Legislature(2009 - 2010)SENATE FINANCE 532
02/10/2010 09:00 AM Senate FINANCE
| Audio | Topic |
|---|---|
| Start | |
| SB229 || SB231 | |
| SB253 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 253 | TELECONFERENCED | |
| += | SB 254 | TELECONFERENCED | |
| += | SB 229 | TELECONFERENCED | |
| += | SB 231 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE FINANCE COMMITTEE
February 10, 2010
9:08 a.m.
9:08:51 AM
CALL TO ORDER
Co-Chair Hoffman called the Senate Finance Committee
meeting to order at 9:08 a.m.
MEMBERS PRESENT
Senator Lyman Hoffman, Co-Chair
Senator Bert Stedman, Co-Chair
Senator Charlie Huggins, Vice-Chair
Senator Johnny Ellis
Senator Dennis Egan
Senator Donny Olson
Senator Joe Thomas
MEMBERS ABSENT
None
ALSO PRESENT
Karen Rehfeld, Director, Office of Management and Budget,
Office of the Governor; Jeff Jessee, Chief Executive
Officer, Alaska Mental Health Trust Authority
PRESENT VIA TELECONFERENCE
None
SUMMARY
SB 229 APPROP:OPERATING BUDGET/LOANS/FUNDS
SB 229 was heard and HELD in Committee for
further consideration.
SB 231 APPROP: MENTAL HEALTH BUDGET
SB 231 was heard and HELD in Committee for
further consideration.
SB 253 APPROP: DEFERRED MAINTENANCE/REPLACEMENT
SB 253 was heard and HELD in Committee for
further consideration.
SB 254 SUPPLEMENTAL/CAPITAL/OTHER APPROPRIATIONS
SB 254 was heard and HELD in Committee for
further consideration.
SENATE BILL NO. 229
"An Act making appropriations for the operating and
programs, and to capitalize funds; making supplemental
appropriations; making appropriations under art. IX,
sec. 17(c), Constitution of the State of Alaska; and
providing for an effective date."
SENATE BILL NO. 231
"An Act making appropriations for the operating and
capital expenses of the state's integrated
comprehensive mental health program; and providing for
an effective date."
9:09:14 AM
Co-Chair Hoffman described the agenda for the day. He said
that the operating budget would be going into
subcommittees. He listed the makeup of the various
subcommittees.
9:13:27 AM
KAREN REHFELD, DIRECTOR, OFFICE OF MANAGEMENT AND BUDGET,
OFFICE OF THE GOVERNOR, related that she had previously
provided an overview of the governor's proposed spending
plan for FY 11, which also included the capital budget. She
explained that the operating budget, SB 229, totals about
$9.8 billion in all funds. The bill has 34 sections and
contains several key elements: operating numbers and
language sections, fund capitalizations, debt service
costs, special appropriations, including revenue sharing,
savings, and all other appropriations. She termed it a
significant bill.
Ms. Rehfeld highlighted items from the budget: the
statutory formula program, education - a $56 million
increase for school formula funding, and increases in
Medicaid by about $36 million more than in the FY 10
budget. She noted that supplemental requests for Medicaid
and budget amendments would be forthcoming. There is an
increase in the enrollment, utilization, and cost of
providing Medicaid services. The unfunded liability of the
retirement system shows about a $73 million increase. Debt
service on an annual basis totals about $276 million, which
is about a $29 million increase in the FY 11 budget.
Ms. Rehfeld reported that the governor is very interested
in holding the line on agency operating growth. Agencies
will be required to absorb increases in their budgets.
There are a few areas which will receive an increase in
funding, such as domestic violence and sexual assault,
which will receive about $7 million of new general fund for
the Departments of Law and Public Safety. She stressed the
importance of holding the line on state agency growth while
meeting the needs of the formula programs and the services
that Alaskans expect from their government.
9:17:30 AM
Co-Chair Hoffman commented about a statement regarding the
supplemental budget, which implied that if the supplemental
is approved, where there are increments, there would be
amendments forthcoming to address them in the FY 11 budget.
Ms. Rehfeld said that was correct. In some areas of the
supplemental, the administration anticipated that
corrections would be needed and they are in the December 14
budget which is before the committee. She noted that
amendments would be forthcoming.
Co-Chair Hoffman asked when labor contracts would be
addressed. Ms. Rehfeld did not know when the agreement on
labor contracts would happen. She offered to provide that
information when it became available.
Co-Chair Hoffman thanked Ms. Rehfeld for her presentation.
He said that the budget subcommittees were in progress and
the Senate Finance Committee looks forward to working with
the administration on the budget process.
Ms. Rehfeld pointed out that SB 231, the comprehensive
mental health budget, contains operating and capital items.
She noted that the subcommittee process would also address
those items.
9:19:43 AM
JEFF JESSEE, CHIEF EXECUTIVE OFFICER, ALASKA MENTAL HEALTH
TRUST AUTHORITY, referred to a handout entitled, "Senate
Finance Committee FY 2011 Budget" (copy on file). He
referred briefly to slide 2 - trust beneficiaries. He noted
that in addition to the list shown, there were also
associated beneficiaries, such as people with traumatic
brain injury. He showed slide 3 - trust advisors - and
commented that the Alaska Mental Health Trust Authority
(AMHTA) does not work in a vacuum.
Mr. Jessee spoke of AMHTA funding for FY 2011 - slide 4. He
said that the amount of $24,870,374 is basically stable
from FY 10. He spoke of a loss of $90 million in the
Permanent Fund; however, he termed the Trust's financial
structure as extremely robust. The Trust Fund's payout is
4.25 percent and there is an income reserve account set at
four times the annual payout. Even in a year with
significant reductions in assets, the Trust is able to
continue to make the payout. He noted when compared to
other foundations, AMHTA fares well.
Mr. Jessee shared joint FY 11 legislative priorities -
slide 5. The first priority is to increase the adult dental
Medicaid reimbursement cap. It was originally set based on
the cost of one plate of dentures, but since then, costs
have increased. Another priority is to establish a regular
and periodic schedule of rate reviews for home and
community-based services. The vehicle for this goal is SB
32. The most expensive level of care is hospital and
nursing home services. Home and community-based services
save money, but require monitoring to do so. He spoke of
the advantages of periodic reviews.
Mr. Jessee said a third priority is to support a 10-year
plan to reduce homelessness, which is making significant
progress. He reminded the committee about the critical
aspects of special needs housing - to combine the three
legs of the stool: capital, operating, and support services
funds. This is now possible due to legislative action to
expand AHFC's authority and provide funding. The last
priority is to fund community-coordinated transportation
systems. He spoke of the need to coordinate transportation
systems in order to save money.
9:27:41 AM
Mr. Jessee turned to slide 6 - the formula for success. It
begins with identifying a problem or community need. Next
is collaboration with governmental agencies, advisory
groups, non-profits, service providers, philanthropic
organization, and the private sector. Another strategy is
to develop strategic, sharply focused solutions. He
emphasized that the solution has to be data-driven.
Finally, it is important to make lasting system
improvements for Trust beneficiaries.
9:30:09 AM
Mr. Jessee listed the five program focus areas - slide 7.
They are Bring the Kids Home, Disability Justice, Workforce
Development, Affordable, Appropriate Housing, and
Beneficiary Projects Initiative.
Mr. Jessee highlighted the very successful Bring the Kids
Home (BTKH) program - slide 8. He detailed how the program
filled a community need. In FY 06 there were 743 Alaskan
children who were served out of state. Currently, less than
110 children are referred to out-of-state placements. In FY
06 $40 million was spent on out-of-state Medicaid care;
currently, that amount has been cut in half. He listed the
partners AMHTA works with.
Mr. Jessee explained the projected BTKH reinvestment
process - slide 9. There was no promise to save the state
money; the intent was to spend effectively by reinvesting
savings, which has been very successful. The chart shows
overall costs as stable and down from the peak in FY 07.
The governor's budget has a number of increments that are
related to these investments.
9:33:12 AM
Mr. Jessee shared the results for beneficiaries - slide 10.
Out-of-state admits are down 85.4 percent; Residential
Psychiatric Treatment Center (RPTC) recidivism is down from
20 percent to 3.4 percent. That means when kids come out of
residential psychiatric treatment, they are receiving
support in the community.
Mr. Jessee spoke about one of the key components of BTKH -
individualized services. He called it a reinvention of the
Alaska Youth Initiative. There is a plan to phase out BTKH
by 2013, but continue to have safeguards. He related the
results of returning youth home and ensuring quality
programs. He emphasized that individualized services used
to require Medicaid eligibility. He gave an example of the
success of individualized services without the need for
Medicaid involvement. He reported that of over 500 youth
who receive individualized services, less than 1 percent
received RPTC care.
9:37:55 AM
Mr. Jessee shared data on the BTKH FY 11 budget - slide 11.
It depicts what the Trust recommended for GF/MH and the
continued investment of MHTAAR in the project. The numbers
in red show where there is a difference between what the
Trust recommended and what the governor included in his
budget. There are some areas that continue to need
attention.
Mr. Jessee did not envision the focus areas to be
perpetual. When the goals are achieved, the Trust moves on
to other focus areas. He requested the committee's support
to bring BTKH to a conclusion.
Mr. Jessee turned to the topic of disability justice -
slide 12. He stated that the Trust has worked very well
with the Department of Corrections (DOC). A study indicates
that 42 percent of those incarcerated are Trust
beneficiaries. They serve longer sentences for similar
crimes and have a higher degree for recidivism. The Trust
has invested significant resources with its partners to try
to turn this problem around. The Criminal Justice Working
Group is trying to address the issue. He emphasized that in
terms of impact on the state budget, a cooperative approach
to lessen recidivism is critical. He expected that the new
prison would be full within 12 to 18 months, prisoners
would have to be housed out-of-state again, a new prison
would have to be built, and costs would increase. He
concluded that other states have been successful at
lessening recidivism and Alaska could also with the right
investment.
9:41:15 AM
Mr. Jessee shared information about outcome driven results
- slide 13. Therapeutic Courts have become central to
diverting beneficiaries from corrections. The basic model
is to engage the participants in treatment and community
service, and provide housing and jobs. He gave an example
of a success in the Anchorage Mental Health Court.
Mr. Jessee showed what the Trust is continuing to
contribute to MHTAAR and to grants for FY 11 - slide 15.
Slide 16 depicts General Fund recommendations. The governor
provided significant support for some of the key
components. He drew attention to the Bethel Project, which
needs additional operating and capital funds.
9:44:15 AM
Mr. Jessee turned to slide 17 - workforce development,
which continues to be a major problem. The focus is on
recruitment and retention, wages and benefits, which are
topics of SB 32, and training and education. He shared that
the Trust has learned that one of the biggest factors of
job retention is having a good supervisor.
Mr. Jessee shared accomplishments of workforce development
- slide 18. He spoke of looking ahead at workforce
development programs - slide 19. There is a plan to start
up a psychiatric residency program in Alaska. Another goal
is to expand the student loan repayment program and other
incentives for health professionals. A Ph.D. psychologist
internship program will be implemented, and increments for
University of Alaska health programs will be supported.
Mr. Jessee highlighted the Trust's plan for financial
support for workforce development - slide 20. Slide 21
depicts a need for continued discussion and dialogue
regarding the governor's budget.
9:48:02 AM
Mr. Jessee reported on affordable, appropriate housing
programs - slide 22. He pointed out that the Trust has $10
million committed to affordable housing. He expressed
frustration that $300 million has been allotted to
weatherization. He preferred to address the needs of the
homeless.
Mr. Jessee said that slide 23 depicts the Bridge Home
program outcomes when there are adequate resources.
Supporting beneficiaries after institutional care leads to
dramatic decreases in admissions to Alaska Psychiatric
Institute (API) and to the Department of Corrections (DOC).
Each decrease is an economic benefit. With additional
resources, the ability to serve these beneficiaries
improves, especially for those in corrections.
Mr. Jessee related fiscal goals for FY 11 - slide 24. He
voiced appreciation for the $10 million included in the
governor's budget to begin implementing the 10-year
homeless plan. He spoke highly of AMHTA's partnership with
AHFC and Housing First projects. He shared examples of
project needs for those with alcohol addictions. He
maintained that the solution is "housing first". He
dispelled several commonly held myths about homeless with
alcohol addictions. He shared results and cost reductions
from a successful Seattle program.
Mr. Jessee shared information about a project in Anchorage
sponsored by the Trust. He suggested that members may want
to view the Seattle program.
9:54:47 AM
Mr. Jessee shared budget recommendations for the homeless
assistance program in FY 11 - slide 25. He praised the
governor's support for the program. He highlighted the
Trust beneficiary projects initiative - slide 26. The Trust
will continue to carry these projects because it believes
that beneficiaries can do a lot to support each other.
Mr. Jessee referred to slide 28 - results for
beneficiaries. He commented on slide 29 - the beneficiary
budget picture. The Trust is carrying a large amount of the
load - nearly $4 million.
Mr. Jessee concluded by voicing support for the governor's
domestic violence and substance abuse initiative. He
suggested other strategies for dealing with the problems of
domestic violence and for enhancing the governor's
initiative. He shared problems with the current system. He
suggested integrating behavioral health and addressing
children's needs. He mentioned that Representative
Fairclough was forming a group to look at ways to enhance
the governor's initiative.
Mr. Jessee suggested using a strategic approach similar to
that of the Trust's to address domestic violence. He also
thought that a work group should be formed. He was
optimistic about "turning the curve" regarding domestic
violence. He listed obvious gaps to addressing the problem,
such as lack of substance abuse help for the victim.
9:59:35 AM
Co-Chair Hoffman spoke of a concern about the high rates of
suicide in Alaska. Mr. Jessee agreed that suicide was a
serious problem. He listed ways the Trust was working with
partners on the problem. He stated that the Trust needs to
have a focus in order to be effective in this area.
Co-Chair Hoffman asked if there was any movement to solve
the problem in the near future. Mr. Jessee did see progress
if the legislative task force could come forth with
evidence-based strategies that are data driven. Co-Chair
Hoffman emphasized that it is an area that needs to be
addressed.
10:02:18 AM
Senator Ellis requested information on traumatic brain
injuries and about only half of the current state taxes on
alcoholic beverages going to substance abuse prevention and
treatment services. He wondered how to proceed to increase
treatment services if that amount were to be increased.
Mr. Jessee addressed the issue of traumatic brain injury.
He commented on new studies about screening for traumatic
brain injuries and the high number of prisoners with
traumatic brain injuries. He opined that Alaska is too
small to have three separate systems of care for traumatic
brain injuries: the state, the tribal health system, and
the Department of Defense and Veterans' Administration.
There is a need for more collaboration. He noted that the
state has not integrated services with the tribal health
care system, the VA, or the Department of Defense. He
suggested there should be one system of care.
Mr. Jessee answered the question about the alcohol tax and
needing more services for alcohol treatment. He thought it
would be a challenge even with significant additional
dollars. He suggested continuing to partner with the tribal
health system. He thought the state could absorb more
resources and enhance services over time. He suggested
being very specific about expected outcomes. He noted that
the Trust produced statistics about the cost of alcoholism
to the state - over $5 million. He shared a recent
frustration with the association between drinking and
sports.
10:09:24 AM
Senator Thomas asked about the number of out-of-state
admissions in the BTKH program, both in FY 04 and currently
- slide 10. He also wondered how much of the capacity is
being used in Fairbanks. Mr. Jessee replied that 740 is the
number of kids served at some time in an out-of-state
facility during FY 04. The high-water mark for out-of-state
admissions at a point in time was about 435. Right now
there are around 117 kids served out of state.
Mr. Jessee provided some history of the program. He
discussed the need for early community support. Most
referrals do not come from the families, so an education
subcommittee was formed to partner with schools to help
identify the kids who need residential services. He spoke
of a need to focus on family issues as a prevention tool.
He explained that small facilities are more successful and
can be converted to family homes.
Senator Thomas asked if the in-state capacity was being
fully utilized. He asked if the state was lacking the
capacity to bring the remaining 117 back to Alaska. Mr.
Jessee replied that there are vacant beds in the state, but
they are not able to provide the level of care that is
needed. The kids living outside have the most severe needs.
They should be brought back to appropriate services, so the
Trust is working with in-state programs to build their
capacity. The facility in Fairbanks is not yet able to
receive Level 5 kids. The kids' needs and the capacity of
the programs need to be matched.
10:16:50 AM
Senator Thomas referred to slide 12 and asked if the 42
percent of those incarcerated included in-state as well as
out-of-state prisoners. Mr. Jessee said it was all
correctional inmates, but he did not know the percentages
of each.
Ms. Rehfeld spoke favorable of working with Mr. Jessee on
common programs and achievements.
SB 229 was heard and HELD in Committee for further
consideration.
SB 231 was heard and HELD in Committee for further
consideration.
SENATE BILL NO. 253
"An Act making capital appropriations for deferred
maintenance projects, equipment replacement, and
emergency repairs; and providing for an effective
date."
10:18:39 AM
Co-Chair Hoffman turned to the issue of deferred
maintenance. Ms. Rehfeld offered to provide that
information as soon as possible.
SB 253 was heard and HELD in Committee for further
consideration.
SENATE BILL NO. 254
"An Act making supplemental appropriations, capital
appropriations, and other appropriations; amending
appropriations; repealing appropriations; making
effective date."
10:20:02 AM
Co-Chair Hoffman asked if there were any questions about SB
254.
SB 254 was heard and HELD in Committee for further
consideration.
ADJOURNMENT
The meeting was adjourned at 10:19 AM.
| Document Name | Date/Time | Subjects |
|---|---|---|
| 2010 Senate Finance Presentation 2_10_10.pdf |
SFIN 2/10/2010 9:00:00 AM |
SB 231 |