Legislature(2019 - 2020)BUTROVICH 205

02/26/2020 01:30 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
-Invited Testimony Followed by Public Testimony-
+ Bills Previously Heard/Scheduled: TELECONFERENCED
Moved SB 173 Out of Committee
Moved SB 134 Out of Committee
           SB 134-MEDICAID COVERAGE OF LIC. COUNSELORS                                                                      
1:33:16 PM                                                                                                                    
CHAIR  WILSON announced  the  consideration of  SB  134. He  noted                                                              
that he was  a sponsor and that  on February 21 the  committee had                                                              
heard  an overview  of  the bill  and  took public  testimony.  He                                                              
called on invited testimony.                                                                                                    
1:35:16 PM                                                                                                                    
DAVE  WALLACE, Chief  Executive Officer,  Mat-Su Regional  Medical                                                              
Center, Palmer,  Alaska, said  that Mat-Su  Regional is  a 125-bed                                                              
acute  care  hospital  in  the fastest  growing  service  area  in                                                              
Alaska. He mentioned  its size because a year ago  it was a 74-bed                                                              
hospital.  It  did a  35-bed  med-surge  expansion and  then  last                                                              
month,  added  a  16-bed  behavioral  health  unit.  The  Medicaid                                                              
coverage  for   licensed  professional  counselors   is  important                                                              
because  it  is part  of  the  continuum  of care  for  behavioral                                                              
health.  The lack  of  behavioral health  services  in Mat-Su  and                                                              
throughout  the state  is  an issue  of  concern. Mat-Su  Regional                                                              
would like  to have care provided  at the most  appropriate level.                                                              
If more counselors  are able to  be paid to see  Medicaid patients                                                              
with  behavioral health  needs,  it will  keep  the patients  from                                                              
going to  a higher, more expensive  level of care, which  for Mat-                                                              
Su Regional  means  overutilization of  its emergency  department.                                                              
This  will  be better  for  everyone.  The patients  will  receive                                                              
treatment in  an environment that  is exclusively meant  for their                                                              
needs. It will  relieve stress on the already  overtaxed emergency                                                              
department, and it will save the state money.                                                                                   
MR. WALLACE said  that Mat-Su Regional is working  with the Mat-Su                                                              
Health  Foundation   to  reduce  the  overuse  of   the  emergency                                                              
department  through  approaches  like  the  High  Utilizer  Mat-Su                                                              
project,  HUMS.   HUMS  targets   patients  that  have   used  the                                                              
emergency  department  at least  five  or more  times  in a  year.                                                              
Sixty-eight  percent of  these patients  are Medicaid  recipients.                                                              
The  majority,  if  not  all, are  suffering  from  a  primary  or                                                              
secondary   diagnosis   related    to   behavioral   health.   His                                                              
counterparts  with the  foundation  have testified  that they  are                                                              
saving money through this program.                                                                                              
MR.  WALLACE said  the  number of  patients  served is  relatively                                                              
small,  but   a  small  number   of  patients  overutilizing   the                                                              
emergency department  is too much. Mat-Su regional  estimates that                                                              
over a million  dollars has been  saved by reducing the  number of                                                              
ER  visits  related  to  this  population.   If  there  were  more                                                              
counselors  to see behavioral  health patients  in the  community,                                                              
there would be  savings to the state in Medicaid  services. Mat-Su                                                              
Reginal has had  a counselor on staff for five years  who works in                                                              
a  primary  care clinic  and  has  been  waiting to  see  Medicaid                                                              
patients.  Sixty  percent of  the  population  that comes  to  the                                                              
emergency department  has a behavioral health diagnosis  and would                                                              
benefit   from   counseling.  Without   this   important   payment                                                              
mechanism,  she  cannot see  Medicaid  patients.  SB 134  adds  an                                                              
important piece to the continuum of care.                                                                                       
1:39:12 PM                                                                                                                    
ELIZABETH   RIPLEY,  Chief   Executive   Officer,  Mat-Su   Health                                                              
Foundation,  Wasilla, Alaska, said  SB 134  is crucial  because it                                                              
will  help  address  an  important   health  issue  facing  Mat-Su                                                              
residents every  day, mental health  and substance  use disorders.                                                              
Licensed  professional   counselors  are  key   behavioral  health                                                              
providers  for  these  issues. Mat-Su  residents  said  these  are                                                              
prominent  issues in the  last three  community needs  assessments                                                              
conducted by the  foundation. In the first one  conducted in 2013,                                                              
residents  and  professionals  said   that  the  top  five  health                                                              
challenges   are    alcohol   and   substance    abuse,   children                                                              
experiencing   trauma  and  violence,   depression  and   suicide,                                                              
domestic  violence  and sexual  assault,  and  lack of  access  to                                                              
behavioral  health  care.  These  issues  can  all  be  helped  by                                                              
residents seeking  counseling. SB  134 would expand  the workforce                                                              
that  could  provide   that  counseling  to  residents   who  have                                                              
Medicaid.  Mat-Su school  nurses  say they  see  waiting lists  of                                                              
four to  eight months for children  and families with  Medicaid to                                                              
see   counselors.  Mat-Su   has  skilled   and  trained   licensed                                                              
professional counselors  in communities  across Mat-Su  that could                                                              
see  these  children and  others,  but  they aren't  because  they                                                              
cannot be paid for their services.                                                                                              
MS.  RIPLEY said  the prevalence  of mental  health and  substance                                                              
use disorders  and crises is  increasing in Mat-Su  and statewide.                                                              
The average annual  growth rate for visits to  the Mat-Su Regional                                                              
emergency   department   by  patients   with   behavioral   health                                                              
diagnoses  grew 20 percent  from 2015  to 2017  due to  the opioid                                                              
epidemic  and  lack of  treatment  access.  As Dave  Wallace  just                                                              
shared, the  hospital now  has an inpatient  unit up  and running.                                                              
Previously,  the  hospital  provided  no  behavioral  health  care                                                              
treatment.  Passage of SB  134 could  bring the appropriate  level                                                              
of  care to  people who  need  help when  a  problem first  starts                                                              
instead of  after it  develops into a  crisis. Mat-Su  Regional is                                                              
inundated   by  residents   in  crisis   with  behavioral   health                                                              
problems.  In 2016,  3,443 residents  were seen  in the  emergency                                                              
department  with  a primary  behavioral  health  diagnosis.  Those                                                              
3,443 people  had 8,400 visits,  and 46 percent were  on Medicaid.                                                              
The top diagnoses were suicidal ideation and self-harm, alcohol-                                                                
related disorders, delirium, dementia, and cognitive disorders.                                                                 
MS.  RIPLEY said  the costs  for  those visits  was $43.8  million                                                              
dollars  in facility  charges  alone. This  does  not include  the                                                              
costs    associated   with    law    enforcement   or    emergency                                                              
transportation. The  average charge per  visit was $5,216  and the                                                              
average  cost per  patient  was  $12,725. Clearly,  the  emergency                                                              
department is the  least cost effective place to  treat behavioral                                                              
health  problems. If  intervention can  be provided  early with  a                                                              
system  that  provides  more  immediate  access  to  a  behavioral                                                              
health provider for  all residents, the state would  save a ton in                                                              
pain and  suffering as  well as money.  An individual  session for                                                              
Medicaid is  $75 while an average  charge for a  behavioral health                                                              
visit  to  the   emergency  department  is  $4,370.   Granted,  an                                                              
individual  needs more  than one  visit to prevent  a crisis,  but                                                              
even 10 visits would save $3,600.                                                                                               
1:44:22 PM                                                                                                                    
MS.  RIPLEY said  that access,  however, remains  a problem.  Very                                                              
few  primary care  practices employ  behavioral health  providers.                                                              
She knows  of two  primary care  practices in  Mat-Su, outside  of                                                              
federally  qualified  health  centers, that  employ  a  behavioral                                                              
health clinician  and there are  many primary care  practices. One                                                              
reason there  is so little  integration of behavioral  health into                                                              
these  practices is  that those  providers  cannot bill  Medicaid.                                                              
Another  reason  was  a shortage  of  psychiatrists  to  supervise                                                              
behavioral health  providers, but  with the passage  of SB  169 in                                                              
2018  that   allows  behavioral   health  care  providers   to  be                                                              
supervised by any  physician, that barrier has  been overcome. She                                                              
thanked Senator Giessel for sponsoring SB 169.                                                                                  
MS.  RIPLEY said  the next  step  is have  more behavioral  health                                                              
providers  who can  bill Medicaid,  thus making  the inclusion  of                                                              
behavioral  health  services  sustainable  in  physician  offices.                                                              
This bill,  combined with SB  105, which allowed  Medicaid billing                                                              
for  marriage and  family  counselors  that passed  last  session,                                                              
will do just  that. A number of  pieces are falling into  place to                                                              
provide more upstream intervention for behavioral health care.                                                                  
MS.  RIPLEY  noted  that  Mr. Wallace  had  referenced  HUMS.  The                                                              
foundation  started HUMS  as a  way to  provide care  coordination                                                              
and access  to community supports  for high utilizers,  defined as                                                              
residents who had  five or more visits in the  emergency system in                                                              
a   year  and   who   were,  for   whatever   reason,  unable   to                                                              
independently access  consistent and appropriate care  and support                                                              
in  the  community.  Mr.  Wallace   mentioned  the  dramatic  cost                                                              
savings of  more than one million  dollars a year.  The foundation                                                              
is  entering  the   third  year  of  the  project.   It  also  has                                                              
alleviated significant  trauma for not just the  patients, but for                                                              
the  health care  providers  and family  who  often suffer  trauma                                                              
along  with  the  patients.  "The current  director  of  the  HUMS                                                              
program,  Dr. Quimby,  told  me that  when  he took  over for  Dr.                                                              
Zink,  who is  now the  chief  medical officer  for  the state  of                                                              
Alaska, he  took it over  as a favor to  her and he  really didn't                                                              
believe  this was  going to  work. And  he said,  'I'm a  believer                                                              
now. I'll  talk about it  to anybody.' In  fact, he said,  'I like                                                              
coming  to  work  more  now  because   the  patients  I'm  serving                                                              
actually get help,'" she said.                                                                                                  
MS. RIPLEY  said that  if people  had access  to care and  support                                                              
before  their  needs  become  a   crisis  and  they  came  to  the                                                              
emergency department,  there would be far less need  for a program                                                              
like HUMS.  The project has had  more than $2.168 million  in cost                                                              
savings.  The project  does have  a third party  evaluator  who is                                                              
tracking progress  and the  need for  course correction.  In 2018,                                                              
$347,288 in  emergency room charges  was saved with the  top three                                                              
utilizers alone.  That same  year seven patients  did not  use the                                                              
emergency department  at all after enrollment in HUMS.  The age of                                                              
the superutilizers  ranges from 16 to 82. Seventy-two  percent had                                                              
Medicaid coverage.  Besides the data and cost  savings, she wanted                                                              
to share the  human piece of the  impact of HUMS. Dr.  Quimby told                                                              
this story  at the annual  meeting of the  health foundation  of a                                                              
young adult who  had had 17 visits to the emergency  department in                                                              
the previous  year before enrolling  in HUMS. He was  not managing                                                              
his diabetes  and had  a long history  of substance  use disorder.                                                              
Most of  his emergency  visits led to  inpatient admission  in the                                                              
intensive  care unit. The  client had  a long  history of  IV drug                                                              
use,  was noncompliant  with primary  care  appointments, and  his                                                              
outlook was poor.  The hospital staff believed this  young man was                                                              
going to die. HUMS  was told the client had little  to no interest                                                              
in improving  his situation.  The HUMS team  built a  rapport with                                                              
the client  and he did  want to change.  This client is  now sober                                                              
and  his diabetes  managed.  He is  working  full time  and has  a                                                              
great relationship  with his primary  care provider. He  has years                                                              
to live to make a positive difference.                                                                                          
1:50:47 PM                                                                                                                    
JARED KOSIN, President  and Chief Executive Officer,  Alaska State                                                              
Hospital  and Nursing  Home Association,  Anchorage, Alaska,  said                                                              
this bill  is good  policy. People  talk constantly  about  how to                                                              
lower  the cost  of care.  This is  how to  do it,  invest in  the                                                              
continuum  of care  at  the community  level,  where it  is a  lot                                                              
cheaper, and reserve  those higher level, more  expensive settings                                                              
for people  who actually  need it. He  was talking  to a CEO  of a                                                              
facility yesterday,  and the CEO said  this bill is a  test and if                                                              
this bill  fails, he  would know  whether anyone  cares about  the                                                              
behavioral health crisis. This is a very practical step forward.                                                                
1:51:46 PM                                                                                                                    
CHAIR WILSON solicited a motion.                                                                                                
1:52:01 PM                                                                                                                    
SENATOR  VON  IMHOF  moved  SB   134,  version  31-LS1261\A,  from                                                              
committee  with  individual recommendations  and  attached  fiscal                                                              
1:52:17 PM                                                                                                                    
There being no objection, the motion passed.                                                                                    

Document Name Date/Time Subjects
SJR13 Bill Text ver. A 1.21.20.PDF SHSS 2/26/2020 1:30:00 PM
SJR 13
SJR13 Sponsor Statement 2.24.20.pdf SHSS 2/26/2020 1:30:00 PM
SJR 13
SJR 13 Sectional Analysis 2.24.20.pdf SHSS 2/26/2020 1:30:00 PM
SJR 13
SJR 13 NPR - Early Abortion Bans- Which States Have Passed Them (Full article) 2.24.20.pdf SHSS 2/26/2020 1:30:00 PM
SJR 13
SJR 13 Public Input 2.24.20.pdf SHSS 2/26/2020 1:30:00 PM
SJR 13
SJR 13 FN Gov Div of Elections 2.23.20.pdf SHSS 2/26/2020 1:30:00 PM
SJR 13
SB 173 Letters of Support 2.14.20.pdf SHSS 2/17/2020 1:30:00 PM
SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 Fact Sheet Feb 2020.pdf SHSS 2/17/2020 1:30:00 PM
SHSS 2/26/2020 1:30:00 PM
SL&C 3/12/2020 1:30:00 PM
SB 173
SB 173 Sectional Analysis.pdf SHSS 2/17/2020 1:30:00 PM
SHSS 2/26/2020 1:30:00 PM
SL&C 3/17/2020 1:30:00 PM
SB 173
SB 173 Sponsor Statement.pdf SHSS 2/17/2020 1:30:00 PM
SHSS 2/26/2020 1:30:00 PM
SL&C 3/17/2020 1:30:00 PM
SB 173
SB 173 Letters of Support 2.14.20.pdf SHSS 2/17/2020 1:30:00 PM
SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 Fiscal Note DCCED CBPL 2.10.20.pdf SHSS 2/17/2020 1:30:00 PM
SHSS 2/26/2020 1:30:00 PM
SL&C 3/17/2020 1:30:00 PM
SB 173
SB 173 - DCCED_DHSS_Medical Oversight Table 2.21.20.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 Fiscal Note DHSS Public Health 2.19.20.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 Investigative Process Overview_v.2 DCCED and HSS 2.23.20.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 DCCED_CBPL_Complaint_Investigation_Flowchart 2.20.20.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 DHSS EMS Investigation Process 12_20_19.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 DCCED_CBPL_Investigative_Process 2.20.20.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB173 DHSS EMS Office audit process 2-20-20.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 Excerpt State Medical Board minutes_Feb2020_part1 2.25.20.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 Excerp State Medical Board minutes_Feb2020_part2 2.23.20.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB 173 Letter of Support - Roy Browning Fire Chief Central Emergency Services.pdf SHSS 2/26/2020 1:30:00 PM
SB 173
SB173 DHSS EMS Office audit process 2-20-20.pdf SHSS 2/26/2020 1:30:00 PM
SB 173