03/07/2017 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Substance Abuse Treatment System in Ak | |
| HB138 | |
| HB43 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | HB 138 | TELECONFERENCED | |
| += | HB 43 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 7, 2017
3:07 p.m.
MEMBERS PRESENT
Representative Ivy Spohnholz, Chair
Representative Bryce Edgmon, Vice Chair
Representative Sam Kito
Representative Geran Tarr
Representative David Eastman
Representative Jennifer Johnston
Representative Colleen Sullivan-Leonard
Representative Dan Saddler (alternate)
MEMBERS ABSENT
Representative Matt Claman (alternate)
COMMITTEE CALENDAR
PRESENTATION: SUBSTANCE ABUSE TREATMENT SYSTEM IN AK
- HEARD
HOUSE BILL NO. 138
"An Act establishing the month of March as Sobriety Awareness
Month."
- HEARD & HELD
HOUSE BILL NO. 43
"An Act relating to prescribing, dispensing, and administering
an investigational drug, biological product, or device by
physicians for patients who are terminally ill; providing
immunity related to manufacturing, distributing, or providing
investigational drugs, biological products, or devices; and
relating to licensed health care facility requirements."
- MOVED HB 43 OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 138
SHORT TITLE: MARCH: SOBRIETY AWARENESS MONTH
SPONSOR(s): REPRESENTATIVE(s) WESTLAKE
02/22/17 (H) READ THE FIRST TIME - REFERRALS
02/22/17 (H) HSS, CRA
03/07/17 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 43
SHORT TITLE: NEW DRUGS FOR THE TERMINALLY ILL
SPONSOR(s): REPRESENTATIVE(s) GRENN
01/18/17 (H) PREFILE RELEASED 1/13/17
01/18/17 (H) READ THE FIRST TIME - REFERRALS
01/18/17 (H) HSS, JUD
02/28/17 (H) HSS AT 3:00 PM CAPITOL 106
02/28/17 (H) Heard & Held
02/28/17 (H) MINUTE(HSS)
03/02/17 (H) HSS AT 3:00 PM CAPITOL 106
03/02/17 (H) Heard & Held
03/02/17 (H) MINUTE(HSS)
03/07/17 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
TOM CHARD, Executive Director
Alaska Behavioral Health Association
Juneau, Alaska
POSITION STATEMENT: Presented a PowerPoint about the substance
abuse treatment system in Alaska.
KATE BURKHART, Executive Director
Advisory Board on Alcoholism & Drug Abuse
Division of Behavioral Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Presented a PowerPoint about the substance
abuse treatment system in Alaska.
REPRESENTATIVE DEAN WESTLAKE
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 138, as the sponsor of the
bill.
FORREST WOLFE, Staff
Representative Dean Westlake
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Explained HB 38 on behalf of the bill
sponsor, Representative Westlake.
GREGORY NOTHSTINE, President
Sobermute Reviving Our Spirit
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 138.
BROOKE IVY, Staff
Representative Jason Grenn
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Recapped HB 43 on behalf of the bill
sponsor, Representative Grenn.
ACTION NARRATIVE
3:07:32 PM
CHAIR IVY SPOHNHOLZ called the House Health and Social Services
Standing Committee meeting to order at 3:07 p.m.
Representatives Spohnholz, Sullivan-Leonard, Johnston, Eastman,
Edgmon, Kito, and Saddler (alternate) were present at the call
to order. Representative Tarr arrived as the meeting was in
progress.
^Presentation: Substance Abuse Treatment System in AK
Presentation: Substance Abuse Treatment System in AK
3:08:25 PM
CHAIR SPOHNHOLZ announced that the first order of business would
be a presentation on the substance abuse treatment system in
Alaska. She noted that the committee had recently focused on
the opioid epidemic in Alaska, which deserved a lot of
attention. She reminded the committee that the number one drug
of choice in Alaska remained alcohol, and this was a huge drain
on the state. She referenced a 2012 study by the McDowell Group
which found that, in 2009, 9.5 percent of the Alaska population,
ages 12 and older, were dependent on or abusing alcohol and
drugs. She reported that, in 2010, this cost the economy $1.2
billion. She pointed out that this was a legal, over the
counter drug.
3:12:12 PM
TOM CHARD, Executive Director, Alaska Behavioral Health
Association, explained that the Alaska Behavioral Health
Association was "a trade association of sorts, made up of mental
health and drug and alcohol [treatment] providers across the
state." He reported that there were about 60 members, both for-
profit, non-profit, tribal, and non-tribal providers, and the
association served all ages.
3:12:53 PM
KATE BURKHART, Executive Director, Advisory Board on Alcoholism
& Drug Abuse, Division of Behavioral Health, Department of
Health and Social Services, stated that they would provide an
overview of the substance use disorder treatment system. She
said they would tell a story based on information from people
who had made the journey toward recovery, and provided an
overview for how the system worked, its strengths its and
weaknesses. She added that they would also share the provider
perspective. She estimated that about 11.5 percent of Alaskan
adults needed substance use disorder treatment, and of those
people, more than one third had a co-occurring mental illness,
which made treatment that much more complicated. She reported
that mental health disorders and substance use disorders "travel
together more often than they travel apart."
REPRESENTATIVE JOHNSTON asked about the methodology for this
estimate.
MR. CHARD replied that the National Survey on Drug Use and
Health contacted individuals and asked them questions and, based
on a clinical approach, determined who might be substance abuse
dependent and might have a disorder. He explained that this
statistical study used research to determine a trend basis and a
state by state comparison for Alaska.
REPRESENTATIVE JOHNSTON asked if these were random telephone
surveys.
MR. CHARD explained that the surveys were statistically
randomized and were oversampled to ensure that they were
statistically valid.
REPRESENTATIVE EASTMAN asked how old the survey results were and
what the Alaska ranking was among states.
MS. BURKHART replied that these were the most current survey
results and that she would follow up with the state ranking.
MR. CHARD offered his belief that these were the survey results
from 2014 and 2015. He addressed slides 3 - 4, "Setting the
Stage," and pointed out that the state funded programs only
provided treatment to 7,808 people. He noted that, although
there were private practitioners that did not receive state
funds, the current discussion would focus on public source
funds.
REPRESENTATIVE JOHNSTON asked if this included tribal funding.
MR. CHARD expressed his agreement.
3:18:09 PM
MS. BURKHART continued with slide 4, and stated that, based on
the Behavioral Risk Factor Surveillance System and questions
based on Adverse Childhood Experiences, 66 percent of Alaskans
reported one or more adverse childhood experience. She reported
that these experiences could range from the death of a parent,
to child abuse and neglect, or incarceration of a parent. She
reported that 21.4 percent of Alaskan adults reported growing up
in a household with one or more adults experiencing mental
illness; that 29.7 percent of Alaskan adults reported growing up
in a household with one or more adults abusing alcohol or other
drugs; and, that 19.5 percent of all Alaskan adults reported
four or more adverse childhood experiences while growing up.
She called this the dose response, as the more you had in your
life, there was a compounding effect.
MS. BURKHART turned to slide 5, "Martha's Story," and introduced
Martha, a fictional composite Alaskan, who is 30 years old,
lives in a small rural community in Western Alaska, and
experiences the consequences of significant childhood trauma and
untreated depression, a moderate mental health disorder. She
lives with her mother, who is also dependent on alcohol. Martha
was convicted of DUI five years ago. She is a frequent user of
the health clinic, seeking relief for a host of physical
ailments and pain. She meets periodically with the itinerant
mental health provider.
MR. CHARD addressed slide 6, "Missed Opportunities," and listed
the mother's dependence on alcohol, the adverse childhood
experiences, and the DUI as examples of missed opportunities for
early intervention and a much more cost effective treatment
outcome to mitigate the impact of the problems.
MS. BURKHART stated it was important to understand that the
current substance abuse disorder treatment was funded and
designed to serve the most acutely addicted, and that there was
not a system designed for early opportunities for intervention.
She explained that this was not a linear process, but was more
"herky-jerky." She stated that Martha was at the pre-readiness
stage, slide 7, as she knows that she has a problem and she was
scared of the pain of opioid withdrawal and the fact that she
was desperate enough to consider using street drugs. She was
also scared that, when she tried to stop using opioids, she had
thoughts of suicide, and she had no one to talk to. Martha has
an appointment at the health clinic and the provider, who knows
Martha well, administered a substance abuse screening as part of
the appointment. Their conversation, supported by motivational
interviewing techniques, allowed Martha to disclose that she was
dependent on alcohol and other drugs, and she was scared of what
might happen if she doesn't get help.
3:24:09 PM
MR. CHARD moved on to slide 8, and Martha divulges to her health
care provider that she might have a substance abuse problem, the
moment of clarity. Mr. Chard reiterated that this was not a
linear path. This moment of clarity was an opportunity for the
treatment system to intervene and to turn the tide. The problem
was that a lot of people don't recognize their problem. Some of
them do recognize, but don't seek treatment. Those who do seek
treatment often face waitlists, or other challenges for
treatment, which can include childcare, housing, or employment
challenges. Only about 33 percent recognize they need treatment
and try to get treatment, which he acknowledged as a big issue,
nationally and regionally. He reported that the treatment
provider had to meet the individual at the moment of clarity, as
that moment could "pass in a blink of an eye."
MS. BURKHART turned attention to slide 9, reporting that Martha
was ahead of the game as she already had a health care provider
and she was receiving health care service in an integrated
health system. Her clinic provider calls the behavioral health
department at the larger health organization, gets Martha an
appointment for her initial intake assessment, and then, Martha
doesn't go, which Ms. Burkhart labeled as a standard
eventuality, as the moment of clarity was fleeting. Martha
makes another appointment, but she arrives late. The counselor
realized that, based on Martha's history, she needs more than a
basic substance abuse assessment, and, as she needs an
integrated mental health and substance abuse assessment, another
appointment was made with a mental health professional through
telehealth.
MR. CHARD shared slide 10, and referenced the integrated
behavioral health assessment [Included in members' packets],
which was based on the work of trained counselors and
clinicians. He referenced the ASAM (American Society of
Addiction Medicine) criteria as the instrument to determine the
level of treatment and care, and then it was determined what the
available resources were for the best treatment outcome. When
the trained counselor does the exam, they find a level of care
corresponding to the individual's needs. He directed attention
to slide 11, the level of care. He reported that,
unfortunately, the substance abuse treatment system was mostly
geared for the later end of the treatment system. He noted that
there were outpatient treatment service providers, as well as
residential providers, and a few withdrawal management service
providers.
3:31:29 PM
MR. CHARD addressed slide 12, "Levels of Care in Alaska," which
included a sobering center (Bethel) with another due to open in
Fairbanks in 2017; 3 withdrawal management centers, with
another due to open in Soldotna in 2017; 21 residential
treatment centers, with another due to open in Mat-Su in 2017; 2
non-profit Medication Assisted Treatment (MAT) with state
grantee methadone programs (Anchorage, Fairbanks); 2 private for
profit MAT programs offering methadone and buprenorphine,
(Anchorage, Mat-Su); and 2 OCS-engaged parents treatment
programs (Anchorage, Mat-Su). There were 45 outpatient
substance use disorder treatment providers, noting that it was
rare for multiple providers in one community to provide the same
service.
MS. BURKHART shared that there was a sobering center in
Anchorage which was funded by the municipality. She moved on to
slide 13, and based on her assessment, the clinicians determined
that Martha needed intensive treatment to help her withdraw from
alcohol and opioids, a treatment not available in her village.
Martha was nervous about going to a big city for treatment,
fearing she would not go to the treatment facility and instead
take advantage of the increased access to alcohol and opioids
and go find people to use with. This was an important point in
Martha's journey toward recovery, as she can seek the
recommended level of treatment in an urban center or seek a less
clinically appropriate alternative closer to home. Ms. Burkhart
noted the importance of the treatment process, the crux in the
road, and either go to the level of care suggested by the
clinical assessment treatment center, or stay and receive
services at a lower level of care. Ms. Burkhart stressed that
this was a crossroads that many people faced.
3:35:22 PM
MS. BURKHART directed attention to slide 14. There were
currently 34 withdrawal management beds in Alaska, in Juneau,
Anchorage, and Fairbanks, and, with last year's funding, there
will be additional withdrawal management beds in Soldotna later
in the year. She declared that some hospitals were able to do
medically monitored detoxification if absolutely necessary,
based on the medical needs.
MR. CHARD emphasized that the 34 withdrawal management beds
served the entire population of the state, and he acknowledged
that there were not enough of these beds. He pointed out that
travel had to be arranged to get to the treatment and that there
was a lot of coordination behind the scenes.
REPRESENTATIVE JOHNSTON asked for clarification between a
management center and a detox center.
MR. CHARD relayed that the older term was detox, which was now
being relabeled nationally as withdrawal management, partially
in recognition that this was a much longer process.
REPRESENTATIVE JOHNSTON asked if this was for some drugs and
alcohol, not necessarily just for opioids.
Mr. CHARD reiterated that there were acute problems from alcohol
in Alaska, and that many of the withdrawal management beds were
set up for alcohol, as people could die from detoxification of
alcohol, whereas detox from many drugs was not as dangerous. He
reported that, because of the emergence of complicated clients,
there were a lot of new detox beds opening, particularly for
opioid detoxification. He stated that these were all medically
monitored services to maintain safety for the patient.
MS. BURKHART, in response to Representative Sullivan-Leonard,
said that Nugens Ranch was a residential program, not a
withdrawal management program. She returned attention to slide
14, and stated that the system was prioritized by these federal
guidelines: 1) pregnant injecting drug users; 2) other pregnant
drug users; and 3) other injecting drug users. She added that
there was additional state guidance, which prioritized families
engaged with the Office of Children's Services. She relayed
that it was a common occurrence for these priorities to
supersede others on the wait list. As a bed was expected to
become available in three weeks in Anchorage, Martha and her
clinician worked together to develop a plan to help her maintain
her treatment readiness while she waited for the withdrawal
management bed. Ms. Burkhart declared that three weeks was a
very long time to "remember that you want to get treatment."
3:41:19 PM
MS. BURKHART moved on to slide 15, and shared that, as Martha
had identified a risk that she would divert from treatment on
the way, the treatment team arranged to have family members take
and wait with her at the village and hub airports. It was also
arranged for the provider to pick her up at the Anchorage
airport. Despite all the precautions and preparation, Martha
showed up at the airport severely intoxicated, and was not
allowed to board the flight to Anchorage. Martha's family
member called the local treatment provider, who worked with the
withdrawal management treatment team in Anchorage to hold the
bed. Martha stayed with a family member overnight, and was
taken to the airport the next day. Martha arrived in Anchorage
and was met at the airport by someone from the withdrawal
management center.
MR. CHARD directed attention to slide 16. Martha spends the
next seven days in Anchorage in a medically monitored high
intensity inpatient setting, a withdrawal management setting.
The treatment team explored whether placement at a residential
treatment setting closer to home following discharge from
withdrawal management was available and was the best treatment
option. This was another important point in Martha's journey
toward recovery, as the discharge and placement process can
either support or divert Martha's progress. He stated that this
was one challenge of the treatment providers, getting ready for
the next service setting, finding a new availability, and
finding travel.
MS. BURKHART stated that it was important to recognize that for
Martha to stay all seven days was a huge victory, as many people
just walked out. She emphasized that maintaining the treatment
readiness was very difficult, especially in the most acute time
frame.
MR. CHARD added that, as these were all voluntary treatment
programs, the individual would go through the necessary level of
treatment, feel better, and then leave the program with the idea
of doing it by themselves.
MS. BURKHART shared slide 17, and said that Martha was ready for
an intensive residential program. There were about 315
residential treatment beds in Alaska today, which included the
aforementioned Nugens Ranch. She pointed out that the
residential treatment programs were not one size fits all, as
some were for males only, some were for women only, and some
were co-ed. Some were for women with children. Some programs
were 30-90 days long, some were 6-12 months long, and each one
had unique features for specific client populations. She
pointed out that there would be additional capacity for women
with children in the Matanuska-Susitna Valley thanks to three
years of funding appropriated by the Legislature last year.
MR. CHARD pointed out that the Institutions for Mental Diseases
(IMD) exclusion, slide 18, dated back to the 60s, early in
Medicaid, to prevent tearing down state psychiatric hospitals
just to build community psychiatric hospitals. One of the
challenges faced by residential substance use disorder treatment
providers was for this IMD Exclusion, which prohibited the use
of Medicaid for care provided to people in mental health and
substance use disorder residential treatment facilities larger
than 16 beds. Flat funding and funding cuts in both grants and
Medicaid have resulted in staffing shortages that make it
difficult to fully utilize the residential beds that are
available. As funding has been cut, facilities cannot
adequately staff all the beds, and this has created an
opportunity, as not all the beds are being fully utilized.
MS. BURKHART addressed slide 19, and asked "What if there is no
residential treatment bed available or what if there's not one
available on a realistic time horizon." She stated that one
option was for Medication Assisted Treatment (MAT), which was an
evidence-based treatment for opioid and/or alcohol dependence.
It combined medication with behavioral health treatment to help
the person achieve and maintain recovery. Opioid dependence MAT
and alcohol dependence MAT had been shown to increase retention
in treatment, decrease illicit opiate use and criminal activity,
increase employability, improve birth outcomes among pregnant
addicted women, and lower risk of contracting HIV or Hepatitis C
by reducing the potential for relapse. Medication Assisted
Treatment was available through some community health centers,
community behavioral health centers, and private physicians'
offices, slide 20. Methadone treatment was available in
Fairbanks, Anchorage, and Wasilla, and MAT capacity had been
actively expanded thanks to a federal grant from the Department
of Health and Social Services, focusing on building capacity in
Anchorage and Juneau.
REPRESENTATIVE TARR asked about federal restrictions to
expanding MAT.
MS. BURKHART replied that not anyone can provide MAT treatment.
If a physician or a nurse practitioner wanted to provide
treatment, licensing was required by the state and federal
governments, and there was a limit to the number of clients
served. She stated that the methadone programs were the most
rigorously regulated. Many other medications were also
effective for pain management, and there were no limits on the
pain management practices. She declared: "same medications,
different regulatory structures."
3:52:10 PM
MS. BURKHART moved on to slide 21, and said that Martha wanted
to find a residential program closer to her home community.
There was a culturally relevant, appropriate clinical level
program in her region, which would have an opening in about two
weeks. Martha can't stay at the withdrawal management treatment
center for the two weeks while she has to wait for the opening
in residential treatment, which creates a warning for the
opportunity to divert off the recovery journey. She works with
the treatment team at the withdrawal management center, her
behavioral health provider at home, and a case manager to come
up with a plan for those two weeks. Martha can go back to the
hub community and stay with a family friend who is sober and
willing to help her stay sober during those two weeks. Martha
can also attend the nightly AA meetings hosted at the
residential treatment center where she was planning to go. This
would also help her to establish a relationship with the
treatment provider.
MR. CHARD directed attention to slide 22. Martha spends six
weeks in the residential treatment program, and then, after
residential treatment, Martha needs to move to a lower level of
outpatient treatment to build on the progress she has made. At
each of these steps there is risk for diversion from the road to
recovery. Martha was able to transition to outpatient treatment
in the hub community, staying with family. Transitioning from
the structure of residential treatment to outpatient treatment
was another critical point in Martha's recovery journey.
Martha's social and familial networks contributed to and
supported her alcohol and drug use.
MS. BURKHART discussed the opportunity for relapse and the need
for a relapse prevention plan, slide 23. Martha was invited to
a family birthday party, and although she really wanted to go,
she knows that it's a risk to her sobriety. She has a
safety/relapse prevention plan that she and her clinician
developed as part of her outpatient treatment plan. There was
alcohol at the party, and everyone was drinking. Martha makes
it through most of the evening, but then decides "one beer won't
hurt,and she drinks until she passes out. The next day, she
is very hung over and someone offers her prescription opioid
pain pills to "take the edge off." Martha takes her usual dose
of pills, but because she's been sober for almost 60 days, she
doesn't have the same tolerance, and she overdoses. Ms.
Burkhart stated that this happens with great frequency for
people who don't realize how their tolerance has waned with
prolonged sobriety.
MR. CHARD shared slide 24, and relays that the first responders
had Narcan onboard, so they were able to save Martha when they
responded to her overdose. Martha's outpatient treatment
provider talks to Martha about going back into a residential
program to help her avoid a long-term relapse. Martha was
worried that she won't be able to stay sober in her home
community. She works with her clinicians to find a residential
treatment program that includes aftercare, transitional living
and recovery support services. He added that, although Narcan
can save a life, it was not treatment.
MS. BURKHART addressed slide 25, and shares that Martha decides
to go to another residential program because she was struggling
to stay on her chosen road. Martha moves successfully through
the levels of treatment offered by the substance use disorder
treatment provider. During that time, she connects with other
people in recovery and starts to build a support network for
healthy and stable social networks to maintain recovery. She
was homesick, but she was also afraid of relapse. Martha worked
with a case manager to address barriers to her recovery: find
stable housing; connect with vocational rehabilitation for
employment; work with the primary care provider regarding actual
health conditions; and find healthy alternatives in the
community which did not include drinking. She points to slide
26, and declares that Martha celebrated 12 months of sobriety.
She was working full-time and sharing an apartment with a
friend. She went to the 12-step meetings 3-4 times each week
for support. Martha was seeing a mental health professional to
address the underlying mental health issues that had been masked
by drug and alcohol use. The coping skills she was learning in
therapy helped her navigate the triggers that might lead her to
drink or want to use again. Martha felt strong enough in her
recovery to go home to visit her mother. They had a good visit.
She reported that for those working to achieve recovery in a new
environment, going home was a big deal, as it could be an
opportunity to address many triggers.
MR. CHARD shared slide 27, and noted that several points along
the journey to recovery hinted at problems the substance use
disorder treatment providers had that were hampering their
ability to provide the support she needs. Providers and
policymakers were working together to address the larger
challenge that was affecting healthcare delivery systems across
the country: Access; Quality; and Cost.
4:00:59 PM
MS. BURKHART turned to slide 29, "Patient & Provider Stigma."
She spoke about an earlier presentation regarding the science of
addiction, and noted that individuals with a substance use
disorder were not treated the same as individuals with other
disorders and diseases. Substance use disorder treatment
providers were not treated the same as other healthcare
practitioners, as there was a stigma attached, in how we pay
them, the documentation that we require of them for oversight,
and how we credential them. The stigma was beyond the person
needing help, and affected everyone involved in helping that
person.
MR. CHARD spoke about slide 30, reporting that the Behavioral
Health providers in Alaska were required by regulation (7 AAC
70.150) to be accredited by a national accrediting body (Joint
Commission, CARF, COA, or other). Accrediting bodies maintained
strict standards that ensured adequate oversight of clinical and
business practices, treatment effectiveness, and continuous
quality improvement. There was duplicative reporting,
documentation, and oversight requirements that diverted
resources from treatment. The 2014 Streamlining Initiative was
a successful public/ private partnership to help address these
issues.
MR. CHARD reported that Alaska was constantly recruiting for
more qualified people in the substance use disorder workforce,
as it was an area of job growth in the economy, with good pay
and benefits in communities across the state, slide 31.
MS. BURKHART moved on to slide 32, and spoke about The Peer
Support workforce, a relatively untapped opportunity that had a
lot of potential to fill vacancies with individuals who have
lived experience that could help inform treatment and improve
outcomes. The way a person's criminal background check was
conducted was still a major hurdle, as people in recovery could
have a felony, which was a disqualifier for many health care
professions. Peer Support providers were not currently
credentialed, and it would be necessary to expand the ability
for reimbursement. She relayed that telehealth was a critical
component to the behavioral health system, and was often used by
substance use disorder treatment providers to tap into outside
expertise.
MR. CHARD said that substance abuse treatment providers were
predominantly funded by unrestricted grant funding, although
there was some designated grant funding from the current alcohol
tax. He said that Medicaid Expansion would allow more
individuals to qualify. He noted that this was also changing
the treatment system with a transition toward a Medicaid
reimbursement, even though Medicaid rates did not actually cover
the cost of care. He said that rates had not been changed since
2006, slide 34. He stressed that there were still some services
which Medicaid would not pay for.
4:09:45 PM
MS. BURKHART stated that, as it was not possible to provide
every service in every community, it was necessary to ensure
that publicly funded substance use disorder treatment providers
operated in concert across the State of Alaska, each as a
critical component in a larger system of care. That system of
care strives to meet every individual where they are on their
journey and help them achieve recovery. It was a customized
approach, operating in a system that seeks uniformity for policy
and funding purposes. It was challenging for trained clinicians
to find the best resources available to assist people in their
journey to recovery. It was extremely difficult for someone,
especially in crisis, to navigate the system themselves. She
relayed that enrollment in Alaska 211 had been encouraged to all
the service providers, slide 35.
MS. BURKHART reported that substance use disorders were
incredibly complex, and the people who experienced them have
many behavioral, physical, and social needs. The substance use
disorder treatment system was difficult to navigate, and there
were multiple transition points where a recovery process could
be derailed. Just as teams of health care professionals work
together to serve clients, Department of Health and Social
Services, the Alaska Behavioral Health Association, and other
stakeholders were working together to maintain and strengthen
the system. She stated that this was "a pretty strong
relationship," slide 36.
REPRESENTATIVE JOHNSTON asked about the possibility for an 1115
waiver.
MS. BURKHART said that she had participated on the writing team
and the policy team for the concept paper. She had positive
conversations with the Centers for Medicare and Medicaid
Services, regarding the concept paper [Included in members'
packets]. She stated that federal healthcare policy was
currently up in the air. She emphasized that they were moving
forward with the process, and that the application would be
submitted this summer.
REPRESENTATIVE JOHNSTON stated that while she was reading the
grant book, she had found duplication and intertwining of
grants, and she opined that it was not a very clear system, even
as she could see legislative intent in some of the grants. She
said that a lot of these were not federal pass through, and that
there was a need to readdress some of these grants. She
declared that she was in total support of non-profit
organizations. She lamented that lack of benchmarks. She
offered her belief that speaking of the stigma was not fair, as
no one had the answers.
MS. BURKHART replied that she had looked at all the FY16 grants.
She explained that you had to be a grantee in order to bill
Medicaid, hence the very small grants.
REPRESENTATIVE EDGMON said that the narrative helped illustrate
that Martha could have had kids, she could have been an FASD
baby, and there could have been domestic violence involved. He
declared that it was an inherently complicated issue.
REPRESENTATIVE TARR offered her belief that the need far
exceeded the amount of service available, hence the appearance
of overlap for the grants. She opined that an organization
could not get too big without losing the personal touch and the
intensive management support toward recovery, and that this
could be the reason for the appearance of similar services.
4:19:49 PM
MR. CHARD acknowledged that the capacity for services could not
meet the demand. He pointed out that there were 34 withdrawal
management beds for 740,000 people. He said that each of the
treatment providers worked to employ evidence based practices,
and some of these models were in smaller settings. He stated
that it depended on the client's needs, and what treatment
program would work best. He asked that the committee mention
any programs that appeared duplicative, as he may be able to
explain any differences. He pointed out that some serve the kid
population, and some serve the adult population.
REPRESENTATIVE SULLIVAN-LEONARD stated that Martha was a clear
description of anyone in Alaska. She mentioned that she had not
noticed any treatment component for faith based groups in the
state. She said that the Department of Corrections had declared
that the faith based treatments within the correctional facility
were successful.
MS. BURKHART replied that some state programs were faith based,
and they were often part of the system. She relayed that the
clinical and accreditation requirements to be part of the system
were the same for everyone. She allowed that having the choice
to pursue was good, but there were not always many options.
CHAIR SPOHNHOLZ stated that addiction treatment was a very
personal experience and that it was necessary to find a
treatment experience that aligned with your values. She
reflected on the pauses necessary for treatment, and that the
challenge was when someone would show up ready for treatment,
but without immediate availability, and the person would often
relapse. She asked if there had been any research for solutions
to this problem.
MR. CHARD expressed his agreement that, although elasticity for
the system was important, there were not enough treatment
programs and providers for the need. He emphasized that
services cost money, and resources were necessary. He declared
that innovations in peer support and telemedicine, among others,
were helping to address this question.
MS. BURKHART added that one area which had not been explored
enough were the natural helpers in the community, and the
resources available from tribal or extended families. As a
system, she asked how the community would keep someone safe
until there were openings.
4:27:09 PM
The committee took a brief at ease.
HB 138-MARCH: SOBRIETY AWARENESS MONTH
4:28:32 PM
CHAIR SPOHNHOLZ announced that the next order of business would
be HOUSE BILL NO. 138, "An Act establishing the month of March
as Sobriety Awareness Month."
4:28:42 PM
REPRESENTATIVE DEAN WESTLAKE, Alaska State Legislature, stated
that proposed HB 138 designated the month of March, each year,
as Sobriety Awareness Month. He relayed that this was to help
and support all those people who have struggled. The proposed
bill would provide the opportunity for schools, community
groups, and other entities to recognize, appreciate and
celebrate those Alaskans that choose to live a life of sobriety.
Individuals that lead sober lives are an asset to Alaska in that
they can help reduce the incidence of alcohol or drug related
social ills such as crime, recidivism, domestic violence, child
abuse and neglect. He relayed an experience with a group of
empowering stories of sobriety at a gathering.
4:30:22 PM
FORREST WOLFE, Staff, Representative Dean Westlake, Alaska State
Legislature, read from the Uniform Alcoholism and Intoxication
Treatment Act [Included in members' packets]:
It is the policy of the state to recognize,
appreciate, and reinforce the example set by its
citizens who lead, believe in, and support a life of
sobriety.
MR. WOLFE offered his belief that a permanent designation of
March as Sobriety Awareness Month would help the State of Alaska
meet this declaration of policy.
4:31:27 PM
GREGORY NOTHSTINE, President, Sobermute Reviving Our Spirit,
said that he was aware the Alaska State Legislature was the
first in the nation to pass a statute recognizing appreciation
and reinforcement of citizens for living a life of sobriety. He
said that there were elders and senior citizens who were not
recognized for contributions and efforts for building a safer
community. He offered his belief that millions of dollars were
spent on treatment centers, whereas, this proposed bill was
reinforcing appreciation of its citizens. He expressed his
support of the proposed bill.
REPRESENTATIVE JOHNSTON stated that she was glad this was March,
as, she opined, spring could be a very stressful time, when
alcohol "rears its ugly head and suicide." She suggested that
celebrations and festivals in March were great. She stated her
support for the proposed bill.
REPRESENTATIVE EDGMON offered his belief that "tribes" could be
added to the wording in the proposed bill.
4:34:48 PM
REPRESENTATIVE SPOHNHOLZ shared that she had been sober for 14
years, and that celebrating sobriety as a healthy lifestyle
choice for Alaskans was a step in the right direction for our
community to come together in March every year. She stated that
making it dedicated forever showed commitment from the state.
She stated her support for the proposed bill.
[HB 138 was held over.]
HB 43-NEW DRUGS FOR THE TERMINALLY ILL
4:35:48 PM
CHAIR SPOHNHOLZ announced that the final order of business would
be HOUSE BILL NO. 43, "An Act relating to prescribing,
dispensing, and administering an investigational drug,
biological product, or device by physicians for patients who are
terminally ill; providing immunity related to manufacturing,
distributing, or providing investigational drugs, biological
products, or devices; and relating to licensed health care
facility requirements."
4:36:12 PM
BROOKE IVY, Staff, Representative Jason Grenn, Alaska State
Legislature, recapped the proposed bill, and stated that it
would streamline an existing process through the U.S. Food and
Drug Administration, the Compassionate Use Program, which
allowed for those diagnosed as terminally ill to access
investigational medications outside the clinical trial process
in an effort to save their own lives. The proposed bill would
allow terminally ill patients to work directly with their doctor
and the drug manufacturer, given informed consent, to access
those treatments.
4:37:13 PM
CHAIR SPOHNHOLZ opened public testimony on HB 43. There being
no one to testify, she closed public testimony.
4:37:59 PM
REPRESENTATIVE EDGMON moved to report HB 43 out of committee
with individual recommendations and the accompanying fiscal
notes.
4:38:09 PM
REPRESENTAIVE EASTMAN objected. He stated there was "a very
wide gap between the purposes for which a drug is tested and the
actual uses that we are now giving physicians immunity for, and
that's concerning to me."
4:38:45 PM
A roll call vote was taken. Representatives Spohnholz, Tarr,
Sullivan-Leonard, Johnston, Eastman, Edgmon, and Kito voted in
favor of HB 43. Therefore, HB 43 was reported out of the House
Health and Social Services Standing Committee by a vote of 7
yeas - 0 nays.
4:39:49 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:39 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| ABADA ABHA Substance Use Disorder Treatment in Alaska Presentation 3.7.....pdf |
HHSS 3/7/2017 3:00:00 PM |
Substance Use Treatment in Alaska |
| ABADA ABHA Back Up Materials.pdf |
HHSS 3/7/2017 3:00:00 PM |
|
| HB138 ver D.PDF |
HCRA 4/4/2017 8:00:00 AM HHSS 3/7/2017 3:00:00 PM HHSS 3/23/2017 3:00:00 PM |
HB 138 |
| HB138 Sponsor Statement.pdf |
HCRA 4/4/2017 8:00:00 AM HHSS 3/7/2017 3:00:00 PM HHSS 3/23/2017 3:00:00 PM |
HB 138 |
| HB138 Fiscal Note DHSS-BHA-3.3.17.pdf |
HCRA 4/4/2017 8:00:00 AM HHSS 3/7/2017 3:00:00 PM HHSS 3/23/2017 3:00:00 PM |
HB 138 |
| HB138 Support Document-Alcoholism and Intoxication Treatment Act.pdf |
HCRA 4/4/2017 8:00:00 AM HHSS 3/7/2017 3:00:00 PM HHSS 3/23/2017 3:00:00 PM |
HB 138 |
| HB043 ver D 2.22.17.PDF |
HHSS 2/28/2017 3:00:00 PM HHSS 3/2/2017 3:00:00 PM HHSS 3/7/2017 3:00:00 PM |
HB 43 |
| HB043 Sponsor Statement 2.22.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/2/2017 3:00:00 PM HHSS 3/7/2017 3:00:00 PM |
HB 43 |
| HB043 Sectional Analysis ver D 2.22.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/2/2017 3:00:00 PM HHSS 3/7/2017 3:00:00 PM |
HB 43 |
| HB043 Supporting Document - Clinical Trials in Alaska.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/2/2017 3:00:00 PM HHSS 3/7/2017 3:00:00 PM |
HB 43 |
| HB043 Supporting Document - FDA Drug Review Process 2.22.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/2/2017 3:00:00 PM HHSS 3/7/2017 3:00:00 PM |
HB 43 |
| HB043 Supporting Document - Goldwater Institute Fact Sheet 2.22.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/2/2017 3:00:00 PM HHSS 3/7/2017 3:00:00 PM |
HB 43 |
| HB043 Supporting Document - Goldwater Institute Patient Stories 2.22.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/2/2017 3:00:00 PM HHSS 3/7/2017 3:00:00 PM |
HB 43 |
| HB043 Supporting Document - Goldwater Institute Policy Report Summary 2.22.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/2/2017 3:00:00 PM HHSS 3/7/2017 3:00:00 PM |
HB 43 |
| HB043 Supporting Document - Legislative Map 2.22.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/2/2017 3:00:00 PM HHSS 3/7/2017 3:00:00 PM |
HB 43 |
| HB043 Fiscal Note DCCED--DCBPL 2.28.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/2/2017 3:00:00 PM HHSS 3/7/2017 3:00:00 PM |
HB 43 |
| HB43 Supporting Document - Letters of Support 2.27.17.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/2/2017 3:00:00 PM HHSS 3/7/2017 3:00:00 PM |
HB 43 |
| HB 43 Powerpoint Presentation.pdf |
HHSS 2/28/2017 3:00:00 PM HHSS 3/2/2017 3:00:00 PM HHSS 3/7/2017 3:00:00 PM |
HB 43 |
| HB043 Supporting Document - Letters of Support 3.2.17.pdf |
HHSS 3/2/2017 3:00:00 PM HHSS 3/7/2017 3:00:00 PM |
HB 43 |
| HB043 Supporting Document - Goldwater Institute Policy Report.pdf |
HHSS 3/2/2017 3:00:00 PM HHSS 3/7/2017 3:00:00 PM |
HB 43 |