Legislature(2015 - 2016)SENATE FINANCE 532
01/29/2015 09:00 AM Senate FINANCE
| Audio | Topic |
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| Start | |
| Presentation: Mental Health Trust Fy 16 Budget | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
SENATE FINANCE COMMITTEE
January 29, 2015
9:03 a.m.
9:03:09 AM
CALL TO ORDER
Co-Chair Kelly called the Senate Finance Committee meeting
to order at 9:03 a.m.
MEMBERS PRESENT
Senator Anna MacKinnon, Co-Chair
Senator Pete Kelly, Co-Chair
Senator Peter Micciche, Vice-Chair
Senator Click Bishop
Senator Mike Dunleavy
Senator Lyman Hoffman
MEMBERS ABSENT
Senator Donny Olson
ALSO PRESENT
Mike Barton, Board President, Alaska Mental Health Trust
Authority; Jeff Jessee, Chief Executive Officer, Alaska
Mental Health Trust Authority; Ryan Ray, Staff, Senator
Pete Kelly.
SUMMARY
^PRESENTATION: MENTAL HEALTH TRUST FY 16 BUDGET
9:04:36 AM
MIKE BARTON, BOARD PRESIDENT, ALASKA MENTAL HEALTH TRUST
AUTHORITY, discussed the PowerPoint presentation, "Senate
Finance Committee; January 29, 2015; Trust Alaska Mental
Health Authority" (copy on file). He highlighted some
members of the Mental Health Trust Board present at the
meeting. He looked at slide 1, "Trustees." He introduced
other board trustees in the committee room. He communicated
that trustees were advised by statutory advisor groups the
Governor's Council on Disabilities and Special Education,
Council on Aging, Alaska Mental Health Board, and the
Advisory Board on Alcoholism and Drug Abuse.
JEFF JESSEE, CHIEF EXECUTIVE OFFICER, ALASKA MENTAL HEALTH
TRUST AUTHORITY, explained slide 2, "Trust Beneficiaries":
Mental Illness
22,000
Developmental disabilities
13,000
Chronic alcoholism and other substance-related
disorders
20,000
Alzheimer's disease and related dementia
5,000
Traumatic brain injury
Mr. Jessee listed trust beneficiaries on slide 2 including
individuals with mental illness, developmental
disabilities, chronic alcoholism and other substance abuse
disorders, Alzheimer's disease and related dementia, and
traumatic brain injury. He relayed that prevention was a
significant part of the trust's mission; things that could
be done to prevent individuals from ending up in
beneficiary status.
Mr. Jessee highlighted slide 3, "Trust Cash Assets at End
of FY14." He reported that the financial health of the
trust was very good. He detailed that the Alaska Permanent
Fund had been doing well and the trustees had established a
robust financial system. He relayed that the trust had been
able to make its payout even when the Permanent Fund had
done poorly. He stated that the system had stood the trust
in good stead for many years.
Senator Dunleavy wondered if there were environmental
concerns and other related concerns when developing the
Trust-owned land. Mr. Jessee replied in the affirmative.
Senator Dunleavy surmised that the purpose of the fund was
at times hindered by some that preferred that the lands not
be developed. Mr. Jessee replied that there were some
objections, but the Trust remained resolute about moving
through the obstacles. He used the example of old-growth
timber development in Southeast Alaska, and a major
exchange with the United Stated Forest Service.
9:10:24 AM
Senator Dunleavy commented that big oil and big timber were
not the only financial entities that were facing issues. He
felt that "big mental health trust" was also facing issues.
Vice-Chair Micciche wondered if the unit was on an annual
basis. Mr. Jessee replied that there was no official way to
count beneficiaries. The assumption was based on prevalence
data, which was an estimate of the number of beneficiaries
at any given time.
Vice-Chair Micciche commented that 10 percent was a
significant number of Alaskans. Mr. Jessee agreed.
Mr. Jessee looked at slide 4, "Revenues and Expenditures
(in millions)." He stated that the Trust was very
resilient, because of the way it was established. He
discussed that when revenues had been in the negative there
had continued to be a flow of money into the trust to
assist with beneficiary services.
Mr. Jessee displayed slide 5, "Trust Land Office Revenue,
Generated in FY14." He elaborated that the Land Office
continued to do a stellar job of generating revenue
(principal and income) for the trust. He shared that the
office had generated nearly $100 million into the principal
of the trust, which continued to generate revenue over time
(typically around $4 million annually).
Mr. Jessee discussed slide 6, "Impact at a Glance, Grants
awarded in FY14." He addressed grants awarded in FY 14. He
explained that two-thirds of the grant funds came through
state government as Mental Health Trust Authority
Authorized Receipts (MHTAAR) and one-third came directly
from AMHTA. He detailed that the goal was to have an
integrated health system and the trust liked working with
state agencies in a collaborative way; however, there were
situations when a direct grant was the most efficient and
effective option. He expounded that many of the direct
grants were to assist with capital projects for new
facilities, renovations, or other.
Mr. Jessee looked at slide 7, "FY16 Anticipated Income." He
showed anticipated income in FY 16 totaling $28 million; it
included a payout from principal of $20 million, $3 million
from prior years' average lapse, additional funds from the
Land Office average spendable income, and interest average.
Co-Chair Kelly queried the certification of the budget to
determine that it met the constitutional demand for mental
health spending. Mr. Jessee replied that the trustees
recommend a level of general fund (GF) in addition to the
trust funding. He explained that the legislature must write
the governor a letter, if they do not fund the
recommendations at the requested level.
9:15:26 AM
Mr. Jessee slide 8, "Utilize POMV strategy":
The Trust's base payout is 4.25 percent of the average
value of the fund's cash assets
-Funding approach ensures relatively stable cash
flow from year to year
Mr. Jessee emphasized that the trust utilized a percentage
of market value (POMV) strategy, which meant it was
dependent upon the revenue generated by the Permanent Fund.
He detailed that the trust's base payout was 4.25 percent
of the average value of the fund's cash assets. He
explained that the method had enabled the trust to have
financial stability in good and bad times. He knew there
had been many discussions about what would happen with the
Permanent Fund and whether it would switch to a POMV
methodology. He furthered that the trust was an example of
a fund that had switched to POMV and had created much
stability for the AMHTA.
Senator Bishop wondered if there were be a discussion
regarding POMV later in the presentation. Mr. Jessee
responded that there would not be further presentation on
POMV.
Senator Bishop wondered if the 4.25 percent was regularly
reviewed. Mr. Jessee replied that the percentage was
regularly reviewed. He stated that the Trust Authority
hired Callan Associates to analyze the fund, and trust
increases its payout authority each time the reserve is
fully funded and inflation proof. He explained that the
recent downturn in the economy had a negative effect on the
reserves. There were discussions regarding the payout
limit.
9:20:33 AM
Vice-Chair Micciche wondered if the fund was managed by the
Permanent Fund Corporation. Mr. Jessee replied that the
majority of the fund was managed by the Permanent Fund
Corporation, and half of the reserve was managed by the
Department of Revenue (DOR).
Vice-Chair Micciche asked if the asset allocation was
identical. Mr. Jessee replied in the affirmative. He
explained that it was like a mutual fund. The trust
received its share of the profit or loss, and the trust
paid its share of expenses.
Vice-Chair Micciche remarked that FY 14 had a return of $82
million, with a $100 million difference. He noted that the
five-year projections were conservative. He wondered if the
projections accounted for the downturns. Mr. Jessee replied
in the affirmative. He explained that the trust relied on
the Permanent Fund projections. He remarked that,
historically, the Trust had weathered two severe economic
downturns.
Mr. Jessee addressed slide 9, "FY16 GF/MH Recommendations"
(millions):
IT Application/Telehealth Service System Improvements:
$100.0 MHTAAR; $100.0 GF/MH
National Family Caregiver Grant Program: $325.0 GF/MH
Senior In-Home Services: $350.0 GF/MH
Long-Term Care Ombudsman Office - Increment: $35.0
GF/MH
Area Health Education Centers: $330.0 GF/MH
Licensed Marriage and Family Therapist: $25.0 GF/MH
TOTAL: $100.0 MHTAAR; $1,165.0 GF/MH
Mr. Jessee explained that a bulk of the funds were
designated to the National Family Caregiver Grant Program
and Senior In-Home Services. He addressed that during the
difficult financial climate it would be challenging to
determine how to have a sustainable budget in the short-
term, while looking at strategic investments for the
future. He discussed challenges related to an aging
population such as the importance of supporting family
caregivers, in-home caregiving, and home healthcare. He
highlighted the potential for caregiver burnout, which
would mean individuals requiring care would need higher
levels of care. He referred to higher levels of care and
the necessary long-term thinking associated with the issue.
He referenced previous discussions with Co-Chair Neuman
related to recidivism. He elaborated that some things could
be done to save money in the budget, but it was not a smart
fiscal strategy if it meant the state was heading towards
building another prison in upcoming years. He noted that
the senior care issues were an area of particular concern
because they would only continue to increase in coming
years. He briefly highlighted increments for the Long-Term
Care Ombudsman Office, area health education centers, and
the licensed marriage and family therapist program. He
discussed a proposed partnership on information technology
application telehealth service system improvements. He
stated that it was necessary to look at alternative ways of
delivering cost efficient and effective services in order
to build a long-term sustainable budget. He believed
telemedicine needed to be at the top of the list. He noted
that there were significant opportunities to partner with
tribal health and education systems.
9:27:09 AM
Co-Chair Kelly remarked the previous year's budget allowed
for $6 million for broadband. Senator Hoffman clarified
that it was probably approximately $10 million.
Co-Chair Kelly noted that the Tribal Health had broadband
capacity in each community. Mr. Jessee replied in the
affirmative.
Co-Chair Kelly wondered if the money for health concerns
and education concerns should be considered separate
concerns. Mr. Jessee replied that there were some
duplications within the tribal health system. H
Co-Chair Kelly asked if the broadband was available, and
only needed to be purchased. Mr. Jessee replied in the
affirmative. He shared that there were some clinics with
the telemedicine carts in the small villages that were not
utilized eight hours per day. He felt that using the
broadband for other purposes could generate revenue.
Co-Chair Kelly queried the definition of a "telemedicine
cart." Mr. Jessee replied that it was a cart with a variety
of medical instruments that was created by the tribal
health community. The readings could then be sent
electronically to a regional hospital.
Senator Hoffman did not know if additional broadband would
be available in Bethel. He shared that GCI must keep a
certain amount of broadband for the health facilities.
9:31:55 AM
Mr. Jessee slide 10, "FY16 Capital Recommendations." He
explained that the slide included historical numbers that
had gone into the capital budget to cover deferred
maintenance on nonprofit facilities, home modifications and
upgrades to retain housing for elderly family members, the
Homeless Assistance Project and Special Needs Housing
Grant, and coordinated transportation. He elaborated that
home modifications were a good investment if it allowed an
elderly family member to remain at home, thereby reducing
long-term costs for the state for out-of-home care. He
relayed that a significant portion of the Homeless
Assistance Project funding went towards operating homeless
assistance programs; services for the homeless population
would cease without the funding. The trust had partnered
with the Alaska Housing Finance Corporation (AHFC) on the
special needs housing grant to secure housing for high
users of community services. He referred to the Housing
First program under evaluation by the University of Alaska.
He detailed that the program did not require residents to
get sober prior to being housed. The strategy was to
provide housing first, which increased the health of the
individuals while dramatically reducing costs associated
with hospital visits, alcohol, and other. The hope was that
some of the individuals would move on into permanent
housing. Coordinated transportation helped beneficiaries
access needed services and work.
Vice-Chair Micciche wondered how the Medicaid expansion
would affect the Mental Health Trust and its beneficiaries.
Mr. Jessee replied that there would be some slides that
address that question.
Senator Hoffman asked for more information about the
Homeless Assistance Project. He wondered if the program was
only specifically in Anchorage. Mr. Jessee responded that
the program was in other parts of the states, and provided
core funding for shelters and other homeless assistance
programs.
Mr. Jessee addressed slide 11 titled "Established Focus
Areas." He spoke to disability justice related to reducing
recidivism and pulling individuals out of the cycle of the
criminal justice system through therapeutic, mental health
courts, and other. He discussed substance abuse prevention
and treatment, which the trust believed it could make
progress on over time. He reminded the committee that the
McDowell Group had reported the cost of alcohol as $1.2
billion to the State of Alaska. He asked how the number
could be accurate. In response, he addressed criminal
behavior related to alcohol, child protection and the
Office of Children's Services caseload driven by alcohol,
lost productivity at work due to alcohol abuse, all of
which represented a substantial costs. He reasoned that if
demand for alcohol could be cut it would have a significant
impact. He spoke to the importance of beneficiary
employment and engagement; with an emphasis on getting real
jobs in the community. He stated that whether the price of
oil was below $50 or above $100, the trust wanted its
beneficiaries to be the least dependent on government
programs as possible. He elaborated that it was in the
beneficiaries' long-term interest in terms of services and
as fully functional members of the community. He mentioned
advertisements produced by AMHTA with the goal of getting
employers to understand that trust beneficiaries were real
workers; in many cases they were more reliable, longevity
was better, and they were appreciative to get a check. He
addressed workforce development and efforts in the area.
Co-Chair Kelly asked if there was a long-term plan to
reduce recidivism. Mr. Jessee replied that both finance
committees had recently charged a number of agencies to
produce a recidivism reduction plan, which was due on
February 2, 2015. There was a recognition that recidivism
was more than an issue for the usual criminal justice
programs, because it included various other departments.
Successful reentry and reducing recidivism required people
to have safe, supported housing; a job; and support for
their recovery.
Co-Chair Kelly wondered if there was research regarding the
original reason for the person's incarceration. Mr. Jessee
replied that the therapeutic courts, mental health courts,
and various other programs were working to determine the
underlying causes.
Co-Chair Kelly stressed that the number remained at 65
percent.
Vice-Chair Micciche noted that 10 percent of Alaskans
received MHT services, and 65 percent of the prison
population received MHT services. He queried the recidivism
rate comparison between MHT beneficiaries and non-
beneficiaries. Mr. Jessee stressed that each beneficiaries
may not necessarily receive MHT services. He remarked that
some of those beneficiaries were unserved outside of
incarceration. He agreed to provide further information.
Mr. Jessee addressed the importance of workforce
development on slide 11. He noted that workforce demands
could increase if Medicaid expansion took place. He relayed
that AMHTA had the infrastructure in place through its
trust training collaborative to ensure it had people ready
to take the jobs. He looked at housing and long-term
services and supports for seniors and others with
disabilities, which would enable them to stay at home to
the maximum extent possible.
9:42:21 AM
Mr. Jessee highlighted slide 12, "Current Priorities":
Medicaid Expansion and Reform
Recidivism
Substance Abuse Prevention and Treatment
Mr. Jessee addressed Medicaid expansion on slides 13
through 15. He relayed that expansion would impact many
trust beneficiaries. He stated that projections were around
40,000. He stressed that the expansion opportunity was
particularly significant for single males between the ages
of 18 to 65 (who had not been eligible previously), many of
whom were using substance abuse treatment services. He
continued that the Division of Behavioral Health was
estimating that 5,000 beneficiaries would become Medicaid
eligible. He elaborated that as the new population gained
coverage there would be some offsets and savings to general
funds. He stated that initially Medicaid expansion would be
100 percent covered and would drop to 90 percent in the
future. He expounded that the needed services would not all
be covered by Medicaid. Another important component was
timing related to expansion and when the savings would be
recognized (e.g. July 1, 2015 or a later time). He did not
believe the state would have 100 percent of Medicaid
expansion on July 1.
Mr. Jessee explained that the Trust expected the expansion
to result in savings. He felt that the transition was not
perfect, because there would be some people who would gain
and lose services. He added that there should be some off-
sets over time.
Mr. Jessee addressed slide 16, "Medicaid Expansion: Impact
on DOC":
-In FY14, Alaska Department of Corrections processed
approximately $8.5 million in billings for inmate in-
patient stays that lasted more than 24 hours.
-Under Medicaid expansion, it is estimated that $6.8-
$7.65 million could be paid for by federal Medicaid
rather than State funds based on 80 percent-90 percent
of the population being eligible.
This is an estimate based on what we know now and
our interpretation of the expansion rules so the
numbers may change.
Mr. Jessee remarked that inmates may become Medicaid
eligible and some of the costs for inmate inpatient stays
may be offset. He pointed to the estimate that $6.8 million
to $7.65 million could be paid for with federal Medicaid,
but believed the savings would not be achieved in the first
year. He emphasized that the savings were all dependent on
the timing of how expansion was implemented. He did not
believe it would be possible to continue with the status
quo under the expansion. He stressed that expansion would
have to be used as a catalyst for reform (slide 17);
exactly what the reform looked like was not yet known. He
addressed the desire to move to a system that paid more for
outcomes and less for activities. The trust was working
with the department on developing a contract to obtain
input from others (particularly related to behavioral
health) to help the state understand how other states had
used expansion to catalyze reform and what may work for
Alaska. He believed the reform was critical. He stated that
current Medicaid projections were unsustainable.
Mr. Jessee displayed slide 17, "Medicaid expansion is a
catalyst for reform." He felt that only expanding Medicaid
would not simply yield positive reform. He stressed that
there must be Medicaid reform, because it was growing at an
unsustainable rate. He shared that he was highly motivated
to create positive reform of Medicaid. He stressed that it
was critical to help develop a sustainable Medicaid system
in Alaska. He believed that the Medicaid system would
collapse at some point if it did not become a sustainable
system. He added that the collapse could occur sooner if
the price of oil did not increase. He stressed that a
sustainable system was in the best interest of the state
and the trust's beneficiaries. He turned to slide 18
related to recidivism. He stated that one of the best
opportunities to reduce long-term budget demands was by
investing in proven strategies to reduce criminal
recidivism. He spoke to other states such as Texas that had
been successful in curbing recidivism and avoiding future
prison construction. He moved to slide 19 titled
"Disability Justice...Investing Wisely?" The slide included
a historical chart projecting that the state would need to
open a prison in 2012; it had opened a prison right on
schedule. He detailed that the state was on the path to
open another prison in a couple of years. However, the red
line showed a way to match the prison population to the
available beds, but it would require a data driven,
evidence-based approach to implement strategies, constantly
monitor the results, and fine tune the strategies to ensure
the desired results were achieved. He stated that unlike
Bring the Kids Home, if the state failed at the recidivism
effort there would be significant state liability. The
trust believed that Medicaid expansion was one of the
state's best opportunities to pay for many of the services.
9:48:07 AM
Mr. Jessee looked at slide 18, "Recidivism":
· Maintain efforts of current policy and program efforts
o 2014 SB64 passed and created Alaska Criminal
Justice Commission
o 2014 HB266 Legislative intent: workgroup formed
to develop Recidivism Reduction Plan (to be
delivered Feb. 2, 2015)
o 2007 Criminal Justice Working Group
o 2005 Trust disability justice focus area
Mr. Jessee elaborated that the Alaska Criminal Justice
Commission was looking at things like barrier crimes,
levels of sentences, and other. He referred to a statement
by Representative Craig Johnson that it was necessary to
assess "how mad we are, and how afraid we are of people"
because those were the reasons for incarceration. He
believed the state needed to look at what it could do to
address the issue. He stated that the state may have become
tougher on crime, but it may not have gotten smarter. He
discussed that Co-Chair Neuman had been integral in
developing HB 266 in 2014, which encompassed legislative
intent to form a workgroup to develop a recidivism
reduction plan. He opined that the bill represented a leap
in conceptual thinking. He elaborated that in the past the
state had looked at criminal justice in terms of the
Departments of Corrections, Law, and other. The bill
recognized that it was not necessarily these departments
that would be leading the charge to keep people out of
prison. He recognized that DOC had a significant role while
people are incarcerated, in treatment services, and in
supervised release. He stressed that most prisoners were
not released into supervision; the bill's intent language
recognized three things to keep recidivism down including
housing, employment, and support for recovery. He
elaborated that the intent language had included various
agencies including AHFC, the Department of Labor and
Workforce Development, the Department of Health and Social
Services (DHSS), and AMHTA. The trust was hopeful that the
Recidivism Reduction Plan would start to give the
legislature a road map on how to approach the issue.
Mr. Jessee discussed slide 19, "Disability Justice …
Investing Wisely?" The graph was from the University of
Alaska Anchorage (UAA) Institute for Social and Economic
Research (ISER).
Mr. Jessee explained slide 20, "Institutional Inmate
Population 2004 to 2022." He stated that the total offender
population was project to grow at an average of 1.93
percent annually for the following eight years. Historical
numbers were the actual institutional daily average
population excluding electronic monitoring and community
residential center population information.
Co-Chair MacKinnon requested a copy of the current actual
slide. Mr. Jessee agreed to provide that information.
Senator Dunleavy wondered if the trust had a position
regarding the recent marijuana initiative, and whether it
would affect the prison rates. Mr. Jessee replied that
there were some slides related to marijuana later in the
presentation. He stressed that increasing the consumption
of any intoxicant was not likely to improve the mental
health or criminality behavior of Alaskans.
Co-Chair Kelly remarked that he wished he had that same
quote during his election. Mr. Jessee remarked that it was
wrong to believe that the prisons were full of people that
were arrested for small quantities of marijuana. He
remarked that it may benefit some beneficiaries to
decriminalize marijuana. He did not feel that promoting the
increased use of marijuana to be beneficial to the state of
Alaska.
9:52:12 AM
Mr. Jessee addressed slide 21, "Proven results … Texas":
Funding for probation officers to use for outpatient
substance abuse treatment for offenders
Funding for a mental health pre-trial diversion
program
Expansion of in-custody substance abuse therapeutic
communities
A prison dedicated to providing DWI offenders with
intensive substance abuse treatment
Use of intermediate sanction facilities for
probationers who violate probation conditions
Early school intervention programs
Nurse family partnership program
-With these and other measures, Texas
successfully averted construction of previously
planned prison beds through 2012
-And Texas prison population completely leveled
off as a result
Mr. Jessee explained that that the trust had been asked to
assess the potential impact of expanded broadband use on
the long-term General Fund operating costs. He detailed
that the trust had begun to look at the statewide tribal
health and K-12 education systems and at opportunities for
partnerships. He had met with the chief operations officer
of the Tribal Health Consortium and subsequently with all
of the chief investment officers from all of the health
corporations. He had reported to the group that the state's
broadband study had indicated another broadband system was
needed. He stated that many of the telemedicine services
were in the tribal organizations' "health wheelhouse." He
had asked the organizations about opportunities for
partnership to try to use some of the resources together.
He relayed that the organizations had been receptive. He
had learned that currently the technology and broadband
capacity was not as much an impairment to expanding
telehealth as program development. He stated that it was
not just the technology any longer, it was getting the
programs developed in order to have billable hours to
handle electronic records properly. He stressed that the
state was lagging in programmatic infrastructure
development.
9:52:38 AM
Mr. Jessee discussed that the education system also had
access to broadband. He addressed opportunities for
partnership. For example, Alaska Children and Family was an
Anchorage agency that had reached out to upper and lower
Kalskag in the Yukon Kuskokwim region to offer remote
telehealth services for children with severe emotional
disturbances. He elaborated that it used a combination of
occasional site visits in addition to the use of
telemedicine to check in with the child and family on a
regular basis. He noted that there had been no extra state
broadband capacity in the region, but it had been available
in the school. Therefore, the services had been included in
the child's independent education plan for special
education, which had allowed the Anchorage agency to have
access to the broadband. He added that the situation had
been very successful. He spoke to better utilizing what was
currently available instead of reinventing the wheel. He
explained that some of the tribal funding systems and
education systems had limitations to what they could do. He
discussed that Alaska could not afford to maintain multiple
systems in rural Alaska and that some barriers may require
congressional action. He stressed the importance of getting
maximum utilization of the existing systems.
Senator Dunleavy looked at slide 21, and queried some
successful programs that have proven to reduce recidivism
rates. Mr. Jessee replied that the state of Washington had
a program which conducted a meta-analysis of the
intervention strategies.
Senator Dunleavy wondered if any of those programs were
cited in the research. Mr. Jessee replied there were some
programs that the state tried to pilot. He shared that some
programs, like the "Scared Straight" program may increase
criminality. He furthered that some school programs which
used police officers to present anti-drug messages did not
work. He stressed that bringing adolescent recovering
addicts presenting in elementary schools was more
effective.
Vice-Chair Micciche requested copies of some the research
on the effectiveness of substance abuse programs as related
to recidivism. He wanted to be careful to continue to fund
effective programs.
Co-Chair Kelly wondered if that research would be included
in the February 2 report. Mr. Jessee replied that there was
some information included in that report, and agreed to
provide more detailed research.
9:58:57 AM
Mr. Jessee looked at slide 23, "Recommendations":
1. Maintain current community behavioral health system
capacity
2. Establish an office focused on re-entry within
Department of Corrections
3. Attain technical assistance through Pew Charitable
Trust for Results First Initiative
Mr. Jessee addressed slide 24, "Substance Abuse Prevention
and Treatment":
The prevalence rates and negative consequences of
alcohol and drug abuse upon Alaskans are substantial.
In 2010, Alaska's costs associated with individuals
dependent on or abusing alcohol/drugs was $1.2
billion.
Mr. Jessee offered to provide the committee with a copy of
the McDowell Group report on substance abuse prevention and
treatment. He moved to slide 24 and discussed collaboration
on joint strategies. He highlighted Recover Alaska, an
initiative by the Rasmussen Foundation; the Mat-Su Health
Foundation; and the Denali Commission. Additionally,
judges, advocates, providers, and tribal groups had pulled
together to look at how the private sector may contribute
to reducing the impact of alcohol abuse in the state. He
discussed the Alaska Wellness Coalition, which was starting
a positive social norms campaign. He referred to a recent
commercial about a man with throat cancer. He relayed that
scientific research was pointing to the effectiveness of
positive approaches. For example, children wanted to be
normal. He pointed out the effectiveness of educating
children that most kids do not drink and most kids do not
smoke. He spoke to a kid's perception that "everybody's
doing it and if everybody's doing it then I should be doing
it." He believed the positive approach would be interesting
to see. He added that when the State of Washington had
evaluated a variety of intervention strategies for cost-
benefit analysis, it had evaluated the Scared Straight
program. The program took children who got into trouble
into prisons or other to try to scare them away from
committing crimes. He relayed that the program had actually
increased criminal behavior. He discussed that the
evidence-based practice was an evolving area.
Mr. Jessee looked at slide 25, "Substance Abuse Prevention
and Treatment":
Collaboration on joint strategies
-Recover Alaska
-Alaska Wellness Coalition (Positive Social Norms
Campaign)
-ABC board (Title 4 statute rewrite)
-Implementation of Proposition 2 (Marijuana)
Partnership with Department of Corrections on the
recidivism reduction planning with opportunities for
Trust investment in:
-Prisoner re-entry coalitions
-Access to effective treatment
-Prevention strategies focused on incarcerated
parents and their children
Mr. Jessee looked at slide 26, "Recover Alaska":
Mission: Reduce harms associated with excessive
alcohol consumption in Alaska
Formed by Funding Partners
•Rasmussen Foundation
•Alaska Mental Health Trust Authority
•Mat-Su Health Foundation
•Department of Health and Social Services
•Southcentral Foundation
•Other stakeholders
Guided by a multi-sector action group
•Judges
•Foundations
•Health professionals
•Elected officials including Senator Ellis,
Representative Hughes and
Representative Herron
10:02:50 AM
Mr. Jessee addressed slide 27, "Recover Alaska":
Active collaborations:
Connecting Alaskans to help
Funding media partnerships to increase general
public's understanding of alcohol's broad impacts
across Alaska
Title 4 statute review
Alaska Wellness Coalition: positive social norms
campaign on underage drinking
Efforts to increase awareness of the Adverse
Childhood Experiences Study
Mr. Jessee discussed slide 28, "Title 4":
Most of Title 4 has not been updated since 1980. The
laws are outdated and confusing.
A systematic review of Title 4 helps the board carry
out its mission and will benefit communities and
businesses.
Mr. Jessee explained that a couple of years earlier the
legislature had decided that the Alcohol Beverage Control
Board should be moved from the Department of Public Safety
to the Department of Commerce, Community and Economic
Development. He noted that the trust had lost the argument.
He stated that the effort had revealed that the state's
Title 4 statutory framework had not been reviewed for some
time and had developed in a very haphazard manner, usually
by a special interest getting a legislator to sponsor
legislation to get around the population base licensing
limits by creating new license types (e.g. recreational
site licenses, remote military contractor license, and that
only a florist could deliver alcohol to a hotel room). He
relayed that it was positive that the trust partnered with
the ABC Board and a group of over 60 people from industry,
public health, and public safety to address how to simplify
and decrease the number of license types, update the fees
to support the ABC budget, realign the system to better
enforce population limits, and bring all of the licenses,
endorsements, and permits into one place in statute.
Mr. Jessee highlighted slide 29, "Licensing Revisions":
Decrease the number of license types and simplifies
the licensing system to achieve more consistent
enforcement and adherence to state alcohol regulation.
Update license fees to support the ABC budget; adjusts
wholesale license fees and simplifies supplier
reporting.
Realign the system to better enforce population
limits.
Bring all licenses, endorsements and permits into one
place in statute, removes redundant or unused types.
Mr. Jessee addressed slide 30, "Role of the ABC Board
Revisions":
Ensure the ABC board fairly represents the interests
of all Alaskans and can lead in alcohol education,
policy and control.
Implement uniform police department reporting
requirements; develop enforcement, education, and
prevention plans directly connected to the matching
funds.
Allow data about alcohol purchases to be released
(aggregated at the region or community level) for
analysis and community self-assessment.
Base the ABC budget on the activities and staffing
needed to achieve the ABC's mission.
Designate ABC board seats to ensure representation by:
1 public health, 1 public safety, 2 industry and 1
rural public member; include Director's background in
filling the designations.
Mr. Jessee stated that the trust agreed with industry that
a limited entry system was in everyone's best interest; it
protected the value of industry's business and it was in
the trust's interest because it limited the number of
outlets. He stated that the current system of dealing with
underage drinking was broken. He discussed current
consequences such as suspension of a driver's license,
mandatory community service and treatment. He furthered
that the courts had required a higher level of due process
because of the consequences; therefore, the police had to
write an entire report. He continued that from a police
officer's perspective it was discouraging on a Friday or
Saturday night to have to write a report when they needed
to get back out to patrol; therefore, sometimes the report
was not written. He spoke to inconsistent enforcement
related to the issue. He added that because the citations
were issued in adult court they stayed on the individual's
record forever, which impacted military service,
scholarships, and other.
10:07:31 AM
Mr. Jessee looked at slide 31, "Underage Drinking
Revisions":
Reform underage drinking sanctions so that adults who
supply minors with alcohol are held to greater
accountability.
Reduce the penalty for a licensee, agent or employee
selling alcohol to a minor (Sec. 04.16.052) from a
class A misdemeanor to a minor offense violation.
Require statewide keg registration.
Mr. Jessee shared that the goal was to reform underage
drinking sanctions to hold adults providing alcohol to
minors accountable. He discussed that the recommendation
would be to change the punishment to a straight $500 fine;
if the fine was not paid, it would be garnished from an
individual's Permanent Fund Dividend (PFD). The trust
believed the change would lead to more consistent
enforcement. Additionally, the trust thought some parents
would be more concerned about their child losing a portion
of their PFD than with drinking. The trust did not want to
make the offenders criminals. He added that the fine could
be applied to treatment. He remarked that tickets would
help identify individuals receiving multiple tickets.
Mr. Jessee addressed slide 32, "Underage Drinking
Revisions":
Reform underage drinking sanctions so that minors do
not become criminals for making one poor decision.
Clarify required sign language warning minors of the
legal consequences of their entering licensed
premises.
Restore the minor consuming alcohol offense to a true
violation.
Mr. Jessee highlighted slide 33, "Local Option Revisions":
Strengthen local option laws and the ability to
enforce them.
Repeal local option 4, which bans sale and importation
of alcohol, but not possession.
Increase ABC budget for dedicated Title 4 enforcement
staff.
Increase the local option boundary from a 5-mile
radius to a 10-mile radius from the village center.
-Increase the misdemeanor-level fines for
bootlegging and imposes additional unit fines per
container of alcohol.
-Make possession of homebrew ingredients and/or
equipment with intent to produce alcohol illegal
in all local option communities.
Vice-Chair Micciche wanted to remain focused on the
underage drinking revisions, because there was an effort to
match those with the marijuana legislation.
Co-Chair MacKinnon wondered if there was consideration for
the three strikes rule, because of the fine reduction to
$500. Mr. Jessee replied that the current draft did not
have a three strikes rule.
Co-Chair MacKinnon felt that the individual may not be
receiving proper treatment, because they were only paying a
repeated fine. She shared that there was a discussion about
increasing the fine to $1000.
Senator Bishop wondered if there were any budget
calculations about the impact of possible marijuana
treatment. Mr. Jessee replied that there were no numbers
about the possible increase in marijuana related treatment.
He shared that he had studied Colorado's possible increase
in emergency room admissions and increased use among
adolescents. He stressed that increased use of marijuana
was not likely to have a positive outcome.
10:13:39 AM
Mr. Jessee continued to discuss slide 34:
Addiction rate
2011, 43 percent of the 590 treatment admissions
for Alaskans between the age of 12-17 was for
marijuana
2012, 17 percent of individuals admitted to
treatment reported marijuana as their primary
substance of abuse (U.S.)
Increased marijuana use during pregnancy
6.1 percent of mothers in 2006
7.8 percent of mothers in 2011
Psychotic symptoms can occur at 3 to 7 times the rate
among marijuana users versus those who do not use.
10:15:43 AM
Mr. Jessee slide 35, "Impact on Beneficiaries." He looked
at the far right bar which displayed the percentage of
students who think smoking marijuana once or twice a week
has slight or no risk. He noted that the bar was
substantial among the state's at-risk population. He
stressed that youth were severely impacted by their
perception of risk of harm. In that was the dilemma with
the advertising of promoting increased use of marijuana,
because it reduces the perception of harm, which would lead
to an increase in production.
Mr. Jessee slide 36, "Lessons Learned in Colorado":
Data
-Colorado wasn't measuring marijuana related
date, this lack of baseline has led to an
inability to understand the impacts of increased
commercial marijuana
Home grows are out of control
-Nontaxable, difficult to enforce, non-regulated
and hard to manage
Edibles and concentrates
-Dosage, THC content, portion control and
packaging still continue to be difficult to
manage
-Butane hash oil explosions and impacts to
residential areas
Advertising
-State is being sued by local newspapers as they
believe they have the right to advertise without
government restrictions on their commercial free
speech
Local control
-Majority of communities opted out of commercial
sales (approx. 212)
-Communities have opted out of grow operations
and put more restrictions on businesses
(locations, quantity)
-Local law enforcement needing training and
funding
Black market
-Legalized commercial marijuana has not decreased
the black market
Mr. Jessee slide 37, "Lessons Learned from Alcohol and
Tobacco":
Avoiding harms to others
-Indoor air
-Driving and injury restrictions
Sales and marketing restrictions
-Time, place, manner
Price
Use of tax revenue
-For prevention in youth and young adults
-Harm reduction and cessation in adult users
Strong public health infrastructure
-State and local
-Collaboration with NGO's
Strong public health messaging from trusted source
Attention to vulnerable populations
Mr. Jessee slide 38, "Recommendations":
Inter-disciplinary task force
-Ensure the regulations are informed by a
comprehensive field of experts with various
backgrounds (public health, regulatory groups,
industry, law enforcement, etc.).
Data
-Make certain that the right data and metrics are
being collected and funded
Regulations
-Start with strict regulations and then with time
and data have the ability to adapt
Local option
-Ensure that communities understand their rights
and abilities to exercise local controls
Licensing
-Staging of licenses
-Potency limits
Edibles and concentrates
-Only consider through a preapproval process
Advertising
-Enforce strict advertising; unlimited and
unregulated advertisement has a direct impact on
youth use
Law enforcement
-Need training now on how to enforce new
regulations
-Effectiveness of enforcement happens at the
local level
-Regulations needed on levels while driving;
using while driving
10:19:00 AM
Senator Dunleavy queried the smoking rates among minors
over the last 20 years. Mr. Jessee agreed to provide that
information.
Mr. Jessee slide 39, "Fetal Alcohol Spectrum Disorders"
(FASD):
• Alaska has the highest documented rate of FASD in
the nation
• More than 129 children are born with FASD every year
in Alaska
•Each child born with FASD costs the State between
$860,000 - $4.2 million (birth to age 18)
•129 kids x $4.2 million = $541.8 million
•FASD is 100 percent preventable
Mr. Jessee slide 40, "FASD":
$500.0 appropriation for media campaign to educate
Alaskans
-Prevention message vs intervention (not
targeting women who battle addiction)
Mr. Jessee slide 41, "FASD":
There is a high level of knowledge that alcohol use
during pregnancy is harmful to an unborn baby.
But, many women receive misinformation about alcohol
and pregnancy, including the consequences of alcohol
use, safe times to drink during pregnancy and safe
amounts or types of alcohol.
Mr. Jessee slide 42, "FASD Campaign Messaging":
Campaign will inform and encourage Alaska women aged
20 to 35 to ensure they are not pregnant before they
drink alcohol or to abstain from alcohol if they are
not sure of their pregnancy status in order to prevent
occurrences of FASD.
Mr. Jessee slide 43, "FASD Media Campaign":
Increase understanding among Alaska women that:
Alcohol use during pregnancy can cause birth defects
and brain damage
It is best to stop drinking before conception
It is safest not to drink any alcohol during pregnancy
There is no known safe time or amount to drink during
pregnancy
Mr. Jessee slide 44, "FASD Media Campaign":
Tactics to include:
-Video
-TV
-Radio
-Online
-Social media
-Out-of-home
Campaign will launch in March
Mr. Jessee slide 45, "FASD Prevention":
Investing in FASD prevention now will save the state
money and most importantly reduce the number of
families dealing with the heartbreaking effects of
FASD.
Thank you for your support in eradicating FASD in
Alaska.
10:23:16 AM
Co-Chair Kelly shared that there was a recent budget
infusion to address the problem of FASD in the state. He
had hired a staff member to head the effort in addressing
FASD. He had produced a video that was intended to illicit
a response from a large group of people. He stated that it
was a long video, so it probably would not be used as a
commercial. He stated that the Empowering Hope Group, which
Co-Chair MacKinnon was a member, wanted to identify who
would lead the efforts in each community. The budget
appropriation was used to hire the First Alaskans Institute
to identify those grassroots leaders. He shared that 160
people were named, and attended a meeting. He noted that
some of the people did not understand why they would be
selected as leaders.
Co-Chair Kelly presented a video about FASD. It showed a
woman who was pregnant, but she was drinking early in her
pregnancy. That drinking resulted in FASD in her son. The
message of the video was that drinking during pregnancy has
a harmful impact on the fetus.
10:31:57 AM
Co-Chair Kelly remarked that the video was intended to
solicit funds from private industry. He shared that the
video would be remastered to be used on social media,
radio, and television.
Vice-Chair Micciche remarked that the program was very
effective and honorable. He shared that he had kept each
pregnancy test from his wife's urine with each of his
child's names attached to the test. He felt that the press
had misrepresented the program during the prior year.
Senator Dunleavy wondered if there was a list of
ineffective program recommendations for removal. Mr. Jessee
agreed to provide that information.
Co-Chair MacKinnon wondered if there was information
regarding Daylight Savings Time. Mr. Jessee replied that he
did not have that information, but agreed to research that
request.
10:37:23 AM
Co-Chair Kelly asked for some explanation of the research
and contacts to eradicate FASD.
RYAN RAY, STAFF, SENATOR PETE KELLY, shared that he had
been personally upset when studying the issue of FASD. He
thanked the committee for their commitment to eradicating
FASD. He shared that the UAA study was a full academic
study on the effectiveness of a pregnancy test dispenser
located in bar bathrooms on raising public awareness of
FASD, and the impact of drinking during pregnancy. He
stressed that the pregnancy dispensers were not a
prevention mechanism. He remarked that the study was
complex, because of the many variables to identify whether
the dispenser would cause public awareness. The intention
was to create a discussion, and provide an opportunity to
use a pregnancy test. He shared that the study had caused
some international interest, because Alaska was the first
place in the world that had initiated the program. He
shared that the study would compare the Mat-Su valley and
the Kenai Peninsula.
Co-Chair Kelly queried the effectiveness of a program that
was once titled, "Community Helper." Mr. Ray replied that
initially the process was intended for a cost-effective
solution. He shared that it was important to identify the
local, "living room leaders" that would effect change. He
shared that the collection of individuals knew what was
occurring, and how to fix the communities. The intention
was the development of listening to the community members
regarding what needs to change in their communities.
10:43:48 AM
Co-Chair Kelly remarked that a goal Empowering Hope Group
was to partner with private industry to fund the response
to preventing FASD. He shared that there were many state
leaders in the Empowering Hope Group. He shared that the
program was a long-term response, in order to eradicate
FASD. There were programs through the state, but he wanted
to focus on prevention. He felt that there was
underreporting of people that were affected by FASD. He
would like a screening method that would identify who was
affected by FASD. He opined that there may be a national
effort in partnership with some pharmaceutical companies on
the screening development. He stressed that the
incorporation of identification was because the measure of
success could not be determined until the diagnoses
occurred.
Vice-Chair Micciche wondered if a 501C3 had been
established. He wondered if there was a way for a citizen
to contact the effort. Co-Chair Kelly replied that Mr. Ray
was a contact for the program. He furthered that the group
anticipated an attachment to a separate program.
Mr. Ray stressed that the goal was to keep the Empowering
Hope Group costs as low as possible. He stated that there
were partnerships to conduct the media campaigns and
research in order to streamline the funding and keep the
group at a volunteer level.
ADJOURNMENT
10:49:46 AM
The meeting was adjourned at 10:49 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| 012915 SFC Mental Health Trust Presentation.pdf |
SFIN 1/29/2015 9:00:00 AM |
Budget Overview |