03/07/2018 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s): Mental Health Trust Authority Board of Trustees | |
| Department of Health and Social Services Office of Children's Services Response to the Citizen Review Panel Presentation | |
| SB169 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
| += | SB 169 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 7, 2018
1:34 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Natasha von Imhof, Vice Chair
Senator Cathy Giessel
Senator Peter Micciche
Senator Tom Begich
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
CONFIRMATION HEARING(S):
Mental Health Trust Authority Board of Trustees
Verne Boerner
CONFIRMATION ADVANCED
DEPARTMENT OF HEALTH AND SOCIAL SERVICES OFFICE OF CHILDREN'S
SERVICES RESPONSE TO THE CITIZEN REVIEW PANEL PRESENTATION
HEARD
SENATE BILL NO. 169
"An Act relating to the definition of 'supervision or direct
supervision' for purposes of medical assistance coverage of
behavioral health clinic services."
- MOVED CSSB 169(HSS) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: SB 169
SHORT TITLE: MEDICAID: BEHAVIORAL HEALTH COVERAGE
SPONSOR(s): SENATOR(s) GIESSEL
01/31/18 (S) READ THE FIRST TIME - REFERRALS
01/31/18 (S) HSS
03/05/18 (S) HSS AT 1:30 PM BUTROVICH 205
03/05/18 (S) Heard & Held
03/05/18 (S) MINUTE(HSS)
03/07/18 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
VERNE BOERNER, Appointee
Alaska Mental Health Trust Authority Board of Trustees
Anchorage, Alaska
POSITION STATEMENT: Testified as appointee to the Alaska Mental
Health Trust Authority Board of Trustees.
MIKE POWERS, Appointee
Alaska Mental Health Trust Authority Board of Trustees
Fairbanks, Alaska
POSITION STATEMENT: Testified as appointee to the Alaska Mental
Health Trust Authority Board of Trustees.
CHRISTY LAWTON, Director
Office of Children's Services
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented Office of Children's Services
Response to the Citizen Review Panel Presentation.
RANDALL BURNS, Director
Division of Behavioral Health
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions about SB 169.
ACTION NARRATIVE
1:34:00 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 1:34 p.m. Present at the
call to order were Senators Micciche, Begich, von Imhof, and
Chair Wilson. Senator Giessel arrived during the meeting.
^CONFIRMATION HEARING(S): Mental Health Trust Authority Board of
Trustees
CONFIRMATION HEARING(S):
Mental Health Trust Authority Board of Trustees
1:34:30 PM
CHAIR WILSON announced the consideration of the governor's
appointees to the Alaska Mental Health Authority Board of
Trustees.
1:35:13 PM
VERNE BOERNER, Appointee, Alaska Mental Health Trust Authority
Board of Trustees, testified about her appointment. She stated
her Inupiaq name. She is an enrolled tribal member of the
sovereign village of Kiana. She shared her earliest memory of
going to the Head Start in the armory at Kiana with her
grandmother, one of the first generation of community health
aides. Her grandmother was her first exposure to tribal health.
Back then patients often came to their home for care. She
remembers scampering to the outhouse in the middle of winter.
She noted so many homes in Kiana still do not have water and
sewer hookups. Her tribal leaders created Ilitqusiat, I?upiat
values that are shared by many tribal people in Alaska and many
indigenous cultures. "The premise is every I?upiaq person is
responsible to all other I?upiat for the survival of our
cultural spirit and the values and traditions through which it
survives. Through our extended family, we retain, teach and live
our I?upiaq way of life. With guidance and support from our
Elders, we teach our children our I?upiat Ilitqusiat values,"
she said.
She said these were her formative experiences and the briefest
way she can think of to introduce herself and the foundational
experiences that she brings to the table. Her specific interest
in the Alaska Mental Health Authority comes from the tribes and
tribal leaders. She is president and CEO of the Alaska Native
Health Board (ANHB). It is a statewide voice on Alaska Native
health issues, in its 50th year as an advocacy organization for
the health needs and concerns of all Alaska Native people. Its
mission is to promote the spiritual, physical, mental, social,
and cultural well-being and pride of Alaska Native people. Their
leadership has stated that the Alaska Mental Health Trust
Authority Board of Trustees needs representation from those
familiar with the Alaska tribal health system, particularly
considering the overrepresentation of their people as trustee
beneficiaries.
1:39:02 PM
MS. BOERNER explained that the Alaska tribal health system is a
system of care with voluntary participation of sovereign tribes
and tribal health organizations through a single negotiated
compact with the federal government. This system provides health
services for Alaska Natives and American Indians in over 200
facilities and locations across the state. The Alaska tribal
health system provides health care in every community and is a
critical component of the Alaska public health system. She comes
with the blessing and encouragement of the Alaska Native Health
Board. She has over 20 years of experience in tribal health,
health promotion, disease prevention, and administration and
budgeting experience. She has served tribes in the establishment
and formation of tribal epidemiology centers and has over 13
years of experience serving on a tribal institutional review
board working on human protection issues, with particular
attention to the vulnerable populations, such as those who
comprise the beneficiaries of the Alaska Mental Health Trust
Authority.
MS. BOERNER said she is Native American Research Centers on
Health Fellow, holds a master's degree in public health, and an
undergraduate degree in business administration. Her passion is
addressing health disparities in indigenous and minority
populations through health research, policy development, and
education and outreach. She is a firm believer in community-
based approaches to best tap the existing strengths and
resources of these resilient populations in order to address
health disparities. She has observed that culturally-intelligent
approaches are needed to build and build upon evidence-based
approaches and interventions and outreach and treatment.
She said she has had the honor of being entrusted by tribes to
represent them on health issues at the state and national
levels, including complex work groups, such as the restructuring
initiative of the Indian Health Service (IHS) and the national
IHS budget formulation work group. She has served on
translational research into practice advisory groups. In her
role as an administrative officer at the Northwest Portland Area
Indian Health Board, she oversaw grant and contract management,
as well as fiscal management in accordance with Office of
Management and Budget circulars and Single Audit Act. She was
the lead contact for the annual audit and was responsible for
negotiating lease and contract agreements. She held
responsibilities and authority for investment strategies for the
98-638 funds the tribes received. She was the Northwest Portland
Area Indian Health Board representative on the Portland area
facility advisory board, which reviewed construction and
renovation projects of facilities and sanitation systems for the
then 43 recognized tribes in Washington, Oregon, and Idaho.
1:42:33 PM
MS. BOERNER said as a person with three citizenships--Kiana, the
United States, and Germany (naturalized)--she has a unique
perspective regarding Alaska's diversity and immigrant
population. Alaska has grown so much that even Kiana has
naturalized citizens from around the world. She knows what it is
like to seek health care and mental health services in a foreign
country with limited command of the language. She has academic
and personal experience with the unique challenges and concerns
of naturalized families. Like all the trustees, she has a
personal drive for wishing to serve as a trustee. She wants to
honor her late sister who lost her battle with alcohol three
days before her 29th birthday. She was trying to quit and had no
other drugs in her system. The coroner listed her cause of death
as natural due to complications of chronic ethylism. There is
nothing natural about the death of a 29-year-old.
SENATOR MICCICHE said he was very glad that she is interested in
being on the Alaska Mental Health Trust Authority Board.
CHAIR WILSON asked if the Alaska Native Health Board receives
money from the Alaska Mental Health Trust Authority.
MS. BOERNER said no.
1:45:45 PM
MIKE POWERS, Appointee, Alaska Mental Health Trust Authority
Board of Trustees, testified about his appointment. He said he
was a 34-year resident of Alaska. He first came to Alaska as a
VISTA volunteer in 1981 and then became a writer for the Senior
Voice. After two years, he left to pursue a master's degree in
health services administration. He then returned to Fairbanks.
He was the chief financial officer at Fairbanks Memorial
Hospital for ten years. He has been the CEO for the past 20
years. When he retired, he was on the University of Alaska Board
of Regents. He served as interim chancellor for the University
of Alaska Fairbanks from 2015-2016 after the chancellor at the
time stepped down in late spring. He returned to the Tanana
Valley Clinic last spring. As CEO of the Fairbanks Memorial
Hospital, much of his time was focused on building programs and
recruiting personnel related to behavioral health issues.
Behavioral health is a crisis in Fairbanks and Alaska and
nationally. Much of his time building the behavioral health
program was spent dealing with the emergency department, the 20-
bed behavioral health unit with four secure beds, relationships
with the court system, downtown businesses, police, support
agencies, and family members. He shared that in his own family,
he has been helping his brother address the housing needs of his
23-year-old developmentally disabled daughter. After looking
back on 30 some years in various health capacities in the
Interior, he sees two vulnerable populations, seniors and the
mentally ill and developmentally disabled.
MR. POWERS said he wants to help address those needs in his
community and across the state. That is what drives his interest
in the Alaska Mental Health Trust Authority. He shared that that
morning in Senate Finance the issue came up of the need to wait
two years after being with entities that receive money from the
Alaska Mental Health Trust. He said he was not aware of any
Alaska Mental Health Trust funds received by the university
while he was interim chancellor, but Senate Finance is pursuing
a legal review of the situation.
1:50:56 PM
SENATOR BEGICH asked when he completed his time as the interim
chancellor.
MR. POWERS said in August of 2016.
SENATOR MICCICHE said he would certainly recommend Mr. Powers if
the ruling from Senate Finance is favorable.
1:51:48 PM
CHAIR WILSON said he will hold Mr. Powers appointment at this
time.
1:52:28 PM
CHAIR WILSON opened and closed public testimony on the
governor's appointees.
CHAIR WILSON entertained a motion to advance Ms. Boerner's name.
1:52:52 PM
SENATOR VON IMHOF moved to forward the appointment of Verne
Boerner to the Mental Trust Authority Board of Trustees to a
joint session for consideration. She reminded members that this
does not reflect an intent by any of the members to vote for or
against the confirmation of the individual during any further
sessions.
1:53:22 PM
CHAIR WILSON found no objection and the name Verne Boerner for
appointment to the Mental Trust Authority Board of Trustees was
forwarded to the full body for consideration.
At ease.
^Department of Health and Social Services Office of Children's
Services Response to the Citizen Review Panel Presentation
DEPARTMENT OF HEALTH AND SOCIAL SERVICES OFFICE OF CHILDREN'S
SERVICES RESPONSE TO THE CITIZEN REVIEW PANEL PRESENTATION
1:55:44 PM
CHAIR WILSON reconvened the meeting and announced the next order
of business was a presentation from the Office of Children's
Services responding to the presentation by the Citizen Review
Panel.
1:56:13 PM
CHRISTY LAWTON, Director, Office of Children's Services,
Department of Health and Social Services (DHSS), presented
Office of Children's Services Response to the Citizen Review
Panel Presentation. She said "the last 6 years at a glance"
slide shows the growth in the number of protective services
reports over the last years. The number jumped 16 percent
between calendar year 2016 and calendar year 2017. She has
concerns about next year because they have not encouraged more
reports and wonders why there is such a huge spike. She believes
that it is reflective of what's happening in communities. With
more reports coming, more will likely be screened in for
investigations and a proportion of those will lead to services
such as foster care.
She reported that of the 20,000 reports in calendar year 2017,
about 70 percent came from mandated reporters. The other 30
percent came from citizens, relatives perhaps, or other people
who are just worried about a child. Most reports are allegations
of neglect, which is a broad category that encompass things
around supervision, parents' inability to care for children
because of substance abuse; mental injury, which is reflective
of domestic violence issues; physical abuse; and then child
sexual abuse, with the lowest number of reports.
She displayed a graph to show how the number of children in out
of home has grown over the last ten years. She noted that the
numbers on the graph are children who were in foster care for at
least one day during the year. From 2011 to 2016, the number of
kids in out of home grew by 54 percent. There are multiple
reasons for the growth, but one is the opioid epidemic. In 2010
they had started to look at processes around intake. The
national average for screening in reports was 65 percent. Alaska
was screening out 65 percent, the complete opposite from the
rest of the country. As a result, they were seeing an increased
rate in repeat maltreatment of children because they were not
going out to offer enough services. They made policy and
practice decisions to look at families more closely to prevent
them from returning over and over.
2:01:18 PM
MS. LAWTON said workforce challenges are always the elephant in
the room, which drives almost all the outcomes they struggle to
keep at the expected rate. Case-carrying workers turned over at
almost 50 percent for 2017. Many left the agency because the job
was not doable and it didn't meet their expectations to truly
help kids and families. OCS struggles to have staff
representative of those served, particularly in smaller,
outlying offices. The positions are often filled with people
from out of state because the pay looks so desirable. Those
people are not generally prepared or realistic about what life
will look like in Alaska or they look to transfer to a large,
urban area as soon as possible. Every time a case worker turns
over, it will take an additional six to eight months for a child
to reach permanency, whether that be reunification,
guardianship, or adoption.
She said worker turnover affects the rates of reentry. Children
are more likely to reenter foster care if they have had many
case workers because of the quality of services and the quality
of that relationship diminish over time. The governor's amended
budget includes funds for a full-time, statewide safety officer,
as well as two full-time security officers in the Kenai and
Fairbanks offices. That will make a total of 6 security
officers, adding to the two in Anchorage, one in Juneau, and one
in Wasilla. She said it gives her heartburn to be a helping
family-oriented agency with security at the front door, but
worker safety must come first. But they still try to keep the
environments as welcoming as possible.
2:04:29 PM
MS. LAWTON said OCS has collaborative goals with the University
of Alaska Anchorage (UAA) and University of Alaska Fairbanks
(UAF). They have been meeting with a new director of the School
of Social Work at the University of Alaska Anchorage to develop
an interdisciplinary child welfare certificate track. They want
to resurrect and recreate a more robust stipend program for
employees to go back to school to pursue their Bachelor or
Master of Social Work degrees. They want to beef up campus
recruitment efforts across disciplines besides social work.
Within the last five years they have worked with the National
Child Welfare Workforce Institute, particularly with its
leadership academy for middle managers. OCS has a number of
goals that will create competency-based evaluations so when new
employees leave the classroom following their three to five
weeks of training, their competency will be assessed, and OCS
will have a chance to work with them if necessary.
CHAIR WILSON asked what the turnover rate is for OCS.
MS. LAWTON replied in 2016-2017 it was 49 percent.
2:07:48 PM
SENATOR MICCICHE asked if any outreach with Native corporations
is being done to see if they would assist with scholarship
programs for the child welfare certificate.
MS. LAWTON said she has not done any specific outreach to
corporations, but conversations have started around various
issues. If tribes will be doing more social work through the
Alaska Tribal Child Welfare Compact, they will need workforce
development.
SENATOR MICCICHE suggested it is something worthy of
consideration.
2:11:11 PM
MS. LAWTON related that in May 2017 OCS went through a third
round of the federal Child and Family Services Review. They did
random sampling of cases in Anchorage, Fairbanks, and Ketchikan.
OCS did not achieve the high national performance standard of 95
percent in Safety, Permanency, or Well-Being. Areas of strength
that were identified were stability of foster care placement,
keeping siblings together, and making sure educational needs of
children are met. Areas of weakness are keeping children in the
home by finding ways to wrap services to prevent removal, having
permanency and stability in all living situations, and having
families get services to enhance their capacity to safely care
for their children. They do a good job with caseworker visits
with children, but it is difficult for caseworkers to see
parents monthly. If caseworkers don't see parents frequently,
parents are less likely to be successful. The compact may help
because the tribes are located in communities where OCS is not.
SENATOR BEGICH asked whether the number of foster homes has
grown to match the 54 percent increase in out-of-home care.
2:14:30 PM
MS. LAWTON said they have licensed more homes, but the biggest
push is to get kids into homes of relatives. The number of
foster homes has not grown at the rate needed. They have enough
homes, but not enough to evaluate to find the best match for the
child.
SENATOR MICCICHE related that he was invited to a Child and
Family Services Review. The state and OCS have challenges, but
very few states meet the 95 percent standard. He asked if the
state could be penalized for not meeting the standard and
whether the national standards are realistic.
MS. LAWTON responded that the expectations should be exceedingly
high because of what they expect a child to receive as a result
of an intrusive act. Given the state of child welfare funding
across the country, the opioid crisis, and lack of resources,
meeting the goals is not realistic. Nevertheless, the goals are
what they should be.
She explained that over the next year, OCS will be negotiating
the Program Improvement Plan with their partners at region 10 to
identify the strategies they will use to improve outcomes. Once
they agree on a final plan, benchmarks will be set for the next
two years. If they do not meet negotiated goals, the Program
Improvement Plan can be extended, but the possibility of
financial penalties exists. She has gone through the process
twice since she has worked for the agency, and they have met the
Program Improvement Plan goals.
2:19:41 PM
MS. LAWTON said the Program Improvement Plan focuses on three
areas. Safety is something they look at throughout the entire
lifetime of a case. Success comes down to human engagement and
building some semblance of trust to work collaboratively with
parents. They have a lot of work to do to increase engagement to
help parents increase their protective capacity. She said the
federal government uses Alaska as an example of great work of
quality assurance, but they are still missing a real Continuous
Quality Improvement process. They don't have a way to monitor
whether responses to quality assurance reports are working.
2:22:26 PM
MS. LAWTON said she wanted to respond to questions Senator von
Imhof had had about HB 30, the 2013 legislative audit
recommendations:
3.2.I.2 Separate foster care licensing and regulations
from other residential care facilities
3.2.I.4 Develop a template or checklist for OCS
workers and/or eligibility technicians to assist in
correctly documenting the components of Title IV-E
eligibility within appropriate timeframes
She said separating the licensing work is almost done. The
regulations are out for public comment through April 6, and the
template is completed. They have made a number of adjustments on
their claim process. The federal Title IV-E penetration rate has
improved. The general fund was almost neutral because of the
gains in federal dollars.
At ease.
2:24:00 PM
CHAIR WILSON reconvened the meeting and asked about the status
of the recommendation to combine licensing for DHSS's five
divisions.
MS. LAWTON said the recommendation as she understood it was to
separate foster care licensing regulations from other
residential care facilities.
CHAIR WILSON agreed after reviewing the recommendation.
SENATOR VON IMHOF said the DHSS unrestricted general funds this
year are less than a few years ago even though the number of
recipients in Medicaid and in OCS has increased. The 2018
supplemental tips the scale a bit in much higher unrestricted
general funds. Looking at 2019 and beyond, one can speculate,
with the significant jump in number of children served, that the
pressure on unrestricted general funds may be a great deal,
especially if many of these additional people served are not in
the expansion population with the 90/10 split with the federal
government, but the 50/50 split. It is interesting to note the
decline or static state of unrestricted general funds for the
last few years when not factoring in the supplemental. She is
curious about what future years may hold when considering the
sum of all the presentations they have been having about the
incredible jump in participants in Medicaid.
2:29:54 PM
MS. LAWTON said the presentation last night to the Senate
Finance HSS subcommittee had a slide that looked at budget
changes from FY 15 and FY 19 that did include the supplemental
request. OCS had an $89,000 decrease in unrestricted general
funds. She cannot speak to other departments, but OCS attributes
that to maximizing the federal revenue. She was not sure whether
that would hold for next year, but it was a reduction for this
year.
SENATOR VON IMHOF said that is a fair statement, but the
question is whether that will hold for the future.
2:30:54 PM
CHAIR WILSON noted the arrival of Senator Giessel.
2:31:00 PM
MS. LAWTON reviewed 2017 successes and 2018 priorities. Efforts
to safely discharge children and slow down new foster care
entries are working. Exits are exceeding entries. The tide is
turning. The repeat maltreatment rate dropped. That goes back to
policy decisions mentioned earlier. They are centralizing intake
services (where to report maltreatment). In the past they had
intake workers in all 23 of their offices, which resulted in
inconsistent practices. Over the last five years they have been
moving to centralized intake, which is more responsive to the
community. A 24/7 hotline system will be put in place. Now an
answering service takes calls between the hours of midnight and
7 a.m. They need intake professionals to make decisions about
how to respond to calls during that time. She said that OCS
continues to find the best ways to find people who are well
matched for the job.
CHAIR WILSON asked if centralized intake correlated with the
increase in protective services reports.
MS. LAWTON said she does not think so.
CHAIR WILSON asked if the Alaska Tribal Child Welfare Compact is
a way to privatize some of the functions of OCS.
MS. LAWTON said she does not view the compact as privatization;
it is a government-to-government relationship. Tribes are
already operating foster care programs and helping families in
distress. In the long run they hope it will improve services to
children and families. Also, it has the potential of cost
savings for Alaska.
2:36:25 PM
SENATOR VON IMHOF referred to the successes and failures from
the Child and Family Services Review. She asked if tribes will
be more accountable for these types of reports as more tribal
compacts are created.
MS. LAWTON said initially they will be accountable to the state
of Alaska because they will need to demonstrate that they are
doing the services that OCS would have. The long-term goal is
that tribes will access federal funding and have a portion of
state funds to operate their own programs more autonomously.
Then then they would be accountable primarily to the feds.
2:38:56 PM
MS. LAWTON went over the entities that have oversight of OCS:
Federal Administration for Children & Families
Child & Family Services Review
Title IV-E Audit
Legislative Audit
Alaska Court System
Facing Foster Care in Alaska
Alaska State Ombudsman
Children's Justice Act Taskforce
Citizen Review Panel
Resource Family Advisory Board
She said they are all different in nature, but OCS receives
input from all of them. Sometimes ideas and recommendations
align and sometimes not. It can be challenging to look at all
the recommendations.
MS. LAWTON went over the Citizen Review Panel recommendations
for OCS.
1. Assign CRP a significant role in implementation
of priority areas of the "Transforming Child
Welfare Outcomes for Alaska Native Children:
Strategic Plan 2016-2020.
She said OCS is doing this by significant participation of CRP
in the Community Engagement work group.
2:42:16 PM
MS. LAWTON said OCS has implemented a new tracking system.
Another method did not pan out. They are establishing a
connection between a case file and any related grievances while
protecting worker identity.
2. Speed up the process and implement the new
tracking system of grievances by December 2017.
3. Establish adequate connection between a case file
and any related grievances, with necessary
protection for worker identity.
She said OCS is deciding what aggregate data to post on the
website, but they will do that.
4. Publish monthly aggregate data on number of
grievances received, nature of those grievances,
and time to resolution of those grievances
online.
She said OCS is fully engaged and eager to help CRP's
effectiveness to dialogue with the public.
5. OCS should work with the CRP to strengthen the
CRP's ability as a robust mechanism for public
participation, and rely on it to improve public
awareness of the nature and content of OCS work.
She said a participatory evaluation framework is a new term that
she has learned from Diwakar Vadapalli, Chair of the Alaska
Citizen Review Panel. She agrees that it makes sense and looks
forward to that endeavor.
6. OCS should continue to work with the CRP to
identify a clear working relationship under the
participatory evaluation framework.
2:45:38 PM
CHAIR WILSON said the audit stated that the training process for
OCS case workers is too short. They are going to address
training and workforce issues with a future bill, but he asked
if the department has a strategic plan or document to address
long-term goals. He noted the Department of Public Safety just
came out with a workforce retention plan.
MS. LAWTON said they do not have a comprehensive document that
covers all those issues. The five-year plan they submit to the
federal government talks about workforce challenges and things
OCS is doing. She would like to work with UAA to create a
comprehensive, 10-year strategic workforce plan.
SENATOR GIESSEL said she has asked UAA what it is doing to meet
the needs of social workers, but has yet to receive a reply.
2:47:58 PM
CHAIR WILSON said OCS doesn't have a way of having soft contacts
with folks, to show the value of what it can do, but the Citizen
Review Panel can fill the advocacy role. It is part of their
core mission and function.
2:48:52 PM
At ease.
SB 169-MEDICAID: BEHAVIORAL HEALTH COVERAGE
2:48:57 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SB 169. He noted the committee adopted the
committee substitute, version J, on March 5, 2018.
2:50:46 PM
CHAIR WILSON asked if there were any amendments.
2:50:50 PM
SENATOR BEGICH moved Amendment 1, labeled 30-LS1283\J.1.
AMENDMENT 1
OFFERED IN THE SENATE BY SENATOR Begich
TO: CSSB 169( ), Draft Version "J"
Page 1, line 7:
Delete "psychiatrist"
Insert "physician"
Page 1, line 9:
Delete "psychiatrist"
Insert "physician"
2:51:24 PM
CHAIR WILSON objected for purposes of discussion.
SENATOR BEGICH said the amendment deletes the word
"psychiatrist" and inserts the word "physician." The memo from
Legislative Legal shows that "psychiatrist" is under the
definition of physician. Alaska has fewer psychiatrists than
they thought.
SENATOR GIESSEL reported that since the last meeting she
accessed an Arctic Mental Health Work Group report that
identified 85 psychiatrists in the entire state. This was based
on a 2015-2016 primary care needs assessment. She also reported
that Alaska has about 140 clinical psychologists, 780 clinical
social workers, and 80 family and marital therapists. Alaska has
about 1,000 clinicians that could work under supervision of a
physician or an advanced nurse practitioner certified in
psychiatric mental health.
SENATOR MICCICHE said he walked through how behavioral health is
charged to Medicaid. The savings to the state are potentially
significant with the expanded supervision provided in this bill.
He predicted it will be in the millions of dollars. He stated
support for the zero fiscal note.
2:54:05 PM
RANDALL BURNS, Director, Division of Behavioral Health,
Department of Health and Social Services (DHSS), answered
questions about SB 169.
CHAIR WILSON asked Mr. Burns if he saw any potential issues with
the term physician instead of psychiatrist.
MR. BURNS said he has no comments about replacing "psychiatrist"
with "physician," but would point out that the Centers for
Medicare & Medicaid Services has a rule that limits who can
supervise clinic services to a physician or a dentist, if it's a
dental practice. The committee may want to talk about that
correction. Advanced nurse practitioners can already bill
Medicaid directly. For just clinic services, they may want to
limit that to physicians.
2:55:54 PM
CHAIR WILSON removed his objection. Finding no further
objection, Amendment 1 was adopted. He entertained a motion to
move CSSB 169 from committee.
2:56:19 PM
SENATOR VON IMHOF moved to report CSSB 169, version J as
amended, from committee with individual recommendations and
attached fiscal notes.
2:56:31 PM
There being no objection, CSSB 169(HSS) moved from the Senate
Health and Social Services Standing Committee.
2:56:42 PM
At ease.
2:58:24 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee at 2:58 p.m.