Legislature(1997 - 1998)
04/30/1997 09:16 AM Senate HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SCR 14 PARITY FOR MENTAL HEALTH TASK FORCE Number 161 CHAIRMAN WILKEN announced that SCR 14 would be the next order of business before the committee. WALTER MAJOROS , Executive Director of the Alaska Mental Health Board (AMHB), noted that AMHB requested that legislation regarding mental health parity in Alaska be introduced. The AMHB is the state planning and advocacy organization for seriously mentally ill and emotionally disturbed children and adults in Alaska. The AMHB strongly endorses SCR 14. Mr. Majoros explained that parity refers to parity of insurance practices for mental health services to receive parity with those receiving physical health services through insurance coverage. Mr. Majoros estimated that since 1995, 31,000 Alaskans, adults and children, suffer from serious mental illnesses and emotional disturbances. Many of these people require a range of mental health treatment services, from counseling, medication, case management, rehabilitation, crisis intervention, assessment, hospitalization, evaluation, etc. In most cases, private insurance does not cover mental health services and in the case that it does, the services are very inadequate and the restrictions are greater than that imposed on physical health services. Mr. Majoros stated that the AMHB believes this to be a form of bias and discrimination against those with mental illnesses and emotional disturbances. There has been tremendous change in the efficacy of mental health treatment. Mental health treatment now parallels physical health treatment in terms of the ability to diagnose and treat. Further, the developments of recent years provide a more cost effective method of treatment. Number 224 Mr. Majoros informed the committee that many mentally ill persons have testified that they cannot afford to get a job because they would have to go off Medicaid which funds mental health services. Mr. Majoros pointed out that the mental health system supports remaining on public assistance, Medicaid. If these individual's had the opportunity to receive basic coverage through private insurance, then there would not be the dependence on public programs. Parity would decrease the reliance on public assistance as well as creating a greater partnership between the public and private sector in terms of meeting mental health needs in Alaska. Mr. Majoros noted that much of SCR 14 is based on the federal legislation, the Mental Health Parity Act of 1996. The Mental Health Parity Act is the first national parity legislation that has been passed. Furthermore, the Mental Health Parity Act establishes a requirement for parity on lifetime and annual dollar limits for expenditures for mental health services for recipients of all insurance programs, but with many exceptions. Mr. Majoros mentioned that small businesses of 50 or less employees are exempt from the program. Furthermore, there is no requirement to have mental health coverage; an employer could choose not to have such coverage or drop that coverage. Employers can adjust co-insurance, deductibles, service and medical necessity definitions all of which can be different from those for physical health services. If employers can document that the net increase in premiums are greater than one percent, the employer can be exempt. Mr. Majoros believed that this could be the beginning of parity, but recipients of mental health services are not parallel with recipients of primary health care services. Therefore, Mr. Majoros indicated the necessity for a task force to review the federal legislation. Number 274 Mr. Majoros informed the committee that 13 states have passed or proposed mental health parity laws and in total 35 states are considering this issue. SCR 14 is an opportunity to create a public-private partnership to transfer some of the cost for mental health services to the private sector which can save money. The present situation is an obstacle for mental health consumers and beneficiaries to become independent. Currently, those folks are in a double bind, in other words, those folks cannot get off Medicaid coverage nor can they get a job because there is no private sector insurance to meet their needs. SCR 14 would eliminate the view that mental health services are different than primary health care, it is part of primary health care. SENATOR WARD inquired as to who was responsible for drafting SCR 14 and who determined the make-up of the group. WALTER MAJOROS explained that he was part of a group of people reviewing drafts. The make-up of the task force was determined by the group, not anyone specific. Currently, the trend is to have as many mental health consumers on the task force. This resolution was modelled somewhat after resolutions in other states. Number 319 SENATOR GREEN informed the committee of a conflict due to her husband's employment and requested that she not be required to vote. SENATOR WARD objected. Therefore, Senator Green will be required to vote. SENATOR GREEN noted that her staff had discussed with the AMHB the possibility of the AMHB creating its own task force, to which there did not seem to be a problem. Senator Green said that when she was on the Governor's Council for Handicapped & Gifted, the council dealt with many issues that were similar to this. The council joined with other boards to report on health care; is that possible with this? WALTER MAJOROS agreed that there are many issues that AMHB and the Governor's Council take up independently. The task force was chosen because it is a national model. Furthermore, it is difficult to generate a consensus on major mental health issues. Mr. Majoros emphasized the importance of having the Legislature's involvement and endorsement from the start in order to increase the likelihood of passing the legislation and building consensus. SENATOR GREEN believed that the task force could be accomplished through the AMHB without a resolution. Senator Green suggested that course be taken. In response to Chairman Wilken, WALTER MAJOROS stated that he was the Executive Director of the AMHB. CHAIRMAN WILKEN noted that SCR 14 does not expect any General Fund money to be provided for the task force. Is there federal or other state money available for those expenses? WALTER MAJOROS deferred to Jeff Jessee from the Alaska Mental Health Trust Authority. Several discussions have occurred with the authority who supports the task force, although there is no guarantee that the authority would be involved with the cost of the task force. Mr. Majoros mentioned that the AMHB will do a formal proposal to the authority during its budget process this year. Number 381 JAN MCGILLIVARY , CEO of the Alaska Mental Health Association(AMHA), informed the committee that she was the Coordinator for the Building Bridges Campaign for mental health. The coalition represents about 40 community based mental health services which are grantees of the Division of Mental Health & Developmental Disabilities. Ms. McGillivary supported SCR 14 and the attempt to join the national movement on this issue. Ms. McGillivary was sure that the task force will find that overall use of medical benefits will drastically decrease once discrimination is eliminated from the insurance benefits arena. PETER BRAVEMAN , Family Centered Services of Alaska, informed the committee that he had a mentally ill sister in another state and would be speaking from that perspective as well as a provider. Current insurance company practices discriminate against consumers which perpetuates the stigma consumers and families live with. Mr. Braveman stated that his sister receives woefully inadequate services, costly, and crisis driven services. Often his family does not interrupt a crisis for his sister because insurance benefits will run out or the insurance does not cover actions until in crisis. As a provider, Mr. Braveman sees consumers that do not have a choice when the insurance ends and the consumer must use publicly funded grantees and have limited access to other community providers. Such situations tax public mental health providers. Mr. Braveman supported SCR 14. Number 427 DON DAPCEVICH , Executive Director of the Advisory Board on Alcoholism & Drug Abuse, noted that the Advisory Board on Alcoholism & Drug Abuse has an interest in being part of the task force. This issue is equally important for chemical dependency programs as for mental health programs. Mr. Dapcevich indicated that the Mental Health Trust Authority would be interested in chemical dependency being added to the task force. Mr. Dapcevich encouraged the committee to include chemical dependency as a participant in the task force. During this era of welfare reform, quality services both in the private and public sector are necessary and SCR 14 would be a vehicle for that. Private sector involvement in chemical dependency has significantly diminished in Alaska due to the insurance practices of the predominant carriers. The predominant carriers have severely restricted access to the resources of insurance companies for third party payments. Mr. Dapcevich noted that this would require minimal costs. In terms of insurance premiums to include mental health and chemical dependency treatment services, Mr. Dapcevich had received two different studies which reported that the cost ranges from .4 percent to .7 percent increase in premiums. This is a minimal cost when considering the quality of services and the decrease in dependency on public funded services. Mr. Dapcevich reiterated the need to include chemical dependency and noted that he would provide the committee with a letter with the specific language changes to the resolution to include chemical dependency. RAY GILLESPIE , Charter North Star Behavior Health Systems, supported SCR 14. Gathering the facts about parity is good public policy. Mr. Gillespie said that he did not have any preconceived notions regarding the findings, conclusions, or resulting public policy recommendations. With regard to why this task force could not be done by a private organization, Mr. Gillespie believed that the findings would be more credible if the findings came from a group such as the Parity Task Force established by the Legislature. CHAIRMAN WILKEN announced that SCR 14 will be held to the next scheduled meeting. With regard to Senator Ward's question about the authors of SCR 14, Chairman Wilken informed the committee that those involved were Mr. Majoros from the AMHB, Ms. Macklen from the Coalition of Mental Health Organizations, and Mr. Jessee from the Mental Health Trust Authority. JEFF JESSEE , Alaska Mental Health Trust Authority, said that the trustees are supportive of exploring mental health parity. The resolution may allow the possibility to review strategic options for introducing parity legislation. SCR 14 has the potential to significantly increase the availability of mental health services. The trustees view the resolution as a way to spread some of the risk across a larger constituency and perhaps, reduce the fiscal demands on both the state General Fund and on the Trust Authority funds. CHAIRMAN WILKEN said that SCR 14 would be held.
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