Legislature(2017 - 2018)BUTROVICH 205
01/25/2017 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
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| Start | |
| Overview: Department of Health and Social Services | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
January 25, 2017
1:31 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Natasha von Imhof, Vice Chair
Senator Cathy Giessel
Senator Tom Begich
MEMBERS ABSENT
Senator Peter Micciche
COMMITTEE CALENDAR
OVERVIEW: DEPARTMENT OF HEALTH AND SOCIAL SERVICES -
Commissioner Valerie Davidson
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
VALERIE DAVIDSON, Commissioner
Alaska Department of Health & Social Services
Juneau, Alaska
POSITION STATEMENT: Provided a departmental overview.
SHAWNDA O'BRIEN, Acting Assistant Commissioner
Alaska Department of Health & Social Services
Juneau, Alaska
POSITION STATEMENT: Provided a departmental overview.
DR. JAY BUTLER, Chief Medical Officer and Public Health Director
Division of Public Health
Alaska Department of Health & Social Services
Anchorage Alaska
POSITION STATEMENT: Provided an overview of the Division of
Public Health.
ACTION NARRATIVE
1:31:39 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 1:31 p.m. Present at the
call to order were Senators Giessel, Begich, von Imhof, and
Chair Wilson.
CHAIR WILSON announced that the committee's first order of
business is to elect a vice chair.
SENATOR GIESSEL moved that Senator von Imhof be elected vice
chair of the Senate Health and Social Services Committee.
CHAIR WILSON announced that without objection, so ordered. He
set forth that Senator von Imhof will serve as vice chairman of
the Senate Health and Social Services Committee.
^Overview: Department of Health and Social Services
OVERVIEW: DEPARTMENT OF HEALTH AND SOCIAL SERVICES
1:32:52 PM
CHAIR WILSON announced that the committee will hear a
departmental overview from Valerie Davidson, commissioner for
the Alaska Department of Health and Social Services.
1:33:26 PM
VALERIE DAVIDSON, Commissioner, Alaska Department of Health &
Social Services (DHSS), Juneau, Alaska, introduced DHSS
personnel to the committee.
She detailed that DHSS was originally established in 1919 as the
Alaska Territorial Health Department. Upon statehood in 1959,
the department's responsibilities were expanded to include the
protection and promotion of public health and welfare, as
outlined in article 7, sections 4 and 5 of the Alaska
Constitution. She called attention to various DHSS website links
and detailed departmental organization chart.
1:36:09 PM
She explained that the Division of Alaska Pioneer Homes provides
the highest quality life as possible and a safe home environment
for older Alaskans and veterans:
· Division of Alaska Pioneer Homes:
ƒDirector: Vickie Wilson;
ƒ611 positions;
ƒOperating budget: $62.6 million in total funding;
· $34 million unrestricted general funds (UGF) spending;
ƒ2.3 percent of DHSS FY2018 operating budget.
SENATOR GIESSEL asked if the number of positions has changed
since 2016.
COMMISSIONER DAVIDSON replied that the number of positions has
changed: since 2015, a 4-percent reduction or 23 positions.
1:38:09 PM
SHAWNDA O'BRIEN, Acting Assistant Commissioner, Alaska
Department of Health & Social Services (DHSS), Juneau, Alaska,
added that the department can provide specific information on
position reductions for FY2017 after the committee meeting.
CHAIR WILSON asked the commissioner to address a privatization
report for the Division of Alaska Pioneer Homes.
COMMISSIONER DAVIDSON replied that as part of SB 74, which was
the 2016 bipartisan Medicaid reform bill, a number of
privatization reports were required. She detailed that the
Division of Alaska Pioneer Homes' report was originally intended
to address facility privatization, but an amendment changed the
report to pharmaceutical privatization. She added that
privatization feasibility reports from the Alaska Psychiatric
Institute and the Juvenile Justice Facilities were included. She
revealed that the three-privatization reports will be released
on Friday, January 27.
She addressed the Division of Behavioral Health. She detailed
that the division's mission is to manage an integrated and
comprehensive behavioral-health system based on sound policy,
effective practice and partnerships:
· Behavioral Health:
ƒDirector: Randall Burns;
ƒ369 positions;
ƒOperating budget: $134.2 million in total funding;
· $60.2 million UGF spending;
ƒ4.9 percent of DHSS FY2018 operating budget.
She added that SB 74 required an 1115 [Medicaid] waiver for the
department to look at its behavioral health-system care delivery
challenges. She recognized that the department has significant
gaps within its care continuum and the result impacts other
areas. She specified that the use of emergency rooms is impacted
because no one can legally be turned away and some people use
the emergency room to access services that are not available to
them. She revealed that additional impacts include:
corresponding rates of child maltreatment and child neglect; the
number of law enforcement encounters with people experiencing
unaddressed behavioral-health needs; and the corresponding
number of inmates in correctional facilities, whether
temporarily in jail or in long-term sentences.
COMMISSIONER DAVIDSON revealed that the department recognized
that after working through SB 74 and Medicaid reform, the
biggest opportunity to make improvements was to address the
behavioral-health system. She asserted that the department has
undertaken a significant effort in reaching out to stakeholders
and looking at behavioral-health system reform. She divulged
that the department has submitted a concept paper to the Centers
for Medicare and Medicaid to implement a reform plan. She said a
benefit from an approved plan is that budget neutrality will
require the department to show that service can be provided more
cost effectively.
1:43:58 PM
She explained that the 1115-waiver also allows the state to
address a challenge from a federal provision called the
Institute for Mental Disease (IMD) exclusion. She explained that
the 1115-waiver allows the state to waive the IMD exclusion for
substance-use-disorder treatment services.
She disclosed that the department is moving forward with the
Criminal Justice Reform bill by working with the Alaska
Department of Corrections. She remarked that the state has an
opportunity to either create more prisons or create healthier
Alaskans.
She addressed the Office of Children's Services and explained
that the division's mission is to prevent and to respond to
child maltreatment in order to ensure safe children and strong
families:
· Office of Children's Services:
ƒDirector: Christy Lawton;
ƒ533 positions;
ƒOperating budget: $152.4 million in total funding;
· $86 million UGF spending;
ƒ5.6 percent of DHSS FY2018 operating budget.
COMMISSIONER DAVIDSON described the Division of Health Care
Services and said the division's mission is to manage health
care coverage for Alaskan's in need. She pointed out that the
division oversees the Medicaid and health facilities group. She
specified that the division does not include the Medicaid
payments that go out the door. She detailed that the division
makes sure that providers get paid and inspected facilities are
safe for Alaskans:
· Division of Health Care Services:
ƒDirector: Margaret Brodie;
ƒ128 positions;
ƒOperating budget: $21.4 million in total funding;
· $8.2 million UGF spending;
ƒ0.8 percent of DHSS FY2018 operating budget.
1:46:48 PM
She addressed the Division of Juvenile Justice and explained
that the division's mission is to hold juvenile offenders
accountable for their behavior, promote safety and restoration
of victims in communities, and to assist offenders and their
families to develop skills to prevent crimes:
· Division of Juvenile Justice:
ƒDirector: Rob Wood;
ƒ456 positions;
ƒOperating budget: $56.5 million in total funding;
· $53.6 million UGF spending;
ƒ2.1 percent of DHSS FY2018 operating budget.
CHAIR WILSON pointed out that two centers are planned for
closure. He noted that the Ketchikan facility has already closed
and asked if the communities with closed or closing facilities
have provided feedback.
COMMISSIONER DAVIDSON revealed that the department met with
facility employees as well as the City of Ketchikan on whether
alternative facility services could be provided, but the numbers
were cost prohibitive. She noted that the Nome facility will be
specifically addressed in the upcoming privatization report. She
revealed that the Nome facility was allocated funding for one
year, but the governor's proposed FY2018 budget did not provide
an extension. She asserted that concerns will be raised on
whether the anticipated savings from closing the Nome facility
will be seen.
1:49:43 PM
SENATOR BEGICH revealed his history in the Division of Juvenile
Justice and noted that he was directly involved with the
Ketchikan and Nome facilities. He asked to confirm that the
state has been able to extract itself from its lease with
Ketchikan when the facility was transferred back.
COMMISSIONER DAVIDSON answered yes.
SENATOR BEGICH addressed the Nome facility and noted that the
division's policy has been based on sound practice. He disclosed
that the division has opposed privatization due to youth system
abuses in the Lower 48. He pointed out that Commissioner
Davidson referenced possible questions and controversy with the
Nome facility's pending report. He asked if Commissioner
Davidson could give the committee a preview on Nome's pending
privatization report.
1:52:01 PM
COMMISSIONER DAVIDSON replied that she could not provide a
preview. She noted that the previous and current administrations
have explored partnering with the Norton Sound Health
Corporation (NSHC) as a tribal health organization to not only
improve services, but to take advantage of a 100-percent federal
match. She revealed that NSHC did not indicate an interest in
taking over the Nome facility. She asserted that providing care
as close to home as possible results in better outcomes;
however, the state's budget environment does not always make
that possible. She noted that the Juneau facility was available
in Southeast when the Ketchikan facility closed, but Nome is the
only detention facility located in the Northwest Alaska.
1:54:23 PM
She commented on the Division of Public Assistance and explained
that the division's mission is to provide self-sufficiency and
basic living expenses to Alaskans in need:
· Division of Public Assistance:
ƒActing Director: Monica Windom;
ƒ557 positions;
ƒOperating budget: $305.1 million in total funding;
· $136.3 million UGF spending;
ƒ11.2 percent of DHSS FY2018 operating budget.
She revealed that the number-one complaint is the division's
inability to provide timely customer service. She detailed that
a combination of recent Medicaid expansion and budget cuts to
public assistance has resulted in long wait periods. She noted
that even with a new centralized-call center, the division will
not be able to meet customer service expectations.
1:57:42 PM
CHAIR WILSON asked if the data represents all public assistance
programs.
COMMISSIONER DAVIDSON answered yes. She revealed that there is a
toll-free phone number to expedite Medicaid enrollment for
pregnant women to make sure Alaskan women have good access to
prenatal care to ensure a healthy baby. She added that people
with urgent needs and certain incomes can receive public
assistance for risk of eviction or getting utilities shutoff.
She addressed the Division of Public Health and specified that
the division's mission is to protect and promote the health of
Alaskans:
· Division of Public Health:
ƒDirector: Dr. Jay Butler;
ƒ425 positions;
ƒOperating budget: $117.4 million in total funding;
· $43 million UGF spending;
ƒ4.3 percent of DHSS FY2018 operating budget.
She revealed that Dr. Butler is the national president of Alaska
State and Territorial Health Officials and noted that his policy
initiative is on substance-use disorders, specifically opioid
addiction.
CHAIR WILSON noted that the Division of Public Health's mission
and scope has been scaled back. He asked that the division's
core functions be addressed.
2:01:06 PM
DR. JAY BUTLER, Chief Medical Officer and Public Health
Director, Division of Public Health, Alaska Department of Health
& Social Services, Anchorage, Alaska, disclosed that the
division has absorbed much of its 22 percent UGF cut over the
past three years with most of the UGF going into public-health
nursing. He admitted that closing public-health centers has
proved to be challenging and some services have been reduced. He
revealed that some public-health centers no longer have resident
public-health nurses in town and an itinerant nurse makes visits
on a regular basis or for emergencies.
DR. BUTLER detailed that public-health nurses have a broad range
of activities that include:
· Client services;
· Outbreak response;
· Infectious disease containment;
· Working with local officials on emergency preparedness
planning.
He noted that some client services are often not billable. He
summarized that the rest of the division has a core of general funds,
but the larger revenue's portion are from federal grants or fee
authority.
2:03:13 PM
SENATOR BEGICH asked if Dr. Butler can carry forward the
division's mission in the face of budget cuts.
DR. BUTLER answered yes, on a broad basis. He specified that the
division continues to carry out its mission in the protection
and promotion of health for all Alaskans.
SENATOR BEGICH queried if Alaskans are safe if itinerant nurses
are being sent into communities rather than having nurses
onsite.
DR. BUTLER admitted that not having immediate access to a
health-care provider does increase the risk of a problem.
COMMISSIONER DAVIDSON added that the gap has been made up
through a partnership with the Alaska Tribal Health System and
community-health centers that are federally funded through the
Health Resources and Services Administration (HRSA).
2:07:16 PM
She addressed the Division of Senior and Disabilities Services
and specified that their mission is to promote the independence
of Alaska's seniors and persons with physical and developmental
disabilities:
· Senior and Disabilities Services:
ƒDirector: Duane Mayes;
ƒ173 positions;
ƒOperating budget: $67.8 million in total funding;
· $42.5 million UGF spending;
ƒ2.5 percent of DHSS FY2018 operating budget.
COMMISSIONER DAVIDSON noted that services provided in Senior and
Disabilities Services through Medicaid are captured elsewhere in
the Medicaid costs.
She addressed DHSS's service population and priorities: [health
and wellness across the lifespan; health care access delivery
and value; safe and responsible individuals, families and
communities]. She set forth that the department's breadth of
Alaskans served spans from prenatal to after death.
CHAIR WILSON asked if the department has a way to rank and
prioritize programs in each division.
COMMISSIONER DAVIDSON replied that ranking programs is a
challenge. She specified that DHSS provides statutorily-required
services and the department is not allowed to choose to provide
one service over another.
CHAIR WILSON concurred that DHSS must follow federal guidelines
and state statutes for core services, but noted that there are
ancillary services that sometimes support the core services as
well. He asked if there is a way to come up with a program
matrix or program evaluation to prioritize importance. He noted
that other states have ranked their services and programs.
2:11:21 PM
COMMISSIONER DAVIDSON pointed out that DHSS provided another
committee with a list of 99 program and allocation priorities.
She detailed that the programs were ranked as being critical,
program importance was based on the committee's criteria, and
the level of effectiveness was evaluated on a descending scale
of 1 to 3.
CHAIR WILSON noted that the levels of effectiveness of the
programs were all listed as "1" or "2". He remarked that he did
not see the criticalness or ranking in the report that
Commissioner Davidson referenced.
COMMISSIONER DAVIDSON answered that DHSS has sustained large
cuts over the last three years and some of the lower-ranked
programs were eliminated from the department's budget.
CHAIR WILSON replied that his intent is to work towards a rank-
in-order program report.
SENATOR BEGICH suggested that Commissioner Davidson provide a
list of eliminated entities to identify the areas that were not
effective.
COMMISSIONER DAVIDSON replied that DHSS can provide a list of
services that either the department is no longer providing or
made cuts to. She specified that the governor's FY2018 budget
request reflects the ranking and the priorities from the
administration; DHSS turns that information over to the
Legislature for assessment and the department redesigns or
eliminates programs based on the Legislature's budget. She added
that DHSS also seeks out more federal authority or other
partnerships to fill a critical function that the department
feels is important to Alaska.
2:15:08 PM
At ease.
2:15:55 PM
CHAIR WILSON called the committee back to order.
SENATOR VON IMHOF asked that the list referenced by the
commissioner be provided to the committee and to separate
ancillary programs from those that are provided due to state
statutes or federal guidelines.
COMMISSIONER DAVIDSON revealed that the report to the other
committee did provide the information that Senator von Imhof
requested. She specified that the report also included data on
funding sources, costs, employees, the number of Alaskans
served, levels of effectiveness and rankings.
SENATOR BEGICH specified that he is strictly looking for a list
of programs eliminated, who was served and how many people were
served.
2:18:26 PM
MS. O'BRIEN addressed DHSS's FY2018 budget, specifically on
formula versus non-formula programs. She noted that the
department's largest formula program in its budget is Medicaid
services. She detailed the formula and non-formula program
percentages as follows:
· Medicaid-Federal: 43 percent
· Medicaid-general fund (GF): 22 percent
· All other formula: 10 percent
· Non-formula-grants and benefits: 6 percent
· Non-formula-"other" line items: 19 percent"
MS. O'BRIEN noted that the "other" formula programs in the
department are housed in the Children Services Division, Public
Assistance Division, and the Health Care Services Division. She
specified that grants and benefits go out directly to serve
Alaskans and "other" non-formula items include administrative
costs, leasing, etc.
2:20:25 PM
She addressed the department's FY2018 adjusted base to the
governor's budget. She detailed that overall FY2018 UGF spending
is $190 million less than FY2015. She revealed that services
have been maintained through increased federal authorization
while UGF spending has been reduced. She added that formula
programs are tied directly to standards in statute or
regulation.
She revealed that 74 percent of the department's overall budget,
including all funding sources, are formula programs:
· Office of Children's Services
ƒ$33 million in UGF spending.
ƒ1.2 percent of DHSS budget.
· Division of Health Care Services
ƒ$153,000 in UGF spending.
ƒLess than 1 percent of DHSS budget.
· Division of Public Assistance
ƒ$109 million in UGF spending.
ƒ4 percent of DHSS budget.
· Medicaid
ƒ$580 million in UGF spending.
ƒ21.4 percent of DHSS budget.
2:25:05 PM
COMMISSIONER DAVIDSON addressed major DHSS activities happening
as follows:
1. Medicaid redesign:
· Presentation on Friday, January 27.
2. Tribal and federal partnerships:
· DHSS has aggressively advanced federal and tribal
partnerships to ensure Alaskans continue to receive
critical services.
3. Child welfare:
· Working with its tribal partners to improve the
department's Indian Child Welfare Act (ICWA)
compliance.
· Realize efficiencies in the adjudication of children
in need of aid: one family-one court, one family-one
judge.
· Working with the court system to implement changes for
better children and family outcomes.
· 3,000 children are in out-of-home placements.
· Repeat maltreatment has seen a reduction.
· Encouraging tribal-service organizations to work with
tribal-health partners to make sure services are
better coordinated.
· 1115-waiver work to assist with consolidating
reunification services within communities.
· Providing telehealth equipment to extend the
department's reach with limited dollars.
2:29:50 PM
COMMISSIONER DAVIDSON addressed opioid misuse and addiction,
noting the governor's interest in undertaking a five-part
strategy as recommended by the Opioid Policy Task Force.
CHAIR WILSON asked for a brief overview of the Human Services
Community Matching Grant and the Community Initiative Matching
Grants.
COMMISSIONER DAVIDSON explained that the major cut for the Human
Services Community Match Grant occurred in the Community Health
Aid Training Program which provides training for community
health aides. She revealed that the department was able to
reduce the grant's UGF by negotiating with Tribal Health for a
100-percent federal match.
MS. O'BRIEN specified that the two grant programs offer services
to supplement other grant programs in communities. The Human
Services Matching Grant goes out to several different providers
or grantees to offer additional supplements for: housing needs,
food for shelters, etc. The Community Initiative Matching Grants
goes out to three-different grantees and some of the
municipalities like Anchorage. She set forth that the reductions
are representative of funds that were not being spent.
SENATOR GIESSEL asked that a list be provided for the cost of
optional services that the state provides in Medicaid.
2:33:52 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Committee at 2:33 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Senate HSS Overview Presentation for 1-25-17.pdf |
SHSS 1/25/2017 1:30:00 PM |
Departmental Overview DHSS |