Legislature(2005 - 2006)CAPITOL 106
01/27/2005 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Overview: Bring the Kids Home Initiative | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
January 27, 2005
3:03 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Tom Anderson
Representative Lesil McGuire
Representative Paul Seaton
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
Representative Vic Kohring
COMMITTEE CALENDAR
OVERVIEW: BRING THE KIDS HOME INITIATIVE
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
BILL HOGAN, Director
Division of Behavioral Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Presented an overview the Bring the Kids
Home Initiative.
JEFF JESSE, Executive Director
Alaska Mental Health Trust Authority
Anchorage, Alaska
POSITION STATEMENT: Presented an overview of the Trust's
partnership in the Bring the Kids Home Initiative.
CHARLES FAGERSTROM
Residential and Extended Services Development
Alaska Native Tribal Health Consortium
Anchorage, Alaska
POSITION STATEMENT: Presented an overview of the Consortium's
partnership in the Bring the Kids Home Initiative.
JOEL GILBERTSON, Commissioner
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions regarding the Bring the
Kids Home Initiative
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:03:58 PM.
Representatives Wilson, Seaton, Cissna, and Gardner were present
at the call to order. Representatives Anderson and McGuire
arrived as the meeting was in progress.
^OVERVIEW: BRING THE KIDS HOME INITIATIVE
3:05:09 PM
BILL HOGAN, Director, Division of Behavioral Health, Department
of Health and Social Services, reaffirmed the division's
commitment to ensure that kids with serious emotional
disturbance, substance abuse problems, fetal alcohol spectrum
disorder, developmental disabilities, and traumatic brain injury
are able to stay with their families and be treated in Alaska.
MR. HOGAN explained that over the past six years there has been a
marked increase in the number of kids going to out-of-state
psychiatric treatment centers. Alaskan children are being
treated at up to 50 different facilities spread throughout the
Lower 48. Referring to a chart, he pointed out that in 1998
there were few children in out-of-state placement. There was a
marked increase in fiscal year (FY) 2000 and it has risen
steadily since then. Referring to a second chart, he showed that
the length of days that a child spends in a treatment center has
increased by about two months; he stated that this is a
significant problem. His third chart showed a sharp increase in
the amount of money spent on out-of-state residential psychiatric
treatment centers (RPTC) as compared to treatment centers in
general.
3:08:02 PM
MR. HOGAN stated that last fiscal year the state spent nearly $50
million on residential psychiatric treatment for children in
Outside placements. The typical Medicaid match for the treatment
is 40-42 percent state general fund (GF) dollars; the rest is
from federal Medicaid. He calculated that the state GF spent
$18-20 million for the Medicaid match.
MR. HOGAN suggested that the marked increase in number of kids
sent to Outside RPTCs is partially due to the start of Denali Kid
Care in 2000; due to this program, a number of children with
mental health problems became newly eligible for Medicaid. He
stated another possible reason for the increases:
We really have not had a very adequate ... care
coordination or gate keeping mechanism, ... we really
have not done a good job of making sure that kids stay
in-state if there are in-state options, nor have we
been very aggressive in monitoring their care out of
state. So, in many instances, kids have languished,
sometimes ... over two years, in these placements. And
... the most obvious thing is that we really have not
had in-state capacity, not only at this level of care,
but at all levels of care.
3:10:14 PM
MR. HOGAN explained that the division envisions a comprehensive
system of care for children and families that focuses on
prevention, early intervention, treatment, and recovery. He
emphasized that the division wants to have that system built on
the principles of keeping kids in their own communities and in
their own homes, if at all possible, noting that nearly 40
percent of the children in out-of-state placements are Alaska
Natives. He told the committee that the state won't be able to
solve this problem without basic core services in villages and in
hub communities. The division is working to develop a solution
with the help of several partners: The Alaska Mental Health
Trust Authority, the Alaska Mental Health Board, The Advisory
Board on Alcohol and Drug Abuse, the Governor's Council on
Disabilities, all of the Native health organizations, including
Alaska Native Tribal Health Consortium, consumers, family
members, and advocates.
3:12:09 PM
MR. HOGAN said,
When you look at the number of kids in out-of-state
placement, only about 75-80 of those kids at any one
time are "custody kids": kids in the custody of the
Office of Children's Service or the Division of
Juvenile Justice. [The division] wants to build on
what they already have in place. They have regional
placement teams, ... an out-of-state placement
committee, and we want to use that structure to ensure
that we're exploring all in-state options before a
child goes out. [The division wants] to make sure that
we include in [the] system of care many more services
on the front end of care, [meaning] things like in-home
intervention, wrap-around services similar to the
Alaska Youth Initiative program that we used to have in
Alaska. [The division wants] to expand school-based
services, respite and crisis respite options, a crisis
nursery. [The division wants] to enhance [the]
treatment foster care program, ... develop some small
group homes, ... a multidimensional home for kids who
may be coming out of the juvenile justice system, ...
enhance the residential treatment options that are
already available for kids in custody, ... and
certainly we want to develop some residential
psychiatric treatment center capacity in Alaska.
MR. HOGAN clarified that he is not suggesting that because there
are more than 400 Alaskan children in out-of-state RPTCs, the
state needs 400 RPTC beds in Alaska. The division's emphasis is
on the lower levels of community-based care; however the state
does need to have some RPTC capacity and is in the process of
determining how many beds are needed and where they should be
located. The division's goal is for there to be no Alaskan kids
in out-of-state centers by 2015.
3:14:47 PM
MR. HOGAN referred to a pie chart handout which demonstrated that
by FY 2006 the division expects to reduce number of kids in out
of state placement by 50; by FY 2010 there would be further
increase in in-state care; by 2015 all kids would be in Alaska.
He explained that the division has developed some performance
indicators to ensure that it is making progress toward this goal:
there must be a shift to children staying in-state rather than
going out of state; there must be a funding shift to ensure that
the Medicaid dollars are staying in-state; the division needs to
ensure that kids are not staying in treatment centers longer than
necessary; there must be increased service capacity at all
treatment levels; there must be a reduction in recidivism; and
the division must monitor client and family satisfaction.
MR. HOGAN said that the division anticipates an increase of funds
of $5 million for this initiative in FY 2006 and FY 2007; about
$2.2 million will be from the Alaska Mental Health Trust
Authority and about $2.8 million from Medicaid. The General Fund
(GF) increase will be going to the Medicaid match. He emphasized
that the division is not asking for additional pure GF dollars.
MR. HOGAN stated that the number of children sent out of state to
RPTCs seem to be stabilizing at about 400 and that the state is
beginning to bring kids back in a deliberate and planned way. To
illustrate this he described the Anchorage Five Kid Project,
which returns kids from Outside centers home to Alaska. This
project is being replicated in Fairbanks.
MR. HOGAN concluded his presentation by saying that the division
would like to build a system of care to focus resources and
efforts on the "front end" of care; to develop a system that
ensures that kids are ultimately self-sufficient as adults; to
make sure the faith-based and voluntary organizations are
included in the effort; to ensure that the system is cost-
effective and efficient; and to make sure there is community
input in the project.
3:21:39 PM
JEFF JESSE, Executive Director, Alaska Mental Health Trust
Authority stated that the trust selected the Bring the Kids Home
Initiative as one of its four main areas of concentration. He
remarked that the trust assembled a workgroup to pull together
various stakeholders and has worked very closely with the
department on the initiative. He said, "We know that what we
don't want is to build a bunch of inpatient beds in the State of
Alaska. This is the 'Bring the Kids Home', not 'Bring the Kids
to Anchorage', not 'Bring the Kids to other institutional ...
settings in the state'." He noted that a disproportionate number
of the kids that are placed out of state are Alaska Natives, and
the fact that the Alaska Native Tribal Health Consortium is
involved in this project is another example that this is truly a
collaborative process.
3:23:57 PM
CHARLES FAGERSTROM, Residential and Extended Services
Development, Alaska Native Tribal Health Consortium in Anchorage,
Alaska reiterated the "need to respond and not have a knee-jerk
reaction, and look at the whole continuum of care." He said that
in the last few weeks he facilitated a meeting amongst all of the
tribal health programs in order to respond to the RPTC need in
the state. The workgroup participants agreed on the importance
of looking at the whole spectrum of care, particularly the "front
end" of care. He said that he has an aggressive four-month
schedule of tribal meetings with behavioral health providers
during which the health providers will articulate the plan for
bringing kids back to Alaska for treatment; they will be looking
for ways to "get kids back home and keep them home in the least
restrictive and most culturally appropriate setting. "
3:26:29 PM
CHAIR WILSON asked if any preventative measures can be taken.
MR. HOGAN explained that most diagnoses are affective psychoses,
which includes serious diagnoses such as major depression or bi-
polar disorder with psychotic features. Regarding prevention, he
said that it's important to work with the kids, families, and
communities to focus on resiliency; building strengths and
assets, and reducing risk factors.
3:27:52 PM
REPRESENTATIVE SEATON asked if the state was taking care of all
of the needs within the state prior to 1998; he wanted
clarification regarding whether the increase of children being
sent out of state was due to a growth in population or if there
was a shift from in state to out-of-state treatment.
MR. HOGAN responded that he wouldn't suggest that prior to 1998
the state was meeting all the needs of every child; he said that
there is probably some general population growth in state. He
stated, "The prevalence rate nationally is about 10-15 percent of
all kids have a serious emotional disturbance, and that's ...
fairly typical for our state as well." He said that he is not
sure why there has been such a tremendous increase. He offered
to research the topic for the committee.
REPRESENTATIVE SEATON commented that he would appreciate the
information as it would establish the baseline and help determine
the factors that are contributing to the problem. He then asked
if any facility construction had been slowed down under the
certificate of need (CON) program.
MR. HOGAN answered that he didn't know of any such problems. He
noted that the department had received two applications and one
letter of intent under the CON program. He emphasized that the
department wants to be deliberate and make sure that the "right
kind of capacity in the right geographic locations" is being
built. He deferred further questioning to the department
commissioner.
3:31:02 PM
JOEL GILBERTSON, Commissioner, Department of Health and Social
Services, stated that House Bill 511, which was passed last
session, required a CON review for RPTC projects. He emphasized
that in-state RPTC capacity is "a piece of the service array that
we do need to develop as part of that continuum of care." He
stated that he does not believe projects are being slowed down
[by the CON process]. He said:
There are some other extraneous issues going on right
now, including litigation against the state, around the
[CON] Program generally that has delayed the
application of some of the [CON] statute to some of the
pending applications. We have had dialogue with both
of the parties who have completed applications before
the state; to the best of my knowledge both of them are
satisfied with the process that we are engaged in right
now to get those projects reviewed. We are expediting
promulgation of regulations even in the next couple of
weeks we'll have the regulations on the street for new
[CON] standards for these projects. So I think that
the review process is moving forward, the parties who
are developing them are all planning, if approved, to
have projects up and running sometime next calendar
year. So these projects still have some time delay
before they even come online. ... Each of these pieces
of this service array, this continuum of care, they
have to come in a concerted fashion and with some
deliberation. It's not putting one ahead of the other.
That "gate keeping" system, that ability of doing care
coordination, the ability of getting service capacity
available in-state, needs to be done in an organized
fashion, and RPTC-capacity building is a part of that,
but it has to come online in an orderly fashion with
the other supportive services around it. I don't think
the projects are slowed down. ... And the parties that
we are working with right now in applications are
satisfied with the process.
3:34:12 PM
REPRESENTATIVE SEATON asked for clarification on the moratorium
on the issuance of CON.
COMMISSIONER GILBERTSON replied that to some extent, the
moratorium is a "legal fiction." He continued:
The moratorium is merely a public acknowledgement by
the department because we do believe in transparency;
we want all parties affected by [CON] to be aware of
the process that's underway. We have made the
administrative decision to delay final decision-making
on [CON] applications until new standards are
promulgated.... House Bill 511 ... did include intent
language ... [which] required two things by the
department: one was the convening of a task force to
look at various aspects of [CON], and to involve
parties that are affected by [CON] and for them to
provide input on how we can adopt regulations to
streamline the process and to make it least burdensome
upon the providers who have to participate with the
[CON] program, which is a statute. And the second
portion of the intent language that is attached to that
legislation by the legislature was that the department
would move expeditiously to adopt new standards of
review for the [CON] program. We took that intent
language seriously in the interim. We convened that
task force in August of last year. We invited all
participants, all entities that are affected by [CON]
in the state of Alaska. ... Slightly over 20 took us up
on the offer and participated in the facilitated
session in Anchorage. We also began a process ... to
adopt those new standards. We procured the services of
an entity, Information Insights, to do a first round of
drafting standards. ... These standards apply much
broader than just [RPTC]; this is all aspects of [CON]
from in-patient hospital services to imaging services,
various services across the state that are regulated by
[CON]. ... One of the requests that came from the task
force meeting ... was a request from the actual
entities in state, that the state put those standards
out for public comment even before they're ready to go
into regulation. We put them out for public comment in
September. At the request of some providers we
extended the comment period through the end of November
of last year. That comment period finished, we
received about 90 pages of good comments from
providers. During that time there were ... some other
issues that arose ... there was a need for us to
announce that we were not going to issue any additional
[CON] until these standards were being adopted those
regulation. It was the intention of the department ...
to update the standards, and we certainly felt that, as
we were getting ready to put the new standards out ...
for public comment and to get them implemented, it
didn't make a lot of sense to start rushing CON
decisions through the process while you're changing the
standards. So we worked with all the parties affected,
we met with organizations who had applications pending
before the department, we explained the process. To
the best of my knowledge they were completely satisfied
with the process.
COMMISSIONER GILBERTSON said, in order to speed up the
application process, "We carved out the [RPTC] portion of that
regulatory package and we're putting them out on an expedited
basis out for public comment in the next few weeks." He said
that the regulations will be finalized as soon as the public
comment period wraps up, and the Department of Law and the
Lieutenant Governor sign off on them. At that point the
department will either award or deny CON for RPTC.
3:38:47 PM
REPRESENTATIVE MCGUIRE noted that it might be helpful to have a
formal presentation on the results of the task force.
COMMISSIONER GILBERTSON agreed that it would be a good idea. He
commented that the task force was very productive; the department
received a number of comments and therefore will be changing a
number of aspects of the CON process through regulation. He said
that it was the department's initial intent to put out one large
regulatory package and promulgate those regulations that adopted
both the standards and the process change, but because of the
need to move these RPTC reviews faster the department split up
the package. He said, "We've not yet put out for public comment,
we put them as the second package to go out, the actual standard
changes and the process changes for non-RPTC care." He noted
that he'd sent all legislators summaries of the task force
meeting and the transcript is available as well.
3:39:56 PM
REPRESENTATIVE ANDERSON stated, "I think that members of the
committee should be privy to the fact that ... there's the
litigation and there's the entities that you mentioned, Cornell
and NorthStar, that are interested in this." He voiced concern
that a few businesses are ready to build treatment centers in
Anchorage but are frustrated by slow issuance of CON, which he
believes the department could issue much sooner if they so chose.
COMMISSIONER GILBERTSON reiterated that he does not think the
projects are being slowed down by the CON process. He said that
he has met informally with "the affected parties" to discuss the
process for getting the regulations out for public comment. He
said that both Cornell and Northstar have expressed to him that
they are satisfied with the expedited process for getting the
regulations out for public comment. He said that the department
will be making a decision on the CON applications as soon as
possible.
3:42:53 PM
REPRESENTATIVE CISSNA emphasized the need for preventative work
with children and their families, and asked what the state is
doing about this.
COMMISSIONER GILBERTSON stated his belief in the importance of
preventative measures as well, and then deferred to Hr. Hogan.
MR. HOGAN said that the department is integrating mental health
and substance abuse services throughout the state because it
recognizes that many kids and adults have both problems and co-
occurring disorders. He said that the department will reframe
the governor's substance abuse initiative as a behavioral health
initiative and the funds will go to community agencies that teach
11-12 year old kids skills such as: coping and problem-solving
skills, conflict resolution, and anger management. He said that
the department is also planning a multimedia education campaign
that will be built around assets.
3:48:16 PM
REPRESENTATIVE CISSNA posited that parents need help managing
the behaviors of their children and learning to be proper
advocates.
MR. HOGAN agreed; he said that he thinks that faith-based or
voluntary organizations could offer basic parenting-skills
classes.
REPRESENTATIVE ANDERSON asked if there is a potential for an
alcohol tax.
MR. HOGAN answered that he is not sure. In response to
Representative Seaton, he clarified that by the year 2015, no
kids will be in out-of-state facilities and instead will be in an
array of facilities within Alaska. The exact number of beds in
each type of facility is flexible. He explained that Level 2-4
refers to residential facilities that are primarily licensed
through the Office of Children's Services and funded through
Medicaid; these are usually small facilities with between 5-8
beds. Level 5 refers to the RPTCs.
REPRESENTATIVE SEATON asked if about half of the kids coming
back to Alaska would be in some kind of residential center.
MR. HOGAN agreed, and said, "There will be some kids, no matter
what we do, that need to, unfortunately, go into out-of-home
placements."
Due to technical difficulties, the committee took an at-ease
from 3:55 p.m. to 4:02 p.m.
4:04:08 PM
REPRESENTATIVE SEATON asked what percentage of the kids
currently in out-of-state treatment centers have fetal alcohol
syndrome.
MR. HOGAN stated that [the department] can get that information
to him later.
4:05:10 PM
CHAIR WILSON added that the committee is focusing on how alcohol-
related issues affect the state as a whole, and she requested
that the department provide committee members with information
regarding how many of the kids in out-of-state treatment centers
have been impacted in any way by alcohol use by family members.
REPRESENTATIVE ANDERSON asked that the department also record
instances where "there is something applicable that alcohol
isn't related to but we may think it is."
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 4:06:52 PM.
| Document Name | Date/Time | Subjects |
|---|