Legislature(2019 - 2020)CAPITOL 106

04/16/2019 03:00 PM HEALTH & SOCIAL SERVICES

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Audio Topic
03:12:19 PM Start
03:12:55 PM HB89
03:21:25 PM HB114
03:26:11 PM Confirmation Hearing: Mental Health Trust Authority Trustees
04:07:47 PM Confirmation: Department of Health and Social Services Commissioner
05:22:39 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 89 OPIOID PRESCRIPTION INFORMATION TELECONFERENCED
Heard & Held
-- Public Testimony --
+= HB 114 MEDICAL PROVIDER INCENTIVES/LOAN REPAYM'T TELECONFERENCED
Moved HB 114 Out of Committee
+ Consideration of Governor's Appointees: TELECONFERENCED
-Alaska Mental Health Trust Authority Board of
Trustees
-Commissioner-Designee Adam Crum, Dept. of Health
& Social Services
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         April 16, 2019                                                                                         
                           3:12 p.m.                                                                                            
                                                                                                                                
                             DRAFT                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Ivy Spohnholz, Co-Chair                                                                                          
Representative Tiffany Zulkosky, Co-Chair                                                                                       
Representative Matt Claman                                                                                                      
Representative Harriet Drummond                                                                                                 
Representative Geran Tarr                                                                                                       
Representative Sharon Jackson                                                                                                   
Representative Lance Pruitt                                                                                                     
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 89                                                                                                               
"An Act relating to the  prescription of opioids; relating to the                                                               
practice  of dentistry;  relating  to the  practice of  medicine;                                                               
relating to  the practice of  podiatry; relating to  the practice                                                               
of osteopathy; relating  to the practice of  nursing; relating to                                                               
the  practice  of optometry;  and  relating  to the  practice  of                                                               
pharmacy."                                                                                                                      
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 114                                                                                                              
"An Act  relating to a  workforce enhancement program  for health                                                               
care professionals  employed in the  state; and providing  for an                                                               
effective date."                                                                                                                
                                                                                                                                
     - MOVED HB 114 OUT OF COMMITTEE                                                                                            
                                                                                                                                
CONFIRMATION HEARING(S):                                                                                                        
                                                                                                                                
Mental Health Trust Authority, Trustee                                                                                        
                                                                                                                                
     Ken McCarty - Eagle River                                                                                                  
                                                                                                                                
     John Sturgeon - Anchorage                                                                                                  
     - CONFIRMATION(S) ADVANCED                                                                                                 
                                                                                                                                
Commissioner - Department Of Health And Social Services                                                                       
                                                                                                                                
     Adam Crum - Anchorage                                                                                                      
                                                                                                                                
     - CONFIRMATION(S) ADVANCED                                                                                                 
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 89                                                                                                                   
SHORT TITLE: OPIOID PRESCRIPTION INFORMATION                                                                                    
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ                                                                                         
                                                                                                                                
03/11/19       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/11/19       (H)       HSS, FIN                                                                                               
04/04/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/04/19       (H)       Heard & Held                                                                                           
04/04/19       (H)       MINUTE(HSS)                                                                                            
04/09/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/09/19       (H)       -- MEETING CANCELED --                                                                                 
04/11/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/11/19       (H)       -- MEETING CANCELED --                                                                                 
04/16/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 114                                                                                                                  
SHORT TITLE: MEDICAL PROVIDER INCENTIVES/LOAN REPAYM'T                                                                          
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ                                                                                         
                                                                                                                                
03/27/19       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/27/19       (H)       HSS, FIN                                                                                               
04/04/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/04/19       (H)       Heard & Held                                                                                           
04/04/19       (H)       MINUTE(HSS)                                                                                            
04/09/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/09/19       (H)       -- MEETING CANCELED --                                                                                 
04/11/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
04/11/19       (H)       -- MEETING CANCELED --                                                                                 
04/16/19       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
MIRANDA DORDAN, Intern                                                                                                          
Representative Ivy Spohnholz                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Reviewed HB 89 on  behalf of Representative                                                             
Spohnholz, sponsor.                                                                                                             
                                                                                                                                
ROBIN MINARD, Chief Communications Officer                                                                                      
Mat-Su Health Foundation                                                                                                        
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT:  Testified in support of HB 89.                                                                           
                                                                                                                                
PATTY OWEN, Member, Board of Directors                                                                                          
Alaska Public Health Association                                                                                                
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in support of HB 89.                                                                           
                                                                                                                                
BERNICE NISBETT, Staff                                                                                                          
Representative Ivy Spohnholz                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Reviewed HB  114 on behalf of Representative                                                             
Spohnholz, sponsor.                                                                                                             
                                                                                                                                
KEN MCCARTY, MA, LMFT, Director                                                                                                 
Discovery Cove Recovery and Wellness Center, LLC                                                                                
Eagle River, Alaska                                                                                                             
POSITION  STATEMENT:   Testified  as appointee  to  the board  of                                                             
trustees of the Mental Health Trust Authority.                                                                                  
                                                                                                                                
JOHN STURGEON                                                                                                                   
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:   Testified  as appointee  to  the board  of                                                             
trustees of the Mental Health Trust Authority.                                                                                  
                                                                                                                                
ADAM CRUM, Commissioner Designee                                                                                                
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:     Testified  and  answered   questions  as                                                             
designee for commissioner of the  Department of Health and Social                                                               
Services (DHSS).                                                                                                                
                                                                                                                                
LIN DAVIS                                                                                                                       
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified in  opposition to the confirmation                                                             
of Mr. Adam Crum as commissioner of DHSS.                                                                                       
                                                                                                                                
TINA WILLIAMS                                                                                                                   
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in  opposition to the confirmation                                                             
of Mr. Adam Crum as commissioner of DHSS.                                                                                       
                                                                                                                                
KEN HELANDER, Advocacy Director                                                                                                 
American Association of Retired Persons (AARP) Alaska                                                                           
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in  opposition to the confirmation                                                             
of Mr. Adam Crum as commissioner of DHSS.                                                                                       
                                                                                                                                
VINCE BELTRAMI, President                                                                                                       
American  Federation   of  Labor   and  Congress   of  Industrial                                                               
Organizations (AFL-CIO)                                                                                                         
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in  opposition to the confirmation                                                             
of Mr. Adam Crum as commissioner of DHSS.                                                                                       
                                                                                                                                
DAWN BUNDICK                                                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in  opposition to the confirmation                                                             
of Mr. Adam Crum as commissioner of DHSS.                                                                                       
                                                                                                                                
JAN CAROLINE-HARDY                                                                                                              
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in  opposition to the confirmation                                                             
of Mr. Adam Crum as commissioner of DHSS.                                                                                       
                                                                                                                                
BEV GAJARING                                                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in  opposition to the confirmation                                                             
of Mr. Adam Crum as commissioner of DHSS.                                                                                       
                                                                                                                                
JENNIFER CUNNINGHAM                                                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in  opposition to the confirmation                                                             
of Mr. Adam Crum as commissioner of DHSS.                                                                                       
                                                                                                                                
MARK NELSON                                                                                                                     
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT:  Testified in  opposition to the confirmation                                                             
of Mr. Adam Crum as commissioner of DHSS.                                                                                       
                                                                                                                                
MAUREEN SUTTMAN                                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in  opposition to the confirmation                                                             
of Mr. Adam Crum as commissioner of DHSS.                                                                                       
                                                                                                                                
BECKY SEWELL                                                                                                                    
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in  opposition to the confirmation                                                             
of Mr. Adam Crum as commissioner of DHSS.                                                                                       
                                                                                                                                
KAREN CAMERON                                                                                                                   
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in  opposition to the confirmation                                                             
of Mr. Adam Crum as commissioner of DHSS.                                                                                       
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:12:19 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  IVY  SPOHNHOLZ  called  the  House  Health  and  Social                                                             
Services  Standing  Committee  meeting  to  order  at  3:12  p.m.                                                               
Representatives Claman,  Drummond, Tarr, Zulkosky,  and Spohnholz                                                               
were  present  at  the  call to  order.    Representative  Pruitt                                                               
arrived as the meeting was in progress.                                                                                         
                                                                                                                                
             HB 89-OPIOID PRESCRIPTION INFORMATION                                                                          
                                                                                                                                
3:12:55 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ announced  that the  first order  of business                                                               
would be HOUSE BILL NO. 89,  "An Act relating to the prescription                                                               
of opioids;  relating to the  practice of dentistry;  relating to                                                               
the practice of  medicine; relating to the  practice of podiatry;                                                               
relating to the practice of  osteopathy; relating to the practice                                                               
of nursing; relating  to the practice of  optometry; and relating                                                               
to the practice of pharmacy."                                                                                                   
                                                                                                                                
[Before the committee was the  proposed committee substitute (CS)                                                               
for HB  89, labeled 31-LS0421\U,  Fisher, 4/3/19, adopted  as the                                                               
working document on 4/4/19.]                                                                                                    
                                                                                                                                
3:13:29 PM                                                                                                                    
                                                                                                                                
MIRANDA  DORDAN,  Intern,  Representative Ivy  Spohnholz,  Alaska                                                               
State  Legislature, reviewed  HB 89  on behalf  of Representative                                                               
Spohnholz, sponsor.  She said  the bill would mitigate the opioid                                                               
public  health epidemic  that Alaska  is currently  facing.   The                                                               
bill  would do  this by  increasing patient  awareness of  opioid                                                               
dependence and  addiction before  the patient receives  an opioid                                                               
prescription.    She  paraphrased   from  the  following  written                                                               
sectional analysis  included in the committee  packet, which read                                                               
[original punctuation provided]:                                                                                                
                                                                                                                                
     Section  1.   Bill  Name   is  Opioid   Addiction  Risk                                                                  
     Disclosure.  Legislative Findings  hold that  The State                                                                    
     has a  moral, financial, and public  health interest in                                                                    
     reducing opioid  and heroin addiction in  Alaska. There                                                                    
     has  been  a  copious   amount  of  medically  document                                                                    
     evidence that shows that  opioid prescription drugs are                                                                    
     addictive and can create issues for patients                                                                               
                                                                                                                                
     Section  2.  Amends  AS   08.36.070  Duties  of  Opioid                                                                  
     Prescribing  Dentists: Inform  patients, in  provider's                                                                    
     "own  words",  of   potential  addiction  dangers  from                                                                    
     extended  opioid  use;  and  any  reasonable  treatment                                                                    
     alternatives, if they exist,  to the recommended opioid                                                                    
     prescription;  distribute  Department   of  Health  and                                                                    
     Social  Services   short  handout  on   some  potential                                                                    
     dangers.                                                                                                                   
                                                                                                                                
     Regulations/Enforcement   of  Bill:   Board  power   to                                                                    
     consider  discipline  for   dentists  who  "habitually"                                                                    
     violate bill requirements;  potential board discipline,                                                                    
     but  no  additional  legal  civil  liability  cause  of                                                                    
     action  created by  bill,  to  protect against  hostile                                                                    
     legal relationship between patient and provider.                                                                           
                                                                                                                                
     Section  3. Amends  AS  08.64.101(a)  Duties of  Opioid                                                                  
     Prescribing    Medical,    Osteopathy   and    Podiatry                                                                    
     Providers: Inform patients,  in provider's "own words",                                                                    
     of  potential addiction  dangers  from extended  opioid                                                                    
     use;  and  any  reasonable treatment  alternatives,  if                                                                    
     they  exist, to  the  recommended opioid  prescription;                                                                    
     distribute  Department of  Health  and Social  Services                                                                    
     short handout on some potential dangers.                                                                                   
                                                                                                                                
     Regulations/Enforcement   of  Bill:   Board  power   to                                                                    
     consider   discipline  for   medical,  osteopathy   and                                                                    
     podiatry  providers   who  "habitually"   violate  bill                                                                    
     requirements;  potential   board  discipline,   but  no                                                                    
     additional  legal  civil   liability  cause  of  action                                                                    
     created  by  bill,  to protect  against  hostile  legal                                                                    
     relationship between patient and provider.                                                                                 
                                                                                                                                
     Section  4. Amends  AS  08.68.100(a)  Duties of  Opioid                                                                  
     Prescribing  Registered  Nurses:  Inform  patients,  in                                                                    
     provider's "own words",  of potential addiction dangers                                                                    
     from extended opioid use;  and any reasonable treatment                                                                    
     alternatives, if they exist,  to the recommended opioid                                                                    
     prescription;  distribute  Department   of  Health  and                                                                    
     Social  Services   short  handout  on   some  potential                                                                    
     dangers.                                                                                                                   
                                                                                                                                
     Regulations/Enforcement   of  Bill:   Board  power   to                                                                    
     consider   discipline   for   registered   nurses   who                                                                    
      habitually"   violate  bill   requirements;  potential                                                                    
     board  discipline,   but  no  additional   legal  civil                                                                    
     liability cause  of action created by  bill, to protect                                                                    
     against hostile legal  relationship between patient and                                                                    
     provider.                                                                                                                  
                                                                                                                                
     Section  5.  Amends  AS   08.72.050  Duties  of  Opioid                                                                  
     Prescribing    Optometrists:   Inform    patients,   in                                                                    
     provider's "own words",  of potential addiction dangers                                                                    
     from extended opioid use;  and any reasonable treatment                                                                    
     alternatives, if they exist,  to the recommended opioid                                                                    
     prescription;  distribute  Department   of  Health  and                                                                    
     Social  Services   short  handout  on   some  potential                                                                    
     dangers.                                                                                                                   
                                                                                                                                
     Regulations/Enforcement   of  Bill:   Board  power   to                                                                    
     consider  discipline  for registered  optometrists  who                                                                    
     "habitually"   violate  bill   requirements;  potential                                                                    
     board  discipline,   but  no  additional   legal  civil                                                                    
     liability cause  of action created by  bill, to protect                                                                    
     against hostile legal  relationship between patient and                                                                    
     provider.                                                                                                                  
                                                                                                                                
     Section  6. Amends  AS  08.80.030(b)  Duties of  Opioid                                                                  
     Prescribing    Pharmacists:    Inform   patients,    in                                                                    
     provider's "own words",  of potential addiction dangers                                                                    
     from extended opioid use;  and any reasonable treatment                                                                    
     alternatives, if they exist,  to the recommended opioid                                                                    
     prescription;  distribute  Department   of  Health  and                                                                    
     Social  Services   short  handout  on   some  potential                                                                    
     dangers.                                                                                                                   
                                                                                                                                
     Regulations/Enforcement   of  Bill:   Board  power   to                                                                    
     consider  discipline  for  registered  pharmacists  who                                                                    
     "habitually"   violate  bill   requirements;  potential                                                                    
     board  discipline,   but  no  additional   legal  civil                                                                    
     liability cause  of action created by  bill, to protect                                                                    
     against hostile legal  relationship between patient and                                                                    
     provider.                                                                                                                  
                                                                                                                                
     Section  7. Inserts  a new  paragraph  in AS  47.37.040                                                                  
     under  subheading (24)  that creates  a visual  aid for                                                                    
     providers to hand  out to patients when  they are being                                                                    
     prescribed  opioids. This  handout will  provide easily                                                                    
     understandable  and  concise  information  on  opioids,                                                                    
     including the inherent  addictive and harmful qualities                                                                    
     of  opioids. This  visual aid  also  will also  provide                                                                    
     information on opioid statistics specific to Alaska.                                                                       
                                                                                                                                
3:15:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JACKSON  inquired how HB 89  provides that doctors                                                               
would be held accountable.                                                                                                      
                                                                                                                                
CO-CHAIR  SPOHNHOLZ replied  the  bill would  allow  each of  the                                                               
governing  boards  that  oversee   the  practicing  providers  to                                                               
develop and enforce the regulations as the boards see fit.                                                                      
                                                                                                                                
3:15:55 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ opened public testimony on HB 89.                                                                            
                                                                                                                                
3:16:23 PM                                                                                                                    
                                                                                                                                
ROBIN  MINARD,   Chief  Communications  Officer,   Mat-Su  Health                                                               
Foundation,  testified  in support  of  HB  89.   She  noted  the                                                               
foundation  shares  ownership  in  the  Mat-Su  Regional  Medical                                                               
Center in Wasilla and Palmer,  and that the foundation's share of                                                               
the profits are  invested back into the community  to improve the                                                               
health and wellness of residents.  She continued:                                                                               
                                                                                                                                
     Along with community  partners the foundation conducted                                                                    
     a  community health  needs assessment  and it  included                                                                    
     data analysis,  public polling  in 24  community forums                                                                    
     as  well as  an  online forum.    Our community  ranked                                                                    
     alcohol and  substance abuse as  the number  one health                                                                    
     issue in Mat-Su.                                                                                                           
                                                                                                                                
     In response  to that  we completed a  behavioral health                                                                    
     environmental scan,  and this was a  multi-year project                                                                    
     that   resulted   in   three   reports   and   numerous                                                                    
     recommendations.    One  of those  recommendations  was                                                                    
     adoption   of   strict   guidelines   for   prescribing                                                                    
     narcotics.   The  Prescription Drug  Monitoring Program                                                                    
     is helping a lot in that  arena and HB 89 builds upon a                                                                    
     safer   prescribing   environment  by   ensuring   that                                                                    
     prescribers   educate   patients  about   the   dangers                                                                    
     associated with opioids.                                                                                                   
                                                                                                                                
     There were 10 opioid  related overdose deaths in Mat-Su                                                                    
     in  2018 and  114  deaths statewide.    That means  114                                                                    
     families lost a  child, a father, a  mother, a brother,                                                                    
     or a  sister.  Even  one death is too  many, especially                                                                    
     when  it is  entirely  preventable.   Many  individuals                                                                    
     addicted to heroin  were first exposed to  opioids as a                                                                    
     result  of  legally   written  prescriptions  for  pain                                                                    
     management.   They may have made  different choices had                                                                    
     they  known that  the drug  prescribed by  their doctor                                                                    
     was  highly addictive.    People  occasionally do  need                                                                    
     assistance dealing  with pain,  but when they  do, they                                                                    
     should be  fully informed  about the  potential dangers                                                                    
     of opioids.                                                                                                                
                                                                                                                                
     The impact  of drug  abuse goes  beyond the  tragic and                                                                    
     unnecessary loss  of life and  devastated families.   A                                                                    
     2015  report  from  the   Alaska  Mental  Health  Trust                                                                    
     Authority stated that the estimated  cost of drug abuse                                                                    
     to the Alaska economy  totaled $1.22 billion.  Included                                                                    
     in   that  figure   are   productivity  loss,   traffic                                                                    
     collisions, criminal  justice and  protective services,                                                                    
     health   care,  and   public   assistance  and   social                                                                    
     services.   These costs  are borne  by state  and local                                                                    
     governments, employers,  and residents of Alaska.   The                                                                    
     devastation to  our communities  being done  by opioids                                                                    
     must end.   We believe that HB 89 will  help bring that                                                                    
     end.                                                                                                                       
                                                                                                                                
3:19:12 PM                                                                                                                    
                                                                                                                                
PATTY  OWEN, Member,  Board of  Directors,  Alaska Public  Health                                                               
Association,  testified  in support  of  HB  89.   She  said  the                                                               
association  is a  membership organization  of  about 150  health                                                               
professionals and community members  statewide that are dedicated                                                               
to improving the health and  wellbeing of Alaska's public health.                                                               
The association is  an affiliate of the  national American Public                                                               
Health  Association.     The  association  supports   HB  89  and                                                               
subscribes  to  the multi-pronged  approach  of  the Centers  for                                                               
Disease  Control and  Prevention (CDC)  in opioid  use and  abuse                                                               
prevention,   which   includes  better   prescribing   practices,                                                               
supporting   the  Prescription   Drug  Monitoring   Program,  and                                                               
expanded use of  naloxone.  She is here today  to support patient                                                               
education and education in general  for providers and the public.                                                               
Additionally, the association supports  public education in terms                                                               
of media campaigns and education in schools and communities.                                                                    
                                                                                                                                
3:21:09 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ closed public testimony and held over HB 89.                                                                 
                                                                                                                                
        HB 114-MEDICAL PROVIDER INCENTIVES/LOAN REPAYM'T                                                                    
                                                                                                                                
3:21:25 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ announced  that  the next  order of  business                                                               
would be  HOUSE BILL  NO. 114,  "An Act  relating to  a workforce                                                               
enhancement  program for  health care  professionals employed  in                                                               
the state; and providing for an effective date."                                                                                
                                                                                                                                
3:21:37 PM                                                                                                                    
                                                                                                                                
BERNICE  NISBETT,  Staff,  Representative Ivy  Spohnholz,  Alaska                                                               
State Legislature,  reviewed HB  114 on behalf  of Representative                                                               
Spohnholz, sponsor.   She said  HB 114, also known  as "SHARP-3,"                                                               
would   establish  the   Health   Care  Professionals   Workforce                                                               
Enhancement  Program  to  address  the shortage  of  health  care                                                               
professionals  in Alaska.   These  professionals  will work  with                                                               
eligible employers  for three  years in  areas where  health care                                                               
shortages are occurring  and can choose to do  the loan repayment                                                               
route,  the direct  incentives route,  or both.   Employers  will                                                               
fully  fund SHARP-3  without any  state general  funds.   SHARP-2                                                               
will sunset  June 30,  2019, and SHARP-3  would proceed  and take                                                               
effect July 1, 2019.                                                                                                            
                                                                                                                                
3:22:40 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY  moved to report  HB 114 out of  committee with                                                               
individual  recommendations and  attached  fiscal  notes.   There                                                               
being no  objection, HB  114 was reported  from the  House Health                                                               
and Social Services Standing Committee.                                                                                         
                                                                                                                                
3:22:59 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:22 p.m. to 3:26 p.m.                                                                       
^Confirmation Hearing: Mental Health Trust Authority Trustees                                                                 
                                                                                                                                
  Confirmation Hearing: Mental Health Trust Authority Trustees                                                              
                                                                                                                              
3:26:11 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ announced  that  the next  order of  business                                                               
would be the confirmation hearing  for appointees to the board of                                                               
trustees of the Mental Health Trust Authority ("Trust").                                                                        
                                                                                                                                
CO-CHAIR  SPOHNHOLZ  invited  Mr.   Ken  McCarty,  appointee,  to                                                               
introduce himself  and describe  his interest  and qualifications                                                               
for serving on the board.                                                                                                       
                                                                                                                                
3:26:43 PM                                                                                                                    
                                                                                                                                
KEN  MCCARTY, MA,  LMFT, Director,  Discovery  Cove Recovery  and                                                               
Wellness  Center, LLC,  testified as  appointee to  the board  of                                                               
trustees of the  Mental Health Trust Authority.  He  said he is a                                                               
licensed  marriage and  family therapist.    In the  past he  has                                                               
served as president  of the Alaska Association  of Marital Family                                                               
Therapists, has  served five years  as a  member of the  State of                                                               
Alaska Marital Family Therapy Licensing  Board, and has served as                                                               
secretary  for  the  Alaska   Associations  of  Telemedicine  and                                                               
Teletherapy.   He  is involved  throughout Alaska  in doing  work                                                               
with  opiates,  psychotherapy,  and  psychiatric  services.    He                                                               
thanked the committee for its work on  HB 89.  He said he is very                                                               
interested  in what  the  Mental Health  Trust  Authority is  all                                                               
about and what  it is doing for the community,  and would like to                                                               
contribute as a  board member to help people  in Alaska, programs                                                               
that are effective, and innovative ways to help in the future.                                                                  
                                                                                                                                
3:28:12 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ asked what  inspired Mr. McCarty's application                                                               
to the Mental Health Trust Authority board.                                                                                     
                                                                                                                                
MR. MCCARTY replied  he has seen several things  happening in the                                                               
state  that he  thinks  could  be done  differently.   There  are                                                               
challenges with  the Alaska Psychiatric  Institute (API)  as well                                                               
as other  aspects throughout the state.   He would be  honored to                                                               
bring in  some thoughts in  this regard  and to provide  input on                                                               
how  to fund  different  and  creative ideas.    For example,  in                                                               
November 2018  he had a  hip replacement  done in Costa  Rica for                                                               
about  80 percent  less than  what it  costs in  Alaska.   He was                                                               
astounded that no opiates were used  at all for dealing with pain                                                               
and he  was working on  his computer the afternoon  after surgery                                                               
with full cognitive  functioning.  This kind  of thinking outside                                                               
the box to  help people could also be done  for mental health and                                                               
he would like to contribute to that process.                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  inquired about what things  the Mental Health                                                               
Trust Authority could be doing differently.                                                                                     
                                                                                                                                
MR. MCCARTY responded  that the Mental Health  Trust Authority is                                                               
involved in  the funds  to help  with programs.   One of  the two                                                               
components in the  Trust is property and funding  that comes from                                                               
the property that feeds to the  Trust.  That is highly audited to                                                               
ensure  that the  funds  appropriately go  to  programs, and  the                                                               
programs themselves  are audited  to ensure  that they  are being                                                               
used appropriately.   The different agencies  are being respected                                                               
when they say  the funds really are going  to help beneficiaries.                                                               
So, on  the financial side    auditing on the money  coming in as                                                               
well as the  money going out to programs to  ensure the most bang                                                               
for the  buck.  On the  program side   looking  at the innovative                                                               
things that  are being found today.   For example, in  2009 doing                                                               
opiate  treatment using  buprenorphine was  highly minimized,  if                                                               
not loathed  upon, by  agencies throughout Alaska.   In  2011 the                                                               
theme   at  an   addiction  conference   was  medication-assisted                                                               
treatment and  a third  of the  regular conference  attendees did                                                               
not  attend  because  they  did  not believe  in  that  means  of                                                               
treatment.  Yet  today, medication assistance is found  to be one                                                               
of the most  effective ways of treating opiate  addiction.  Being                                                               
open  minded about  different ways  that  could be  used to  help                                                               
people with  mental health issues.   A current example  is strong                                                               
data collection that shows mental  health is related to nutrition                                                               
issues and being open to exploring such avenues in Alaska.                                                                      
                                                                                                                                
3:32:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  asked whether  Mr. McCarty is  still working                                                               
in  the field  of marriage  and  family therapy  with the  Alaska                                                               
Association  of Marriage  and Family  Therapists  or whether  his                                                               
focus has changed in the past few years.                                                                                        
                                                                                                                                
MR.  MCCARTY answered  he served  in the  voluntary positions  of                                                               
president for three  years and board member for a  total of about                                                               
six  years  of the  Alaska  Association  of Marriage  and  Family                                                               
Therapists.  The  association disbanded about two  years ago when                                                               
the  national association  took  on a  different  format for  the                                                               
different divisions throughout the country.                                                                                     
                                                                                                                                
REPRESENTATIVE  TARR inquired  whether  Mr. McCarty  is a  direct                                                               
service provider  in his present  employment with  Discovery Cove                                                               
Recovery and Wellness Center.                                                                                                   
                                                                                                                                
MR. MCCARTY replied yes.                                                                                                        
                                                                                                                                
REPRESENTATIVE TARR  asked whether  as a direct  service provider                                                               
Mr. McCarty would  have any conflicts of interest  because of the                                                               
ways in  which the Mental  Health Trust Authority  awards grants.                                                               
She surmised grants are awarded  at the level of program officers                                                               
rather than at  the level of board members,  but further inquired                                                               
whether there could be real or perceived conflicts of interest.                                                                 
                                                                                                                                
MR. MCCARTY responded  he is the owner and  executive director of                                                               
Discovery Cove Recovery and Wellness  Center, a for-profit mental                                                               
health  agency.   The  center's  main  format  has been  fee  for                                                               
service, although  the center  just applied  for a  federal grant                                                               
for telemedicine for  opiate addiction throughout the  state.  If                                                               
something came up, he would have to recuse himself if necessary.                                                                
                                                                                                                                
REPRESENTATIVE TARR  offered her  appreciation for  Mr. McCarty's                                                               
answer  and related  that  this  issue had  been  brought to  her                                                               
attention as a  concern.  For example, if  Mr. McCarty's business                                                               
takes Medicaid  there could be  concern for conflict  of interest                                                               
if any  changes are  proposed to  Medicaid.   There would  be the                                                               
benefit  of having  a direct  service provider  involved, but  it                                                               
must be assured that there are no issues in that grey area.                                                                     
                                                                                                                                
MR. MCCARTY indicated he does not  want to have the appearance of                                                               
doing  something wrong.   He  pointed out  that the  decision for                                                               
where  a  Medicaid  beneficiary  would  receive  treatment  isn't                                                               
determined by the trust or trustees,  so at this point he doesn't                                                               
see a conflict  if someone on Medicaid were to  choose to come to                                                               
Discovery Cove.   He stated his appreciation  for the involvement                                                               
of Representative  Tarr and other  committee members  with Senate                                                               
Bill 105,  which acknowledged marriage  and family  therapists to                                                               
be able to provide Medicaid services.                                                                                           
                                                                                                                                
3:37:17 PM                                                                                                                    
                                                                                                                                
JOHN STURGEON testified as appointee  to the board of trustees of                                                               
the Mental Health  Trust Authority.  He said that  in the past he                                                               
worked  for the  U.S.  Forest  Service and  the  State of  Alaska                                                               
[Division of Forestry], and he  currently works for Concor Forest                                                               
Products,   Ouzinkie  Native   Corporation,  and   has  his   own                                                               
import/export  business  of wood  products.    He served  on  the                                                               
Pacific  Northwest  Medical  University's board  of  trustees,  a                                                               
university that  trains doctor generalists  to go to  rural areas                                                               
in the five northwest states including  Alaska.  Prior to that he                                                               
was on their  regional advisory committee.  [Currently]  he is on                                                               
the boards  of the  Resource Development  Council and  the Alaska                                                               
Forest Association.                                                                                                             
                                                                                                                                
MR. STURGEON  said he is  interested in  serving on the  board of                                                               
trustees  for  the  Mental Health  Trust  Authority  for  several                                                               
reasons.   He has  a special  needs daughter,  so he  is familiar                                                               
with the services  provided to the mental health  recipients.  He                                                               
has  been  interested  in  mental   health  for  quite  a  while,                                                               
especially given all the opioid  and homeless problems around the                                                               
state.   His greatest asset that  can be helpful to  the Trust is                                                               
that he has been in  the resource development and land management                                                               
fields for  almost 49 years in  Alaska.  The Mental  Health Trust                                                               
Authority  has  a  lot  of  assets, 2  million  acres,  and  most                                                               
recently  completed  a trade  with  the  U.S. Forest  Service  to                                                               
secure  some  very  good  timberlands that  the  Trust  plans  on                                                               
selling.                                                                                                                        
                                                                                                                                
3:39:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CLAMAN  noted that  Mr. Sturgeon's  volunteer work                                                               
has been in  mental health and his professional work  has been in                                                               
lands and  forestry.  He  recognized there is  a lot of  land and                                                               
asset  management   where  Mr.  Sturgeon's  lands   and  forestry                                                               
experience would be  an asset to the board.   He inquired how Mr.                                                               
Sturgeon  would transition  into  the essential  function of  the                                                               
board in  terms of providing  support for mental  health services                                                               
and the people who need those services.                                                                                         
                                                                                                                                
MR. STURGEON allowed there is no  question that it is going to be                                                               
a learning  process because it  is a  world, he is  interested in                                                               
but has not  lived in.  While  not on the board yet,  he has been                                                               
attending all  the meetings,  has gone  to a  couple debriefings,                                                               
and he will be in all-day  meetings tomorrow and the next day, as                                                               
well  as a  coming two-day  board meeting  in Fairbanks.   He  is                                                               
learning a  lot about  what the  Trust does  and what  the issues                                                               
are.  If  he is confirmed to  the board, he will have  had a week                                                               
or more  of training and materials  to read.  His  greatest asset                                                               
will be  to help the  board generate  revenue from the  lands the                                                               
Trust has, and  he is very interested in  providing mental health                                                               
services to people across Alaska.                                                                                               
                                                                                                                                
REPRESENTATIVE CLAMAN  described the  Trust as  being independent                                                               
with some  degree of legislative  oversight of the spending.   He                                                               
said his general  view is that the Mental  Health Trust Authority                                                               
is really independent  of the executive branch and  needs to make                                                               
independent decisions  about what  it thinks  are in  the Trust's                                                               
best interest, including the folks  that the Trust is supposed to                                                               
be serving.   He requested  Mr. Sturgeon  to provide his  view in                                                               
terms of  the independence of the  Trust and the board's  duty to                                                               
maintain that  independence to  the extent that  that may  or may                                                               
not  coincide  with priorities  of  either  the governor  or  the                                                               
legislature.                                                                                                                    
                                                                                                                                
MR.  STURGEON answered  that  that  was made  very  clear at  the                                                               
orientation.  He  understands it was set up to  be an independent                                                               
organization and that it can  make decisions irrespective of what                                                               
the state  is doing  and be able  to focus on  what the  board of                                                               
trustees  thinks  are  the  priorities   across  the  state,  not                                                               
necessarily the  governor or  the legislature.   The Trust  is an                                                               
independent body  to help solve  the mental health  issues across                                                               
Alaska.                                                                                                                         
                                                                                                                                
3:42:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   JACKSON  congratulated   Mr.  Sturgeon   on  his                                                               
victories with the supreme court.   She said Mr. Sturgeon has the                                                               
diligence that  is needed for  such a  major board in  the state.                                                               
She asked how old Mr. Sturgeon's daughter is.                                                                                   
                                                                                                                                
MR. STURGEON replied she is  18, just graduated from high school,                                                               
and  is going  through some  special needs  training to  give her                                                               
employment in the workforce.                                                                                                    
                                                                                                                                
3:43:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  noted  that  her preference  would  be  for                                                               
individuals on  the board with direct  professional experience in                                                               
public health,  mental health,  and substance  abuse.   The Trust                                                               
has  a  professional  lands office  that  should  have  qualified                                                               
individuals to  help with the decisions  there.  This has  been a                                                               
point  of contention  that resulted  in staff  changeover in  the                                                               
last few years and the management  of the Trust and the direction                                                               
it is going.   Perhaps, though, Mr.  Sturgeon's family experience                                                               
would add  a unique  perspective of the  services provided.   She                                                               
requested  Mr. Sturgeon  to provide  more background  on how  his                                                               
personal experience would help the board.                                                                                       
                                                                                                                                
MR.  STURGEON clarified  it is  his granddaughter,  not daughter,                                                               
who  is  a   special  needs  child.    He   said  he  understands                                                               
Representative  Tarr's position  and although  it is  one of  the                                                               
qualifications,  one  of  the  categories  is  that  they  wanted                                                               
someone in land  management.  He is very well  qualified for that                                                               
after 50  years in Alaska.   It is something he  is interested in                                                               
since  he has  followed his  granddaughter's development  through                                                               
school and  the programs she  has gone  through.  His  family has                                                               
been a victim of drug abuse  through thefts.  He is interested in                                                               
Alaska's homeless  problem.  Due to  his interests he has  done a                                                               
lot  of reading  and has  embraced the  training he  has recently                                                               
received.   He is  the first  to admit that  he doesn't  have the                                                               
qualifications like some of the others  on the board, but he does                                                               
have the  perspective of land management,  timber, and generation                                                               
of revenue.                                                                                                                     
                                                                                                                                
3:47:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  said she wants  to ensure a  trauma informed                                                               
approach,  that rehabilitation  is believed  in, and  that people                                                               
get second chances.   The punitive approach has  failed people in                                                               
significant  ways, especially  if  addiction is  looked  at as  a                                                               
health  issue, not  a  lifestyle choice,  which  is supported  by                                                               
science.  It is important to  her [that Mr. Sturgeon] knows about                                                               
these things.  She asked whether  Mr. Sturgeon thinks that is the                                                               
right direction.                                                                                                                
                                                                                                                                
MR. STURGEON responded that he does.   He noted that opinions are                                                               
formed by personal experiences and  that a year ago while working                                                               
out at  the gym he  returned to his locker  to find the  lock cut                                                               
off  and his  clothes, wallet,  and car  keys gone,  and his  new                                                               
truck stolen.   When his  truck was recovered later  that evening                                                               
there were  hypodermic needles and drugs  in it.  The  person who                                                               
stole the  truck was  a former  Marine who  had gone  to college.                                                               
This made him  think about what that person went  through to be a                                                               
Marine, go to  college, and suddenly have a drug  problem.  Prior                                                               
to stealing  the truck  this person had  charges against  him for                                                               
writing checks.   He has  been following this person  through the                                                               
court system and a court requirement  before trial was to go to a                                                               
rehabilitation  center.   The rehabilitation  and help  from this                                                               
person's  family has  been heartening,  and it  is this  personal                                                               
experience that  has motivated him  to see  if he can  help other                                                               
people.                                                                                                                         
                                                                                                                                
REPRESENTATIVE TARR  offered her appreciation for  Mr. Sturgeon's                                                               
answer  and said  it underscores  where  she was  going with  her                                                               
aforementioned question.                                                                                                        
                                                                                                                                
3:51:02 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ   stated  that  given  his   background,  Mr.                                                               
Sturgeon's appointment to the board  of trustees was confusing to                                                               
her.     She  expressed  her  appreciation   for  Mr.  Sturgeon's                                                               
description  of his  experiences and  what he  has learned  since                                                               
joining the board.   She noted the Mental  Health Trust Authority                                                               
board has had  some governance challenges in recent  years.  Some                                                               
members of  the board believed  that they  could do a  better job                                                               
investing  resources than  was allowed  by  statute and  operated                                                               
outside of  statute in doing  some investments that  are supposed                                                               
to be handled  a different way.  Legislative Budget  & Audit came                                                               
out  with  a  report  that  was  fairly  scathing  regarding  the                                                               
governance  procedures  of  the Mental  Health  Trust  Authority.                                                               
Under [new CEO] Mike Abbott there  have been some changes and new                                                               
training.   She requested  Mr. Sturgeon to  describe what  he has                                                               
learned about the governance responsibilities of the board.                                                                     
                                                                                                                                
MR.  STURGEON answered  that Mike  Abbott took  several hours  to                                                               
explain  the  problem  that  was  had, why  the  board  went  the                                                               
direction that it did,  and why it was a problem.   It may not be                                                               
totally done yet  because the Mental Health  Trust Authority owns                                                               
some land and there is some  management work that has to be done.                                                               
There was a  review of what the  Trust can and cannot  do as well                                                               
as  what the  procedures are  for what  money can  and cannot  be                                                               
spent.  It  seems like all the other board  members and staff are                                                               
committed to making  sure that what happened before  is not going                                                               
to be a problem in the future.                                                                                                  
                                                                                                                                
CO-CHAIR SPOHNHOLZ  requested Mr.  Sturgeon to describe  the next                                                               
steps for reconciling the assets that need to be moved.                                                                         
                                                                                                                                
MR. STURGEON  replied the  Trust is  still working  on that.   He                                                               
cannot vote  yet, but  there was discussion  at the  last meeting                                                               
about properties the  Trust must get rid of and  some things that                                                               
must be  changed and  options for  resolving those  problems were                                                               
given.   At  the May  8-9 meeting  the board  is going  to decide                                                               
which options  to go with.    Management  did a wonderful  job of                                                               
saying this was not handled  properly and providing three or four                                                               
ways  that it  could be  fixed.   Board members  have had  a fair                                                               
amount  of time  to  think  about the  options  presented by  the                                                               
management to solve the problem and get back on track again.                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  requested Mr. Sturgeon to  describe any other                                                               
education  he has  undertaken  to  get up  to  speed  on the  big                                                               
challenges that  the Mental Health  Trust Authority is  facing to                                                               
serve its beneficiaries.                                                                                                        
                                                                                                                                
MR.  STURGEON replied  he was  on the  Pacific Northwest  Medical                                                               
University's board  of trustees  for several  years and  prior to                                                               
that he was on the advisory  committee.  As part of the trustees'                                                               
orientation  the  meetings  involved  field  trips  to  different                                                               
facilities, including  mental health facilities.   He has  done a                                                               
lot  of  self-education  and  reads every  chance  he  gets;  for                                                               
example, reading about trying to solve the homeless problem.                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  inquired about  the medical  programs offered                                                               
by the university.                                                                                                              
                                                                                                                                
MR. STURGEON responded  that the main purpose  of this relatively                                                               
new university out  of Yakima [Washington] is  to produce doctors                                                               
to  serve in  rural or  underserved areas  in the  five northwest                                                               
states.  These doctors are  meant to be general practitioners who                                                               
cover  everything.   For example,  they could  go to  Wrangell or                                                               
Bethel and as  the only medical help in the  town they would also                                                               
have to  take care of the  mental health issues.   The university                                                               
produced about 85 graduates this year.                                                                                          
                                                                                                                                
3:57:19 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ   offered  her  understanding   that  Pacific                                                               
Northwest  University of  Health Sciences  provides education  in                                                               
[Doctor of Osteopathic Medicine (DO)].                                                                                          
                                                                                                                                
MR. STURGEON answered correct.                                                                                                  
                                                                                                                                
CO-CHAIR SPOHNHOLZ  asked how many  of the  university's students                                                               
are from Alaska.                                                                                                                
                                                                                                                                
MR. STURGEON  replied he resigned  from the board last  year, but                                                               
he  thinks four  or five  Alaskans  were in  the last  graduating                                                               
class.   Two  graduates are  currently  serving in  Kodiak.   The                                                               
university would like to have more students from Alaska.                                                                        
                                                                                                                                
REPRESENTATIVE  CLAMAN commented  that a  close family  friend is                                                               
currently a first year medical student at the university.                                                                       
                                                                                                                                
MR. STURGEON responded that it is a great university.                                                                           
                                                                                                                                
3:58:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR noted  that  timber  harvest for  generating                                                               
monies can be controversial and  result in litigation.  She noted                                                               
that logging on [University of  Alaska] lands generates income in                                                               
30-40 year intervals.   She asked whether Mr.  Sturgeon has ideas                                                               
outside  of   timber  harvest  on  Trust   lands  for  generating                                                               
sustainable revenue on an annual basis.                                                                                         
                                                                                                                                
MR. STURGEON  answered that when originally  selecting lands, the                                                               
university  chose  a  lot  of   land  located  near  communities,                                                               
probably for  real estate development.   But when  the university                                                               
went  to harvest  timber on  those  lands it  was in  everybody's                                                               
backyards.  So  the university traded lands with  the U.S. Forest                                                               
Service  via bills  passed by  Congress and  selected lands  that                                                               
were less controversial to harvest.   The rotation age for timber                                                               
in Alaska  is 80-90 years.   It  should be remembered  that there                                                               
are peaks in  revenue; for example, in looking  at the "permanent                                                               
fund" for the Mental Health  Trust Authority, spikes will be seen                                                               
where  $2-$3  million in  cash  went  into investment  and  those                                                               
spikes came  from timber harvests.   In that way it  is permanent                                                               
because the  funds are  invested and the  permanent fund  for the                                                               
Trust is  increased.  Regarding  other lands,  there is a  lot of                                                               
opportunity for  leasing and also  opportunities for  mining from                                                               
the lands that  were chosen for that potential.   Currently funds                                                               
are  being received  from  a  mine near  Fairbanks  and there  is                                                               
potential for  mining in  Icy Bay.   Adding  mining funds  to the                                                               
permanent fund  increases the  amount of  earnings each  year for                                                               
passing  out  to the  Trust's  clients.    There are  lands  near                                                               
Anchorage that  can be leased.   So  there is much  potential for                                                               
making a lot of money from the lands that the Trust already has.                                                                
                                                                                                                                
REPRESENTATIVE TARR  related she lives  a stone's throw  from one                                                               
of those  properties and people  watch closely for signs  that it                                                               
is  going  to be  developed.    She  recalled a  presentation  by                                                               
Sealaska in the  House Resources Standing Committee  in which the                                                               
corporation said that  in addition to its  timber management plan                                                               
it was  also talking  about the  new opportunities  for financial                                                               
rewards of  having a carbon sink.   She suggested there  could be                                                               
places  where the  Mental Health  Trust  Authority could  benefit                                                               
from  that,  which  would  be good  environmentally  as  well  as                                                               
financially for the Trust.                                                                                                      
                                                                                                                                
MR. STURGEON replied  he is very familiar with  the carbon credit                                                               
program.  It is a very  complicated program and is something with                                                               
which he  could help the Trust  because he has worked  on several                                                               
of those projects.                                                                                                              
                                                                                                                                
CO-CHAIR  SPOHNHOLZ  recalled  from a  House  Resources  Standing                                                               
Committee hearing that Sealaska is  using carbon credits as a way                                                               
to monetize  properties that  it is choosing  not to  develop for                                                               
other reasons.                                                                                                                  
                                                                                                                                
4:05:01 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  opened public  testimony.  She  closed public                                                               
testimony after ascertaining no one wished to testify.                                                                          
                                                                                                                                
4:05:23 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY  moved to  advance  the  confirmations of  Ken                                                               
McCarty and  John Sturgeon, appointees  to the board  of trustees                                                               
of  the Mental  Health Trust  Authority, to  a joint  session for                                                               
consideration.    She reminded  the  committee  that signing  the                                                               
reports regarding  appointments to  boards and commissions  in no                                                               
way reflects  individual members' approval or  disapproval of the                                                               
appointees, and the nominations are  merely forwarded to the full                                                               
legislature  for  confirmation  or  rejection.   There  being  no                                                               
objection, the confirmations were advanced.                                                                                     
                                                                                                                                
4:05:52 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 4:05 p.m. to 4:07 p.m.                                                                       
                                                                                                                                
^Confirmation:   Department  of   Health   and  Social   Services                                                             
Commissioner                                                                                                                  
     Confirmation: Department of Health and Social Services                                                                 
                          Commissioner                                                                                      
                                                                                                                                
[Includes discussion of HB 135.]                                                                                                
                                                                                                                              
4:07:47 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  SPOHNHOLZ announced  that the  final order  of business                                                               
would be  continuation of  the confirmation  hearing of  Mr. Adam                                                               
Crum, designee for  commissioner of the Department  of Health and                                                               
Social Services.                                                                                                                
                                                                                                                                
4:08:21 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY  recalled that during the  4/13/19 confirmation                                                               
hearing  for  Mr. Crum,  the  commissioner  designee stated  that                                                               
there  was   no  intention   to  change   any  support   for  the                                                               
continuation of Medicaid expansion.   Introduced yesterday by the                                                               
governor was  HB 135,  which would  turn back  the authorizations                                                               
and support for  Medicaid expansion.  She  asked the commissioner                                                               
designee to reconcile this change in position.                                                                                  
                                                                                                                                
4:08:58 PM                                                                                                                    
                                                                                                                                
ADAM  CRUM,  Commissioner  Designee,  Department  of  Health  and                                                               
Social Services  (DHSS), replied HB  135 would provide   tools to                                                               
grow  and  provide  for  the expansion  population  so  they  can                                                               
actually increase  their economic  prosperity and we  can provide                                                               
for them, so they  don't have to face the fiscal  cliff.  ... The                                                               
idea  ... behind  this was  open transparency  to align  with the                                                               
[Alaska  Supreme   Court]  decision   so  that   the  legislature                                                               
understood where this  stood on this process."  He  said he looks                                                               
forward to  discussing this  further throughout  the subcommittee                                                               
process.  The  Department of Law (DOL) is drawing  up a statement                                                               
for legislators  that will  provide further  explanation.   It is                                                               
not the  intent to  cancel out the  eligibility for  the Medicaid                                                               
expansion population.                                                                                                           
                                                                                                                                
4:09:59 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY  observed that  [Section 2, subsection  (a)] of                                                               
HB  135 states  that  the  department is  not  required to  cover                                                               
individuals who  are eligible for  medical assistance  under this                                                               
section as  a result of  the expansion authorized by  the Patient                                                               
Protection  and Affordable  Care Act,  which the  committee often                                                               
refers  to  as  Medicaid  expansion.     She  recalled  that  the                                                               
commissioner designee's  comments on  4/13/19 were in  support of                                                               
continuing Medicaid  expansion because of the  recognition of the                                                               
federal  funding and  investment  and how  that propels  Alaska's                                                               
economy and how that protects the  health of Alaskans.  She asked                                                               
how  the  commissioner  designee  feels  such  a  stark  turn  of                                                               
position within  a matter of  days from his testimony  on 4/13/19                                                               
to yesterday's introduction of this bill can be rectified.                                                                      
                                                                                                                                
COMMISSIONER CRUM responded  that the intent of HB 135  is not to                                                               
actually remove any care or  treatment for the Medicaid expansion                                                               
population.   The particular line  referenced is  a clarification                                                               
to show  that it matches the  [Alaska] Supreme Court as  being an                                                               
option.  There  will be some more discussion to  ensure there are                                                               
no legal  issues or  unintended consequences  through this.   The                                                               
main idea  through this  is to make  sure that  opportunities are                                                               
had for these individuals.   [For example,] he has previously had                                                               
employees who  turned down a  raise because they would  no longer                                                               
qualify  for  benefits  with  the  raise,  which  is  a  rational                                                               
economic thought.   In his talks with legislators  there has been                                                               
a lot  of concern for  this fiscal cliff.   So how could  a glide                                                               
path be provided for these  individuals?  This bill would provide                                                               
tools so  options could be  explored to  move forward so  if this                                                               
population  does  grow [DHSS]  can  still  provide care  and  the                                                               
Medicaid would be  a secondary payer for  services like substance                                                               
use disorder (SUD) training, behavioral  health, and other things                                                               
now provided in the private marketplace.                                                                                        
                                                                                                                                
4:12:15 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY said she didn't  hear an answer but appreciates                                                               
the commissioner  designee's attempt.   She stated  that Medicaid                                                               
expansion  has provided  a significant  amount  of investment  in                                                               
Alaska as it  relates to behavioral health  services and Medicaid                                                               
is the  lead funder of  addiction treatment  in a time  of opioid                                                               
crisis.     Given   Medicaid  expansion   could  potentially   be                                                               
destabilized through HB 135, she  asked the commissioner designee                                                               
to talk about  what he sees as Medicaid's role  in addressing the                                                               
opioid epidemic or other behavioral health issues.                                                                              
                                                                                                                                
COMMISSIONER CRUM answered that it  would continue the exact same                                                               
way  as it  is now,  proceeding  with the  Medicaid Section  1115                                                               
Behavioral  Health Waiver  Demonstration  Project ("Section  1115                                                               
Waiver") that DHSS has approved for  the SUD treatment.  As well,                                                               
funding  mechanisms would  continue for  the Section  1115 Waiver                                                               
for behavioral  health so  that mild and  moderate issues  can be                                                               
treated upfront.   The  Medicaid would act  as a  secondary payer                                                               
for that process.  This is going  to be a long process of working                                                               
together  to  make  sure.     The  department's  full  intent  in                                                               
discussions  with the  Centers for  Medicare &  Medicaid Services                                                               
(CMS) is to ensure that that level of stability is maintained.                                                                  
                                                                                                                                
4:13:53 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY  related that an  analysis of the  cost savings                                                               
to Alaska's general fund as  a result of Medicaid expansion shows                                                               
that  between  fiscal  years  2016  and  2019  behavioral  health                                                               
services within the  division have seen an offset  of $23 million                                                               
with an  additional $10.5  million projected  through 2020.   She                                                               
stated she  is disappointed to see  that within a matter  of days                                                               
of  having a  conversation with  the commissioner  designee about                                                               
his  support of  Medicaid expansion  that there  would be  such a                                                               
significant policy  shift without  any collaboration in  terms of                                                               
moving forward.   It gives her pause about  ability and readiness                                                               
to  advocate  to  the  governor  to uphold  the  mission  of  the                                                               
department given all  of the complex health policies  that are in                                                               
front of  the division.   She said  she would  leave conversation                                                               
about the policy of HB 135 to a future date.                                                                                    
                                                                                                                                
COMMISSIONER  CRUM  replied that  this  is  going  to be  a  long                                                               
process.  He said his intent  has not changed since 4/13/19; [the                                                               
bill] is to maintain the Medicaid  population, to allow a tool in                                                               
the mechanism  for growth,  and to  maintain available  assets so                                                               
[DHSS]  can actually  treat using  the waiver  system that  it is                                                               
working towards.   Bringing forth HB 135  provides an opportunity                                                               
to have open discussions on this  and he looks forward to working                                                               
with the  co-chair on this to  address these issues to  make sure                                                               
it is the right path for Alaska.                                                                                                
                                                                                                                                
CO-CHAIR SPOHNHOLZ maintained that  HB 135 suggests restructuring                                                               
the  way   Alaska  provides  care   to  the   Medicaid  expansion                                                               
population.  She  said it doesn't describe how a  step down would                                                               
be provided  for people  who would be  moving out  of eligibility                                                               
for Medicaid  expansion.   She thinks  of a  glide path  as being                                                               
something that  prevents a person  from falling off the  cliff of                                                               
losing all health  insurance when he/she no  longer qualifies for                                                               
Medicaid expansion.  She doesn't think  of a glide path as taking                                                               
out the supports from underneath  someone before he/she even gets                                                               
to the cliff.                                                                                                                   
                                                                                                                                
COMMISSIONER CRUM  responded he agrees  100 percent on that.   He                                                               
said the main intent of this and  some of the tools is to ask for                                                               
permission  for DHSS  to continue  to go  after these  waivers to                                                               
build  this  program to  make  sure  that these  individuals  are                                                               
supported before they actually lose these benefits.                                                                             
                                                                                                                                
CO-CHAIR SPOHNHOLZ  related that  she and Co-Chair  Zulkosky were                                                               
surprised  to  see  something  as expansive  as  HB  135  dropped                                                               
without getting  any heads  up.   She noted  the bill  includes a                                                               
provision that would allow the  department to implement emergency                                                               
regulations  to cut  rates without  the opportunity  for provider                                                               
comment.   She  inquired  whether the  commissioner designee  has                                                               
consulted  with the  provider  community  and community  partners                                                               
about how these proposals would impact them.                                                                                    
                                                                                                                                
COMMISSIONER CRUM  answered that [DHSS]  has not yet  started the                                                               
consulting process.  This is  the opening, the information is now                                                               
out,  and these  issues  can  now be  addressed.   The  emergency                                                               
regulations in  the bill  are related  specifically to  this act,                                                               
which is an order for [DHSS] to  speed up this process.  If these                                                               
waivers  are  received,  the intent  is  any  regulatory  changes                                                               
necessary on the side [of DHSS].                                                                                                
                                                                                                                                
CO-CHAIR SPOHNHOLZ  noted that the  nurse hotline is  included in                                                               
HB  135.    She  related  that  when  presenting  the  [proposed]                                                               
Medicaid Phase  One reductions  to the  Health &  Social Services                                                               
Finance  Subcommittee  this  year,   DHSS  staff  said  that  the                                                               
department  did not  need legislation  to implement  the proposed                                                               
Phase One  changes.   She asked  what changed  the minds  of [the                                                               
commissioner designee and his staff].                                                                                           
                                                                                                                                
COMMISSIONER CRUM  replied that depending on  the budget received                                                               
from the legislature  and the savings areas  involved, DHSS could                                                               
use dollar savings  in order to save  some of this.   If the full                                                               
proposal  that DHSS  presented moving  forward were  to be,  then                                                               
DHSS would need this budgetary ask to implement those items.                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  advised that, typically, dropping  a piece of                                                               
legislation on roughly day 92  of the legislative session without                                                               
any  consultation is  a recipe  for not  getting the  bill passed                                                               
because there is no way to  get through this level of substantive                                                               
content  in this  amount of  time.   She said  she does  not take                                                               
lightly the  kinds of  proposals made  in this  bill as  they are                                                               
going  to have  broad sweeping  changes.   If  the proposals  are                                                               
good,  then they  warrant the  time to  engage with  the provider                                                               
community  to understand  properly how  to implement  them.   For                                                               
example, earlier  today she decided  to set aside a  fairly small                                                               
bill for a couple of days  to ensure she addressed a concern that                                                               
the provider community  had.  She further advised  that the scope                                                               
of what HB  135 proposes is not even technically  possible to get                                                               
done in this  amount of time unless the  whole provider community                                                               
was lined up in lockstep behind the department.                                                                                 
                                                                                                                                
4:19:20 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY asked  what the largest number  of employees is                                                               
that the commissioner designee has personally supervised.                                                                       
                                                                                                                                
COMMISSIONER  CRUM  responded  he   has  directly  supervised  20                                                               
employees.                                                                                                                      
                                                                                                                                
CO-CHAIR ZULKOSKY noted that a  person might directly supervise a                                                               
certain  number  of  employees and  that  those  employees  might                                                               
directly supervise  other individuals.   She asked  whether there                                                               
is a broader team that the  commissioner designee can speak to on                                                               
a total number of people that he has lead in an organization.                                                                   
                                                                                                                                
COMMISSIONER CRUM answered 75 employees  and said the company had                                                               
offices in a couple states.                                                                                                     
                                                                                                                                
CO-CHAIR ZULKOSKY pointed  out that the Department  of Health and                                                               
Social Services has  more than 3,000 employees  across the state.                                                               
She  noted  there  is  a  big  need  to  travel  around,  as  was                                                               
previously mentioned  by the commissioner designee,  because many                                                               
of  these  employees  are  working  in  diverse  communities  and                                                               
handling  diverse  programs.    She  requested  the  commissioner                                                               
designee to  explain how his management  experience qualifies him                                                               
to lead a department of this size and scope.                                                                                    
                                                                                                                                
COMMISSIONER CRUM replied that coming  from a background of doing                                                               
organizational development strategic  leadership, a manager knows                                                               
that  not much  more than  eight individuals  can be  effectively                                                               
managed unless they are  incredibly high functioning individuals.                                                               
So, he  said, the goal  is to set up  an organization in  which a                                                               
manager has great  deputies that manage the tier  below them, and                                                               
that tier manages the tier  below them.  The organizational comes                                                               
from the top.  It's the  vision a manager works through, creating                                                               
the  employee buy-in,  and the  inspiration  aspect, so  it is  a                                                               
scalable  function across  the board.   He  ran and  worked large                                                               
projects  with 20  direct employees,  but if  talking large-scale                                                               
projects  it added  up  into the  thousands; it  is  a matter  of                                                               
semantics  when  it comes  towards  that.   What  the  leadership                                                               
ability comes from is management at that scalable aspect.                                                                       
                                                                                                                                
4:21:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR stated  that this  is hard  for her  because                                                               
clearly the commissioner designee would  bring a lot of energy to                                                               
the  position,  but  he  doesn't  really  have  a  public  health                                                               
background or a  direct health care or  health policy background.                                                               
While she is trying to be  open minded, she is challenged because                                                               
this  is coming  during an  administration that  she believes  is                                                               
going in  the wrong direction  regarding the health  of Alaskans.                                                               
She cannot separate the commissioner  designee from what she sees                                                               
as heading  in the wrong direction.   She is troubled  that these                                                               
conversations start  with just looking  for every  opportunity to                                                               
cut costs when her vision is  about how to improve health.  While                                                               
it  happens more  slowly than  is wanted,  successfully improving                                                               
health always reduces  cost and she would be  more comfortable if                                                               
that  was the  view [of  the administration].   [Legislators  and                                                               
state employees]  get to  benefit from  state paid  insurance and                                                               
she  doesn't  see anyone  in  the  room  giving up  their  health                                                               
insurance.    Yet needy  Alaskans  who  also have  state  covered                                                               
health insurance  have much more  difficulty in  actually finding                                                               
access to that service and it  seems as if these people are being                                                               
beaten down like  they've done something wrong  while they really                                                               
haven't.  It is the fact  that health care costs are astronomical                                                               
and barely anyone can afford them,  unless lucky enough to have a                                                               
job with good  health insurance [as do the people  in this room].                                                               
Going in the  direction of only seeing people by  dollar signs is                                                               
troubling because  she is so  motivated to improve the  health of                                                               
Alaskans.   The commissioner designee  is a hard worker,  but the                                                               
direction and the vision are challenging for her.                                                                               
                                                                                                                                
4:24:14 PM                                                                                                                    
                                                                                                                                
COMMISSIONER CRUM responded  he 100 percent agrees,  which is why                                                               
any solution that  is put forward will continue to  work with the                                                               
department's current ongoing  Section 1115 Waivers.   The goal of                                                               
the waivers  is to  shift the  dollar spend from  one end  of the                                                               
spectrum to  the other  to provide mechanisms  to treat  the mild                                                               
and moderate  and not always just  pay for the severe.   The goal                                                               
is to  do family resiliency.   A DHSS employee is  being sent for                                                               
the  federal Family  First Prevention  Services Act  and how  can                                                               
Title  IV-E  dollars be  spent  for  getting some  mental  health                                                               
training and  for licensed marriage family  therapists to address                                                               
family issues.   The timing of  HB 135 is unfortunate,  but it is                                                               
going to be  a long-term process of addressing  this together and                                                               
always keeping in  mind that [DHSS] is going  to continue working                                                               
down this  path of providing  this access.  Other  items proposed                                                               
by  DHSS,  like  diagnosis-related  groups  (DRGs),  are  a  move                                                               
towards  a value-based  system to  make sure  there are  improved                                                               
health outcomes for the dollars spent.                                                                                          
                                                                                                                                
4:25:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR offered her  appreciation to the commissioner                                                               
designee for saying  that, but said she doesn't  hear that coming                                                               
from the third floor.   Frequently heard is the term "able-bodied                                                               
individuals," but  many people  work really  hard and  yet cannot                                                               
get ahead  because of the  economics.  Therefore  that philosophy                                                               
troubles her.                                                                                                                   
                                                                                                                                
COMMISSIONER  CRUM said  he  looks forward  to  sharing with  the                                                               
committee the  information about  how this  would work  for those                                                               
able-bodied people, so  they have a chance to  actually get ahead                                                               
if possible; if  not, this is no means of  removing them from the                                                               
program.   This is so  that as they do  grow, they don't  have to                                                               
make that hard decision and [DHSS] can grow along with them.                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ maintained that that is not what HB 135 says.                                                                
                                                                                                                                
4:26:46 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY  recognized that  the committee asks  many hard                                                               
questions,  but said  it is  because  the committee  cares a  lot                                                               
about what  it is  doing.   While the committee  might be  on the                                                               
opposite  side of  the  table  and push  forward  a  lot of  hard                                                               
questions, it  is because the  committee might have  a difference                                                               
of opinion on how to get from Point  A to Point B.  Clearly there                                                               
is a  difference of opinion on  what HB 135 is  actually going to                                                               
do and  how it will  impact the Medicaid expansion  population in                                                               
Alaska.   Alaska is in  a time  of challenging and  lean budgets.                                                               
Medicaid expansion  brings in $27  of federal funds for  every $1                                                               
of state  funds that are  spent.  She requested  the commissioner                                                               
designee  to talk  about his  plan and  vision for  ensuring that                                                               
health coverage for  Alaskans continues in a  time of challenging                                                               
budgets.                                                                                                                        
                                                                                                                                
COMMISSIONER  CRUM answered,   Part  of  our initial  discussions                                                               
with CMS with  a plan like this would actually  to be to maintain                                                               
that 90 percent match for  that Medicaid expansion population for                                                               
the paying  of their  premiums through  the individual  market as                                                               
well as the secondary payer aspect.                                                                                             
                                                                                                                                
CO-CHAIR  ZULKOSKY commented  that if  a state  match is  not put                                                               
forward to leverage  those federal resources, there  might not be                                                               
sustainability of a  system at all.  She said  this appears to be                                                               
a way  to destabilize  the Medicaid  program as a  whole.   It is                                                               
hard to  understand how moving  along this  path is going  to, in                                                               
the long run, preserve the sustainability of this program.                                                                      
                                                                                                                                
4:28:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JACKSON  commended the co-chairs for  being on top                                                               
of the recently  introduced HB 135 and noted she  has not yet had                                                               
the  opportunity to  review the  bill.   She said  Representative                                                               
Tarr really  cares that everyone  needing care is taken  care of.                                                               
Representative Jackson cautioned, however,  that she doesn't want                                                               
to  make it  look  like  the people  in  the administration  have                                                               
anything against a  better tomorrow for all Alaska.   Noting that                                                               
Co-Chair Spohnholz  put forth a bill  that would try to  curb the                                                               
opioid  crisis, she  asked what  is being  done with  Medicaid to                                                               
curb the prescriptions that go out.                                                                                             
                                                                                                                                
COMMISSIONER CRUM  replied DHSS  has a  lot of  processes through                                                               
the Medicaid  program, such as  the Prescription  Drug Monitoring                                                               
Program  (PDMP) and  working with  providers.   He  said DHSS  is                                                               
working with the pharmacy board  about the professional standards                                                               
because it is this very fine  line of individuals in need in pain                                                               
that  have to  be managed  to over-prescription  and how  to deal                                                               
with those issues.   The Department of Public  Safety, the Office                                                               
of Drug  Control Policy  in the governor's  office, and  DHSS are                                                               
addressing this ongoing  issue to make sure  that individuals who                                                               
do need it  can get the proper supply, and  that it is controlled                                                               
thereafter.   Providing  an alternative  means is  something that                                                               
could be explored in the future.                                                                                                
                                                                                                                                
REPRESENTATIVE JACKSON expressed her  concern about people having                                                               
to turn  down raises in  order to  stay on Medicaid  benefits and                                                               
said it  goes hand in hand  with the step down.   Hopefully there                                                               
is a  process for empowering  people to  grow, while at  the same                                                               
time not dropping overnight the  medical benefits that they have.                                                               
She inquired whether the commissioner  designee has any foresight                                                               
on how to do that or working with businesses in this regard.                                                                    
                                                                                                                                
COMMISSIONER CRUM responded  DHSS is working on  that through the                                                               
levers  that it  controls.   Through this  process, part  of this                                                               
waiver would be to find ways  to expand the federal poverty level                                                               
(FPL) so that  as they grow, they  get a little bit  of a subsidy                                                               
as opposed  to just binary  yes or no.   The department  wants to                                                               
make  sure that  it  can expand  along  with them.    One of  the                                                               
primary goals through  this is to make sure  that the able-bodied                                                               
in  this population  can  work, have  the  opportunity to  better                                                               
themselves, and  can take  advantage of  other programs,  such as                                                               
vocational  training  or  vocational rehabilitation,  to  improve                                                               
their economic lot.  That  also helps everything across the board                                                               
with family resiliency to social determinacy of health.                                                                         
                                                                                                                                
4:32:26 PM                                                                                                                    
                                                                                                                                
CO-CHAIR ZULKOSKY reviewed the questions  and answers between the                                                               
committee and the  commissioner designee on 4/13/19  in regard to                                                               
the  Alaska  Psychiatric  Institute  (API)  and  the  sole-source                                                               
contract  that  the  commissioner designee  awarded  to  Wellpath                                                               
Recovery Solutions  ("Wellpath") during  the time he  had invoked                                                               
statutory  authority  for  the  no bid  process.    She  inquired                                                               
whether the  commissioner designee, in his  role as commissioner,                                                               
would be issuing  a competitive request for  proposals (RFPs) for                                                               
Phase Two or the long-term management of API.                                                                                   
                                                                                                                                
COMMISSIONER CRUM responded that when  it comes to patient safety                                                               
and the stability  of the facility, options are on  the table and                                                               
[a competitive  RFP] could be  worth evaluating.   As far  as his                                                               
direct answer on Saturday, he said  he believes it is actually in                                                               
procurement's hands  at this point, given  where it is at  in the                                                               
contract process.                                                                                                               
                                                                                                                                
CO-CHAIR ZULKOSKY  asked whether the commissioner  designee has a                                                               
plan  to return  API back  to state  management once  the initial                                                               
contract term with the private  company for this initial phase is                                                               
over, or whether this move is  intended to be a permanent move to                                                               
privatize API.                                                                                                                  
                                                                                                                                
COMMISSIONER CRUM  answered that at  this point there is  no plan                                                               
to move  it back  into state  control if  Wellpath meets  the key                                                               
performance metrics; however, it is something worth evaluating.                                                                 
                                                                                                                                
CO-CHAIR ZULKOSKY  stated that that  feels a bit  oppositional in                                                               
terms of  the commissioner designee  being willing to  consider a                                                               
competitive RFP,  however there is  not an intention to  bring it                                                               
back to state  management.  But, she added,  she also understands                                                               
that if a competitive RFP were  put forward it wouldn't be coming                                                               
back under  state management.   She urged  that Mr. Crum,  in his                                                               
role  as  commissioner,  use  his   leadership  for  such  a  big                                                               
complicated issue  to put forth  a competitive RFP for  Phase Two                                                               
because there are  a lot of stakeholders in the  state and in the                                                               
community that are  very concerned with how this  initial part of                                                               
the contract came forward.                                                                                                      
                                                                                                                                
4:35:19 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ  opened public  testimony on  the confirmation                                                               
of Mr. Adam Crum as commissioner of DHSS.                                                                                       
                                                                                                                                
4:36:02 PM                                                                                                                    
                                                                                                                                
LIN  DAVIS testified  in opposition  to the  confirmation of  Mr.                                                               
Adam Crum  as commissioner of  DHSS.  She  said she is  a retired                                                               
state worker and spoke as follows:                                                                                              
                                                                                                                                
     Quietly coiling under the  governor's chair, a venomous                                                                    
     philosophy  swells.   Human needs  as burdens.   Common                                                                    
     good too  burdensome.  Under Commissioner  Crum's chair                                                                    
     quietly  coiling.    Cuts  to  Medicaid  through  block                                                                    
     grants.   Cuts to  senior benefits  and no  benefits at                                                                    
     all for May  or June.  Cuts to  Alaskans who experience                                                                    
     chronic  mental illness.   Cuts  to those  so ill  they                                                                    
     need API.  Human needs  and common good too burdensome.                                                                    
     Cut  the  funds  for  domestic  violence  programs  for                                                                    
     opioid  recovery,  for   dental  cleanings  and  cavity                                                                    
     repair.   Human needs  and common good  too burdensome.                                                                    
     Cut all  social services.   Let  PTSD and  suicide ride                                                                    
     the land.  Less of this  and less of that might make us                                                                    
     more the  venom says.  Mr.  Crum in my view  has tried,                                                                    
     but too many  unhealthy results have rolled  out of his                                                                    
     office.  I encourage you not to confirm him.                                                                               
                                                                                                                                
4:38:25 PM                                                                                                                    
                                                                                                                                
TINA WILLIAMS testified in opposition  to the confirmation of Mr.                                                               
Adam Crum as  commissioner of DHSS.    She said she  has 31 years                                                               
of state service  and was chief financial officer  for over eight                                                               
years  at  API.    She  returned June  2018  based  on  an  offer                                                               
requesting  that   she  assist   the  hospital   to  re-establish                                                               
financial infrastructure due to  an ever degrading administrative                                                               
and financial situation of the  last several years.  Placed under                                                               
her  supervision  were   business  office  operations,  financial                                                               
processes,  structure,  reporting,  and after  approximately  one                                                               
week on the job the Human Resource  Section at API.  She was told                                                               
her last day with API would  be 3/1/19, with no explanation.  She                                                               
asked then-Acting CEO Gavin Carmichael  if she could use leave to                                                               
achieve her  final high three  years.  He  had to check,  but the                                                               
answer was no, and she retired with three days' notice.                                                                         
                                                                                                                                
MS.  WILLIAMS said  Governor Dunleavy  and Commissioner  Designee                                                               
Crum rely  on a  team of people  to help steer  the ship.   After                                                               
watching  much of  the House  Finance Committee  presentation, as                                                               
well  as court  testimony,  the story  unfolding  by DHSS  Deputy                                                               
Commissioner  Wall  over  several  weeks  involved  some  changes                                                               
seemingly just as a changing  narrative.  Was there an emergency?                                                               
Was  there an  emergent issue?   Was  there a  reason to  bring a                                                               
vendor from  outside of Alaska  to manage the hospital?   Neither                                                               
the commissioner  nor the deputy commissioner  has had experience                                                               
with running a  hospital.  It is a complicated  department to run                                                               
even without API.  While  she applauds Mr. Crum's business acumen                                                               
and  willingness to  take on  the commissioner  position, she  is                                                               
concerned about Mr.  Crum as the commissioner and Mr.  Al Wall as                                                               
deputy commissioner as they continue  to allow the degradation of                                                               
services  at   the  hospital  and  support   increased  fees  for                                                               
vulnerable  senior citizens  in Alaska's  Pioneer Homes  based on                                                               
the governor's 2020 budget request to the legislature.                                                                          
                                                                                                                                
MS. WILLIAMS  related that the  [API] hospital census  was around                                                               
36 or  37 when  she left  in March.   According to  testimony the                                                               
numbers  last week  were 26  for an  80-bed hospital.   She  said                                                               
continued  pressure to  open  beds to  80  exists throughout  the                                                               
community and  is also demonstrated by  the commissioner's office                                                               
with the Wellpath contract having  this as one of the milestones,                                                               
even  though that  is a  clinical  decision.   The hospital  must                                                               
operate safely  and not  bow to executive  pressure to  open beds                                                               
when    nursing    staff,   psychiatric    nursing    assistants,                                                               
psychiatrists, physicians,  and other licensed  practitioners are                                                               
not   available   while   issues   are   investigated   regarding                                                               
allegations of abuse or neglect from the patient population.                                                                    
                                                                                                                                
MS.  WILLIAMS   recalled  that  according  to   the  commissioner                                                               
designee's 4/13/19  testimony before the committee,  Wellpath was                                                               
vetted  and the  commissioner  designee was  aware of  Wellpath's                                                               
litigation.   She said  this vetting appears  not to  follow good                                                               
business  practice and  also  sets the  state  up for  additional                                                               
litigation  regarding the  procurement practices  that led  up to                                                               
the   approximately   $44   million   contract   with   Wellpath.                                                               
Administrative  and  financial  infrastructure of  the  hospital,                                                               
additional  direct patient  care positions  of psychologists  and                                                               
social  workers,  and  nursing   vacancies  still  exist  at  the                                                               
hospital.   Recruitment for positions  has been off and  on since                                                               
January  2019 where  managers  have been  confused  if they  were                                                               
allowed  to recruit  or not.   Recruitment  for positions  at the                                                               
hospital has  been difficult  and to  find people  interested and                                                               
not  be able  to hire  or  proceed with  the recruitment  process                                                               
ensured that the hospital would  not have the resources needed on                                                               
site to resolve some of the issues.   The place continues to be a                                                               
stressful  environment for  those  who work  in  direct care  and                                                               
supportive positions.   Wellpath's message is that  the jobs must                                                               
be competed  for and  Wellpath's infrastructure  is still  not in                                                               
place or transparent.                                                                                                           
                                                                                                                                
MS.  WILLIAMS  said decisions  were  made  at the  commissioner's                                                               
office level  without API  staff awareness  or involvement.   She                                                               
stated that the  contract terms, amount, and  milestones were not                                                               
provided to the entire executive  team at the hospital, much less                                                               
to her as the CFO prior  to execution.  They actually should have                                                               
been  on  file  at  the  hospital, which  is  a  requirement  for                                                               
surveys.   Failure  to provide  updated contract  information was                                                               
previously cited  and yet Deputy  Commissioner Wall  proceeded to                                                               
keep  it hidden  until the  week that  the first  payment for  $1                                                               
million  was  necessary.   Unless  a  person watches  legislative                                                               
testimony,  one  wouldn't  have  known  that  this  contract  was                                                               
coming.   The Department of  Health and Social Services  has been                                                               
managing  a hospital  from afar  for  several years  and has  not                                                               
understood the  complexities, regulations, and  general processes                                                               
to serve a  diverse and vulnerable in-patient  population.  Every                                                               
time  there  is new  leadership  education  must start  all  over                                                               
versus  taking action  to resolve.   The  department's leadership                                                               
takes credit  for work that  started prior to  the administration                                                               
change.   There was just  no concurrence from DHSS  leadership or                                                               
funding to allow the hospital  to proceed with this contract that                                                               
would  have  helped  staff  and   patients  before  the  Wellpath                                                               
contract.   Shouldn't the goal  be to  provide the best  level of                                                               
care for  the most vulnerable  mentally ill patients?   This will                                                               
be a  milestone that DHSS  will use to celebrate  achievement and                                                               
make a case that Wellpath is working.                                                                                           
                                                                                                                                
MS. WILLIAMS stated that many  of the day-to-day decisions needed                                                               
DHSS  commissioner office  leadership because  there was  lack of                                                               
funding  to  be able  to  manage  and  run the  hospital    daily                                                               
operations.  When  she left the hospital she put  out yet another                                                               
plea  for  additional  funds  to  be  moved  to  the  contractual                                                               
services  and  grant lines  to  pay  for  vendors that  had  been                                                               
providing services, but the commissioner's  office made sure that                                                               
$5 million was  moved from the API personal services  line to pay                                                               
for  a new  contract  with  Wellpath, ignoring  the  rest of  the                                                               
pending obligations.                                                                                                            
                                                                                                                                
MS.  WILLIAMS related  that  Deputy  Commissioner Wall  testified                                                               
during  Judge  Morris's court  hearing  with  the Disability  Law                                                               
Center.   She  said  the  lawsuit continues  to  have a  changing                                                               
narrative  about  immediate  jeopardy, Wellpath,  and  milestones                                                               
without a plan to relieve the  backlog of people waiting for some                                                               
type  of care  or  evaluation  services at  the  hospital.   When                                                               
Deputy  Commissioner  Wall  was   director  of  the  Division  of                                                               
Behavioral  Health, he  did nothing  to resolve  issues with  the                                                               
continuum of care  that would make a positive  and lasting impact                                                               
so  the mentally  ill would  not languish  in jails  or emergency                                                               
rooms.   The backlog existed  when Mr.  Wall was in  his previous                                                               
position and  the hospital reported  directly to the  Division of                                                               
Behavioral Health, whose agenda then  and now is to privatize the                                                               
hospital.                                                                                                                       
                                                                                                                                
MS. WILLIAMS  concluded by  saying that  the confirmation  of Mr.                                                               
Crum  would  not  be  in  the  state's  best  interest  with  his                                                               
selection of Mr. Wall for deputy commissioner.                                                                                  
                                                                                                                                
4:45:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE DRUMMOND  thanked Ms.  Williams for  her testimony                                                               
and requested a written copy.                                                                                                   
                                                                                                                                
4:46:32 PM                                                                                                                    
                                                                                                                                
KEN HELANDER, Advocacy Director,  American Association of Retired                                                               
Persons   (AARP)  Alaska,   testified   in   opposition  to   the                                                               
confirmation  of Mr.  Adam  Crum  as commissioner  of  DHSS.   He                                                               
stated  it isn't  customary for  his organization  to comment  on                                                               
administrative appointments,  but this was changed  by the recent                                                               
abrupt  action by  DHSS that  directly affects  low income  older                                                               
Alaskans  who will  not receive  a  May or  June senior  benefits                                                               
payment.    This  action, without  forewarning,  raised  numerous                                                               
questions  of  its  necessity, management  of  the  process,  and                                                               
concern for  the wellbeing  of those affected.   The  position of                                                               
commissioner is  a position of  public trust that brings  with it                                                               
the necessary burden  of concern for people in need  and in pain.                                                               
The job  of committee members is  to vote whether to  advance Mr.                                                               
Crum's confirmation.   His job as an advocate  for older Alaskans                                                               
is to always hold the commissioner accountable.                                                                                 
                                                                                                                                
MR. HELANDER  stated that every  action taken by  the department,                                                               
like the unfortunate one taken  against senior beneficiaries last                                                               
week,  has an  impact  on  real lives  in  real situations  being                                                               
played out all over  Alaska every day.  It is  not enough for the                                                               
commissioner  to  execute the  agenda  of  the administration  to                                                               
reduce spending.   It  is at least  equally important  to ensure,                                                               
regardless of  the cut,  that the wellbeing  of every  Alaskan is                                                               
protected and supported.   Each cut affects persons  in some kind                                                               
of  need.   Every cut  affects the  job of  someone helping  that                                                               
person in need.   Without well-managed public  services, who will                                                               
tend to those  in need?  Will the commissioner?   Will the people                                                               
in the  department?  Will the  governor?  Those Alaskans  will be                                                               
tended by families,  friends, neighbors, and by  scores of public                                                               
and  private  organizations established  to  ensure  that no  one                                                               
falls through a hole in the safety net.                                                                                         
                                                                                                                                
MR. HELANDER said  AARP Alaska will be  watching the commissioner                                                               
and his department in the  execution of their responsibilities to                                                               
Alaskans.  The commissioner's salary  comes from the same coffers                                                               
as do  the funds  that support  Alaskans in need.   On  behalf of                                                               
those in need and  on behalf of those who help  those in need and                                                               
on behalf of  AARP's 85,000 members, AARP Alaska  pledges to hold                                                               
Mr. Crum  accountable for  every action.   AARP Alaska  urges Mr.                                                               
Crum to listen  as intently for the real human  needs and to look                                                               
as  closely at  the human  dignity displayed  as he  does to  the                                                               
administration that  has nominated him  for this position.   Only                                                               
then  can  the commissioner  warrant  the  public trust  that  is                                                               
essential for the health and wellbeing of all Alaskans.                                                                         
                                                                                                                                
4:49:49 PM                                                                                                                    
                                                                                                                                
VINCE  BELTRAMI,  President,  American Federation  of  Labor  and                                                               
Congress  of  Industrial  Organizations (AFL-CIO),  testified  in                                                               
opposition to the  confirmation of Mr. Adam  Crum as commissioner                                                               
of DHSS.   He noted that his organization  represents over 50,000                                                               
members in  the state.   During his 12 years  at this job  he has                                                               
never before felt compelled to  testify against the nomination of                                                               
any commissioner because generally  he thinks the governor should                                                               
get to choose  his people.  However, this governor  has made some                                                               
odd choices in  commissioners that did not stand  the scrutiny of                                                               
a process and that  is the job of legislators.   He is here today                                                               
because  standing   up  for  collective  bargaining   rights  and                                                               
contracts is his job.                                                                                                           
                                                                                                                                
MR. BELTRAMI said  this commissioner designee has  made himself a                                                               
target  by  engaging  in  some   very  dubious  actions.    If  a                                                               
commissioner designee cannot  abide by the law, he  or she should                                                               
not be  confirmed.  Yesterday, the  Alaska Employees Association,                                                               
an  AFL-CIO affiliated  union, filed  a request  for a  temporary                                                               
restraining order  on the  illegal contract  entered into  by the                                                               
commissioner  designee with  Wellpath.    This contract  violates                                                               
long-standing provisions of [the  state's] contracts that clearly                                                               
lay  out how  any efforts  to  privatize state  services must  be                                                               
conducted.   [The state's] contracts,  these rules, are  the law.                                                               
It doesn't  matter if the  law is broken through  incompetence or                                                               
intent.   Mr.  Crum  doesn't  even officially  have  the job  and                                                               
already the  rules are being  disregarded.  If  this commissioner                                                               
designee will  violate the collective bargaining  agreement, what                                                               
other provisions of law would he disregard?                                                                                     
                                                                                                                                
MR.  BELTRAMI stated  that legally  and competently  managing the                                                               
largest department  in Alaska  government is  the charge  of this                                                               
position  and it  is  off to  a  very bad  start.   Dealing  with                                                               
employment and contracts should be  the easiest part of this very                                                               
complicated job.   Complying with the myriad of  federal laws and                                                               
rules that  govern the department  is more complicated,  but also                                                               
not  negotiable.     This  violation  of   collective  bargaining                                                               
agreements should give everyone  pause and cause reflection about                                                               
whether a  violation on the  least complicated aspect of  the job                                                               
doesn't foreshadow  future problems.  He  urged committee members                                                               
to oppose the confirmation of Mr. Crum.                                                                                         
                                                                                                                                
4:52:28 PM                                                                                                                    
                                                                                                                                
DAWN BUNDICK, testified in opposition  to the confirmation of Mr.                                                               
Adam  Crum as  commissioner of  DHSS.   She said  she has  been a                                                               
public servant for  many years working for Alaskans.   She stated                                                               
that  Mr. Crum  is not  a person  who is  looking to  protect the                                                               
health  and human  services  of  Alaskans.   He  has allowed  the                                                               
Senior Benefits Program funding  to expire without legislative or                                                               
public notice.   He is  committing a crisis to  support budgetary                                                               
plans  to  eliminate  senior benefits  altogether.    Her  mother                                                               
received a letter  saying that her senior benefits  would be cut,                                                               
and this has  affected her making ends meet.   The public elected                                                               
the  committee members  as stewards  for Alaskans  and protecting                                                               
in-state jobs and  families.  She asked the  committee members to                                                               
oppose  the confirmation  of Mr.  Crum and  stated, "people,  not                                                               
profits.                                                                                                                        
                                                                                                                                
4:53:54 PM                                                                                                                    
                                                                                                                                
JAN CAROLINE-HARDY  testified in  opposition to  the confirmation                                                               
of Mr.  Adam Crum as  commissioner of DHSS.   She said  she works                                                               
for the Department  of Transportation & Public  Facilities and is                                                               
testifying for  herself and seven  DHSS employees who  are unable                                                               
to  testify for  fear of  retribution.   She  opposes Mr.  Crum's                                                               
confirmation  for  at  least  three reasons.    First,  Mr.  Crum                                                               
initiated  a sole-source  privatization  contract  with API  that                                                               
disregards  current employee  rights, future  Alaskan employment,                                                               
and patient  rights.  Outsourcing  steals Alaskan jobs.   Second,                                                               
Mr. Crum does not have the  best interests of Alaska's elders and                                                               
vulnerable populations.   He broke  faith with them  by rejecting                                                               
Medicaid block  grant funds, which  would help alleviate  some of                                                               
the  extraordinarily  high costs  of  health  care.   How  should                                                               
Alaska's  most vulnerable  citizens be  entrusted to  someone who                                                               
has  only shown  a pattern  of  cutting and  privatization?   The                                                               
third reason strikes her personally.   She is a 70-year-old woman                                                               
with no family.   Her retirement income plus  Social Security was                                                               
insufficient  to  live  on  without  making  sacrifices,  so  she                                                               
returned to work  at age 70.   With no family and no  one to take                                                               
care of her  when she becomes incapacitated, she will  have to go                                                               
to the  Pioneer Home for her  final years, months, or  days.  She                                                               
could afford  to reside there at  the current level of  cost, but                                                               
with the  fees now being raised  to 140 percent of  today's costs                                                               
it will be  impossible.  Is this how to  treat Alaska's pioneers?                                                               
Outsourcing  and cutting  benefits for  Alaska's most  vulnerable                                                               
population is criminal, immoral, and vicious.                                                                                   
                                                                                                                                
4:56:15 PM                                                                                                                    
                                                                                                                                
BEV GAJARING testified  she opposes the confirmation  of Mr. Adam                                                               
Crum as commissioner of DHSS  because he supports the outsourcing                                                               
privatization of  API.  She said  she has family and  friends who                                                               
are at risk of losing their jobs  at API if Mr. Crum is confirmed                                                               
because  he  will privatize  the  facility.   Privatization  will                                                               
cause them to  lose their homes, benefits,  take other positions,                                                               
or relocate.   Mr. Crum has no vested interest  in the persons of                                                               
the  public sector  and  its  employees because  he  has no  real                                                               
experience in the Department of  Health and Social Services.  How                                                               
can an  individual be relied  upon to run  DHSS who is  unable to                                                               
relate  to  its employees  or  patients?   Alaskan's  health  and                                                               
social services  should not  be up  for profit  or privatization.                                                               
Someone is  needed who  is willing  to put his  or her  best foot                                                               
forward in  securing DHSS in  the right direction and  by finding                                                               
ways that will  benefit and protect employees,  patients, and the                                                               
vulnerable population.   Mr. Crum is  not the person.   She urged                                                               
the committee to stand by her  and those in the communities whose                                                               
lives  are  in  jeopardy  and  cast a  no  vote  for  Mr.  Crum's                                                               
confirmation.                                                                                                                   
                                                                                                                                
4:58:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JACKSON asked whether Ms. Gajaring works for API.                                                                
                                                                                                                                
MS. GAJARING replied no, family and friends.                                                                                    
                                                                                                                                
REPRESENTATIVE JACKSON pointed out the  threat of API closing and                                                               
asked  whether those  people would  have lost  their jobs  either                                                               
way.                                                                                                                            
                                                                                                                                
MS. GAJARING responded  they would end up losing their  jobs.  If                                                               
it is no longer  API and Wellpath takes over, who  is to say that                                                               
Wellpath will  hire them?  There  are also others who  are of age                                                               
and how can they be guaranteed job security?                                                                                    
                                                                                                                                
4:58:51 PM                                                                                                                    
                                                                                                                                
JENNIFER  CUNNINGHAM testified  she opposes  the confirmation  of                                                               
Mr.  Adam  Crum as  commissioner  of  DHSS  because he  has  zero                                                               
experience in health and human  services or working in the public                                                               
sector.   She stated she has  worked at API for  three years, and                                                               
in this job,  she has been assaulted twice.   She has a traumatic                                                               
brain injury and these assaults  have had a deleterious effect on                                                               
her  life,  including   headaches,  post-traumatic  stress  (PTS)                                                               
episodes, short-term memory loss,  and panic attacks, which makes                                                               
her feel overwhelmed  with her family and in the  community.  She                                                               
has  increased  her  current  medication  because  of  the  brain                                                               
injury.  She loves her job  and further assaults could make her a                                                               
quadriplegic or dead.   She fears that supporting  Mr. Crum would                                                               
lead to job losses and increased  risk of danger to API staff and                                                               
patients.  She does not believe  that Mr. Crum has the knowledge,                                                               
interest, or  skills in  protecting her or  her co-workers.   She                                                               
urged the committee to vote no on Mr. Crum's confirmation.                                                                      
                                                                                                                                
5:00:34 PM                                                                                                                    
                                                                                                                                
MARK NELSON  testified in opposition  to the confirmation  of Mr.                                                               
Adam Crum as  commissioner of DHSS.   He addressed Representative                                                               
Pruitt's statement that was made  during the 4/13/19 confirmation                                                               
hearing that  Mr. Crum's politics  shouldn't have anything  to do                                                               
with whether he  is confirmed as commissioner  since politics are                                                               
not involved in  any of the decision making process.   Mr. Nelson                                                               
therefore looked at  Mr. Crum's qualifications related  to API as                                                               
a sample of the  commissioner designee's work, knowledge, skills,                                                               
and abilities.  He recalled  that according to an earlier hearing                                                               
there was some  sort of jeopardy at API in  early February [2019]                                                               
at which time  the commissioner designee invoked  a statute where                                                               
he was  "stepping in,"  so it  appears the  commissioner designee                                                               
didn't even  realize that he  is in charge  of API.   Stepping in                                                               
and  having a  private company  come to  facilitate the  hospital                                                               
means Mr.  Crum doesn't have the  ability to do it  himself.  The                                                               
CEO  and  staff   of  API  answer  to  the   commissioner.    The                                                               
commissioner  designee has  been in  charge since  early December                                                               
[2018].   Since that time, the  API CEO and all  six doctors have                                                               
left  their  positions.    According  to  the  hearings  this  is                                                               
unprecedented.   This  should be  a red  flag.   The commissioner                                                               
designee  appointed dozens  of people  into positions  within the                                                               
division, yet  for the  number one sore  spot under  his command,                                                               
API, the commissioner designee failed  to appoint a CEO, which by                                                               
his   own  testimony   was  the   reason  why   API  was   having                                                               
difficulties.                                                                                                                   
                                                                                                                                
MR. NELSON  recalled that the commissioner  designee testified on                                                               
4/13/19 that  having a workweek  of 60 hours would  be wonderful.                                                               
He maintained that this indicates Mr.  Crum is over his head.  He                                                               
further  maintained  that Mr.  Crum  doesn't  understand that  as                                                               
commissioner of DHSS he is dealing  with life and death.  This is                                                               
not sitting across  from a teenager as a volunteer.   Mr. Crum is                                                               
taking money away  from elderly people who die if  they don't get                                                               
their  medications.   An  elderly person  who  doesn't get  money                                                               
cannot afford  heat and  gets pneumonia  and dies.   This  is not                                                               
appointing the  CEO at API  and a  person kills themselves.   Mr.                                                               
Crum is not qualified and should not be confirmed.                                                                              
                                                                                                                                
5:03:45 PM                                                                                                                    
                                                                                                                                
MAUREEN SUTTMAN  testified in opposition  to the  confirmation of                                                               
Mr.  Adam Crum  as commissioner  of DHSS.   She  stated she  is a                                                               
retired  licensed professional  counselor and,  surprisingly, she                                                               
is  also a  Medicaid  recipient because  she  wasn't making  much                                                               
money when  she got a  diagnosis of  stage four cancer  two years                                                               
ago.  While  Mr. Crum has sparkling good college  degrees, he has                                                               
absolutely no  work experience in  the health field, which  is of                                                               
concern for  someone who is  heading up the Department  of Health                                                               
and Social Services.  There is so  much to know and when a person                                                               
doesn't  have the  work  experience  to know,  that  is when  the                                                               
person runs  into legal concerns, which  Mr. Crum has done.   She                                                               
noted she has  a master's degree and has worked  in mental health                                                               
with  a  variety  of  populations   across  the  state,  and  the                                                               
populations  are  a concern  because  she  hasn't heard  anything                                                               
about stakeholders.  Rather, she  is hearing business ideology by                                                               
a political  placement from a governor  who has a certain  way of                                                               
looking  at  things.    Alaska  has  high  cultural  needs,  high                                                               
transition  needs  in and  out  of  treatment, and  high  ongoing                                                               
treatment  needs.   These are  not being  attacked from  a health                                                               
perspective  but from  a business  and  money perspective,  which                                                               
concerns her.  Mr. Crum is not qualified.                                                                                       
                                                                                                                                
5:06:27 PM                                                                                                                    
                                                                                                                                
BECKY SEWELL testified  in opposition to the  confirmation of Mr.                                                               
Adam Crum  as commissioner of DHSS.   She stated she  has her own                                                               
business  working out  of her  home.   She  shared a  story of  a                                                               
friend working for  API that began in late December  [2018].  The                                                               
story started with  API requesting that the State  of Alaska fund                                                               
API appropriately  to cover the  salaries of nurses and  to cover                                                               
the hiring of more staff to  keep staff safe around patients.  It                                                               
all  started   with  staff  safety  because   the  patients  were                                                               
physically  aggressive and  there  wasn't enough  staff to  cover                                                               
that.   Her friend states  that the  nurses  salaries are  $10 an                                                               
hour less than  the other hospitals in Anchorage,  along with API                                                               
being the only  hospital in Anchorage where staff gets  hurt on a                                                               
regular  basis.    These  are  really dedicated  people.    In  a                                                               
previous legislative hearing Mr. Crum  said there were six deaths                                                               
at API  in 2018.   But,  she maintained, that  is untrue  - there                                                               
were no  deaths at API.   Both  Mr. Crum and  Deputy Commissioner                                                               
Wall have done a lot of things  in secret.  She doesn't trust Mr.                                                               
Crum and thinks he should not become commissioner.                                                                              
                                                                                                                                
5:09:07 PM                                                                                                                    
                                                                                                                                
KAREN CAMERON testified in opposition  to the confirmation of Mr.                                                               
Adam Crum  as commissioner of DHSS.   She said her  opposition is                                                               
based  on  lack of  integrity  and  not having  the  professional                                                               
experience and expertise to do  the job as a health commissioner.                                                               
Mr. Crum  has misstated  his education and  work experience.   He                                                               
doesn't   have  a   degree  in   health   services  or   hospital                                                               
administration.   The  degree is  in something  called industrial                                                               
hygiene  and his  work experience,  self-described,  was a  truck                                                               
driver  and  he was  working  for  his  father  at that  time  at                                                               
Northern Industrial Training.  Neither  of these qualifies him to                                                               
be  a hospital  administrator  or  health systems  administrator.                                                               
Regarding lack  of integrity,  one of the  first things  Mr. Crum                                                               
did was to  award a contract of $1 billion  contract to Wellpath,                                                               
a Nashville, Tennessee, company  with massive financial and legal                                                               
problems.  Wellpath's experience  is not in psychiatric hospitals                                                               
but in prisons,  jails, and detention centers.   This contract is                                                               
a  giveaway  while  Governor  Dunleavy   is  trying  to  restrain                                                               
spending    it  looks like  a quarter  of a  billion dollars  was                                                               
given  away   in  one  day   without  any  public   testimony  or                                                               
transparency.  There are so many  very real problems in the state                                                               
in  terms of  health and  nothing  has been  heard about  revenue                                                               
generation  or  coming up  with  contracts  and grants  that  are                                                               
available to  the state.  Mr.  Crum and Mr. Wall  feel it doesn't                                                               
make any  difference what  they do  as long as  they cut  DHSS 40                                                               
percent.  The people, patients, and employees deserve better.                                                                   
                                                                                                                                
5:12:30 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ closed public testimony.                                                                                     
                                                                                                                                
5:13:09 PM                                                                                                                    
                                                                                                                                
CO-CHAIR SPOHNHOLZ noted that since  the committee's last meeting                                                               
a  lawsuit  was filed  against  the  state  by the  Alaska  State                                                               
Employees Association alleging that  DHSS violated its bargaining                                                               
agreement,  state   law,  and  the  state   constitution  as  the                                                               
department  seeks  to privatize  operations  at  API.   Lawmakers                                                               
cautioned  the  commissioner  designee that  privatization  of  a                                                               
public  facility  must be  done  with  the  utmost care  and  due                                                               
diligence to prevent  lawsuits as well as to ensure  safety.  Yet                                                               
the commissioner  designee proceeded and  now the state  is being                                                               
sued.   The  inadequate process  and lack  of complying  with the                                                               
contracts  in state  law  now jeopardizes  the  facility and  its                                                               
ability to do  what it needs to do and  has created new liability                                                               
for the  state on which resources  are now being spent  to defend                                                               
against a lawsuit  that was preventable if this  same process had                                                               
been conducted  in a  slower, more deliberative  way.   She asked                                                               
what the  commissioner designee's plan  is for moving  forward in                                                               
regard to this lawsuit.                                                                                                         
                                                                                                                                
COMMISSIONER CRUM  replied that the department  is evaluating the                                                               
lawsuit and  he cannot  comment on pending  litigation.   He said                                                               
that  throughout this  process  his primary  concern was  patient                                                               
safety, which  led to where things  are now.  It  was faster than                                                               
the department  would have liked,  but DHSS believes  the process                                                               
was upheld and  that it had everyone involved and  it was done in                                                               
the correct way.                                                                                                                
                                                                                                                                
CO-CHAIR SPOHNHOLZ stated she respectfully disagrees.                                                                           
                                                                                                                                
CO-CHAIR SPOHNHOLZ recounted that  on [4/12/19] DHSS announced it                                                               
would not  be paying out senior  benefits to the highest  tier of                                                               
recipients for  [the months  of May  and June].   On  4/13/19 the                                                               
committee asked  the commissioner  designee whether he  would ask                                                               
for a supplemental or be  able to move funds between allocations,                                                               
which the  commissioner has the authority  to do.  At  that point                                                               
the commissioner  designee hadn't  had time  to figure  this out.                                                               
She  asked  whether  the  commissioner  designee  would  like  to                                                               
comment  now that  he has  had  two additional  business days  to                                                               
research the issue.                                                                                                             
                                                                                                                                
COMMISSIONER CRUM responded that the  issue of senior benefits is                                                               
frustrating, particularly  for those involved knowing  that it is                                                               
a very vulnerable population and  how much they depend upon those                                                               
funds.   The  department  followed a  process  based on  previous                                                               
years  precedence in  how the  payments  had either  been cut  or                                                               
stopped,  as  well  as  following   legislative  guidance.    The                                                               
department is  evaluating this and  still trying to see  if there                                                               
are available funds  amongst programs.  It is not  an easy ask to                                                               
see who  has extra funds  that could be  moved over as  the other                                                               
programs must still  be projected for the rest of  the year.  All                                                               
programs  deal with  a vulnerable  and needy  population.   It is                                                               
unfortunate  the way  the  guidance  went out  on  that, but  the                                                               
department was trying to do that  in advance.  One thing DHSS has                                                               
control  over   is  that  perhaps  with   these  populations  the                                                               
department can  do an  expedited review  process, and  perhaps if                                                               
they do  qualify, DHSS can mitigate  it a bit by  having enhanced                                                               
Supplemental Nutrition Assistance Program (SNAP) benefits.                                                                      
                                                                                                                                
CO-CHAIR  SPOHNHOLZ offered  her  understanding  that the  Senior                                                               
Benefits Program only  needs $800,000 to fully fund  the top tier                                                               
benefits for  the rest of  the [fiscal]  year.  She  surmised the                                                               
commissioner designee is  saying that with a  $3.4 billion budget                                                               
he cannot find $800,000.                                                                                                        
                                                                                                                                
COMMISSIONER  CRUM  answered DHSS  does  not  have discretion  to                                                               
transfer any  funds away  from the Medicaid  side, so  the entire                                                               
dollar amount  must be extracted  out of  that.  To  continue the                                                               
process to  make sure,  DHSS must  do projections  throughout the                                                               
end of the fiscal year to  see how that program would be affected                                                               
if dollars are found and there are no unintended consequences.                                                                  
                                                                                                                                
CO-CHAIR SPOHNHOLZ remarked that for  someone who has been making                                                               
the pitch that his qualifications,  while not based on experience                                                               
in the health  care arena, health care policy,  or public sector,                                                               
include  organizational development  and  business expertise,  it                                                               
would seem  a small matter to  find $800,000 in a  budget that is                                                               
this large when talking about seniors  who count on this money to                                                               
pay for heating, food, and prescription medications.                                                                            
                                                                                                                                
COMMISSIONER CRUM replied that the  situation is not an easy one.                                                               
He said  this was the  budget given  to the department  last year                                                               
and  DHSS  has  followed  its guidelines  to  manage  within  the                                                               
appropriations.  His goal through next  year is to have more open                                                               
dialogue so that this doesn't sneak up on the department.                                                                       
                                                                                                                                
CO-CHAIR SPOHNHOLZ concurred that that would be wise.                                                                           
                                                                                                                                
5:18:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR said  she is struck that  a supplemental bill                                                               
hasn't come  out to cover this.   Given the amount  of discussion                                                               
with legislators,  it seems this  alternative would  have support                                                               
and  so  she  doesn't  understand why  the  problem  wouldn't  be                                                               
resolved  this  way.   Under  these  circumstances it  seems  the                                                               
commissioner  designee,  as  the   leader,  would  want  to  have                                                               
supplemental legislation dropped tomorrow  to resolve this short-                                                               
term problem  and then move  forward with looking at  a long-term                                                               
solution.                                                                                                                       
                                                                                                                                
COMMISSIONER CRUM responded  DHSS is still trying to  find out if                                                               
there  are  possible  dollars.    If  the  legislature  wants  to                                                               
expedite the  process with a  supplemental, the  department would                                                               
use that accordingly.                                                                                                           
                                                                                                                                
REPRESENTATIVE TARR stated she is  one of about 635,000 permanent                                                               
fund dividend  (PFD) recipients.   This would be under  $1.50 per                                                               
person  to cover  and  she  is willing  to  contribute the  $1.50                                                               
necessary to support the state's seniors.                                                                                       
                                                                                                                                
5:20:16 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY said  the commissioner  of DHSS  should ensure                                                               
that  every  legislative tool  in  the  toolbox is  leveraged  to                                                               
resolve  relatively small  fixes in  the grand  scheme of  things                                                               
within the  department.  Making  sure that any individual  who is                                                               
carrying the mantle for seniors  and people with disabilities and                                                               
those who don't  have the resources to benefit  from systems that                                                               
many others  have been  privileged to benefit  from is  where the                                                               
challenge is.   She echoed the concerns of her  colleagues on the                                                               
committee.                                                                                                                      
                                                                                                                                
CO-CHAIR  SPOHNHOLZ thanked  the  commissioner  designee for  his                                                               
testimony and engaging  in a rigorous conversation.   She offered                                                               
her understanding that this was not  easy, but said this is a big                                                               
job that Mr. Crum  is applying for and sometimes a  big job has a                                                               
tough interview process.                                                                                                        
                                                                                                                                
5:21:43 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  ZULKOSKY  moved to  advance  the  confirmation of  Adam                                                               
Crum, designee  as Commissioner of  the Department of  Health and                                                               
Social  Services, to  a  joint session  for  consideration.   She                                                               
reminded  the  committee  that   signing  the  reports  regarding                                                               
appointments  to  boards  and  commissions  in  no  way  reflects                                                               
individual members'  approval or  disapproval of  the appointees,                                                               
and the nominations are merely  forwarded to the full legislature                                                               
for confirmation  or rejection.   There  being no  objection, the                                                               
confirmation was advanced.                                                                                                      
                                                                                                                                
5:22:39 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health and Social Services Standing Committee meeting was                                                                       
adjourned at 5:22 p.m.                                                                                                          
                                                                                                                                

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