Legislature(2013 - 2014)CAPITOL 106
02/19/2013 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Tribal Behavioral Health Directors Committee | |
| Presentation: Alaska State Hospital and Nursing Homes Association | |
| 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 AND SOCIAL SERVICES STANDING COMMITTEE
February 19, 2013
3:00 p.m.
MEMBERS PRESENT
Representative Pete Higgins, Chair
Representative Wes Keller, Vice Chair
Representative Benjamin Nageak
Representative Lance Pruitt
Representative Lora Reinbold
Representative Geran Tarr
MEMBERS ABSENT
Representative Paul Seaton
COMMITTEE CALENDAR
PRESENTATION: TRIBAL BEHAVIORAL HEALTH DIRECTORS COMMITTEE
- HEARD
PRESENTATION: ALASKA STATE HOSPITAL AND NURSING HOMES
ASSOCIATION
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
TINA WOODS, Chair
Tribal Behavioral Health Directors (TBHD)
Anchorage, Alaska
POSITION STATEMENT: Testified and answered questions during a
PowerPoint presentation titled, "Tribal Behavioral Health
Directors Committee (TBHDC)."
CHANDA ALOYSIUS, Vice Chair
Tribal Behavioral Health Directors (TBHD)
Anchorage, Alaska
POSITION STATEMENT: Testified and answered questions during a
PowerPoint presentation titled, "Tribal Behavioral Health
Directors Committee (TBHDC)."
JANICE HAMRICK
SouthEast Alaska Regional Health Consortium
Sitka, Alaska
POSITION STATEMENT: Answered questions during the TBHDC
presentation.
MIKE POWERS, CEO
Fairbanks Memorial Hospital
Fairbanks, Alaska
POSITION STATEMENT: Testified and answered questions during a
PowerPoint presentation titled "Overview of Alaska's Hospitals
and Nursing Homes.
LAURIE DOTAS
Prestige Care, Inc.
Anchorage, Alaska
POSITION STATEMENT: Testified and answered questions during a
PowerPoint presentation titled "Overview of Alaska's Hospitals
and Nursing Homes.
ANDREW MAYO, MD
North Star Behavioral Health
Anchorage, Alaska
POSITION STATEMENT: Testified and answered questions during a
PowerPoint presentation titled "Overview of Alaska's Hospitals
and Nursing Homes.
ACTION NARRATIVE
3:00:38 PM
CHAIR PETE HIGGINS called the House Health and Social Services
Standing Committee meeting to order at 3:00 p.m.
Representatives Higgins, Reinbold, and Tarr were present at the
call to order. Representatives Pruitt, Nageak, and Keller
arrived as the meeting was in progress.
^Presentation: Tribal Behavioral Health Directors Committee
Presentation: Tribal Behavioral Health Directors Committee
3:01:42 PM
CHAIR HIGGINS announced that the first order of business would
be a presentation by the Tribal Behavioral Health Directors
committee.
3:02:29 PM
TINA WOODS, Chair, Tribal Behavioral Health Directors (TBHD),
said that she was with the Aleutian-Pribilof Islands
Association, and that she was originally from St. Paul Island.
Directing attention to the PowerPoint presentation, "Tribal
Behavioral Health Directors Committee," she pointed to slide 1
and shared that the Behavioral Health Directors Committee was
created in 2005, as part of the Tribal Health System, and was
approved by the Alaska Native Health Board in 2008. She
reported that there were 24 members from throughout the state,
and they met quarterly. She noted that there were 800 employees
in the Tribal Behavioral Health system, offering both rural and
urban services.
3:04:16 PM
CHANDA ALOYSIUS, Vice Chair, Tribal Behavioral Health Directors
(TBHD), said that she was an Athabascan Indian and Yupik Eskimo
from Holy Cross. She spoke about slide 3, "Statewide Tribal
Behavioral Health Services," and said that some of the services
were provided through State of Alaska grants, private grants,
and funding from the Indian Health Service (IHS). These
providers offered a wide range of services and trainings,
including outpatient, group therapy, prevention and intervention
with suicide, trauma based training, residential treatment
programing, family wellness warriors, and statewide crisis
response.
MS. WOODS directed attention to slide 4, "The Behavioral Health
Aide Model," explaining that this model was federally recognized
through the Community Health Aide Program. She noted that
currently there were 134 Behavioral Health aides in Alaska with
a variety of certifications and trainings for a broad range of
behavioral health services. She emphasized that the behavioral
health aides kept individuals out of the residential treatment
facilities, and that often, the aides were raised in the
communities for which they provided services.
3:08:00 PM
REPRESENTATIVE NAGEAK commented that many people with mental
health problems were sent away, and the communities had asked to
bring these people back to the community. He shared that, in
order for those people to heal, they needed to be around family.
He pointed out that there were no centers in rural areas for
mental health patients. He declared that a change was evident
in the patients when they were allowed to come home.
3:10:06 PM
MS. WOODS moved on to slide 5, "The Alaska Tribal Health
System," which pinpointed the behavioral health aides around
Alaska. She expressed her agreement with Representative Nageak
that facilities which were culturally responsive needed to be
built; however, while each organization was looking for funding,
some organizations were still trying to build basic clinics.
She moved on to slide 6, "How does the State benefit from
working with Tribal Behavioral Health?" She pointed out that
the State of Alaska was eligible for 100 percent reimbursement
from the federal government for Tribal Health Behavioral
provided services statewide. She stated her pride that these
services were offered in a culturally responsive way.
3:11:58 PM
MS. ALOYSIUS pointed out that the Federal Medical Assistance
Percentage was cost neutral to the State of Alaska. She stated
that the behavioral health aides, working in partnership with
psychologists, clinicians, and psychiatrists, did help keep
people in the village and out of the emergency rooms and in-
patient units in urban areas. She emphasized that the
behavioral health aide was often the sole behavioral health
provider in a village.
3:13:29 PM
REPRESENTATIVE REINBOLD asked if e-medicine or face to face
technology were used to help reduce costs.
3:13:53 PM
MS. ALOYSIUS replied that although some facilities were equipped
for video conferencing, the cost of the facilities, the lack of
bandwidth, and the interruptions from weather were all factors
to overcome. She detailed that even though there was training
for many of the providers outside the village, they still often
did not understand the difficulty for obtaining resources and
medications in the villages.
3:15:21 PM
CHAIR HIGGINS asked if the behavioral health aide and the
community health aide were the same.
MS. WOODS replied that it was the same model.
CHAIR HIGGINS asked if this was the same person in a village.
MS. ALOYSIUS, in response, said that these were different
people. She explained that the behavioral health aide model was
based on that of the community health aide, but that the
behavioral health aide was a para-professional, and was usually
Native Alaskan from that same village.
3:16:19 PM
MS. WOODS, in response to Chair Higgins, said that the
behavioral health aide training was given throughout the state,
including the University of Alaska Fairbanks.
3:16:48 PM
JANICE HAMRICK, SouthEast Alaska Regional Health Consortium, in
response to Chair Higgins, said that training was done through
[indisc] and through essential learning in the community.
3:17:34 PM
MS. WOODS commented on slide 7, "Tribal Behavioral Health
Directors Committee Currant Priorities," and listed the three
priorities for the current year: Access to Care, Shortage in
Services, and State Requirements. She explained slide 8,
"Priority #1: Access to Care," and stated that there were many
barriers for an individual when entering treatment, including
discussion of personal issues with a stranger. She relayed that
there were even more issues for the Alaska Native population.
She pointed out that there was a high rate of social issues, but
a low utilization of mental health services. She remarked that
the behavioral health aide program worked because individuals
were comfortable speaking with a person from their own
community. She declared that the documentation requirements,
which were culturally invasive and daunting, resulted in many
Alaska Native elders not seeking services. She said there were
5-8 hours of paperwork to process prior to the initial
individual therapy session and that this was a huge barrier.
She stated that the venue requirements did not support
culturally responsive options such as in-home assessments, as
the elder had to come to the clinic for service. She pointed
out that there was not the ability to bill for reimbursement for
behavioral health aide services.
3:21:14 PM
MS. ALOYSIUS stated that it required courage to walk into a
service center and ask for help, and that "when they're greeted
with a binder of information thicker than the books behind you
on your shelf, it's a barrier in itself." She pointed to the
importance of face to face interaction for understanding, and
that it was important for Alaska Native people to know "why
they're hurting, in their hearts, and in their minds, and in
their bodies." She emphasized that it was necessary to bring
wellness to that level in the communities, and to simplify the
documentation, or Alaska would continue to lead the nationwide
indicators for suicide, substance use, and sexual assault.
MS. ALOYSIUS, in response to Chair Higgins, said that the
documentation was for the State of Alaska's new, extensive
Medicaid regulations. She said it could take four to eight
hours to complete the documents, and only then could they begin
the assessments.
3:22:55 PM
MS. WOODS said that often people would not return after sitting
through lengthy paperwork. She asked that the State of Alaska
offer another category for service, a brief intervention
category. She shared that there was currently a one-time crisis
intervention, and she suggested allowing a culturally responsive
intervention to individuals in order to build a relationship of
trust for engagement with the system.
3:24:11 PM
MS. ALOYSIUS moved on to slide 9, "Priority #2: Shortage in
Services," and offered an anecdote about the shortage for
statewide crisis response. She declared that it was important
for the State of Alaska to partner with the villages, in order
to know the community leaders for response to crises. She
pointed out that providers get compassion fatigue, but there was
not anyone to relieve them. She asked that the state have a
fund to support necessary travel for crisis response. She asked
who would respond if there was an incident similar to the
shooting incidences in the schools in the Lower 48, and
suggested that a reasonable, responsible, simple emergency
response plan be developed.
3:27:32 PM
MS. ALOYSIUS stated that Alaska had a shortage of providers,
especially in the rural areas. As there are no resources in a
village, a professional fills many roles, and they get no relief
from all the requirements for documentation. She asked for
state help with loan repayments for service in rural villages.
3:29:32 PM
REPRESENTATIVE NAGEAK shared his story for the difficulty to the
loss of a loved one by suicide.
3:33:28 PM
MS. ALOYSIUS asked the committee to continue to seek funding for
follow up programs.
3:34:26 PM
MS. ALOYSIUS shared slide 10, "Priority #3: State Requirements,"
and the need for balance between provision of a quality service
and accountability. She said that the new Medicaid regulations
had an unfunded mandate for all behavioral health providers to
receive accreditation from certain recognized associations. She
offered a personal anecdote regarding the accreditation of a
small clinic in her district.
3:37:01 PM
MS. WOODS indicated slide 10, and suggested that an Integrated
Healthcare Structure would encourage the integration among
behavioral health and primary care, as the current structure
prevented billing options for behavioral health in the primary
care setting.
3:38:27 PM
MS. ALOYSIUS continued the discussion of slide 10, and explained
that the mandated electronic data base system used by the State
of Alaska did not interface with other electronic health records
systems.
3:40:18 PM
MS. ALOYSIUS, in response to Representative Reinbold, explained
that the Health Information Technology for Economic and Clinical
Health (HITECH) Act was a mandated federal act for health care
systems to have a certified electronic medical record. She
explained that this rewarded organizations with funding for the
prompt integration of electronic medical records, which included
specific certification requirements.
3:41:13 PM
MS. WOODS presented slide 11, "In Summary" and stated that the
Tribal Behavioral Health Directors Committee maintained
partnerships with the State of Alaska and the Alaska Mental
Health Trust Authority for a variety of items. She declared
that it was an underfunded system, and that behavioral health
was "always the last to be considered for anything." She
explained that the regional health organizations were all
different, and had different operational approaches. She
emphasized that behavioral health was the root of the entire
mind, body, and spirit.
3:42:28 PM
REPRESENTATIVE REINBOLD asked if the request for funding had
been through the Department of Health and Social Services.
MS. WOODS explained that that there were areas in the
presentation where support had been requested. She described
the "state plan amendment" which would create billing codes for
behavioral health aide services, as these services were not
currently admissible for billing. She stated that this had been
in discussion since 2008, and noted that this would resolve some
of the priority issues, which included brief intervention
therapy instead of complete assessments.
3:44:55 PM
REPRESENTATIVE REINBOLD asked if these were the diagnostic
codes, if the Patient Protection and Affordable Care Act would
have any effect, and when would the Centers for Medicare and
Medicaid Services (CMS) act on this.
3:45:11 PM
MS. ALOYSIUS, in response, stated that these diagnostic codes
had been sent to CMS by the State of Alaska, but she had no
knowledge of its current status. She opined that the Patient
Protection and Affordable Care Act would have no bearing on
this.
3:46:09 PM
CHAIR HIGGINS asked who funded the 800 employees.
MS. ALOYSIUS replied that it was primarily funded by the Indian
Health Services (IHS), but there were also some private and
State of Alaska grant funds.
3:46:36 PM
CHAIR HIGGINS expressed his understanding that, for something to
work, the villages had to endorse and accept it.
3:47:23 PM
The committee took a brief at-ease.
3:53:35 PM
CHAIR HIGGINS brought the committee back to order at 3:53 p.m.
^Presentation: Alaska State Hospital and Nursing Homes
Association
Presentation: Alaska State Hospital and Nursing Homes
Association
3:53:42 PM
CHAIR HIGGINS announced that the final order of business would
be a presentation by the Alaska State Hospital and Nursing Home
Association.
3:54:10 PM
MIKE POWERS, CEO, Fairbanks Memorial Hospital, stated that he
represented a community hospital with an attached long-term care
facility, a common relationship for continuum of care in Alaska.
He lauded the long-term care programs in Alaska.
3:57:22 PM
MR. POWERS, offering a PowerPoint, "Overview of Alaska's
Hospitals and Nursing Homes," directed attention to slide 3,
"Alaska is Beyond Rural when compared to other States," and
pointed out the staggering difference of bed density in Alaska
compared to most other states. He explained that this lack of
beds brought difficulties which included getting patients to the
hospital during the golden hour, recruiting to the state, and
creating centers of excellence. He declared a need, and a
challenge, for Alaska to recruit highly trained, certified,
competent, skilled providers with high technological training.
3:59:30 PM
MR. POWERS indicated slide 4, "Alaska has 40 Hospitals and
Nursing Homes," which listed the membership of the association.
4:00:03 PM
REPRESENTATIVE REINBOLD asked about the shortage of medical
personnel and asked if there were any teaching institutions in
Alaska.
MR. POWERS identified the Washington, Wyoming, Alaska, Montana,
and Idaho (WWAMI) collaborative medical school program and its
relationship with Providence Alaska Medical Center and the
University of Alaska. He said that outlying areas of Alaska had
area health education centers associated with medical schools.
4:01:49 PM
LAURIE DOTAS, Prestige Care, Inc., said that the nursing homes
were instrumental for training nurses and nurse's aides during
their clinical rotations, and this participation would grow the
workforce.
4:02:17 PM
ANDREW MAYO, MD, North Star Behavioral Health, said that his
clinic had affiliations with 12 higher education institutions in
many disciplines.
4:03:15 PM
MR. POWERS said that these partnerships were the most cost
effective way to recruit during the building of an academic
center. He moved on to slide 5, "Health Care is a Major
Employer in Alaska," which indicated the growth opportunities
for health care in Alaska, currently about 31,000 jobs. Noting
slide 6, "Half of all Health Care Employment is in Hospitals &
Nursing Homes," he said that physicians, outpatient care, and
home health programs were all important. Explaining slide 7,
"Health care employment is throughout the State," he noted the
challenge for assuring appropriate certifications for a level of
competence to all Alaskans.
4:05:58 PM
CHAIR HIGGINS reflected that the health care profession was the
second or third largest employer in the State of Alaska, and
expressed his agreement with Mr. Powers that health care was an
economic anchor in the state.
4:06:42 PM
MR. POWERS reviewed slide 8, "Alaska Costs Compared to
Comparison States," and stated that the cost of living in Alaska
was 30 percent higher than the U.S., and that hospital costs
were 38 percent higher. He attributed this to the higher labor
costs for hard to recruit positions. He spoke about a recent
training program for surgical nurses in Alaska.
4:07:57 PM
REPRESENTATIVE REINBOLD asked who were the comparison states in
slide 8.
MR. POWERS replied that this was the Northwest rural areas.
MR. POWERS said that rotating travelling nurses into Alaska was
a good way to gauge interest for permanent positions.
4:09:08 PM
MR. POWERS moved on to slide 9, "Cost Drivers Impacting the Cost
of Care in Alaska."
4:09:29 PM
MS. DOTAS, in reference to slide 9, stated that her company was
owned and operated by a company in the Lower 48, and that
Prestige Care was its only Alaska center. She expressed her
envy for competitors in the Lower 48 for free shipping of
equipment, food, and other products. She stated that this did
impact costs in Alaska.
4:10:33 PM
DR. MAYO voiced his support for the military population, but he
pointed out that this was often a transient population which
affected recruiting and hiring. He offered an anecdote about
the high cost of food in Alaska.
4:12:05 PM
MR. POWERS considered slide 10, "Alaska Pays more for health
care practitioners than 8 comparison state," which graphed the
state wage comparisons between Alaska and other western states,
and reflected that Alaska wages were 20 percent above the U.S.
average.
4:12:45 PM
MR. POWERS commented on slide 11, "Hospital must serve all who
need care," stating that health care finance "is a strange
beast" with the complexity of uncompensated care. He reported
that although everyone who came to the emergency room received
care, the cost for any uncompensated care was shifted to other
payers. He declared that the health care industry was
supportive of Medicaid expansion, as more than 40,000 Alaskans
would be covered in the next 10 years, it would bring $1.1
billion of federal funding to Alaska, $1.2 billion of additional
salaries in Alaska, and $2.5 billion of increased economic
activity. He recognized the possibility for the future loss of
federal sharing. He noted that there had been suggestions for a
co-pay system, so that patients would have "skin in the game."
He declared that the Medicaid expansion could have a tremendous
economic benefit for the state.
4:15:21 PM
REPRESENTATIVE REINBOLD asked if he would advocate for a copay
system and for what percentage.
MR. POWERS expressed his agreement with a copay system, and he
suggested that it be "some kind of tiered mechanism." He
established that this would offer a reasonable sense of
accountability.
4:15:57 PM
REPRESENTATIVE REINBOLD offered her belief that a co-pay system
would make people show up.
4:16:59 PM
MR. POWERS called attention to slide 12, "2011 distribution of
Hospital Charges by Primary Pay Source," and stated that 32
percent of payments came from Medicare, 20 percent from
Medicaid, 30 percent from commercial insurance, and about 17
percent from self-pay.
4:17:32 PM
MR. POWERS offered a snapshot of Fairbanks Memorial Hospital,
slide 13, "Fairbanks Memorial Hospital," and slide 14, "Who Do
We Serve." He stated that the hospital was a sole community
provider, with a close relationship with the Native and military
communities, and that the majority of its patients came from
within a 30 mile radius. He said the top diagnoses were normal
deliveries, psychosis, and alcohol.
4:19:26 PM
MR. POWERS concluded with slide 15, "Economic Impact," slide 16,
"Fairbanks Memorial Hospital," and slide 17, "Going Forward."
He reported that the hospital had 1350 employees, with $107
million in salary and benefits, and $360 million in gross
revenues. He pointed to some of the challenges which included
the impact for niche providers, chronic inebriates, assisted
living, and adolescent behavioral health services. He noted the
sources of pride to include the native and military
partnerships, and the recruitment of 70 physicians in the last 6
years.
4:22:17 PM
DR. MAYO introduced the North Star Behavioral Health facility,
slide 18, and slide 19, "Who do we Serve," reporting that it was
a 76 bed acute facility, with the only child and preteen acute
mental health units in Alaska. He said there were a semi-secure
level 5 treatment center, and a locked level 6 unit. He noted
that it was the only facility for military children needing
residential care in Alaska, and that they worked closely with
Alaska Psychiatric Institute (API). He shared that 30 percent
of admissions came from outside the Anchorage Bowl. He reported
that the primary diagnoses were mood disorders, substance
related disorders, post-traumatic stress disorder, and
developmental disabilities. He listed the demographics of the
patients, noting that 48 percent were Caucasian and 30 percent
Native Alaskan.
4:26:41 PM
DR. MAYO assessed slide 20, "Economic Impact," and reported that
there were five facilities, and the salaries and benefits were
about $22 million for 425 part-time and full time employees. He
stated that they spent about $700,000 in contract services,
about $900,000 in purchased services, and about $2.3 million in
supplies, all from local vendors.
4:27:05 PM
DR. MAYO explained that the challenges for the facility included
nursing recruitment, continuity of care with outpatient
providers to keep the recidivism rate low, low cost
telemedicine, specialty care populations, and effective
prevention strategies, slide 21. He expressed his pride in the
distribution of suicide prevention training plans in the
schools, the stability of the medical staff, and the
scientifically based and statistically significant outcome data
for the children they had in their care.
4:31:35 PM
DR. MAYO concluded with slide 22, "Going Forward," and said that
he foresaw continued growth in specialty services, so children
could stay close to their families, as well as a continuum of
care for adults. He expressed a desire for an expansion of the
telemedicine program, continued recruitment for doctors for
outpatient services, and continued training and education for
mental health issues in Alaska.
4:32:04 PM
MS. DOTAS introduced "Prestige Care," slide 23, and reported
that Prestige had taken over the nursing home facility in July,
2009. She stated that they were one of two long term care and
sub-acute providers in Anchorage, slide 24, "Who Do We Serve."
She reported that 97 percent of the admissions came directly
from acute care, usually after an injury or acute illness. She
said the average length of stay was 946 days, and there was a
fine balance between a medical facility and a home. She said
they strive to make it a comfortable place to live. For the HMO
and Medicare rehabilitation patients, the average length of stay
was 58 days. She noted that 85 percent of the patients were
long term, while 45 percent of the residents had dementia or
short term impaired cognition.
4:34:41 PM
MS. DOTAS called attention to slide 25, "The Silver Tsunami,"
and stated that the senior population in Alaska would double by
2020 and would almost triple by 2030. As most of the facilities
were already close to full occupancy, there was going to be a
bed issue for long term care. She pointed out that 90 percent
of long term care service in Alaska was paid by Medicaid, slide
26, "Long Term Care."
4:35:47 PM
MS. DOTAS briefed the committee about slide 27, "Residents
Activities of Daily Living Levels," stating that most patients
were admitted after some sort of traumatic event, a fracture or
neurological event, and had not planned for admission. She
reported that 26 percent of the patients required a mechanical
lift, or a lot of manpower, to move and take care of them. She
moved on to slide 28, "Economic Impact" and relayed that
Prestige Care employed 144 people, had an all-time low turnover
rate of 30 percent, and annual salary and benefit costs of $8.1
million, which included the contract therapy services. She said
there were gross revenues of $12.6 million. She noted that they
had just received approval to add 12 beds, for a total of 102
beds. She shared that Prestige Care, Inc. had recently
purchased the facility, and this was the first time that this
facility had been owned and operated by the same firm. She
declared that "it had a huge impact, for my residents and for my
staff alike. It was a big day, the day that financing went
through ... to say we own it was a big pride factor."
4:37:53 PM
MS. DOTAS announced that Prestige Care had won the Bronze
Quality Award by the American Health Care Association in 2012,
was a recipient of Mountain-Pacific Quality Health's Excellence
in Care & Quality Award, and was the only five star rated center
for Quality Ratings, slide 29, "Sources of Pride."
4:39:11 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:39 p.m.
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