Legislature(2021 - 2022)DAVIS 106

02/08/2022 03:00 PM House HEALTH & SOCIAL SERVICES

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Audio Topic
03:04:28 PM Start
03:05:23 PM Executive Order 121: Dhss Reorganization
05:02:07 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Overview: Executive Order 121: DHSS TELECONFERENCED
Reorganization
-- Testimony <Invitation Only> --
**Streamed live on AKL.tv**
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                        February 8, 2022                                                                                        
                           3:04 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Liz Snyder, Co-Chair                                                                                             
Representative Tiffany Zulkosky, Co-Chair                                                                                       
Representative Ivy Spohnholz                                                                                                    
Representative Ken McCarty                                                                                                      
Representative Mike Prax                                                                                                        
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Zack Fields                                                                                                      
Representative Christopher Kurka                                                                                                
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
EXECUTIVE ORDER 121:  DHSS REORGANIZATION                                                                                       
                                                                                                                                
     - HEARD AND HELD                                                                                                           
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
STACIE KRALY, Director                                                                                                          
Civil Division                                                                                                                  
Department of Law                                                                                                               
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Gave a presentation and answered questions                                                               
during the hearing on Executive Order 121.                                                                                      
                                                                                                                                
ADAM CRUM, Commissioner                                                                                                         
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Gave a presentation and answered questions                                                               
during the hearing on Executive Order 121.                                                                                      
                                                                                                                                
SYLVAN ROBB, Assistant Commissioner                                                                                             
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Answered questions  during the  hearing on                                                             
Executive Order 121.                                                                                                            
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:04:28 PM                                                                                                                    
                                                                                                                                
CO-CHAIR LIZ SNYDER  called the House Health  and Social Services                                                             
Standing   Committee    meeting   to    order   at    3:04   p.m.                                                               
Representatives  Zulkosky,  Spohnholz (via  teleconference),  and                                                               
Snyder were present  at the call to order.   Representatives Prax                                                               
and McCarty arrived as the meeting was in progress.                                                                             
                                                                                                                                
^EXECUTIVE ORDER 121:  DHSS REORGANIZATION                                                                                      
           EXECUTIVE ORDER 121:  DHSS REORGANIZATION                                                                        
                                                                                                                                
3:05:23 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER announced  that the only order  of business would                                                               
be Executive Order 121: Department  of Health and Social Services                                                               
Reorganization.                                                                                                                 
                                                                                                                                
CO-CHAIR  SNYDER  explained that  Executive  Order  121 (EO  121)                                                               
would  bifurcate the  Department  of Health  and Social  Services                                                               
into the  Department of Health  and the Department of  Family and                                                               
Community services.  Another version  of this proposal, called EO                                                               
119,  was  introduced  last  session but  was  withdrawn  by  the                                                               
governor [on 3/11/21].  She went  on to outline the documents her                                                               
staff  distributed  from  the administration  [available  in  the                                                               
committee packet].                                                                                                              
                                                                                                                                
3:07:10 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER  introduced those presenting and  those available                                                               
for questions.                                                                                                                  
                                                                                                                                
3:08:11 PM                                                                                                                    
                                                                                                                                
STACIE KRALY, Director, Civil Division,  Department of Law, began                                                               
her presentation by explaining that  the sectional analysis is "a                                                               
beast of  a document," so she  would summarize it using  a three-                                                               
legged stool analogy.   One leg creates the  Department of Health                                                               
and the  Department of Family  and Community Services out  of the                                                               
Department of Health  and Social Services (DHSS).   She explained                                                               
that EO  121 "takes everything out  of Title 47 and  Title 44 and                                                               
creates these  two departments."  The  original department, DHSS,                                                               
was defined  under AS 44.29.   That chapter has now  been used to                                                               
create the Department  of Health, while another  chapter has been                                                               
added to create the Department  of Family and Community Services.                                                               
A similar bifurcation  occurs under AS 47.30, which  is the major                                                               
statutory framework for what is currently DHSS.                                                                                 
                                                                                                                                
MS.  KRALY  explained that  leg  two  takes  all the  boards  and                                                               
advocacy  groups currently  under DHSS  and moves  them to  their                                                               
respective  departments  under Title  44.    She noted  that  the                                                               
Alaska Mental  Health Trust Authority  (AMHTA) and  the Long-Term                                                               
Care Ombudsman  are in  the Department  of Revenue  and indicated                                                               
that  EO 121  removes any  reference to  them from  Title 47  and                                                               
moves them to Title  44.  She named boards that  are moved to the                                                               
new Department of  Health:  The Governor's  Council on Disability                                                               
and  Special  Education;  the Commission  on  Aging;  the  Alaska                                                               
Mental  Health  Board;  and   the  Statewide  Independent  Living                                                               
Council.   She  said the  Advisory Board  on Alcoholism  and Drug                                                               
Abuse  and the  Suicide  Prevention Council  are currently  under                                                               
Title 44, so there were no changes  made to them.  She noted that                                                               
the Pioneer  Home Advisory Board is  also under Title 44,  but it                                                               
is  being  moved  to  the  Department  of  Family  and  Community                                                               
Services  because "that's  where  ... the  Pioneer  Home will  be                                                               
located."   She explained that from  an organizational standpoint                                                               
it  made sense  to take  the boards  that have  unique roles  and                                                               
obligations out of the day-to-day statutory obligations.                                                                        
                                                                                                                                
3:13:25 PM                                                                                                                    
                                                                                                                                
MS.  KRALY,  continuing with  the  stool  analogy, described  the                                                               
final leg as being technical.   She explained that it encompasses                                                               
all the necessary conforming amendments  to address the statutory                                                               
provisions  in   which  DHSS   is  involved,   including  audits,                                                               
centralized  licensing, and  background  checks.   She  explained                                                               
that included in  the final leg are the sections  of statute that                                                               
have  been repealed  because of  adoption elsewhere,  as well  as                                                               
instructions  for   the  revisors   of  statutes   for  technical                                                               
amendments including transitional provisions.                                                                                   
                                                                                                                                
3:15:27 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY  asked which sections  are different in  EO 121                                                               
versus EO 119 that was introduced last session.                                                                                 
                                                                                                                                
MS. KRALY explained that EO 121  has a more detailed review.  She                                                               
elaborated that  the major difference  is the division  of mental                                                               
health services between the two  departments is addressed and how                                                               
both departments will  work with AMHTA to  address the integrated                                                               
mental  health services  required  under current  AS  47.30.   On                                                               
reconsideration,  the administration  made  EO  121 more  compact                                                               
with less confusing interactions.                                                                                               
                                                                                                                                
CO-CHAIR ZULKOSKY asked to see those changes in writing.                                                                        
                                                                                                                                
MS. KRALY replied  that DHSS can provide that,  and she mentioned                                                               
that one  of the things that  came up in review  with Legislative                                                               
Legal Services  is that there  were two commissioners on  some of                                                               
the boards, which is a substantial change to state law.                                                                         
                                                                                                                                
3:18:19 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER  echoed Representative  Zulkosky's request.   She                                                               
noted that the  National Alliance on Mental Illness  (NAMI) had a                                                               
similar  request  in  a  1/6/22 communication  and  asked  for  a                                                               
specific and clearly laid out  breakdown in the technical changes                                                               
between the two EOs.   She also asked Ms. Kraly  if the effect of                                                               
EO  121, with  exception of  the board  positions, was  basically                                                               
unchanged.                                                                                                                      
                                                                                                                                
MS.  KRALY  confirmed that  the  effect  of  EO 121  was  largely                                                               
unchanged.                                                                                                                      
                                                                                                                                
3:20:13 PM                                                                                                                    
                                                                                                                                
ADAM  CRUM,   Commissioner,  Department  of  Health   and  Social                                                               
Services, gave  a PowerPoint  presentation on  EO 121  [hard copy                                                               
included  in the  committee packet].   He  directed attention  to                                                               
slide  3,  a "hundred-thousand-foot  view  of  the Department  of                                                               
Health  and Social  Services."    He described  DHSS  as a  "mega                                                               
agency" and  cited South Dakota  as having four  departments that                                                               
share an equivalent workload to DHSS.   He emphasized that with a                                                               
budget  of $3.5  billion and  3,000  employees, DHSS  is a  large                                                               
department.   He opined  that the  resulting complexity  from the                                                               
number of programs offered, the  "multifaceted" services, and the                                                               
vulnerability  of  the  primary  beneficiaries  make  bifurcation                                                               
necessary.  He explained that  the presentation would include the                                                               
challenges  DHSS  faces,  the  proposed   solution,  and  why  an                                                               
executive order  is the appropriate  vehicle for the change.   He                                                               
presented a  list of  some of  the programs  offered by  DHSS and                                                               
asked the  committee which one  they would have  the commissioner                                                               
prioritize to  highlight that  the programs  DHSS offers  and the                                                               
communities  it serves  are all  high priority.   He  went on  to                                                               
opine  that  the  concerns of  stakeholders  cannot  be  properly                                                               
addressed under the current structure.                                                                                          
                                                                                                                                
COMMISSIONER CRUM explained that  the current structure comprised                                                               
119 different  federal funding sources  for DHSS, all  with their                                                               
own regulations and overseers, that  limit what can be delegated.                                                               
He  explained  that many  program  funding  requests require  the                                                               
signature  of  the  commissioner  or  deputy  commissioner.    He                                                               
explained  that  the  due  diligence  of  these  responsibilities                                                               
creates  a  bottleneck  in the  department.    Commissioner  Crum                                                               
opined that the  creation of more deputy positions  is not enough                                                               
to fix  the problem.  He  explained that the bottleneck  has been                                                               
an ongoing problem and will continue  to be a problem unless DHSS                                                               
is  bifurcated.   He pointed  out the  diverse array  of agencies                                                               
that  work  with and  receive  funding  from the  department  and                                                               
pointed  out  the tough  decision-making  when  deciding what  to                                                               
prioritize.    He  acknowledged that  time  management  and  hard                                                               
decision-making   encumber   leadership  roles   nationwide   but                                                               
emphasized the pain  of working within a  structure that inhibits                                                               
an appropriate response.                                                                                                        
                                                                                                                                
3:26:17 PM                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM moved  to the number of employees  at the DHSS.                                                               
He explained the  challenge of juggling such a  large and spread-                                                               
out department.  He explained that  DHSS has as many employees as                                                               
five   other  state   departments,  the   legislature,  and   the                                                               
governor's  office  combined,  and  emphasized  that  the  entire                                                               
department   answers  to   one   commissioner's   office.     The                                                               
commissioner  pointed  out  that  DHSS accounted  for  nearly  30                                                               
percent  of  the  state  budget  in fiscal  year  2023  (FY  23).                                                               
Because of its  scale, the department interacts  with every other                                                               
department  in the  state, and  improving  service delivery  will                                                               
help  other departments  provide  better service.   He  explained                                                               
there  are  more  subtle  interactions  between  DHSS  and  other                                                               
departments, such as  working with the Alaska  Department of Fish                                                               
and  Game  (ADF&G)  to  get  special  eligibility  areas  to  use                                                               
Sustainable   Natural  Alternative   Power  (SNAP)   benefits  to                                                               
purchase  hunting and  fishing  equipment.   He  spoke about  the                                                               
cross collaboration  between DHSS  and the Department  of Natural                                                               
Resources (DNR) that started the "Kids Don't Float" campaign.                                                                   
                                                                                                                                
COMMISSIONER CRUM moved  to the proposed solution.   He explained                                                               
that DHSS  has two key functions  that could be better  served by                                                               
two departments with narrower scopes.   The first key function is                                                               
providing  direct care  to  patients and  clients  that would  be                                                               
covered by the  Department of Family and  Community Services, and                                                               
the  second key  function  is managing  the  payment process  and                                                               
programs that would  be covered by the Department of  Health.  He                                                               
explained that  by aligning  these functions,  the Office  of the                                                               
Commissioner and  policy staff  would be able  to focus  on staff                                                               
support,  improvement  of  services, and  broader  bandwidth  for                                                               
stakeholder engagement.                                                                                                         
                                                                                                                                
COMMISSIONER  CRUM  directed attention  to  a  slide showing  the                                                               
current structure  of DHSS and  explained that the  Department of                                                               
Health  will  consist of  the  Medicaid  Divisions of  Healthcare                                                               
Services, Behavioral Health, and  Senior and Disability Services,                                                               
and  it  is  being  aligned with  Public  Assistance  and  Public                                                               
Health.    He  explained  that   the  Department  of  Family  and                                                               
Community Services will consist  of the facility-based divisions,                                                               
including  the  Alaska  Psychiatric Institute,  the  Division  of                                                               
Juvenile  Justice,   the  Pioneer   Homes,  and  the   Office  of                                                               
Children's Services.  He explained  that the reorganization keeps                                                               
the  public-facing  organizations  and  leadership  intact.    He                                                               
explained  that in  order to  keep  services aligned,  designated                                                               
evaluation and  treatment (DET) services  will be moved  from the                                                               
Division of  Behavioral Health  to the  Department of  Family and                                                               
Community  Services in  order to  stay closely  aligned with  the                                                               
Alaska Psychiatric Institute (API)  and the coordination of Title                                                               
47  involuntary commitment  patient movement  between facilities.                                                               
He pointed  out that  the primary  changes in  the reorganization                                                               
are  around financial  and management  services and  commissioner                                                               
staff.                                                                                                                          
                                                                                                                                
3:33:13 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER  asked Commissioner  Crum how many  new positions                                                               
are  included  in  the reorganization  and  whether  the  current                                                               
structure  of  the  Department of  Health  would  remain  largely                                                               
unchanged.                                                                                                                      
                                                                                                                                
COMMISSIONER  CRUM  answered  11  new  position  control  numbers                                                               
(PCNs) and 10  reclassified PCNs.  He confirmed  that the overall                                                               
structure will  remain with  the addition  of a  new commissioner                                                               
position,   along   with   the  addition   of   another   project                                                               
coordinator, a  department reorganization  liaison, and  a tribal                                                               
liaison.   He said he was  unsure whether the new  positions will                                                               
require a designated person.                                                                                                    
                                                                                                                                
3:35:01 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY  asked  Commissioner  Crum  about  the  policy                                                               
considerations as they  relate to API being in  the Department of                                                               
Family  and Community  Services  and  the stakeholder  engagement                                                               
around the separation from behavioral health.                                                                                   
                                                                                                                                
COMMISSIONER  CRUM  explained  that  API is  an  acute  inpatient                                                               
psychiatric hospital  and bills  accordingly.  He  explained that                                                               
there has always been a  question of conflict of interest created                                                               
by the surveying group responsible  for licensing hospitals being                                                               
in the  same department  as the  hospital it  oversees.   He also                                                               
mentioned  that  the  department  worked  with  the  Division  of                                                               
Behavioral  Health  when  deciding  where   to  put  API  in  the                                                               
reorganization.  He mentioned that  being in separate departments                                                               
will  require  a  formal  memorandum  of  agreement  between  the                                                               
Division  of  Behavioral  Health  and  API  to  ensure  that  the                                                               
formalized data process and sharing continues.                                                                                  
                                                                                                                                
CO-CHAIR  ZULKOSKY   asked  about  the  new   positions  and  the                                                               
delegation of the liaison roles.                                                                                                
                                                                                                                                
COMMISSIONER CRUM explained the liaison  roles are not covered at                                                               
this time.                                                                                                                      
                                                                                                                                
CO-CHAIR  ZULKOSKY asked  what the  scope  of the  reorganization                                                               
liaison's responsibilities will be.                                                                                             
                                                                                                                                
COMMISSIONER   CRUM   responded   that  the   idea   behind   the                                                               
reorganization liaison  is to provide  a single point  of contact                                                               
that stakeholders can reach out to  if there are issues that need                                                               
to be  addressed once  the implementation  begins.   He explained                                                               
that the  tribal liaison  role is not  taking over  another role,                                                               
and in talks with tribal partners,  a tribal liaison role will be                                                               
critical for stakeholder engagement.                                                                                            
                                                                                                                                
CO-CHAIR  ZULKOSKY summarized  her understanding  of Commissioner                                                               
Crum's response.                                                                                                                
                                                                                                                                
COMMISSIONER  CRUM   confirmed  that   Representative  Zulkosky's                                                               
understanding was correct.                                                                                                      
                                                                                                                                
CO-CHAIR  ZULKOSKY asked  if there  is a  timeline for  when DHSS                                                               
will decide on the delegation of roles.                                                                                         
                                                                                                                                
COMMISSIONER CRUM  explained that after  60 days, EO  121 becomes                                                               
law, and at that  time many of those decisions will  be made.  As                                                               
the deadline  draws nearer, DHSS  plans on holding  meetings with                                                               
key  stakeholders to  make sure  the people  responsible for  the                                                               
liaison roles are named.                                                                                                        
                                                                                                                                
3:43:55 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER  asked Commissioner  Crum how the  positions will                                                               
be divided between the two departments.                                                                                         
                                                                                                                                
COMMISSIONER CRUM deferred the question to Sylvan Robb.                                                                         
                                                                                                                                
3:44:29 PM                                                                                                                    
                                                                                                                                
SYLVAN  ROBB, Assistant  Commissioner, Department  of Health  and                                                               
Social  Services, explained  that  the Department  of Family  and                                                               
Community Services  will have six  of the new positions  and nine                                                               
reclassified.                                                                                                                   
                                                                                                                                
3:45:15 PM                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM  resumed his presentation by  highlighting that                                                               
the  reorganization  was  designed  to  not  disrupt  payment  or                                                               
service delivery, and financial management  and the Office of the                                                               
Commissioner are the most affected.                                                                                             
                                                                                                                                
3:46:00 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SNYDER  asked  whether the  organization  has  remained                                                               
unchanged from the  original EO 119 except  for public assistance                                                               
now being under the deputy commissioner.                                                                                        
                                                                                                                                
COMMISSIONER  CRUM  confirmed   that  Representative  Snyder  was                                                               
correct and explained that the  goal is to expedite authority and                                                               
oversight.                                                                                                                      
                                                                                                                                
3:47:29 PM                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM  moved to  slide 17,  likening the  issues that                                                               
work their way up to the  Office of the Commissioner to fires and                                                               
emphasizing that  an additional  Office of the  Commissioner will                                                               
prevent  this from  happening.   He talked  about the  crises the                                                               
administration has  faced and  the ways DHSS  has responded.   He                                                               
discussed  the new  funding from  the COVID-19  pandemic and  the                                                               
"herculean effort"  to manage  it.  He  explained that  unless an                                                               
issue is  a crisis  it will  not be given  proper attention.   He                                                               
opined that under the current  structure, DHSS "can only run from                                                               
crisis to crisis."  He talked  about the need to innovate for the                                                               
future  and  that  bifurcation   will  mean  more  bandwidth  for                                                               
engaging with interest  groups and stakeholders.   He spoke about                                                               
the improvement to  the working environment of  DHSS and benefits                                                               
of bifurcation for  employees.  He moved on to  talking about the                                                               
mechanisms of an executive order.                                                                                               
                                                                                                                                
3:54:02 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY   asked  whether  the   department  considered                                                               
potential delays to the implementation  of EO 121 and planned for                                                               
them.   She commented on  the cyber-attack and asked  whether the                                                               
department has made any plans for a worst-case scenario.                                                                        
                                                                                                                                
COMMISSIONER CRUM  explained that the reorganization  was started                                                               
by staff.   He  explained that  this is  the third  iteration and                                                               
that  the  Office of  the  Commissioner  considered many  options                                                               
including  three or  four  departments but  focused  on the  most                                                               
pragmatic  choices.   He  explained that  because  of the  cyber-                                                               
attack  and  because DHSS  is  covered  by the  Health  Insurance                                                               
Portability  and Privacy  Act  (HIPAA),  the department's  "cyber                                                               
security office"  will stay whole through  the reorganization and                                                               
cover both departments.   He deferred to Sylvan  Robb for further                                                               
comment.                                                                                                                        
                                                                                                                                
3:58:30 PM                                                                                                                    
                                                                                                                                
MS. ROBB  noted that the state  has not created a  new department                                                               
since  the Department  of Corrections  (DOC) was  created in  the                                                               
mid-1980s, which  meant there  was little  to guide  the process.                                                               
She talked  about working with  other divisions in the  state and                                                               
planning  for  the  implementation,  and she  emphasized  that  a                                                               
priority of the plan is to ensure a smooth public transition.                                                                   
                                                                                                                                
CO-CHAIR ZULKOSKY  talked about  the cyber-attack and  the impact                                                               
it had during  the COVID-19 pandemic, and she  asked whether DHSS                                                               
has "mapped out" similar potential scenarios.                                                                                   
                                                                                                                                
COMMISSIONER CRUM  replied that the  department has worked  on it                                                               
as  hard  as   it  can  and  is   continually  updating  security                                                               
procedures.                                                                                                                     
                                                                                                                                
CO-CHAIR  ZULKOSKY  asked  Commissioner   Crum  to  describe  the                                                               
metrics of success and anticipated results related to EO 121.                                                                   
                                                                                                                                
COMMISSIONER  CRUM  confirmed  the   department  has  metrics  of                                                               
success  that he  could provide  at a  later date.   He  gave the                                                               
example  of improving  the recruitment  and retention  of finance                                                               
and budget staff.                                                                                                               
                                                                                                                                
CO-CHAIR  SNYDER  pointed to  DHSS's  discussions  with NAMI  and                                                               
stated  that  the  primary  immediate goals  are  that  with  the                                                               
addition of the  11 new positions, the department  will have more                                                               
"bandwidth."  She asked if  her understanding is correct that the                                                               
issues  facing  DHSS  won't  be   quickly  solved  but  that  the                                                               
bifurcation will allow the state to be "in a better position."                                                                  
                                                                                                                                
COMMISSIONER CRUM  confirmed that's  correct and  emphasized that                                                               
these  are long-standing  issues  that  need a  lot  of time  and                                                               
focus.                                                                                                                          
                                                                                                                                
4:09:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MCCARTY asked  about the  evaluation of  efficacy                                                               
and  the baseline  used  in  evaluation.   He  asked whether  his                                                               
understanding is  correct that  service will  become better  as a                                                               
change to the public-facing side of the department.                                                                             
                                                                                                                                
COMMISSIONER   CRUM   explained   that  the   changes   will   be                                                               
incremental.                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MCCARTY talked  about  the  cyber-attack and  the                                                               
efficacy of  the Office  of Children's  Services (OCS)  and asked                                                               
what DHSS is looking at for efficacy of security.                                                                               
                                                                                                                                
COMMISSIONER  CRUM explained  that OCS  has been  a long-standing                                                               
issue that the department is still addressing.                                                                                  
                                                                                                                                
4:14:01 PM                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM,  returning to the presentation,  explained why                                                               
a  bill   is  not  the   appropriate  avenue  to   bifurcate  the                                                               
department.    He  explained  that  executive  orders  are  "well                                                               
defined,"  and  the  process  is   described  as  not  [creating]                                                               
substantive law  change, meaning  programs and services  won't be                                                               
changed by EO 121.  He pointed  out that the timeline laid out in                                                               
Article 3,  Section 23 of  the Alaska State Constitution  is more                                                               
rigid  than the  legislative  process.   He  noted  that DOC  was                                                               
formed  by  an executive  order.    He acknowledged  that  future                                                               
legislation  will  be  needed  to  help  fill  gaps  in  the  EO.                                                               
Commissioner Crum  presented the timeline for  the implementation                                                               
of EO 121 and the revisal  process the Office of the Commissioner                                                               
went through to  rewrite EO 119.   He noted that due  to the size                                                               
of DHSS, it  was impossible to reach  every stakeholder; however,                                                               
he has provided an e-mail address at every meeting.                                                                             
                                                                                                                                
4:18:50 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  CRUM continued  the presentation  by talking  about                                                               
the groups involved in creating EO 121.                                                                                         
                                                                                                                                
4:21:24 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SNYDER summarized  her understanding  that most  of the                                                               
stakeholder  interaction so  far  has been  presentations on  the                                                               
plan followed by question-and-answer  sessions, and she asked the                                                               
commissioner  to  provide  examples specific  to  transition  and                                                               
implementation that  the department has gleaned  from stakeholder                                                               
engagement.                                                                                                                     
                                                                                                                                
COMMISSIONER CRUM explained  that one example is  the post 90-day                                                               
consideration, which consists  of meetings set up  in late March,                                                               
April,  and  May   to  ensure  all  stakeholders   have  had  the                                                               
opportunity to address  their concerns.  He  described the recent                                                               
outreach the office has done  to ensure stakeholders are ready to                                                               
engage in feedback.                                                                                                             
                                                                                                                                
4:24:08 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  CRUM  continued  the   presentation  on  Slide  29,                                                               
outlining the  new positions, and  emphasized that this is  not a                                                               
cost-cutting or job-cutting initiative.                                                                                         
                                                                                                                                
4:25:01 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY  asked whether  the  department  has done  any                                                               
assessment of  possible absorption  of some of  the new  roles by                                                               
existing  staff.   She clarified  that she  was asking  about the                                                               
additional  roles necessary  for the  transition as  well as  the                                                               
additional roles  post transition.   She indicated she  wanted to                                                               
know what percent of day-to-day  function will be impacted by the                                                               
transition.                                                                                                                     
                                                                                                                                
MS. ROBB  explained that  the department  is not  concerned about                                                               
its ability  to manage  the transition  while still  attending to                                                               
its  regular responsibilities.   She  further explained  that the                                                               
function on Finance and Management  Services is necessary to keep                                                               
the  entire  department  running.     She  said  that  after  the                                                               
reorganization there  will be a  huge impact because  the breadth                                                               
of the burden on her staff will be greatly decreased.                                                                           
                                                                                                                                
4:29:13 PM                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM, in  response to a follow-up  question from Co-                                                               
Chair Zulkosky, explained  that one of the primary  goals of DHSS                                                               
is to  ensure that  the public interface  with the  department is                                                               
unaffected.                                                                                                                     
                                                                                                                                
4:29:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  asked how  the continuum of  care could                                                               
be  affected by  adding a  new department  and what  would ensure                                                               
"smooth" cross-department communication.                                                                                        
                                                                                                                                
COMMISSIONER CRUM  pointed to  the in-house  Medicaid eligibility                                                               
unit within  OCS and  explained that because  of a  memorandum of                                                               
understanding (MOA),  that group will  be directly tied  into the                                                               
Division of Public Assistance, and  similar programs will be used                                                               
in  cross-department  lines.    He  explained  that  through  the                                                               
requirement of formal  communication agreements, the commissioner                                                               
expects some inter-division communication to improve.                                                                           
                                                                                                                                
REPRESENTATIVE SPOHNHOLZ  commended Commissioner Crum on  his use                                                               
of "plain  language" and  observed that  a lot  of work  has gone                                                               
into the reorganization since it was introduced the year before.                                                                
                                                                                                                                
4:34:02 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER asked  about the math related  to 3,266 full-time                                                               
positions.  Currently  at 3,259 positions, that would  mean 7 new                                                               
positions;  therefore, she  asked why  the department  was asking                                                               
for 11.                                                                                                                         
                                                                                                                                
MS. ROBB responded  that the department added 11 but  took 4 away                                                               
after transferring them to shared services.                                                                                     
                                                                                                                                
4:35:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   SPOHNHOLZ   inquired   whether  the   PCNs   are                                                               
Information Technology personnel.                                                                                               
                                                                                                                                
SYLVAN ROBB explained that they are accounting positions.                                                                       
                                                                                                                                
4:35:46 PM                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM  resumed the presentation by  talking about the                                                               
effective date for the reorganization at  the start of FY 23.  He                                                               
talked about  the difference  in function of  the Offices  of the                                                               
Commissioners and  the slow  effects of that  going forward.   He                                                               
broke down the  timeline beginning with dividing  the budget into                                                               
two departments.   He moved  on to what  will happen once  EO 121                                                               
becomes  law, including  notifying federal  partners and  ongoing                                                               
work with  the legislature.   He talked about things  that cannot                                                               
be done  until the transition  is ready to become  law, including                                                               
transferring  employees  to   the  new  departments,  redirecting                                                               
charts of  account, and incurring  expenses on behalf of  the new                                                               
departments.   He explained that  staff in both  departments will                                                               
help close DHSS's books for the last time.                                                                                      
                                                                                                                                
4:39:30 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY  asked what kind  of notification DHSS  has had                                                               
as it relates to program recipients.                                                                                            
                                                                                                                                
COMMISSIONER CRUM  said there has  not been  formal communication                                                               
but that DHSS has reached out  to advocacy groups and would begin                                                               
reaching out to recipients around April or May.                                                                                 
                                                                                                                                
CO-CHAIR ZULKOSKY asked  what Alaskans might expect  to hear from                                                               
the department.                                                                                                                 
                                                                                                                                
COMMISSIONER  CRUM  offered  to  follow  up  with  the  committee                                                               
regarding  programs  the  department   has  to  contact,  and  he                                                               
reemphasized DHSS's goal of minimal disruption to services.                                                                     
                                                                                                                                
REPRESENTATIVE  SPOHNHOLZ asked  whether there  were any  federal                                                               
approvals  that   need  to  be   submitted  in  advance   of  the                                                               
reorganization.                                                                                                                 
                                                                                                                                
4:42:01 PM                                                                                                                    
                                                                                                                                
MS.  ROBB answered  no but  stated there  are notifications  that                                                               
need to be made.                                                                                                                
                                                                                                                                
4:43:06 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY  asked whether  DHSS expects  both commissioner                                                               
offices will be fully staffed by July 1.                                                                                        
                                                                                                                                
COMMISSIONER CRUM  answered that the administration  is trying to                                                               
determine whether the governor can  name commissioners before the                                                               
departments are split,  but he said posting  and recruitment will                                                               
be done before July 1.                                                                                                          
                                                                                                                                
4:44:17 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER asked whether DHSS  is archiving the work done on                                                               
the  process  of bifurcation  and  if  there  has been  a  budget                                                               
prepared for the rebranding of the new departments.                                                                             
                                                                                                                                
MS. ROBB  replied that  the department was  pleased to  find that                                                               
most of its facilities do not  use the department's name and will                                                               
not  have to  be changed,  but it  anticipates a  cost of  around                                                               
$50,000 on signage that does need to be changed.                                                                                
                                                                                                                                
CO-CHAIR  SNYDER asked  whether there  will  be an  expense of  a                                                               
similar magnitude for similar materials.                                                                                        
                                                                                                                                
MS.  ROBB explained  that because  of the  use of  digital media,                                                               
there  is  not  much  hard  letter head  that  will  need  to  be                                                               
rebranded.                                                                                                                      
                                                                                                                                
4:47:17 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  CRUM noted  that the  administration  does not  yet                                                               
have  logos and  suggested that  the  state could  reach out  for                                                               
ideas for new logos.                                                                                                            
                                                                                                                                
4:47:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PRAX  asked if his  understanding is  correct that                                                               
positions "down the ladder" will remain largely unaffected.                                                                     
                                                                                                                                
COMMISSIONER CRUM confirmed that is correct.                                                                                    
                                                                                                                                
REPRESENTATIVE PRAX  asked whether  the commissioner  has thought                                                               
about communication of the change to providers and the media.                                                                   
                                                                                                                                
COMMISSIONER  CRUM   explained  that  the  department   has  held                                                               
employee  townhall meetings  and  has more  scheduled to  address                                                               
additional concerns.   In  response to  a follow-up  question, he                                                               
explained that the department has  not had any conversations with                                                               
media  outlets on  the transition;  it  is keeping  communication                                                               
limited until EO 121 becomes law.                                                                                               
                                                                                                                                
4:51:32 PM                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM resumed his presentation  by explaining how the                                                               
two  departments  will  be  addressing   known  issues  once  the                                                               
transition is done.   He finished the presentation  by giving the                                                               
committee contact information.                                                                                                  
                                                                                                                                
4:54:07 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY  asked what systems  are still impacted  by the                                                               
aforementioned cyber-attack.                                                                                                    
                                                                                                                                
COMMISSIONER  CRUM explained  that some  systems are  still down,                                                               
but  most have  been  restored.   He  deferred  to  Ms. Robb  for                                                               
further details.                                                                                                                
                                                                                                                                
4:55:10 PM                                                                                                                    
                                                                                                                                
MS. ROBB  stated that  the department  is "making  good progress"                                                               
but that  it hasn't  gone as quickly  as desired;  the department                                                               
hired  a multi-national  contractor  that  identified 19  systems                                                               
that  need to  be taken  offline.   She confirmed  9 systems  are                                                               
still  going through  recovery.   She  talked about  the need  to                                                               
rebuild the system  and go through penetration testing  to see if                                                               
"they  can get  in," which  is the  last test  before bringing  a                                                               
system back  online.   In response to  a follow-up  question from                                                               
Representative Zulkosky,  she explained  that there  haven't been                                                               
any impediments to the reorganization  in response to the attack,                                                               
and the department has resources requested in the budget.                                                                       
                                                                                                                                
CO-CHAIR ZULKOSKY asked  a question regarding the  expense of the                                                               
transition.                                                                                                                     
                                                                                                                                
MS. ROBB explained  that the budget is for the  new positions and                                                               
the reclassifications.                                                                                                          
                                                                                                                                
4:59:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PRAX stated his concern  about the Office of Child                                                               
Services,  and he  asked what  the focus  would be  a year  after                                                               
reorganization and how it would help the families involved.                                                                     
                                                                                                                                
5:00:00 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  CRUM  explained  [the two  bifurcated  departments]                                                               
will be focusing on recruitment  and retention initially and then                                                               
how to put more prevention into communities.                                                                                    
                                                                                                                                
REPRESENTATIVE PRAX  predicted that the reorganization  will be a                                                               
success.                                                                                                                        
                                                                                                                                
5:01:24 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SNYDER thanked everyone for a productive meeting.                                                                      
                                                                                                                                
5:02:07 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health and Social Services Standing Committee meeting was                                                                       
adjourned at 5:02 p.m.                                                                                                          

Document Name Date/Time Subjects
EO 121.pdf HHSS 2/8/2022 3:00:00 PM
EO 121
HHSS EO 121 Letter (2-7-21).pdf HHSS 2/8/2022 3:00:00 PM
EO 121
Attachment A- DHSS EO Reorg Presentation HHSS 2.8.22.pdf HHSS 2/8/2022 3:00:00 PM
EO 121
Attachment B- EO 121 Sectional Analysis (2-7-22).pdf HHSS 2/8/2022 3:00:00 PM
SHSS 2/10/2022 1:30:00 PM
EO 121
Attachment C- EO 121 Stakeholder Engagment FINAL.pdf HHSS 2/8/2022 3:00:00 PM
SHSS 2/10/2022 1:30:00 PM
EO 121
Attachment D- EO 121 Transition Plan (2-6-22).pdf HHSS 2/8/2022 3:00:00 PM
SHSS 2/10/2022 1:30:00 PM
EO 121
Attachment E- EO 121 Summary of New and Reclassified Positions (2-7-22).pdf HHSS 2/8/2022 3:00:00 PM
SHSS 2/10/2022 1:30:00 PM
EO 121
Attachment F- EO 121 DHSS response to House Leadership Chart (2-7-22).pdf HHSS 2/8/2022 3:00:00 PM
SHSS 2/10/2022 1:30:00 PM
EO 121