Legislature(2021 - 2022)SENATE FINANCE 532
05/12/2022 01:00 PM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB265 | |
| SB124 || HB172 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| + | HB 265 | TELECONFERENCED | |
| + | SB 124 | TELECONFERENCED | |
| *+ | HB 172 | TELECONFERENCED | |
SENATE FINANCE COMMITTEE
May 12, 2022
1:05 p.m.
1:05:02 PM
CALL TO ORDER
Co-Chair Stedman called the Senate Finance Committee
meeting to order at 1:05 p.m.
MEMBERS PRESENT
Senator Bert Stedman, Co-Chair
Senator Lyman Hoffman
Senator Donny Olson
Senator Natasha von Imhof
Senator Bill Wielechowski
Senator David Wilson
MEMBERS ABSENT
Senator Click Bishop, Co-Chair
ALSO PRESENT
Representative Ivy Spohnholz, Sponsor; Genevieve Mina,
Staff for Representative Spohnholz; Heather Carpenter,
Health Care Policy Advisor, Department of Health and Social
Services; Steve Williams, CEO, Alaska Mental Health Trust
Authority; Mark Regan, Legal Director, Disability Law
Center.
PRESENT VIA TELECONFERENCE
April Kyle, President and CEO, Southcentral Foundation,
Anchorage; Kevin Munson, CEO, Mat-Su Health Services,
Wasilla; Winn Davis, Senior Policy Analyst, Alaska Native
Health Board, Anchorage; Emily Nenon, Alaska Government
Relations, American Cancer Society Cancer Action Network,
Anchorage; Renee Gayhart, Director, Health Care Services,
Department of Health and Social Services; James Cockrell,
Commissioner, Department of Public Safety; Ann Ringstad,
Executive Director, NAMI Alaska; Alberta Unok, President
and CEO, Alaska Native Health Board; Arthur Delaune, Self,
Fairbanks; Robyn Bjork, Self, Palmer; Michelle Baker,
Executive Vice President, Behavior Services, Southcentral
Foundation; Shayne LaCroix, Police Officer, Palmer Police
Department; Renee Rafferty, Regional Director of Behavioral
Health, Providence Alaska, Anchorage; David Campbell,
Deputy Chief, Juneau Police Department; Vikki Jo Kennedy,
Self, Juneau.
SUMMARY
SB 124 MENTAL HEALTH FACILITIES & MEDS
SB 124 was HEARD and HELD in committee for
further consideration.
CSHB 172(FIN) am
MENTAL HEALTH FACILITIES & MEDS
CSHB 172(FIN) am was HEARD and HELD in committee
for further consideration.
CSHB 265(FIN)
HEALTH CARE SERVICES BY TELEHEALTH
CSHB 265(FIN) was HEARD and HELD in committee for
further consideration.
CS FOR HOUSE BILL NO. 265(FIN)
"An Act relating to telehealth; relating to the
practice of medicine and the practice of nursing;
relating to medical assistance coverage for services
provided by telehealth; and providing for an effective
date."
1:05:48 PM
Co-Chair Stedman relayed that it was the first hearing for
HB 265. The intention of the committee was to hear a bill
introduction and sectional analysis, take invited and
public testimony, and set the bill aside for further
review.
1:06:54 PM
REPRESENTATIVE IVY SPOHNHOLZ, SPONSOR, relayed that HB 265
was designed to expand the telehealth flexibilities that
had been enjoyed during the Covid-19 pandemic, while
ensuring patient protection and Alaskas sovereignty as it
related to licensing. She recounted that the legislature
had worked for years to expanded telehealth, including
Medicaid for telehealth for behavioral health in SB 74 and
HB 29, which passed in 2020 and required insurance coverage
for telehealth. She noted that the pandemic resulted in
people using telehealth in ways that had not been imagined.
She noted that Alaskan providers had invested in
telehealth, and she did not want to diminish the access to
care and cost savings provided by telehealth.
Representative Spohnholz continued that the state public
health emergency (which had expired one year previously)
and the federal public health emergency had allowed
flexibility in the utilization and regulation of
telehealth. She noted that the federal public health
emergency would expire July 22, and there was some urgency
to ensure Alaskans would get the needed care. She explained
that HB 265 would create a legislative framework for
continued successful delivery of telehealth while
protecting patients and reducing red tape.
Representative Spohnholz continued that Alaska did not have
telehealth payment parity, which was important because it
caused a natural disincentive for providers to offer
telehealth. She cited that 84 percent of providers that
were registered in the telemedicine business registry were
providers within Alaska. She noted that some services were
not available via telehealth. She heard from advocates with
the American Association of Retired Persons (AARP) and
other organizations that telehealth flexibilities would
help to increase access to care, particularly in rural
Alaska. She mentioned barriers to telehealth access,
including requirements for documentation of efforts to have
an in-person examination. There were barriers to basic
kinds of care, including renewals of controlled substances
or medication for ongoing treatments. The legislation
aligned with the United States Drug Enforcement Agency
(DEA) regulations.
1:10:47 PM
Representative Spohnholz continued the bill introduction.
She discussed the challenges of accessing care in rural
parts of the state. She noted that the bill supported
growth in the market of Alaska-based providers. She noted
that the bill would save money for patients and the state.
She cited that between FY 20 and FY 21, the combined
increase in telehealth spend and decreased Medicaid travel
showed a savings of about 23 percent in combined costs for
the state. She reported that elders had liked telehealth
due to easy access. The bill allowed for follow-up visits
with a provider outside the state if there was already an
in-person examination. The exemption was designed in
collaboration with the American Cancer Society and the
Alaska State Medical Association.
Representative Spohnholz reported that people in rural
Alaska reported that the ability to have an audio-only
appointment had increased attendance in behavioral health
appointments by 30 percent, which was important due to poor
broadband access. She emphasized that the bill would
protect the patient-provider relationship. She explained
that the bill did not require patients or providers to
engage in telehealth, but it did remove barriers.
Representative Spohnholz pointed out that the bill did not
open up the market for non-licensed providers with the
narrow exception for follow-up care. Earlier versions of
telehealth legislation allowed for telehealth practice by
any provider anywhere. The bill did not reduce important
protections against over-prescription of controlled
substances. There were prescription limits, requirements to
use the Prescription Drug Monitoring Program (PDMP), and
the DEA required an in-person examination first. She
asserted that the bill did not reduce the quality of care
in Alaska and was not a replacement for in-person care. She
noted that in many parts of the state, people did not have
access to care at all, and the bill was designed to provide
access and improve health and wellbeing.
Representative Spohnholz thanked the 38 stakeholder
organizations that had worked on the bill, as well as the
Department of Commerce, Community and Economic Development
and the Department of Health and Social Services. She
corrected that the federal public emergency expired on July
15 rather than July 22 as previously stated.
1:15:14 PM
GENEVIEVE MINA, STAFF FOR REPRESENTATIVE SPOHNHOLZ,
addressed a Sectional Analysis (copy on file):
Section 1 Adds a new section on telehealth under Title
8 for all health care providers licensed with the
State of Alaska.
? Subsection (a) removes the requirement for an in-
person visit prior to a telehealth appointment.
? Subsection (b) narrowly exempts physicians licensed
in another state to deliver health care services via
telehealth if there is an established physician-
patient relationship, an in-person physical exam, and
the services are related to ongoing treatment or
follow-up care related to past treatment. The language
also references new enforcement language in Section 2.
? Subsections (c) and (d) create limits for a
telehealth appointment. If a telehealth appointment
falls outside of a provider's authorized scope of
practice, they may refer a patient to an appropriate
clinician. The cost of a service delivered through
telehealth must be the same as if it were delivered in
person.
? Subsections (e), (f), and (g) ensure that only
authorized providers licensed with the State of Alaska
can prescribe controlled substances (e.g.,
buprenorphine, Adderall, etc.) via telehealth without
conducting an in-person visit. These providers must
comply with the state and federal laws regarding the
prescription of controlled substances via telehealth.
o Subsection (e) pertains to providers in Title
8, Chapter 64 (Medicine) (i.e., physicians,
podiatrists, osteopaths and physician
assistants).
o Subsection (f) pertains to Advanced Practice
Registered Nurses (APRNs) in Title 8, Chapter 68
(Nursing).
? Subsection (h) removes requirements to document all
attempts for an in-person visit and prevents the
department or board from limiting the physical setting
of a health care provider delivering telehealth.
? Subsection (i) confirms that health care providers
under this section are not required to deliver
telehealth services.
? Subsection (j) provides definitions for all health
care providers applicable to this section, specifies
that the provider must be licensed in good standing,
and defines telehealth.
1:17:33 PM
Ms. Mina continued to address the Sectional Analysis:
Section 2
Creates AS 08.64.33 defining the State Medical Board's
authority to enforce against exempted physicians in
Section 1 and ensures these providers must comply with
Alaska laws for licensed physicians.
o Subsection (a) describes the grounds for the
board to sanction a physician licensed in another
state providing telehealth services in Section 1:
if they violate Alaska laws for Alaska-licensed
physicians; exceed the defined scope of
telehealth services in Section 1; or prescribe,
administer, or dispense a controlled substance to
an Alaska patient located in the state.
o Subsection (b) and (c) ensures that the board
can enforce exempted physicians in the same
manner as Alaska-licensed physicians. In addition
to this authority, they can issue a cease and-
desist order and notify the licensing authority
for each state the physician is licensed.
o Subsection (d), (e), (g), and (h) details the
board's disciplinary actions for exempted
physicians, mirroring similar language regarding
sanctions for Alaska-licensed physicians.
o Subsection (f) ensures that the board can
recover costs related to the proceedings and
investigation directly from an exempted physician
in Section 1.
Section 3
Amends language related to the prescription of
controlled substances via telehealth under the State
Medical Board. This deletes language requiring an
additional health care provider to assist a patient
during a telehealth appointment with a physician or
physician assistant regarding the prescription,
dispensing, and administration of controlled
substances.
Section 4-5
Adds sections related to the prescription of
controlled substances via telehealth under the Board
of Nursing. This does not change the Board of
Nursing's authority or the scope of practice for APRNs
ensures regulatory equity between the Board of Nursing
and the State Medical Board regarding the prescription
of controlled substances via telehealth for all DEA-
registered practitioners.
? Section 4 amends the Board of Nursing's regulatory
authority to include controlled substances via
telehealth in Section 5, mirroring statutory language
for the State Medical Board.
? Section 5 creates a new section AS 08.68.710
defining the telehealth prescriptive authority of
APRNs in statute. This section removes the regulatory
in-person requirement for APRNs under 12 AAC
44.925(c), mirroring the deletion of language for the
State Medical Board in Section 3.
Section 6
Adds a new section on telehealth under Title 18 for
emergency medical services. This section removes the
requirement for an in-person examination prior to a
telehealth encounter. This section replicates the same
provisions on cost, scope of services, documentation,
physical setting, and patient protections as Section
1.
Section 7
Adds a new section on telehealth payment under Title
47 for Alaska Medicaid.
? Subsection (a) requires the Department of Health to
pay for telehealth services in the same manner as an
in person service for the following: behavioral health
services, home and community based services (HCBS),
services provided by a community health aide or
community health practitioner, behavioral health aide
or behavioral health practitioner, dental health aide
therapist, chemical dependency counselor, non-HCBS
services covered under a federal waiver or
demonstration, other services provided by an
individual or entity eligible for department
certification and Medicaid reimbursement, and services
provided at rural clinics and federally qualified
health centers.
This subsection also allows for a telehealth visit to
be conducted through any means which could be useful
in a patient-provider relationship, including an
audio-only (i.e., phone call) appointment.
? Subsection (b) requires the department to adopt
regulations regarding payment of telehealth services.
This provision also allows the department to limit or
restrict Medicaid coverage under this section if a
service delivered via telehealth cannot be safely
delivered according to substantial medical evidence,
or if the federal government will not reimburse the
delivery of the service via telehealth.
? Subsection (c) specifies that the coverage of
services in Alaska Medicaid must be HIPAA compliant.
Ms. Mina continued to address the Sectional Analysis:
Section 8-9
Adds sections on telehealth under Title 47 for
grantees that deliver community mental health
services, or facilities approved by the department to
deliver substance use disorder treatment. Both
sections replicate the same telehealth provisions on
cost, scope of services, patient protections,
documentation, and physical setting as Section 1.
? Section 8 creates AS 47.30.585 to include entities
approved to receive grant funding by the Department of
Health to deliver community mental health services.
? Section 9 creates AS 47.37.145 to include public or
private treatment facilities approved by the
Department of Health to deliver services addressing
substance use disorders.
Section 10
Provides an immediate effective date.
1:23:21 PM
APRIL KYLE, PRESIDENT AND CEO, SOUTHCENTRAL FOUNDATION,
ANCHORAGE (via teleconference), spoke in favor of the bill.
She explained that Southcentral Foundation was a tribal
organization that served 65,000 Alaskans had 2,500
employees. She mentioned innovations in healthcare that
were learned during the Covid-19 pandemic to help create a
better system. She mentioned telehealth previous to the
pandemic, which was not reimbursable. She mentioned the
lack of video capabilities in certain areas of the state
and costly and delayed care. She mentioned the flexibility
of delivering telehealth, and the ability to make decisions
about interventions.
Ms. Kyle continued her testimony. She wanted the committee
to know that the Southcentral Foundation was concerned
about young people and suicide. She emphasized the
importance of timely care, which was aided by telehealth.
She emphasized the importance for reimbursable telehealth
care to be available after the public health emergency
ended. She thought the bill was a clinically sound bill
that allowed for good care, and it was also financially
responsible and cost-effective.
Senator Olson assumed the Southcentral Foundation was a 638
contractor.
Ms. Kyle answered affirmatively.
Senator Olson asked if Ms. Kyle was speaking in support of
the bill on behalf of regional health corporations
throughout the state.
Ms. Kyle stated that the tribal health system supported the
bill, and she spoke on behalf of Southcentral Foundation.
1:27:19 PM
KEVIN MUNSON, CEO, MAT-SU HEALTH SERVICES, WASILLA (via
teleconference), testified in support of the bill. He
relayed that Mat-Su Health Services was a federally
qualified community health center and a comprehensive
community behavioral health center that serviced the
greater Wasilla and Palmer Areas. He continued that Mat-Su
Health Services (MHS) provided a variety of services
including primary care, dental, psychiatric, behavioral
health, and 1115 waiver specialty mental health services.
He noted that telehealth services had been a part of MHS
delivery system for many years. He recounted that the
pandemic and subsequent relaxation of regulations around
telehealth had permitted the expansion of telehealth
services, resulting in greater and easier access to care
and other improvements. He cited that telehealth made up to
approximately 30 percent of MHSs billable contact.
Mr. Munson continued his testimony and thought the bill
would provide statutory framework needed to codify the
lessons learned. He thought the bill would protect patient
access and provide flexibility. He thought that absent the
bill there would be a sizable disruption in patient care.
He discussed parity reimbursement as proposed in the bill.
He thought there was a mistaken notion that telehealth
visits were less costly and could be reimbursed at a lower
rate, which he contended was not true. He cited that the
largest component of a telehealth visit was direct
personnel cost of those delivering care, followed by the
cost of all the other staff. He discussed brick and
mortar costs and emphasized that telehealth appointments
were as costly as in-person appointments.
Mr. Munson mentioned that telehealth had costs that face-
to-face care did not, including specialized training,
supervision, and compliance costs. He thought the failure
to reimburse for telehealth had several downsides such as
disenfranchised patients, increased travel costs, and
diminished access and continuity of care.
1:31:34 PM
Co-Chair Stedman OPENED public testimony.
WINN DAVIS, SENIOR POLICY ANALYST, ALASKA NATIVE HEALTH
BOARD, ANCHORAGE (via teleconference), spoke in support of
the bill. He explained that the Alaska Native Health Board
(ANHB) was the statewide voice for the Alaska tribal health
system and had been active for over 50 years in tribal
health. He asserted that telehealth access during the
Covid-19 pandemic had improved access to healthcare. He
mentioned expanded behavioral health access and increased
care in rural Alaska. He emphasized that the flexibility of
telehealth had saved lives in rural Alaska. He noted that
the legislation ensured Medicaid reimbursement for services
provided via telehealth, such as behavioral healthcare. He
discussed the importance of telephonic audio-only services
in rural Alaska.
Mr. Davis continued his testimony and discussed further
advantages such as a decrease in no-show rates. He
discussed patients that would be without care if there were
not access to telehealth. He reminded that village staff
managed multiple appointments with little resources and
emphasized potential real-world ramifications with the loss
of telehealth access.
1:34:13 PM
EMILY NENON, ALASKA GOVERNMENT RELATIONS, AMERICAN CANCER
SOCIETY CANCER ACTION NETWORK, ANCHORAGE (via
teleconference), testified in support of the bill. She
discussed calls from patients and patient navigators
regarding the need for telehealth. She thought it was time
to modernize the states telehealth regulations and laws.
She referenced an amendment that would allow for local
doctors to get more information and access for patients.
1:36:30 PM
Co-Chair Stedman CLOSED public testimony.
Senator Wielechowski asked if there was anyone from the
Department of Health and Social Services available to
answer questions.
Senator Wielechowski was curious about the reimbursement
provision and wondered if the change would cause an
increase in rates. He commented on the high medical rates
in Alaska. He thought it appeared that under the provision
on page 10, line 20 of the bill, would allow outside
doctors to significantly increase rates. He wondered if
there had been a cost analysis.
1:37:58 PM
RENEE GAYHART, DIRECTOR, HEALTH CARE SERVICES, DEPARTMENT
OF HEALTH AND SOCIAL SERVICES (via teleconference), relayed
that the payment rates for telehealth would be the same as
an in-office visit. She continued that out-of-state
providers were paid their own state rates rather than the
Alaska rate.
Co-Chair Stedman asked committee members to look at the
bill and bring forward any potential amendments for
consideration by Friday, May 13.
HB 265 was HEARD and HELD in committee for further
consideration.
SENATE BILL NO. 124
"An Act relating to admission to and detention at a
subacute mental health facility; establishing a
definition for 'subacute mental health facility';
establishing a definition for 'crisis residential
center'; relating to the definitions for 'crisis
stabilization center'; relating to the administration
of psychotropic medication in a crisis situation;
relating to licensed facilities; and providing for an
effective date."
CS FOR HOUSE BILL NO. 172(FIN) am
"An Act relating to crisis stabilization centers,
crisis residential centers, and subacute mental health
facilities; relating to representation by an attorney;
relating to the administration of psychotropic
medication in a crisis situation; relating to
hospitalizations for mental health evaluation;
relating to licensed facilities; relating to a report
to the legislature on psychiatric patients and patient
rights; and providing for an effective date."
1:38:55 PM
Co-Chair Stedman relayed that it was the first hearing for
SB 124. It was the committees intention to hear a bill
introduction, consider a sectional analysis and comparison
of the House and Senate versions of the bill, take invited
and public testimony, and set the bill aside for further
review.
1:39:55 PM
HEATHER CARPENTER, HEALTH CARE POLICY ADVISOR, DEPARTMENT
OF HEALTH AND SOCIAL SERVICES, introduced herself.
STEVE WILLIAMS, CEO, ALASKA MENTAL HEALTH TRUST AUTHORITY,
showed a presentation entitled "TRANSFORMING A BEHAVIORAL
HEALTH CRISIS SYSTEM OF CARE," (copy on file). He turned to
slide 2, "Change is Needed":
Currently, Alaskans in crisis are primarily served by
law enforcement, emergency rooms, and other
restrictive environments
• Behavioral health crisis response is outside the
primary scope of training for law enforcement,
and reduces focus on crime prevention
• Limited Designated Evaluation & Treatment (DET)
capacity in four communities: Juneau (BRH),
Fairbanks (FMH), Mat-Su (MSRH), Anchorage (API)
• Emergency rooms are not designed for and can be
overstimulating to someone in an acute
psychiatric crisis
Mr. Williams showed slide 3, "HB172 is a Path Forward":
HB172 will:
1) Effectuate a "No Wrong Door" approach to
stabilization services
2) Enhance options for law enforcement and first
responders to efficiently connect Alaskans in crisis
to the appropriate level of crisis care
3) Support more services designed to stabilize
individuals who are experiencing a mental health
crisis
• 23-hour crisis stabilization centers
• Short-term crisis residential centers
4) Protect patient rights
Mr. Williams cited that the proposed protections for
patients' rights had come from advocates in the community.
He continued that the bill proposed a best-practice
framework that would transform Alaskas crisis care system
and had been developed in collaboration with over 300
individuals, 100 organizations statewide, the department,
and other key informants.
Ms. Carpenter showed slide 4, "Building Blocks of
Psychiatric Crisis System Reform":
1) SB74 Medicaid Reform (2016)
• Improve Access, quality, outcomes, and contain
costs
2) 1115 Behavioral Health Waiver
• Targets resources and services to "super
utilizers"
• Provides flexibility in community behavioral
health services and supports
• Creates new crisis service types that promote
interventions in the appropriate settings and at
the appropriate levels
3) System must be intentionally designed and promote a
"no wrong door" philosophy
Ms. Carpenter described the no wrong door philosophy as a
robust crisis response system for those experiencing a
mental health crisis and unable to seek care voluntarily.
1:44:05 PM
Mr. Williams referenced slide 5, "GOAL: Design and
implement a behavioral health crisis response system
analogous to the physical health system," which showed two
graphical flow charts. He described that the graphics [on
the first flow chart] were to illustrate what the current
medical/physical health system looked like. He asserted
that the same structure needed to be available for those in
a mental health crisis, to provide an appropriate response
and level of care or resolution. He noted that the model
[on the second flow chart] had been examined by the
department and the trust and was operated in other states
around the country. He mentioned Maricopa County in
Arizona, and visits to learn about its existing system that
was hoped to be modelled and implemented in Alaska.
Mr. Williams tuned to slide 6, "Stakeholder Engagement":
Healthcare Providers
State Agencies
Law Enforcement and First Responders
Beneficiary Advocates and Nonprofits
Local Governments
Ms. Carpenter addressed slide 7, "Enhanced Psychiatric
Crisis Continuum of Care," which showed a graphic depicting
where the proposed new services fit into the existing
continuum of care. She highlighted that under the 1115
Medicaid waiver, the mobile crisis teams, the 23-hour
stabilization, and the short-term stabilization were all
Medicaid billable services.
1:46:55 PM
Mr. Williams spoke to slide 8, "Crisis Stabilization Center
(23 hour)":
Provides prompt, medically monitored crisis
observation and psychiatric stabilization services
• No wrong door - walk-in, referral, and first
responder drop off
• Staffed 24/7, 365 with a multi-disciplinary team
• High engagement/Recovery oriented (Peer Support)
• Immediate assessment and stabilization to avoid
higher levels of care where possible
• Safe and secure
• Coordination with community-based services
Mr. Williams dicussed the scenario of law enforcement
interfacing with someone in a behavioral health crisis. In
such circumstances, if the individual was taken to an
emergency room, they would be taken in handcuffs.
Additionally, while waiting to be admitted, the individual
would wait in the squad car and it could take several hours
for the law enforcement to be able to return to duties.
Mr. Williams displayed slide 9, "Short-Term Crisis
Residential Stabilization Center":
A 24/7 medically monitored, short-term, crisis
residential program that provides psychiatric
stabilization
• Safe and secure serves voluntary and
involuntary placements
• High engagement/Recovery oriented (Peer Support)
• Multi-disciplinary treatment team
• Short-term with 16 or fewer beds
• Stabilize and restore avoid need for inpatient
hospitalization where possible
• Coordination with community-based services
Mr. Williams showed slide 10, "Enhanced crisis response
would reduce the number of people entering the most
restrictive levels of care," which showed a graphic
depicting a snapshot of ten years of data from Georgia, a
state which operated the full continuum of care. He
described that of 100 calls to the crisis care line, 90
were resolved over the phone. He reminded that the
individuals on the phone were licensed professionals. He
described mobile crisis teams, equipped with a mental
health professional and a peer. He noted that there were
mobile crisis teams operating in Fairbanks and Anchorage.
He discussed success of the mobile crisis team in Georgia.
He summarized that the robust continuum of care showed that
instead of using emergency services as the default
treatment, it was possible to triage the system and avoid
using higher levels of care.
1:51:04 PM
Ms. Carpenter spoke to slide 11, "Alaska Statute Title 47":
Collaborative Approach to Transforming our Response to
Alaskans in a Behavioral Health Crisis
HB172 Mental Health Facilities & Meds
Ms. Carpenter highlighted that in the fall of 2018 the
Alaska Psychiatric Institute (API) was in a crisis and the
census was greatly reduced. At the time, individuals having
a psychiatric crisis (but having committed no crime) were
being held at correctional facilities due to no capacity at
API or other hospitals, and the Disability Law Center and
the Public Defender Agency had then sued the department.
The judge had found against the state in 2019, and the
process of coming to a settlement was begun. Part of the
ruling and settlement was the need to seek alternatives in
places to provide 72-hour evaluations in less restrictive
settings such as crisis stabilization centers and crisis
residential centers that the Crisis Now model would allow.
Ms. Carpenter turned to slide 12, "Key Takeaways":
HB172 Does:
• Create a "no wrong door" approach to providing
medical care to a person in psychiatric crisis
• Provide law enforcement with additional tools to
protect public safety
• Expand the number of facilities that can conduct
a 72-hour evaluation
• Add a new, less restrictive level of care
• Facilitate a faster and more appropriate response
to a crisis, expand the types of first responders
that can transport an individual in crisis to an
appropriate crisis facility
HB172 Does Not:
• Interfere with an officer's authority or ability
to make an arrest
• Change who has the current statutory authority to
administer crisis medication
• Change current statutory authority for who can
order an involuntary commitment
• Reduce the individual rights of the adult or
juvenile in crisis; the parents' rights of care
for their child; or existing due process rights
of the individual in crisis
Ms. Carpenter listed Emergency Medical Technicians (EMTs),
paramedics, and firefighters as the types of first
responders that could transport an individual in crisis to
a crisis center. She noted that under the bill, crisis
medication could only be prescribed by a physician, an
advanced nurse practitioner, or a physicians assistant.
Mr. Williams addressed slide 13, "Current Flow for
Involuntary Commitment," which showed a flow chart that
illustrated the current system. He drew attention to the
bottom left corner, which showed that hospital emergency
rooms and jails were used, with law enforcement as the
primary response.
1:55:00 PM
Mr. Williams showed slide 14, "Flow for Involuntary
Commitment with Statutory Changes," which showed a flow
chart. He drew attention to the lower left of the slide,
which showed the addition of mobile crisis teams, crisis
stabilization centers, and additional crisis residential
centers.
Ms. Carpenter displayed slide 15, "HB 172 Committee
Substitute Highlights (ver. D.A)":
Key Improvements
1) Adds new language for a "health officer", newly
defined in Section 26
2) Changes length of stay from up to 5 days to up to 7
days at a Short-term Crisis Residential Center
3) Adds provisions for protecting patient rights
• 72 hrs. clock for an ex-parte hearing starts when
a person (respondent) is delivered to a Crisis
Stabilization or Crisis Residential Center;
• Attorney is appointed for the respondent;
• Court shall notify the respondent's guardian, if
any
• Computation for seven-days at a Short-term Crisis
Residential Center includes, time the respondent
was receiving care at a Crisis Stabilization
Center, if applicable
4) Adds a new section (Sec. 30) directing the
Department of Health, Department of Family and
Community Services, and the Alaska Mental Health Trust
Authority to submit a report and recommendations to
the Legislature regarding patient rights.
• Patient grievance and appeal policies
• Data collection on patient grievances, appeals
and the resolution
• Patient reports of harm, restraint and the
resolution
• Requirements that could improve patient outcomes
and enhance patient rights
Ms. Carpenter showed slide 16, "HB 172 Committee Substitute
Highlights (ver. D.A)":
Key Improvements Continued
5) Adds requirement that notifications in the
alternative to arrest statutes also go to the peace
officer's employing agency to ensure victim
notification will happen even if the arresting officer
is off duty. (Sections 4, 6, and 10)
6) Addresses statutes found unconstitutional by the
Alaska Court System to align with the court rulings.
• Amends the definition of "gravely disabled" in AS
47.30.915(9) (Section 24)
• Clarifies standards for court to order
administration of non-crisis medication (Sections
20 & 21)
7) New section that clarifies the Public Defender
statutes and their role as the attorneys the Court
will appoint in all proceedings under AS 47.30.
8) Amended the computation of time for both hospitals
and crisis residential centers to have the evaluation
period end at 5:00 pm the next business day after
Saturdays, Sundays and legal holidays if a patient
would be held longer than 72 consecutive hours
(Sections 14 & 18)
2:00:10 PM
JAMES COCKRELL, COMMISSIONER, DEPARTMENT OF PUBLIC SAFETY
(via teleconference), spoke in support of the bill. He
stated that the department was supportive of the bill, and
he was in support of the bill personally and
professionally. He thought the bill was a step forward and
would be long-lasting progress towards handling mental
health issues in the state. He described that often times
law enforcement officers were called upon to address mental
health crises and were ill equipped. He continued that many
times officers ended up putting individuals in patrol cars
and sometimes spent hours trying to find a place for an
individual to receive care. He emphasized that additional
resources were needed. He believed in the direction that
the department was taking with the bill.
2:02:08 PM
MARK REGAN, LEGAL DIRECTOR, DISABILITY LAW CENTER,
testified in support of the bill. He wanted to explain how
current law had worked and how it had broken down leading
to the bill proposal to improve things under the Crisis Now
system. He asserted that current law did not provide for
short-term mental health treatment. Instead, the law asked
people to be held and brought to a facility for a 72-hour
evaluation, after which a person could go in for a 30 day
or longer civil commitment. He thought the system had not
worked well because of the lack of facilities outside of
API and hospitals in Juneau and Fairbanks.
Mr. Regan continued his testimony. He discussed people in
crisis being brought to Anchorage from rural Alaska to find
API at capacity, necessitating a transfer to other cities.
He discussed difficulties that resulted in individuals
having to wait in custody in hospital emergency rooms or
correctional facilities. He described the inadequate
condition of the facilities as the reason the Disability
Law Center had sued the department. He asserted that the
Crisis Now system would provide places for short-term
facilities for those experiencing a mental health crisis
that was much better than what was previously available.
2:06:21 PM
Senator Wilson asked about the possibility of further
action by the Disability Law Center if the bill was not to
pass.
Mr. Regan noted that the settlement of the lawsuit was
based on existing law, and the law center would continue to
try and enforce the settlement and ensure that the 72-hour
evaluations could be done in other places. He emphasized
that the center would deeply regret if the bill were not to
pass and stressed the importance of having a place to be
for the 72-hour evaluation. He theorized that with an
appropriate place, individuals in hub communities could set
up short term treatment centers allowing for people to stay
in their home area.
2:08:07 PM
ANN RINGSTAD, EXECUTIVE DIRECTOR, NAMI ALASKA (via
teleconference), spoke in favor of the bill. She explained
that NAMI was part of the National Alliance on Mental
Illness, the nations largest grassroots mental health
organization. She cited that mental illness affected one in
five adults in the United States, which equated to over
108,000 individuals. She referenced the inadequate system
of care. She shared a story from the director of the
national NAMI, who spoke of her daughters long journey
with mental illness. The daughter had had a mental health
crisis and there had been a profound lack of resources that
had a dire outcome. She summarized that if a behavioral
health crisis response system was in place, the story would
have had a different outcome. She summarized that the No
Wrong Door approach to providing care would provide a
faster and more appropriate response to behavioral health
crises. She thought the legislation would ensure people got
appropriate care swiftly, keep people out of jail and
emergency rooms, and minimize the impact on first
responders. She stated that NAMI strongly supported the
bill.
2:11:20 PM
Co-Chair Stedman OPENED public testimony.
ALBERTA UNOK, PRESIDENT AND CEO, ALASKA NATIVE HEALTH BOARD
(via teleconference), testified in support of the bill. She
explained that the Alaska Native Health Board (ANHB) was
the statewide voice on the entire Alaska tribal health
system and worked with all tribal health organizations on
collective priorities. She asserted that the programs and
services needed to be stood up across Alaska as soon as
possible, especially considering the mental health impacts
of the pandemic. She contended that Alaskans in a
psychiatric emergency faced long waits in the emergency
department or jail when there was not room at API. She
thought the services proposed in the bill would address
major gaps in the continuum of care and give Alaskans the
care they need in a supportive environment.
Ms. Unok highlighted that ANHB supported HB 172s
definition of health officer to be updated to match the
definition found in the Senate version of the legislation,
which includes community health aide programs. She
explained that as a federally certified healthcare
provider, community health aides and behavioral health
aides were frequently first responders that encountered
crises in their communities and played an important role in
mental health care. She urged the passage of the
legislation in the current session.
2:14:05 PM
ARTHUR DELAUNE, SELF, FAIRBANKS (via teleconference), spoke
in support of the bill. He recounted the story of his son,
who experienced fetal alcohol spectrum disorder and co-
occurring mental health disorders. He discussed his sons
mental health struggles and reported a two-week wait for
services. He discussed a wait in a padded room before being
admitted to the behavioral health ward. He discussed his
sons release from treatment and subsequent attempts to
receive services. It had taken 41 days after being suicidal
to receive services. He emphasized the importance of the
passage of the bill in order to have the state be more
responsive to mental health crises.
2:16:52 PM
ROBYN BJORK, SELF, PALMER (via teleconference), testified
about her concerns with the bill. She was concerned that
the previous testimony had not accurately addressed
provisions in the bill. She referenced Section 14 under
Article 9 relating to involuntary admission for treatment.
She expressed concern that first responders be utilized for
taking people into custody for involuntary admission. She
agreed that crisis stabilization centers were needed.
Ms. Bjork expressed concern about the definition of "health
officer," which she thought was nebulous. She had concerns
that the bill poorly defined evaluation facility," and
that the bill could be weaponized against mentally well
Alaskans. She suggested that the committee engage an
outside legal expert to review the bill provisions.
2:20:34 PM
MICHELLE BAKER, EXECUTIVE VICE PRESIDENT, BEHAVIOR
SERVICES, SOUTHCENTRAL FOUNDATION (via teleconference),
spoke in favor of the bill. She explained that the
Southcentral Foundation, in partnership with the Alaska
Native Tribal Health Consortium (ANTHC), was planning on
opening an adult crisis stabilization center on the Alaska
Native Health Campus. There was space identified and the
agencies were ready to invest. She discussed the increase
in mental health needs across the state. She asserted that
using the Crisis Now model and the No Wrong Door approach
would provide less costly services in a more therapeutic
and appropriate environment.
Ms. Baker noted that it was important for people to receive
both voluntary and involuntary services in a crisis
stabilization center. She offered her support HB 172's
definition of health officer to be updated to match the
definition in the Senate version of the bill, to include
Community Health Aid Practitioner as a federally certified
healthcare provider. She reminded that many communities had
no Village Public Safety Officer (VPSO) or Alaska State
Trooper, and the only place to receive care was in the
health clinic.
Ms. Baker continued that the Crisis Now framework had
widespread support across stakeholders. She noted that the
legal framework was necessary to support the planned crisis
stabilization center. She asserted that if the bill did not
pass it would greatly affect how the foundation designed
the program and would result in increased stress and cost
on the health care system.
2:23:58 PM
SHAYNE LACROIX, POLICE OFFICER, PALMER POLICE DEPARTMENT
(via teleconference), testified in favor of the bill. He
expressed the Palmer Police Departments support for the
legislation. He mentioned how mental health crises affected
first responders. He emphasized that the biggest part of
the problem was that people in the community experiencing
behavioral health crises were not getting the help that was
needed. He discussed the lack of facilities and discussed
the advantages of the Crisis Now model.
2:25:22 PM
RENEE RAFFERTY, REGIONAL DIRECTOR OF BEHAVIORAL HEALTH,
PROVIDENCE ALASKA, ANCHORAGE (via teleconference), spoke in
support of the bill. She shared that Providence Health and
Services Alaska had one of the largest behavioral health
offerings in the state, and provided services in Anchorage,
Mat-Su, Kodiak, and Valdez. She noted that Providence had
been collaborating for the previous four years with many of
the stakeholders that had previously testified. The design
behind the collaboration was in aid of strategic planning.
Ms. Rafferty thought it was evident that the bill was well
thought out and presented needed changes. She cited that
Providence was ready to open a crisis stabilization center
in 2023, and the services would increase access to those
that were currently being directed to jails and emergency
services. She opined that additionally, the bill would
allow for collaboration, data gathering, and system change
that had never been seen before. She urged the bill be
passed during the current session to provide the regulatory
framework to build a system of care for vulnerable
Alaskans. She mentioned that the current system provided
costly and ineffective care.
2:27:12 PM
DAVID CAMPBELL, DEPUTY CHIEF, JUNEAU POLICE DEPARTMENT (via
teleconference), testified in support of the bill. He
relayed that police officers often encountered situations
with people in crisis that did not rise to the level that
warranted a Title 47 hold. He discussed a lack of options,
and the occasion when people were arrested for low-level
offenses. He described officers having to have repeat
contacts with individuals that were not able to receive
services or treatment. He relayed that the Juneau Police
Department was very supportive of HB 172, which he thought
would fill a services gap.
2:29:21 PM
VIKKI JO KENNEDY, SELF, JUNEAU (via teleconference), spoke
in support of the bill. She thought that some provisions
needed to be removed from the bill before it was passed.
She mentioned the testimony of Ms. Bjork. She thought the
bill was badly needed. She thought the legislature had been
working on the bill for four years. She thought the bill
needed to be amended. She discussed officers from the
Juneau Police Department diffusing a situation with an
individual. She thought the pandemic had added to the
problem. She mentioned her nephew had taken his own life.
She did not support the mention of federally recognized
providers. She thanked the committee for its work.
2:32:25 PM
Co-Chair Stedman CLOSED public testimony.
Senator Wilson asked if Mr. Gottstein could provide written
commentary as to if he supported the bill in its final
version after amended.
Senator Wilson asked Ms. Carpenter to comment on the
different versions of the bill. He understood the provision
related to the federal officer could reference those that
might be working on a military base or the Public Health
Service Corps, which often worked in tribal health
facilities.
Ms. Carpenter affirmed that the definition for health
officer differed in the two bills. She recounted that there
had been feedback in the Senate Judiciary Committee that
the definition should be cleaned up. Tribal partners had
recommended using the term federally certified provider,
because tribal health employees were considered federal
employees because of the Indian Health Service. The term
found in the Senate version would cover the community
health aides and behavioral health aids as mentioned in
testimony by the Southcentral Foundation and the Alaska
Native Health Board. She stated that the department would
support the Senate version of the definition.
Ms. Carpenter addressed the definition of evaluation
facility, that mentioned a facility operated by the
federal government. She explained that the term referred to
tribal-operated facilities by Indian Health Services.
Technically the term could also include military bases, but
she had never seen bases offer the evaluation services. The
definition clarified with new language that performs
evaluations referenced the evaluations found in the
section of statutes and would necessitate a facility that
could do the 72-hour evaluations.
Senator Wilson thanked Ms. Carpenter for the clarification.
Co-Chair Stedman asked if Ms. Carpenter wanted to make a
final statement.
Ms. Carpenter noted that she had shared a document that
provided a comparison of the two bills (copy on file).
Co-Chair Stedman set the bill aside for further review. He
asked members to provide suggested amendments by noon on
Friday, May 13.
SB 124 was HEARD and HELD in committee for further
consideration.
HB 172 was HEARD and HELD in committee for further
consideration.
Co-Chair Stedman discussed the agenda for the following
day.
ADJOURNMENT
2:37:14 PM
The meeting was adjourned at 2:37 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 172 Transmittal Letter.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 |
| HB 172 Definitions in AS 47.30.915.pdf |
HHSS 3/8/2022 3:00:00 PM SFIN 5/12/2022 1:00:00 PM |
HB 172 |
| HB 172 - Supporting Document - Letters of Support.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 |
| HB 172 - SFIN Presenation 5.12.2022.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 |
| HB 172 - Sectional Anaylsis Ver. D.A.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 |
| HB 172 - Letter of Support - DPS.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 |
| HB 172 - Letter of Support - Alaska ACEP.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 |
| HB 172 - Infographics - Proposed Statutory Changes to Title 47 3.6.22.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 |
| HB 172 - Explanation of Changes Ver. D.A.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 |
| HB 172 - Crosswalk with SB 124 (updated).pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 SB 124 |
| SB 124 Transmittal Letter.pdf |
SFIN 5/12/2022 1:00:00 PM SHSS 4/27/2021 1:30:00 PM SJUD 4/27/2022 1:30:00 PM |
SB 124 |
| HB 265 Sponsor Statement v. E.pdf |
SFIN 5/12/2022 1:00:00 PM SL&C 5/2/2022 1:30:00 PM |
HB 265 |
| HB 265 Sectional Analysis v. E.pdf |
SFIN 5/12/2022 1:00:00 PM SL&C 5/2/2022 1:30:00 PM |
HB 265 |
| HB 265 Explanation of Changes v. W to v. E.pdf |
SFIN 5/12/2022 1:00:00 PM SL&C 5/2/2022 1:30:00 PM |
HB 265 |
| HB 265 Supporting Document - New HFIN Testimony Received as of 04.13.22.pdf |
HFIN 4/14/2022 1:30:00 PM SFIN 5/12/2022 1:00:00 PM |
HB 265 |
| HB 265 Support.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 265 |
| HB 265 Support Kantiyavong.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 265 |
| HB 172 Opposition.pdf |
SFIN 5/12/2022 1:00:00 PM |
HB 172 |