Legislature(1997 - 1998)
02/11/1998 09:00 AM Senate HES
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SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
February 11, 1998
9:00 a.m.
MEMBERS PRESENT
Senator Gary Wilken, Chairman
Senator Loren Leman, Vice-Chairman
Senator Lyda Green
Senator Jerry Ward
Senator Johnny Ellis
MEMBERS ABSENT
None
COMMITTEE CALENDAR
Presentation by the State Independent Living Council (SILC)
SENATE CONCURRENT RESOLUTION NO. 14
Establishing the Alaska Task Force on Parity for Mental Health.
HEARD AND HELD
PREVIOUS SENATE COMMITTEE ACTION
SCR 14 - See HESS minutes dated 4/30/97, 1/30/98, and 2/4/98.
WITNESS REGISTER
Jim Burton, Chairman
State Independent Living Council
1169 Hess Avenue
Fairbanks, Alaska 99709
POSITION STATEMENT: Introduced members of the State Independent
Living Council.
Howard Hedges
P.O. Box 779
Homer, Alaska 99603
POSITION STATEMENT: Gave part of the presentation by the State
Independent Living Council.
Cindy Lynn
Box 1758
Petersburg, Alaska 99833
POSITION STATEMENT: Gave part of the presentation by the State
Independent Living Council.
Joyanna Geisler
P.O. Box 2474
Homer, Alaska 99603
POSITION STATEMENT: Gave part of the presentation by the State
Independent Living Council.
Ruth L'Hommedieu
P.O. Box 80127
Fairbanks, Alaska 99708
POSITION STATEMENT: Gave part of the presentation by the State
Independent Living Council.
Jerie Best
P.O. Box 426
Soldotna, Alaska 99669
POSITION STATEMENT: Gave part of the presentation by the State
Independent Living Council.
ACTION NARRATIVE
TAPE 98-10, SIDE A
Number 001
CHAIRMAN WILKEN called the Senate Health, Education and Social
Services (HESS) Committee to order at 9:05 a.m. Present were
Senators Ellis, Leman, Green and Wilken. The first order of
business before the committee was a presentation by the State
Independent Living Council (SILC).
JIM BURTON, Chairman of the State Independent Living Council in
Fairbanks, stated SILC is responsible for the concerns and
modification services for the disabled who live independently. He
introduced Howard Hedges of Homer, Cindy Lynn of Petersburg,
Joyanna Geisler of Homer, Ruth L'Hommedieu of Fairbanks, and Jerie
Best of Soldotna who would be giving presentations to the committee
today on behalf of SILC.
HOWARD HEDGES referred to a booklet entitled "Programs for People
with Disabilities: FY 99 Interdepartmental Budget Analysis and
Recommendations," and specifically to page 10 which pertains to SB
253. SB 253 will allow people with disabilities to purchase, on a
sliding fee scale basis, health care coverage through the Medicaid
program. Mr. Hedges said many disabled people want to work but
risk living without health care coverage because one must be
receiving public assistance to be eligible for Medicaid. He
explained that in 1993 he had a stroke and became disabled. He had
no insurance at the time and his illness decimated his family's
finances. After three years of physical and occupational therapy,
he was able to return to work. When one returns to work after
receiving public assistance for a disability, a one-year clock
begins to tick, after which time the assistance is cut off. He
began working at the Kenai Independent Living Center and received
a salary of $28,800 per year. Private insurance for his family
would have cost $705 per month with a $2500 deductible. The Center
was unable to provide insurance because it would have equaled 30
percent of its budget, therefore he was laid off. He once again
received public assistance and Medicaid and was fortunate because
in December he unexpectedly had heart surgery which cost $80,000.
MR. HEDGES concluded by saying he would have preferred to continue
to work and to pay a sliding fee scale premium for insurance but
because of the structure of the Medicaid program, he cannot buy
into Medicaid; he has to receive public assistance to be eligible
for Medicaid coverage.
MR. HEDGES said he is caught in the dilemma of not being able to
work so that he can maintain health care coverage through Medicaid.
He knows he is high maintenance but he wants to return to work.
There are many people in his situation who want to work but do not
want to jeopardize their benefits because it is too risky. He
urged the committee to support SB 253.
CINDY LYNN discussed SB 266, described on page 11 of the Analysis
and Recommendations booklet. SB 266 creates a unique opportunity
to provide affordable health care for over 11,000 children and 800
pregnant mothers, paid for by individuals and families. SB 266
will also increase funding in over 34 existing programs and will
not require a budget increase because the federal government is
giving the states an additional 10 percent in Medicaid monies.
MS. LYNN informed committee members that SILC supports SB 266 as
well as the Governor's Smart Start Program. Alaska has the highest
rate of child abuse in the nation. Disabled children are at a
higher risk of abuse, families with disabled children have a higher
divorce rate, and disabled children have a higher out-of-home
placement rate. Money invested in children and families saves
state dollars in the long run, by preventing foster care placement,
increased court costs, and jail time.
MS. LYNN pointed out Alaska is unique in that many people are
either self-employed, work seasonally and do not have year-round
insurance, or work for employers who do not offer insurance. Many
lower income families cannot afford insurance and are ineligible to
receive aid. In rural areas, most health care providers are not
preferred providers which many insurance companies now require
their customers to use. In Petersburg none of the doctors are
preferred providers, nor is the hospital, so she must pay a $100
deductible requirement per day when she gets her blood drawn. SB
266 would allow those Alaskans to purchase and pay for Medicaid
coverage. Medicaid will pay for preventive care, as well as dental
work and nutritional education. Medicaid also pays for emergency
transportation which costs $12,000 one-way from Petersburg to
Seattle.
Number 205
SENATOR ELLIS asked if both SB 253 and SB 266 are in the Senate
HESS committee. CHAIRMAN WILKEN answered yes, both were sponsored
by the Governor and were referred to the committee last week.
JOYANNA GEISLER thanked the committee for considering issues
important to SILC and the 88,000 Alaskans with disabilities. She
focused her remarks on independent living services, which are
described on page 19 of the Analysis and Recommendations booklet.
Last year over 1,000 Alaskans received independent living services.
at a cost of about $900 per person per year in combined state and
federal dollars. The cost of the services to the State was about
$400, or 40 cents per person per day. SILC believes the services
it provides are cost effective and very important to people with
disabilities. Some of those services include assistance with ramp
building and home modification, obtaining adaptive equipment, and
helping people get back to work.
MS. GEISLER explained independent living centers also assist
disabled people living in nursing homes who want to move into their
own homes. It took 1+ years for SILC to get a 30 year old mother
out of a nursing home in Seward because, due to limited resources,
staff was only able to go to Seward once a month for a couple of
days. The mother is now living at home, and is able to be with her
daughter full time. Setting up community supports for people being
released from nursing homes takes time. SILC is requesting
$100,000 to assist people who request to leave nursing homes, and
to help people who are at risk of being placed in nursing homes.
The $100,000 would be used to help set up the community supports
necessary and this small initial investment will save the State
hundreds of thousands of dollars in Medicaid costs. On the Kenai
Peninsula, a typical nursing home charges between $100,000 to
$200,000 per year. Community living situations are estimated to
cost one-third of that amount.
SENATOR GREEN asked if the specific purpose of the $100,000
increase is to develop, rather than implement, independent living
plans. MS. GEISLER replied the plan would include assisting
clients to live on their own by setting up community supports,
among other things.
CHAIRMAN WILKEN asked what a center for independent living looks
like. MS. GEISLER said SILC does not provide residential services.
Independent living centers are staffed and governed by people with
disabilities. The Kenai Center has offices in Homer, Seward, and
Soldotna. The Center receives calls from people with disabilities
and family members on a variety of subjects, such as the ADA and
social security. The Center does not always provide the direct
service but teaches the person to get services themselves and to
self-advocate.
CHAIRMAN WILKEN asked if the centers are repositories of
information rather than homes. MS. GEISLER said they are.
Number 301
RUTH L'HOMMEDIEU, from Fairbanks, thanked committee members for
passing SCR 19, pertaining to the Alaska Deaf, Hard of Hearing, and
Deafblind Council. She referred to page 32 of the Analysis and
Recommendations booklet, which contains the Vocational
Rehabilitation budget and informed committee members she is
requesting an additional $350,000 to the budget. This year the
Division of Vocational Rehabilitation is operating with a $130,000
cut in State funds to their budget. That cut resulted in the loss
of $130,000 in matching federal funds, so the division has suffered
a total loss of $260,000 which was used to provide direct services
to clients. She said the $350,000 budget increase will cover the
$260,000 loss, plus $90,000 to fund a counselor for the deaf, hard
of hearing, and the deafblind, and a counselor for the blind, as
well as direct services for that group of people.
MS. L'HOMMEDIEU said that last summer she found herself unemployed
after working steadily for 15 years. She decided to apply for
vocational rehabilitation services and was placed with a counselor
who has 150 clients. On the third visit, which took about two
months, she was told she qualified for services. On the fourth
visit, the counselor informed her there were no funds available to
help her. She noted the overall unemployment rate in Alaska is 7.5
percent; it is 66 percent for people with disabilities. She asked
committee members to remember that 66 percent when they consider
the $350,000 budget increase request.
Number 359
JERIE BEST from Soldotna thanked the committee for moving HB 170
out of committee last week. She explained that 4-H youth who train
puppies as service animals need the ability to bring those dogs
everywhere to be socialized, before the dogs travel elsewhere for
specialized training.
MS. BEST referred to page 12 of the Analysis and Recommendations
booklet regarding enactment of a lemon law for adaptive devices for
the disabled. Currently no statute provides consumer protection
for people with mobility aid devices. Ms. Best gave ten examples
of situations in which people purchased mobility devices that do
not work correctly and were unable to receive replacements or
refunds. She added these devices are often very expensive and few
dealers and repair shops are located in Alaska. She asked
committee members to support legislation that provides protection
to the consumer, and noted that Representative Green plans to
introduce such legislation next week.
MS. BEST informed the committee that accessibility to buildings
required by the ADA is sorely lacking in Alaska. DOTPF estimates
it will cost $50 million to bring state facilities into compliance.
The Governor has set aside $1 million in his budget this year for
that purpose, which is a start. She described the difficulty she
encounters when trying to take care of motor vehicle business which
must be done in person. She cannot get inside the building because
the door is not wide enough to accommodate her wheelchair. She
needs a handicap parking space permit because those parking spaces
are the only ones wide enough to get her wheelchair out of her car.
She is barely able to see over the counter. She again urged
committee members to support increased funding for ADA compliance
in state facilities and to support the ADA coordinator who plans to
do training and has great ideas for compliance.
CHAIRMAN WILKEN noted he received Ms. Best's e-mail message last
week. He asked her what makes a wheelchair warranty different than
a VCR warranty. MS. BEST answered that wheelchairs are often
customized for an individual's needs. CHAIRMAN WILKEN said the
analogy would be a person adapting a VCR to his/her home and then
not being able to return it. MS. BEST agreed.
CHAIRMAN WILKEN stated that ADA compliance in state facilities is
one of the top three priorities of the Deferred Maintenance Task
Force over the next five or six years. MS. BEST commented the
University of Alaska is making great strides with ADA compliance.
CHAIRMAN WILKEN thought most legislators agree that the Legislature
has used a piecemeal approach to solve this problem. They now
have the opportunity to fix it, and to fix it correctly.
SENATOR GREEN asked if a new lemon law would require litigation.
MS. BEST said she did not think so because statutory protection
alone will help individuals to get action.
SENATOR LEMAN commented there are examples of situations where
governments have tried to impose changes on people in the name of
ADA compliance, at great cost with almost no benefit. He thought
it is important to review which changes will be most effective in
helping people to get access, such as wider doors. MS. BEST said
she thought people tend to make ADA too hard when it is actually a
very creative law. A town on the Kenai made a dock handicap
accessible by filling the large spaces between the planks with wide
rope.
SENATOR LEMAN admired Ms. Best's desire to find practical solutions
and encouraged her to offer that advice to those who consider all
of the changes that need to be made to be difficult. MS. BEST said
simple solutions do not always work and that each situation is
individual.
Number 555
MR. BURTON closed by saying that it would take more than 15 seconds
to list the different ethnic groups or skin colors of people, but
it is the amount of time it takes someone to join the growing
minority of disabled people.
CHAIRMAN WILKEN thanked Mr. Burton and everyone who addressed the
committee.
SCR 14 - PARITY FOR MENTAL HEALTH TASK FORCE
CHAIRMAN WILKEN announced there were five amendments to SCR 14, and
that version H was adopted by the committee at a previous meeting.
SENATOR LEMAN moved to adopt amendment #1. SENATOR ELLIS objected
and asked for an explanation.
TAPE 98-10, SIDE B
SENATOR LEMAN explained amendment #1 splits the tasks to be studied
by the task force into a more understandable order, and more
importantly it requires the task force to identify and define the
unmet mental health needs and then recommend ways to measure the
effectiveness of treatment.
CHAIRMAN WILKEN announced the objection was not maintained,
therefore amendment #1 was adopted.
SENATOR GREEN moved to adopt amendment #2 (labeled H.1). SENATOR
ELLIS objected.
SENATOR GREEN explained that amendment #2 requires the task force
to determine and define the terms "mental disorders," "mental
illness," "serious mental illness," and "mental health consumers"
before undertaking its study. Those phrases are not defined in the
resolution and can be very broad.
SENATOR ELLIS said amendment #2 presumes that those terms are
currently undefined yet they may be in the field, in statute, or in
regulation. SENATOR GREEN said and if that is the case, those
definitions could be used. SENATOR ELLIS clarified that Senator
Green was not asking the task force to redefine those terms.
SENATOR GREEN emphasized the amendment would require the task force
to define those terms for purposes of the work on the report they
produce.
SENATOR ELLIS removed his objection, therefore amendment #2 was
adopted.
SENATOR GREEN moved to adopt amendment #3 (labeled H.2). There
being no objection to the adoption of amendment #3, the motion
carried.
SENATOR LEMAN noted he had no objection to amendment #3, but noted
the number "5" on line 3 should be number "6." SENATOR GREEN
agreed.
SENATOR GREEN moved to adopt amendment #4. SENATOR ELLIS objected.
SENATOR GREEN explained the Mental Health Parity Act of 1996 did
not include chemical dependency disorders. Amendment #4 would
delete the inclusion of chemical dependency disorders from the task
force's study on discrimination in health insurance policies. The
remainder of amendment #4 pertains to the makeup of the task force,
because by narrowing the study, a net of three task force members
would not be necessary. However, to retain an odd number of task
force members, one of the three positions was restored, and she
arbitrarily chose one member who is employed as staff to a member
of Congress simply to have connection with, and access to
information about, mental health parity on the congressional level.
SENATOR GREEN repeated she does not think the task force needs to
go beyond the boundaries of the Mental Health Parity Act by
including chemical dependency disorders.
CHAIRMAN WILKEN commented that amendment #4 eliminates the
inclusion of tasks related to chemical dependency disorders and by
doing so changes the make-up of the task force.
Number 448
DON DAPCEVICH, Executive Director for the State Advisory Board on
Alcoholism and Drug Abuse, testified against Amendment #4. He
stated SCR 14 provides an opportunity to take a look at how
chemical dependency is affecting Alaskans, and to do so at no cost
to the state. The task force will determine whether there is a
cost benefit to including chemical dependency in any changes
considered in the future. If there is no cost benefit, the task
force's recommendations will reflect that. The Mental Health Trust
Authority has offered to share its resources so that the
Legislature will examine their beneficiaries, both mental health
and chemical dependency beneficiaries. Amendment #4 will prevent
any discussion on the issue. Mr. Dapcevich agreed chemical
dependency disorders are not included in the Mental Health Parity
Act of 1996, but an amendment to include it is being introduced
before Congress. Each state taking up the issue of parity is
studying whether chemical dependency disorders should be included.
Mr. Dapcevich emphasized the Alaska Advisory Board on Alcoholism
and Drug Abuse will not know whether to support the issue of parity
unless the task force studies the issue. He strongly encouraged
committee members to reject amendment #4.
SENATOR LEMAN questioned whether there is a way to reword that
section by taking the phrase "chemical dependency disorders" out of
subsection (1), and creating a separate subsection that identifies
the study of the cost benefit relationship of chemical dependency
disorders. He believed it will not hurt to look at the issue and
identify whether there is a cost benefit.
MR. DAPCEVICH thought it would be wise to separate, in the report,
chemical dependency issues from mental health issues. He cautioned
that excluding task force participation of professionals from the
chemical dependency field will provide less than a perfect product
in terms of participants and expertise.
CHAIRMAN WILKEN said his sense is that although there is some
relationship between the two, the issues are different and should
be studied separately. He stated he supports the amendment for
that reason. He asked Mr. Dapcevich why the relationships between
the two cannot be separated.
MR. DAPCEVICH thought the two issues can be separated for
expediency sake, but the Trust Authority does not distinguish
between the beneficiaries, and the parity issues for both groups
are the same. Both have artificial caps on insurance, and the
rationale for exclusion is the same in many cases.
SENATOR GREEN mentioned that the original resolution pertained only
to mental illness. She said she is opposed to summarily saying, by
implication, that substance abuse is mental illness. If substance
abuse leads to mental illness, that needs to be defined in the
definition of mental illness.
SENATOR ELLIS maintained his objection to the adoption of amendment
Ward, Wilken, and Leman voting "yea," and Senator Ellis voting
"nay."
SENATOR LEMAN said that although he voted for the amendment, he
believes Mr. Dapcevich's point is valid. He thought it would be
more useful to have people serve on the task force with expertise
in chemical dependency disorders, than to create two task forces.
CHAIRMAN WILKEN noted SCR 14 has another referral to the Senate
Finance Committee. He asked Senator Leman if he would like to
offer another amendment at the next meeting. SENATOR LEMAN asked
Mr. Dapcevich to provide the committee with a subsection to add
that specifically addresses the cost benefit of parity for chemical
dependency disorders.
Number 398
CHAIRMAN WILKEN said he is very reluctant to include chemical
dependency disorders because he thought it would be more beneficial
to both issues to keep them separate. He announced SCR 14 will be
held until the next meeting on Monday.
CHAIRMAN WILKEN offered amendment #5. SENATOR ELLIS objected.
CHAIRMAN WILKEN explained the prior amendment eliminated chemical
dependency disorders, therefore the annual cost to the state should
be $187,272,000 rather than $432,072,000; and the phrase "annually
costs the state at least" was changed to specify the actual cost in
1996, to be more specific.
SENATOR ELLIS felt the committee's discussion was ironic given the
Senate's strong bipartisan support for Sobriety Awareness Month.
He agreed with Senator Leman's conclusion that the creation of a
second task force to study chemical dependency disorders is
unlikely to occur.
SENATOR LEMAN questioned how Chairman Wilken obtained the 1996
costs. CHAIRMAN WILKEN said he relied on an estimate from the
professionals.
There being no further objection, amendment #5 was adopted.
CHAIRMAN WILKEN announced SCR 14 will be heard again on Monday,
February 16. He adjourned the meeting at 10:18 a.m.
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