                                                                    
of the House  and Senate versions of the  bill, take invited                                                                    
and public  testimony, and  set the  bill aside  for further                                                                    
review.                                                                                                                         
                                                                                                                                
1:39:55 PM                                                                                                                    
                                                                                                                                
HEATHER  CARPENTER, HEALTH  CARE POLICY  ADVISOR, DEPARTMENT                                                                    
OF HEALTH AND SOCIAL SERVICES, introduced herself.                                                                              
                                                                                                                                
STEVE WILLIAMS,  CEO, ALASKA MENTAL HEALTH  TRUST AUTHORITY,                                                                    
showed  a presentation  entitled "TRANSFORMING  A BEHAVIORAL                                                                    
HEALTH CRISIS SYSTEM OF CARE,"  (copy on file). He turned to                                                                    
slide 2, "Change is Needed":                                                                                                    
                                                                                                                                
     Currently, Alaskans  in crisis are primarily  served by                                                                    
     law   enforcement,    emergency   rooms,    and   other                                                                    
     restrictive environments                                                                                                   
                                                                                                                                
        • Behavioral health crisis response is outside the                                                                      
          primary scope of training for law enforcement,                                                                        
          and reduces focus on crime prevention                                                                                 
        • Limited Designated Evaluation & Treatment (DET)                                                                       
          capacity in four communities: Juneau (BRH),                                                                           
          Fairbanks (FMH), Mat-Su (MSRH), Anchorage (API)                                                                       
        • Emergency rooms are not designed for and can be                                                                       
          overstimulating   to    someone   in    an   acute                                                                    
          psychiatric crisis                                                                                                    
                                                                                                                                
Mr. Williams showed slide 3, "HB172 is a Path Forward":                                                                         
                                                                                                                                
     HB172 will:                                                                                                                
     1) Effectuate a "No Wrong Door" approach to                                                                                
     stabilization services                                                                                                     
     2) Enhance options for law enforcement and first                                                                           
     responders to efficiently connect Alaskans in crisis                                                                       
     to the appropriate level of crisis care                                                                                    
     3) Support more services designed to stabilize                                                                             
     individuals who are experiencing a mental health                                                                           
     crisis                                                                                                                     
        • 23-hour crisis stabilization centers                                                                                  
        • Short-term crisis residential centers                                                                                 
     4) Protect patient rights                                                                                                  
                                                                                                                                
Mr.  Williams  cited  that   the  proposed  protections  for                                                                    
patients' rights  had come from advocates  in the community.                                                                    
He  continued   that  the  bill  proposed   a  best-practice                                                                    
framework that  would transform Alaskas  crisis  care system                                                                    
and  had  been  developed  in collaboration  with  over  300                                                                    
individuals,  100 organizations  statewide, the  department,                                                                    
and other key informants.                                                                                                       
                                                                                                                                
Ms.   Carpenter  showed   slide  4,   "Building  Blocks   of                                                                    
Psychiatric Crisis System Reform":                                                                                              
                                                                                                                                
     1) SB74  Medicaid Reform (2016)                                                                                            
        • Improve Access, quality, outcomes, and contain                                                                        
          costs                                                                                                                 
                                                                                                                                
     2) 1115 Behavioral Health Waiver                                                                                           
        • Targets resources   and   services   to   "super                                                                      
          utilizers"                                                                                                            
        • Provides flexibility in community behavioral                                                                          
          health services and supports                                                                                          
        • Creates new crisis service types that promote                                                                         
          interventions in the appropriate settings and at                                                                      
          the appropriate levels                                                                                                
                                                                                                                                
     3) System must be intentionally designed and promote a                                                                     
     "no wrong door" philosophy                                                                                                 
                                                                                                                                
Ms. Carpenter described the  no  wrong door  philosophy as a                                                                    
robust  crisis  response  system for  those  experiencing  a                                                                    
mental health crisis and unable to seek care voluntarily.                                                                       
                                                                                                                                
1:44:05 PM                                                                                                                    
                                                                                                                                
Mr.  Williams   referenced  slide   5,  "GOAL:   Design  and                                                                    
implement  a   behavioral  health  crisis   response  system                                                                    
analogous to  the physical health system,"  which showed two                                                                    
graphical flow  charts. He described  that the  graphics [on                                                                    
the first  flow chart] were  to illustrate what  the current                                                                    
medical/physical  health  system  looked like.  He  asserted                                                                    
that the same structure needed  to be available for those in                                                                    
a mental  health crisis, to provide  an appropriate response                                                                    
and level  of care  or resolution. He  noted that  the model                                                                    
[on  the  second  flow  chart]  had  been  examined  by  the                                                                    
department and  the trust and  was operated in  other states                                                                    
around  the   country.  He  mentioned  Maricopa   County  in                                                                    
Arizona, and visits to learn  about its existing system that                                                                    
was hoped to be modelled and implemented in Alaska.                                                                             
                                                                                                                                
Mr. Williams tuned to slide 6, "Stakeholder Engagement":                                                                        
                                                                                                                                
     Healthcare Providers                                                                                                       
     State Agencies                                                                                                             
     Law Enforcement and First Responders                                                                                       
     Beneficiary Advocates and Nonprofits                                                                                       
     Local Governments                                                                                                          
                                                                                                                                
Ms.  Carpenter  addressed  slide  7,  "Enhanced  Psychiatric                                                                    
Crisis Continuum of Care," which  showed a graphic depicting                                                                    
where  the  proposed  new services  fit  into  the  existing                                                                    
continuum  of  care. She  highlighted  that  under the  1115                                                                    
Medicaid  waiver,  the  mobile  crisis  teams,  the  23-hour                                                                    
stabilization,  and the  short-term  stabilization were  all                                                                    
Medicaid billable services.                                                                                                     
                                                                                                                                
1:46:55 PM                                                                                                                    
                                                                                                                                
Mr. Williams spoke to slide  8, "Crisis Stabilization Center                                                                    
(23 hour)":                                                                                                                     
                                                                                                                                
     Provides    prompt,    medically    monitored    crisis                                                                    
    observation and psychiatric stabilization services                                                                          
        • No wrong door - walk-in, referral, and first                                                                          
          responder drop off                                                                                                    
        • Staffed 24/7, 365 with a multi-disciplinary team                                                                      
        • High engagement/Recovery oriented (Peer Support)                                                                      
        • Immediate assessment and stabilization to avoid                                                                       
          higher levels of care where possible                                                                                  
        • Safe and secure                                                                                                       
      • Coordination with community-based services                                                                              
                                                                                                                                
Mr.  Williams  dicussed  the  scenario  of  law  enforcement                                                                    
interfacing with  someone in a behavioral  health crisis. In                                                                    
such  circumstances,  if  the individual  was  taken  to  an                                                                    
emergency   room,  they   would  be   taken  in   handcuffs.                                                                    
Additionally, while  waiting to be admitted,  the individual                                                                    
would wait in the squad car  and it could take several hours                                                                    
for the law enforcement to be able to return to duties.                                                                         
                                                                                                                                
Mr.   Williams  displayed   slide   9,  "Short-Term   Crisis                                                                    
Residential Stabilization Center":                                                                                              
                                                                                                                                
     A 24/7 medically monitored, short-term, crisis                                                                             
     residential    program   that    provides   psychiatric                                                                    
     stabilization                                                                                                              
                                                                                                                                
        • Safe and   secure       serves   voluntary   and                                                                      
          involuntary placements                                                                                                
        • High engagement/Recovery oriented (Peer Support)                                                                      
        • Multi-disciplinary treatment team                                                                                     
        • Short-term with 16 or fewer beds                                                                                      
        • Stabilize and restore  avoid need for inpatient                                                                       
          hospitalization where possible                                                                                        
      • Coordination with community-based services                                                                              
                                                                                                                                
                                                                                                                                
Mr.  Williams showed  slide  10,  "Enhanced crisis  response                                                                    
would  reduce  the  number  of   people  entering  the  most                                                                    
restrictive  levels   of  care,"  which  showed   a  graphic                                                                    
depicting a  snapshot of ten  years of data from  Georgia, a                                                                    
state  which  operated  the  full   continuum  of  care.  He                                                                    
described  that of  100 calls  to the  crisis care  line, 90                                                                    
were  resolved   over  the  phone.  He   reminded  that  the                                                                    
individuals  on the  phone were  licensed professionals.  He                                                                    
described  mobile  crisis  teams,  equipped  with  a  mental                                                                    
health professional  and a  peer. He  noted that  there were                                                                    
mobile crisis  teams operating  in Fairbanks  and Anchorage.                                                                    
He discussed success  of the mobile crisis  team in Georgia.                                                                    
He summarized that the robust  continuum of care showed that                                                                    
instead  of   using  emergency   services  as   the  default                                                                    
treatment, it  was possible to  triage the system  and avoid                                                                    
using higher levels of care.                                                                                                    
                                                                                                                                
1:51:04 PM                                                                                                                    
                                                                                                                                
Ms. Carpenter spoke to slide 11, "Alaska Statute Title 47":                                                                     
                                                                                                                                
     Collaborative Approach to Transforming our Response to                                                                     
     Alaskans in a Behavioral Health Crisis                                                                                     
                                                                                                                                
     HB172 Mental Health Facilities & Meds                                                                                      
                                                                                                                                
Ms.  Carpenter highlighted  that  in the  fall  of 2018  the                                                                    
Alaska Psychiatric Institute  (API) was in a  crisis and the                                                                    
census was greatly reduced. At  the time, individuals having                                                                    
a psychiatric  crisis (but having  committed no  crime) were                                                                    
being held at correctional facilities  due to no capacity at                                                                    
API or  other hospitals, and  the Disability Law  Center and                                                                    
the  Public Defender  Agency had  then sued  the department.                                                                    
The  judge had  found against  the  state in  2019, and  the                                                                    
process of  coming to  a settlement was  begun. Part  of the                                                                    
ruling and settlement  was the need to  seek alternatives in                                                                    
places to  provide 72-hour  evaluations in  less restrictive                                                                    
settings  such as  crisis stabilization  centers and  crisis                                                                    
residential centers that the Crisis Now model would allow.                                                                      
                                                                                                                                
Ms. Carpenter turned to slide 12, "Key Takeaways":                                                                              
                                                                                                                                
     HB172 Does:                                                                                                                
        • Create a "no wrong door"  approach to  providing                                                                      
          medical care to a person in psychiatric crisis                                                                        
        • Provide law enforcement with additional tools to                                                                      
          protect public safety                                                                                                 
        • Expand the number of facilities that can conduct                                                                      
          a 72-hour evaluation                                                                                                  
        • Add a new, less restrictive level of care                                                                             
        • Facilitate a faster and more appropriate response                                                                     
          to a crisis, expand the types of first responders                                                                     
          that can transport an individual in crisis to an                                                                      
          appropriate crisis facility                                                                                           
                                                                                                                                
     HB172 Does Not:                                                                                                            
        • Interfere with an officer's authority or ability                                                                      
          to make an arrest                                                                                                     
        • Change who has the current statutory authority to                                                                     
          administer crisis medication                                                                                          
        • Change current statutory authority  for who  can                                                                      
          order an involuntary commitment                                                                                       
        • Reduce the individual  rights of  the  adult  or                                                                      
          juvenile in crisis; the parents' rights of care                                                                       
          for their child; or existing due process rights                                                                       
          of the individual in crisis                                                                                           
                                                                                                                                
Ms. Carpenter  listed Emergency Medical  Technicians (EMTs),                                                                    
paramedics,  and   firefighters  as   the  types   of  first                                                                    
responders that  could transport an individual  in crisis to                                                                    
a  crisis center.  She  noted that  under  the bill,  crisis                                                                    
medication  could  only be  prescribed  by  a physician,  an                                                                    
advanced nurse practitioner, or a physicians assistant.                                                                         
                                                                                                                                
Mr.  Williams   addressed  slide   13,  "Current   Flow  for                                                                    
Involuntary  Commitment," which  showed  a  flow chart  that                                                                    
illustrated  the current  system. He  drew attention  to the                                                                    
bottom  left corner,  which showed  that hospital  emergency                                                                    
rooms  and jails  were  used, with  law  enforcement as  the                                                                    
primary response.                                                                                                               
                                                                                                                                
1:55:00 PM                                                                                                                    
                                                                                                                                
Mr.  Williams   showed  slide  14,  "Flow   for  Involuntary                                                                    
Commitment  with Statutory  Changes,"  which  showed a  flow                                                                    
chart. He  drew attention  to the lower  left of  the slide,                                                                    
which  showed the  addition of  mobile crisis  teams, crisis                                                                    
stabilization  centers,  and additional  crisis  residential                                                                    
centers.                                                                                                                        
                                                                                                                                
Ms.  Carpenter   displayed  slide  15,  "HB   172  Committee                                                                    
Substitute Highlights (ver. D.A)":                                                                                              
                                                                                                                                
     Key Improvements                                                                                                           
     1) Adds new language for a "health officer", newly                                                                         
     defined in Section 26                                                                                                      
     2) Changes length of stay from up to 5 days to up to 7                                                                     
     days at a Short-term Crisis Residential Center                                                                             
                                                                                                                                
     3) Adds provisions for protecting patient rights                                                                           
        • 72 hrs. clock for an ex-parte hearing starts when                                                                     
          a person (respondent) is delivered to a Crisis                                                                        
          Stabilization or Crisis Residential Center;                                                                           
       • Attorney is appointed for the respondent;                                                                              
        • Court shall notify the respondent's guardian, if                                                                      
          any                                                                                                                   
        • Computation for seven-days at a Short-term Crisis                                                                     
          Residential Center includes, time the respondent                                                                      
          was receiving care at a Crisis Stabilization                                                                          
          Center, if applicable                                                                                                 
                                                                                                                                
     4)  Adds   a  new  section  (Sec.   30)  directing  the                                                                    
     Department   of  Health,   Department  of   Family  and                                                                    
     Community Services, and the  Alaska Mental Health Trust                                                                    
     Authority  to submit  a report  and recommendations  to                                                                    
     the Legislature regarding patient rights.                                                                                  
        • Patient grievance and appeal policies                                                                                 
        • Data collection on patient grievances, appeals                                                                        
          and the resolution                                                                                                    
        • Patient reports of harm, restraint and the                                                                            
          resolution                                                                                                            
        • Requirements that could improve patient outcomes                                                                      
          and enhance patient rights                                                                                            
                                                                                                                                
Ms. Carpenter showed slide 16, "HB 172 Committee Substitute                                                                     
Highlights (ver. D.A)":                                                                                                         
                                                                                                                                
     Key Improvements Continued                                                                                                 
     5)   Adds  requirement   that   notifications  in   the                                                                    
     alternative  to arrest  statutes also  go to  the peace                                                                    
     officer's   employing    agency   to    ensure   victim                                                                    
     notification will happen even  if the arresting officer                                                                    
     is off duty. (Sections 4, 6, and 10)                                                                                       
     6)  Addresses statutes  found  unconstitutional by  the                                                                    
     Alaska Court System to align with the court rulings.                                                                       
        • Amends the definition of "gravely disabled" in AS                                                                     
          47.30.915(9) (Section 24)                                                                                             
        • Clarifies standards    for   court    to   order                                                                      
          administration of non-crisis medication (Sections                                                                     
          20 & 21)                                                                                                              
     7)  New  section  that clarifies  the  Public  Defender                                                                    
     statutes  and their  role as  the  attorneys the  Court                                                                    
     will appoint in all proceedings under AS 47.30.                                                                            
     8) Amended  the computation of time  for both hospitals                                                                    
     and crisis  residential centers to have  the evaluation                                                                    
     period  end at  5:00  pm the  next  business day  after                                                                    
     Saturdays,  Sundays and  legal  holidays  if a  patient                                                                    
     would  be   held  longer  than  72   consecutive  hours                                                                    
     (Sections 14 & 18)                                                                                                         
                                                                                                                                
2:00:10 PM                                                                                                                    
                                                                                                                                
JAMES  COCKRELL, COMMISSIONER,  DEPARTMENT OF  PUBLIC SAFETY                                                                    
(via  teleconference),  spoke in  support  of  the bill.  He                                                                    
stated that the  department was supportive of  the bill, and                                                                    
he   was   in   support   of   the   bill   personally   and                                                                    
professionally. He thought  the bill was a  step forward and                                                                    
would  be  long-lasting  progress  towards  handling  mental                                                                    
health issues  in the state.  He described that  often times                                                                    
law enforcement officers were called  upon to address mental                                                                    
health crises and were ill  equipped. He continued that many                                                                    
times officers  ended up putting individuals  in patrol cars                                                                    
and  sometimes spent  hours trying  to find  a place  for an                                                                    
individual to  receive care.  He emphasized  that additional                                                                    
resources  were needed.  He believed  in the  direction that                                                                    
the department was taking with the bill.                                                                                        
                                                                                                                                
2:02:08 PM                                                                                                                    
                                                                                                                                
MARK   REGAN,  LEGAL   DIRECTOR,   DISABILITY  LAW   CENTER,                                                                    
testified in support  of the bill. He wanted  to explain how                                                                    
current law  had worked and  how it had broken  down leading                                                                    
to the bill proposal to  improve things under the Crisis Now                                                                    
system. He  asserted that  current law  did not  provide for                                                                    
short-term mental  health treatment. Instead, the  law asked                                                                    
people to  be held and brought  to a facility for  a 72-hour                                                                    
evaluation, after  which a person could  go in for a  30 day                                                                    
or longer  civil commitment. He  thought the system  had not                                                                    
worked well  because of  the lack  of facilities  outside of                                                                    
API and hospitals in Juneau and Fairbanks.                                                                                      
                                                                                                                                
Mr. Regan  continued his testimony.  He discussed  people in                                                                    
crisis being brought to Anchorage  from rural Alaska to find                                                                    
API at  capacity, necessitating a transfer  to other cities.                                                                    
He  discussed  difficulties  that  resulted  in  individuals                                                                    
having to  wait in  custody in  hospital emergency  rooms or                                                                    
correctional   facilities.  He   described  the   inadequate                                                                    
condition  of the  facilities as  the reason  the Disability                                                                    
Law Center  had sued  the department.  He asserted  that the                                                                    
Crisis  Now  system  would  provide  places  for  short-term                                                                    
facilities  for those  experiencing a  mental health  crisis                                                                    
that was much better than what was previously available.                                                                        
                                                                                                                                
2:06:21 PM                                                                                                                    
                                                                                                                                
Senator  Wilson  asked  about  the  possibility  of  further                                                                    
action by the  Disability Law Center if the bill  was not to                                                                    
pass.                                                                                                                           
                                                                                                                                
Mr.  Regan noted  that  the settlement  of  the lawsuit  was                                                                    
based on existing law, and  the law center would continue to                                                                    
try and enforce  the settlement and ensure  that the 72-hour                                                                    
evaluations  could be  done in  other places.  He emphasized                                                                    
that the center would deeply regret  if the bill were not to                                                                    
pass and  stressed the  importance of having  a place  to be                                                                    
for  the  72-hour  evaluation. He  theorized  that  with  an                                                                    
appropriate place, individuals in  hub communities could set                                                                    
up short term treatment centers  allowing for people to stay                                                                    
in their home area.                                                                                                             
                                                                                                                                
2:08:07 PM                                                                                                                    
                                                                                                                                
ANN   RINGSTAD,  EXECUTIVE   DIRECTOR,   NAMI  ALASKA   (via                                                                    
teleconference), spoke  in favor of the  bill. She explained                                                                    
that  NAMI  was part  of  the  National Alliance  on  Mental                                                                    
Illness,  the  nations   largest  grassroots  mental  health                                                                    
organization. She cited that mental  illness affected one in                                                                    
five  adults in  the United  States, which  equated to  over                                                                    
108,000  individuals. She  referenced the  inadequate system                                                                    
of  care.  She shared  a  story  from  the director  of  the                                                                    
national  NAMI, who  spoke of  her  daughters  long  journey                                                                    
with mental  illness. The daughter  had had a  mental health                                                                    
crisis and there had been  a profound lack of resources that                                                                    
had  a dire  outcome. She  summarized that  if a  behavioral                                                                    
health crisis response system was  in place, the story would                                                                    
have had  a different  outcome. She  summarized that  the No                                                                    
Wrong  Door  approach  to providing  care  would  provide  a                                                                    
faster and  more appropriate  response to  behavioral health                                                                    
crises. She thought the legislation  would ensure people got                                                                    
appropriate  care  swiftly,  keep  people out  of  jail  and                                                                    
emergency   rooms,  and   minimize  the   impact  on   first                                                                    
responders.  She stated  that  NAMI  strongly supported  the                                                                    
bill.                                                                                                                           
                                                                                                                                
2:11:20 PM                                                                                                                    
                                                                                                                                
Co-Chair Stedman OPENED public testimony.                                                                                       
                                                                                                                                
ALBERTA UNOK, PRESIDENT AND CEO,  ALASKA NATIVE HEALTH BOARD                                                                    
(via teleconference), testified in  support of the bill. She                                                                    
explained  that the  Alaska Native  Health Board  (ANHB) was                                                                    
the  statewide  voice on  the  entire  Alaska tribal  health                                                                    
system and  worked with all  tribal health  organizations on                                                                    
collective priorities.  She asserted  that the  programs and                                                                    
services  needed to  be stood  up across  Alaska as  soon as                                                                    
possible, especially  considering the mental  health impacts                                                                    
of  the   pandemic.  She  contended   that  Alaskans   in  a                                                                    
psychiatric  emergency faced  long  waits  in the  emergency                                                                    
department  or jail  when there  was  not room  at API.  She                                                                    
thought  the services  proposed  in the  bill would  address                                                                    
major gaps  in the continuum  of care and give  Alaskans the                                                                    
care they need in a supportive environment.                                                                                     
                                                                                                                                
Ms.   Unok  highlighted   that  ANHB   supported  HB   172s                                                                     
definition of   health officer  to  be updated to  match the                                                                    
definition found  in the Senate version  of the legislation,                                                                    
which   includes  community   health   aide  programs.   She                                                                    
explained   that  as   a   federally  certified   healthcare                                                                    
provider,  community  health  aides  and  behavioral  health                                                                    
aides  were  frequently  first responders  that  encountered                                                                    
crises in their communities and  played an important role in                                                                    
mental   health  care.   She  urged   the  passage   of  the                                                                    
legislation in the current session.                                                                                             
                                                                                                                                
2:14:05 PM                                                                                                                    
                                                                                                                                
ARTHUR DELAUNE, SELF,  FAIRBANKS (via teleconference), spoke                                                                    
in support of  the bill. He recounted the story  of his son,                                                                    
who  experienced fetal  alcohol  spectrum  disorder and  co-                                                                    
occurring mental  health disorders.  He discussed  his sons                                                                     
mental  health struggles  and reported  a two-week  wait for                                                                    
services. He discussed a wait  in a padded room before being                                                                    
admitted  to the  behavioral health  ward. He  discussed his                                                                    
sons   release from  treatment  and  subsequent attempts  to                                                                    
receive services. It had taken  41 days after being suicidal                                                                    
to  receive services.  He emphasized  the importance  of the                                                                    
passage  of the  bill in  order to  have the  state be  more                                                                    
responsive to mental health crises.                                                                                             
                                                                                                                                
2:16:52 PM                                                                                                                    
                                                                                                                                
ROBYN  BJORK, SELF,  PALMER (via  teleconference), testified                                                                    
about her  concerns with  the bill.  She was  concerned that                                                                    
the   previous  testimony   had  not   accurately  addressed                                                                    
provisions  in the  bill. She  referenced  Section 14  under                                                                    
Article 9  relating to involuntary admission  for treatment.                                                                    
She expressed concern that first  responders be utilized for                                                                    
taking people  into custody  for involuntary  admission. She                                                                    
agreed that crisis stabilization centers were needed.                                                                           
                                                                                                                                
Ms. Bjork expressed concern about  the definition of "health                                                                    
officer," which  she thought was nebulous.  She had concerns                                                                    
that  the bill  poorly  defined   evaluation facility,"  and                                                                    
that  the bill  could  be weaponized  against mentally  well                                                                    
Alaskans.  She  suggested  that   the  committee  engage  an                                                                    
outside legal expert to review the bill provisions.                                                                             
                                                                                                                                
2:20:34 PM                                                                                                                    
                                                                                                                                
MICHELLE   BAKER,   EXECUTIVE   VICE   PRESIDENT,   BEHAVIOR                                                                    
SERVICES,  SOUTHCENTRAL   FOUNDATION  (via  teleconference),                                                                    
spoke  in  favor  of  the   bill.  She  explained  that  the                                                                    
Southcentral  Foundation,  in  partnership with  the  Alaska                                                                    
Native  Tribal Health  Consortium (ANTHC),  was planning  on                                                                    
opening an  adult crisis stabilization center  on the Alaska                                                                    
Native  Health Campus.  There was  space identified  and the                                                                    
agencies were  ready to invest.  She discussed  the increase                                                                    
in mental health  needs across the state.  She asserted that                                                                    
using the Crisis Now model  and the  No Wrong Door  approach                                                                    
would  provide less  costly services  in a  more therapeutic                                                                    
and appropriate environment.                                                                                                    
                                                                                                                                
Ms. Baker noted that it  was important for people to receive                                                                    
both  voluntary   and  involuntary  services  in   a  crisis                                                                    
stabilization  center.  She  offered her  support  HB  172's                                                                    
definition of   health officer  to  be updated to  match the                                                                    
definition in  the Senate  version of  the bill,  to include                                                                    
Community Health  Aid Practitioner as a  federally certified                                                                    
healthcare provider. She reminded  that many communities had                                                                    
no  Village Public  Safety Officer  (VPSO)  or Alaska  State                                                                    
Trooper,  and the  only place  to  receive care  was in  the                                                                    
health clinic.                                                                                                                  
                                                                                                                                
Ms.  Baker  continued  that the  Crisis  Now  framework  had                                                                    
widespread support  across stakeholders. She noted  that the                                                                    
legal framework was necessary to  support the planned crisis                                                                    
stabilization center. She asserted that  if the bill did not                                                                    
pass  it would  greatly affect  how the  foundation designed                                                                    
the program  and would result  in increased stress  and cost                                                                    
on the health care system.                                                                                                      
                                                                                                                                
2:23:58 PM                                                                                                                    
                                                                                                                                
SHAYNE  LACROIX, POLICE  OFFICER,  PALMER POLICE  DEPARTMENT                                                                    
(via  teleconference), testified  in favor  of the  bill. He                                                                    
expressed  the Palmer  Police Departments   support for  the                                                                    
legislation. He mentioned how  mental health crises affected                                                                    
first  responders. He  emphasized that  the biggest  part of                                                                    
the problem  was that people  in the  community experiencing                                                                    
behavioral health crises were not  getting the help that was                                                                    
needed. He  discussed the lack  of facilities  and discussed                                                                    
the advantages of the Crisis Now model.                                                                                         
                                                                                                                                
2:25:22 PM                                                                                                                    
                                                                                                                                
RENEE  RAFFERTY,  REGIONAL  DIRECTOR OF  BEHAVIORAL  HEALTH,                                                                    
PROVIDENCE ALASKA, ANCHORAGE  (via teleconference), spoke in                                                                    
support of the  bill. She shared that  Providence Health and                                                                    
Services  Alaska had  one of  the largest  behavioral health                                                                    
offerings in the state, and  provided services in Anchorage,                                                                    
Mat-Su, Kodiak,  and Valdez. She  noted that  Providence had                                                                    
been collaborating for the previous  four years with many of                                                                    
the stakeholders  that had previously testified.  The design                                                                    
behind the collaboration was in aid of strategic planning.                                                                      
                                                                                                                                
Ms. Rafferty thought  it was evident that the  bill was well                                                                    
thought  out and  presented needed  changes. She  cited that                                                                    
Providence was  ready to open a  crisis stabilization center                                                                    
in 2023,  and the  services would  increase access  to those                                                                    
that were  currently being directed  to jails  and emergency                                                                    
services.  She  opined  that additionally,  the  bill  would                                                                    
allow for  collaboration, data gathering, and  system change                                                                    
that  had never  been seen  before.  She urged  the bill  be                                                                    
passed during the current session  to provide the regulatory                                                                    
framework  to   build  a  system  of   care  for  vulnerable                                                                    
Alaskans.  She mentioned  that the  current system  provided                                                                    
costly and ineffective care.                                                                                                    
                                                                                                                                
2:27:12 PM                                                                                                                    
                                                                                                                                
DAVID CAMPBELL, DEPUTY CHIEF,  JUNEAU POLICE DEPARTMENT (via                                                                    
teleconference),  testified  in  support  of  the  bill.  He                                                                    
relayed  that police  officers often  encountered situations                                                                    
with people  in crisis that did  not rise to the  level that                                                                    
warranted a Title  47 hold. He discussed a  lack of options,                                                                    
and  the occasion  when people  were arrested  for low-level                                                                    
offenses.  He  described  officers  having  to  have  repeat                                                                    
contacts  with individuals  that  were not  able to  receive                                                                    
services  or treatment.  He relayed  that the  Juneau Police                                                                    
Department was very  supportive of HB 172,  which he thought                                                                    
would fill a services gap.                                                                                                      
                                                                                                                                
2:29:21 PM                                                                                                                    
                                                                                                                                
VIKKI JO  KENNEDY, SELF, JUNEAU (via  teleconference), spoke                                                                    
in support  of the  bill. She  thought that  some provisions                                                                    
needed to  be removed  from the bill  before it  was passed.                                                                    
She mentioned  the testimony of  Ms. Bjork. She  thought the                                                                    
bill was badly needed. She  thought the legislature had been                                                                    
working on  the bill  for four years.  She thought  the bill                                                                    
needed  to  be  amended.  She discussed  officers  from  the                                                                    
Juneau  Police  Department  diffusing a  situation  with  an                                                                    
individual.  She  thought  the  pandemic had  added  to  the                                                                    
problem. She  mentioned her nephew  had taken his  own life.                                                                    
She  did not  support  the mention  of federally  recognized                                                                    
providers. She thanked the committee for its work.                                                                              
                                                                                                                                
2:32:25 PM                                                                                                                    
                                                                                                                                
Co-Chair Stedman CLOSED public testimony.                                                                                       
                                                                                                                                
Senator Wilson asked if Mr.  Gottstein could provide written                                                                    
commentary  as to  if he  supported  the bill  in its  final                                                                    
version after amended.                                                                                                          
                                                                                                                                
Senator  Wilson  asked  Ms.  Carpenter  to  comment  on  the                                                                    
different versions of the bill.  He understood the provision                                                                    
related to  the federal  officer could reference  those that                                                                    
might be  working on  a military base  or the  Public Health                                                                    
Service  Corps,   which  often   worked  in   tribal  health                                                                    
facilities.                                                                                                                     
                                                                                                                                
Ms.  Carpenter  affirmed  that  the  definition  for  health                                                                    
officer differed in the two  bills. She recounted that there                                                                    
had  been feedback  in the  Senate Judiciary  Committee that                                                                    
the  definition should  be cleaned  up. Tribal  partners had                                                                    
recommended using  the term  federally  certified provider,                                                                     
because  tribal  health  employees were  considered  federal                                                                    
employees  because of  the Indian  Health Service.  The term                                                                    
found  in  the  Senate  version would  cover  the  community                                                                    
health  aides and  behavioral health  aids  as mentioned  in                                                                    
testimony  by the  Southcentral  Foundation  and the  Alaska                                                                    
Native Health  Board. She stated  that the  department would                                                                    
support the Senate version of the definition.                                                                                   
                                                                                                                                
Ms.  Carpenter  addressed   the  definition  of   evaluation                                                                    
facility,   that  mentioned  a   facility  operated  by  the                                                                    
federal government. She explained  that the term referred to                                                                    
tribal-operated  facilities   by  Indian   Health  Services.                                                                    
Technically the term could also  include military bases, but                                                                    
she had never seen bases  offer the evaluation services. The                                                                    
definition  clarified  with   new  language   that  performs                                                                    
evaluations   referenced   the  evaluations  found   in  the                                                                    
section of  statutes and would  necessitate a  facility that                                                                    
could do the 72-hour evaluations.                                                                                               
                                                                                                                                
Senator Wilson thanked Ms. Carpenter for the clarification.                                                                     
                                                                                                                                
Co-Chair Stedman  asked if  Ms. Carpenter  wanted to  make a                                                                    
final statement.                                                                                                                
                                                                                                                                
Ms.  Carpenter noted  that she  had shared  a document  that                                                                    
provided a comparison of the two bills (copy on file).                                                                          
                                                                                                                                
Co-Chair Stedman set  the bill aside for  further review. He                                                                    
asked  members to  provide suggested  amendments by  noon on                                                                    
Friday, May 13.                                                                                                                 
                                                                                                                                
SB  124  was  HEARD  and   HELD  in  committee  for  further                                                                    
consideration.                                                                                                                  
                                                                                                                                
HB  172  was  HEARD  and   HELD  in  committee  for  further                                                                    
consideration.                                                                                                                  
                                                                                                                                
Co-Chair  Stedman discussed  the  agenda  for the  following                                                                    
day.                                                                                                                            
                                                                                                                                

Document Name Date/Time Subjects
HB 172 Transmittal Letter.pdf SFIN 5/12/2022 1:00:00 PM
HB 172
HB 172 Definitions in AS 47.30.915.pdf HHSS 3/8/2022 3:00:00 PM
SFIN 5/12/2022 1:00:00 PM
HB 172
HB 172 - Supporting Document - Letters of Support.pdf SFIN 5/12/2022 1:00:00 PM
HB 172
HB 172 - SFIN Presenation 5.12.2022.pdf SFIN 5/12/2022 1:00:00 PM
HB 172
HB 172 - Sectional Anaylsis Ver. D.A.pdf SFIN 5/12/2022 1:00:00 PM
HB 172
HB 172 - Letter of Support - DPS.pdf SFIN 5/12/2022 1:00:00 PM
HB 172
HB 172 - Letter of Support - Alaska ACEP.pdf SFIN 5/12/2022 1:00:00 PM
HB 172
HB 172 - Infographics - Proposed Statutory Changes to Title 47 3.6.22.pdf SFIN 5/12/2022 1:00:00 PM
HB 172
HB 172 - Explanation of Changes Ver. D.A.pdf SFIN 5/12/2022 1:00:00 PM
HB 172
HB 172 - Crosswalk with SB 124 (updated).pdf SFIN 5/12/2022 1:00:00 PM
HB 172
SB 124
SB 124 Transmittal Letter.pdf SFIN 5/12/2022 1:00:00 PM
SHSS 4/27/2021 1:30:00 PM
SJUD 4/27/2022 1:30:00 PM
SB 124
HB 265 Sponsor Statement v. E.pdf SFIN 5/12/2022 1:00:00 PM
SL&C 5/2/2022 1:30:00 PM
HB 265
HB 265 Sectional Analysis v. E.pdf SFIN 5/12/2022 1:00:00 PM
SL&C 5/2/2022 1:30:00 PM
HB 265
HB 265 Explanation of Changes v. W to v. E.pdf SFIN 5/12/2022 1:00:00 PM
SL&C 5/2/2022 1:30:00 PM
HB 265
HB 265 Supporting Document - New HFIN Testimony Received as of 04.13.22.pdf HFIN 4/14/2022 1:30:00 PM
SFIN 5/12/2022 1:00:00 PM
HB 265
HB 265 Support.pdf SFIN 5/12/2022 1:00:00 PM
HB 265
HB 265 Support Kantiyavong.pdf SFIN 5/12/2022 1:00:00 PM
HB 265
HB 172 Opposition.pdf SFIN 5/12/2022 1:00:00 PM
HB 172