Legislature(2019 - 2020)BUTROVICH 205
02/26/2020 01:30 PM HEALTH & SOCIAL SERVICES
Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
Download Mp3. <- Right click and save file as
Download Video part 1. <- Right click and save file as
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
SB 134-MEDICAID COVERAGE OF LIC. COUNSELORS 1:34:36 PM CHAIR WILSON reconvened the meeting and announced the consideration of SENATE BILL NO. 134, "An Act relating to medical assistance reimbursement for the services of licensed professional counselors; and providing for an effective date." He noted that he is the prime sponsor of SB 134. The bill was presented on February 21, 2020 and public testimony was taken. This is the second hearing on the bill. 1:35:16 PM DAVE WALLACE, Chief Executive Officer, Mat-Su Regional Medical Center, Palmer, Alaska, said Mat-Su Regional is a 125-bed acute care hospital in the fastest growing service area in Alaska. The Medicaid coverage for licensed professional counselors is important because it is part of the continuum of care for behavioral health. He expressed concern on the lack of behavioral health services in Mat-Su and throughout the state. Mat-Su Regional seeks to have care provided at the most appropriate level. If more counselors are paid to see Medicaid patients with behavioral health needs, it will keep the patients from going to a higher, more expensive level of care, such as the emergency department. MR. WALLACE said Mat-Su Regional works with the Mat-Su Health Foundation to reduce the overuse of the emergency department through the High Utilizer Mat-Su project [HUMS]. HUMS targets patients who have used the emergency department at least five or more times in a year. He reported that 68 percent of over utilizers are Medicaid recipients. The majority of these patients suffer from a primary or secondary diagnosis related to behavioral health. His counterparts at Mat-Su Health Foundation have testified that this program has reduced costs. MR. WALLACE said the number of patients served is relatively small but Mat-Su Regional estimates it has saved over $1 million dollars by reducing the number of emergency room (ER) visits by overutilizers. Sixty percent of ER patients have a behavioral health diagnosis and would benefit from counseling. Allowing counselors to serve behavioral health patients will result in additional savings to the state for Medicaid services. With passage of SB 134, Mat-Su Regional's primary care clinic can use its licensed professional counselor to serve Medicaid patients. SB 134 will enhance 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 Mat-Su residents' mental health and substance use disorders. Licensed professional counselors are key behavioral health providers for these issues. Mat-Su residents identified prominent issues in the Mat-Su Health Foundation's last three community needs assessments. In 2013, residents and professionals indicated the top five health challenges were 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. Counseling services can address these issues. SB 134 would expand the health care professions by including professional counseling services to residents on Medicaid. MS. RIPLEY said the prevalence of mental health and substance use disorders and crises is increasing in the Mat-Su region and statewide. The average annual growth rate for Mat-Su Regional emergency department visits for patients with behavioral health diagnoses was 20 percent from 2015 to 2017. This increase is largely due to the opioid epidemic and lack of access to treatment. She said Mr. Wallace reported that Mat-Su Regional has an inpatient unit, but up until last year the hospital did not provide behavioral health care treatment. Passage of SB 134 will help address behavioral health issues by providing patients with the appropriate level of care at the onset of the problem, before their behavior health issues escalate. Mat-Su Regional is inundated with behavioral health patients in crisis. In 2016, 3,443 residents seen by the ER had a primary behavioral health diagnosis. Of the 3,443 patients using the ER 8,400 times, 46 percent were on Medicaid. The top diagnoses for these patients were suicidal ideation and self-harm, alcohol-related disorders, delirium, dementia, and cognitive disorders. These ER visits cost $43.8 million dollars solely for facility charges. The average charge per visit was $5,216 and the average per patient cost totaled $12,725. Clearly, the emergency department is the least cost effective method to treat behavioral health problems. Early intervention with more immediate patient access to a behavioral health providers can reduce costs for the hospital and the state and reduce patient pain and suffering. 1:44:22 PM MS. RIPLEY said access remains a problem. Very few primary care practices employ behavioral health providers. She indicated that two of the many primary care practices in Mat-Su, outside of federally qualified health centers, employ a behavioral health clinician. One reason there is so little integration of behavioral health in these practices is that providers cannot bill Medicaid for professional counseling services. Another reason is due to a shortage of psychiatrists to supervise behavioral health providers. She noted that Senator Giessel sponsored Senate Bill 169, which passed the legislature in 2018, allows behavioral health care providers to be supervised by any physician. MS. RIPLEY said Senate Bill 105 authorized Medicaid reimbursement for marriage and family counselors. The next step is to add Medicaid reimbursement to behavioral health providers, which will meet patient needs and make behavioral health services sustainable in physician offices. MS. RIPLEY noted that Mr. Wallace referenced HUMS. The Mat-Su 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 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 Mat-Su 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. MS. RIPLEY said there would be far less need for programs like HUMS if people had access to care and support before their needs become a crisis. The project has had more than $2.168 million in cost savings. The project has a third party evaluator who tracks its progress and any need for course correction. In 2018, $347,288 in emergency room charges was saved by the top three utilizers alone. That same year seven patients who enrolled in HUMS did not use the emergency department at all. She said the age of the super utilizers ranges from 16 to 82. Seventy-two percent have Medicaid coverage. She related a story of a young adult who had 17 visits to the emergency department before enrolling in HUMS. Most of his emergency visits led to inpatient admission and he seemed to have little to no interest in improving his situation. The HUMS team built a rapport with the client and he did want to change. He is now sober, his diabetes is 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 SB 134 is good policy. People talk about cutting costs and investing in the continuum of care at the community level, where it is a lot cheaper, and reserving those higher level, more expensive settings for people who actually need it is the way to do so. This is a very practical step forward. 1:51:46 PM CHAIR WILSON solicited a motion. 1:52:01 PM SENATOR VON IMHOF moved to report SB 134, version 31-LS1261\A, from committee with individual recommendations and attached fiscal notes. There being no objection, SB 134 was reported from the Senate Health and Social Services Standing Committee.