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                                                                       
1:34:36 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                                                              
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.                                                                                  

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