Legislature(2019 - 2020)DAVIS 106
03/05/2020 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Presentation: Addressing Gaps in the Crisis Psychiatric Response System | |
| HB86 | |
| HB183 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | HB 183 | TELECONFERENCED | |
| += | HB 86 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 86-MENTAL HEALTH HOSPITAL: CONTRACTS/BIDS
3:49:00 PM
CHAIR ZULKOSKY announced that the next order of business would
be HOUSE BILL NO. 86, "An Act relating to a state-owned
inpatient mental health treatment hospital; and providing for an
effective date." [Before the committee, adopted as a work draft
on 3/28/19, was the proposed committee substitute (CS) for HB
86, Version 31-LS0623\U, Marx, 3/26/19.]
3:49:08 PM
REPRESENTATIVE SPOHNHOLZ, in response to Chair Zulkosky,
[renewed] the motion to adopt the proposed committee substitute
(CS) for HB 86, Version 31-LS0623\U, Marx, 3/26/19, as the
working draft.
3:49:21 PM
CHAIR ZULKOSKY objected for the purpose of discussion.
3:49:43 PM
REPRESENTATIVE ZACK FIELDS, Alaska State Legislature, as prime
sponsor of HB 86, using a PowerPoint presentation, shared some
history and facts about API on slides 2-3. He said API had far
fewer beds than were needed to meet present needs, which created
a myriad of problems ranging from people with psychiatric
illnesses not receiving treatment, which put Alaskans at risk
and necessitated hospitals' holding of psychiatric patients in
the ER, guarded one-on-one, effectively driving up the cost of
health care. Representative Fields noted the controversy
surrounding attempted privatization of API since the
introduction of HB 86; some headlines from news stories could be
seen on slide 4 of the PowerPoint. The state was not
permanently privatizing API, he said; Wellpath (WP) continued to
have shorter-duration contracts to provide some management
services. What HB 86 would do was prevent overall privatization
of the entire facility, he related, while not prohibiting
privatization of certain functions within API.
3:51:45 PM
REPRESENTATIVE FIELDS related there were many troubling examples
of negligent care at WP facilities across the U.S., and Correct
Care Solutions, which was the former name of WP, had been sued
about 1,400 times since 2003, including substantiated claims of
wrongful death and inadequate care.
3:52:58 PM
REPRESENTATIVE FIELDS, referencing slides 5-6, shared with the
committee a timeline of API's relationship with WP and the
latter's corporate history. Referencing slides 7-8,
Representative Fields noted there had been a high turnover of
numerous positions under WP. Staff were concerned with WP
management, he related, and there has been criticism, including
in the media, of WP's failure to bring conditions at API where
they needed to be. Referencing slide 9, Representative Fields
noted that the legislature had looked at API management in a
recent comprehensive study in 2017, examining a wide range of
options for managing the facility ranging from wholesale
privatization to partial privatization to modified state
management. In the study, full privatization entailed decreased
quality of service and higher costs, and recommended state
management with outsourcing what they considered non-core
services. Consistent with the 2017 study, HB 86 would ensure
public management with opportunities to outsource certain
functions, but not management of the whole facility.
3:55:24 PM
REPRESENTATIVE FIELDS noted public support for continued public
management of API, as exemplified on slide 10. Pacific
Consulting Group (PCG) had looked at private management of
facilities such as API, and when those facilities were privately
managed for profit, it cost a significant amount of extra money
in terms of profit margin on top of basic operations of the
facility. In conclusion, Representative Fields stated that the
for-profit model was incompatible with the basic mission of API
because it created an ongoing incentive for the private owner to
provide inadequate staffing to meet patients' and employees'
needs.
3:56:19 PM
REPRESENTATIVE FIELDS said HB 86 had some adjusted terminology
and did allow for privatization of certain functions, a good
balance to ensure the entity that ran API had a public mission
but there was flexibility to run the facility and adjust to
current needs.
3:57:01 PM
REPRESENTATIVE PRUITT confirmed API had been managed by the
state prior to the last election. He then asked, when looking
at the Ombudsman's report and some things that occurred under
state management including the sexual assaults in 2018 and 2019,
why state management would be better than a private entity. He
also mentioned HB 86 seemed to group all private entities in
with WP, when the important consideration was that the most
vulnerable of the population were properly cared for, no matter
who managed the facility.
3:58:44 PM
REPRESENTATIVE FIELDS expressed that the issue was complex and
said he was aware of three bills all addressing different
aspects of problems with API. He admitted that passing HB 86
would not, in and of itself, solve the problems. Representative
Fields said he appreciated the committee's hearing another bill
he introduced addressing API staffing and capacity issues. He
said the sexual assault and other safety-related incidences were
related to inadequate staffing. He said he has a problem with
"a profit motive." He said he would not have the same problem
with a non-profit running the facility because the same problems
did not exist in terms of incentives. He said the legislature
must appropriate sufficient money "to run the facility" while
recognizing that not having sufficient funds "creates the public
safety and cost ripple effect." He said he thinks HB 86 would
be one part of a broader solution. In the last year, WP has
had a chance to fix problems with API and they have not done so,
he added.
4:00:48 PM
JAKE METCALFE, Executive Director, Alaska State Employees
Association, testified in support of HB 86 and said he agreed
with Representative Fields' statements. Mr. Metcalfe shared the
Alaska State Employees Association (ASEA) experience with its
staff at the facility. Understaffing and underfunding had been
problems for a long time, he related, including with WP. One of
the more concerning aspects, he shared, were the discussions of
outsourcing having created a high amount of instability in the
workplace: according to ASEA calculations, 75 people have left
in the last year for the reason of uncertainty regarding what
will happen at the facility. Employees do not want to work for
a private contractor; they want leadership, he shared. Some of
those who have left had been at API their entire careers, he
added.
MR. METCALFE blamed the privatization for the employees'
departure. They had been told a feasibility study would be
done, he related, at the end of February when it had been
announced that WP would come in as the contractor. It had not
been done, which resulted in litigation. There had been a
feasibility study scheduled for April [2019], and then June, and
then September, and then December, before the February date was
missed, and [at the time of Mr. Metcalfe's testimony] one more
had been scheduled for March 9. The inability to get a study
done, or to provide the results, has created moral issue in the
workplace. Mr. Metcalfe referenced the 2017 study
Representative Fields had brought up, which showed privatization
would only be successful by a major cut in staff. This created
safety problems for staff and patients alike, he reiterated.
MR. METCALFE noted there had been problems not only with staff
but with leadership, as there had been between five and seven
chief executive officers (CEOs) during the current
administration, in addition to another six prior to the
privatization effort. Leadership had changed every couple of
months, both under state management and with WP in the facility.
From ASEA's standpoint, Mr. Metcalfe stated, the situation was
"privatization by attrition," both within leadership and among
staff who took care of people in need. Among neither group was
the instability welcome, he said, and the way to fix the problem
was to have the state run it and to staff it properly.
4:07:28 PM
REPRESENTATIVE PRUITT said that sexual assaults were due not to
a lack of funding but to failure by staff, and since WP has been
at the helm there has been additional training of staff.
4:09:23 PM
MR. METCALFE replied he had been with ASEA since 2018 and knew
from experience dealing with API what the record was like prior
to that time. He said he also knew from his experience dealing
with WP and the privatization issue he would stand by API as a
state-run facility as opposed to one run by WP. He admitted
this stance did not account for perfection of all staff, and it
was possible additional training may in certain cases be
required. Mr. Metcalfe shared some background prior to the
transition to WP. He said that in his experience the problem
was with the transition to WP, but API had been underfunded and
understaffed for many years. He said stable leadership and
adequate staff were needed on all levels, and if that were able
to happen, issues such as sexual assault would be able to be
prevented. He reiterated understaffing would not work at a
hospital that is at full capacity. State-run programs implement
decisions by policy makers that the funding and staffing will be
adequate because of the constitutional obligation to provide the
service to people, he added.
4:13:30 PM
REPRESENTATIVE PRUITT said that funding and bed levels had been
increased in 2017, and one of the sexual assaults was in spring
of 2018. Even when additional funding was given, assaults
happened, he stated.
4:15:38 PM
MR. METCALFE said funding had been increased but it had not been
enough, as API had been underfunded for years prior to 2017, and
the 2017 funding had in fact been a "Band-Aid funding approach."
As far as WP was concerned, Mr. Metcalfe stated 70 staff had
left since the WP takeover, including six to seven new CEOs.
Mr. Metcalfe repeated that WP lacked leadership and admitted the
cause may be other bills which addressed wage issues and other
changes. He stated that privatization had not been successful
in psychiatric facilities; the state had made the decision to
care properly and responsibly for its vulnerable people and not
"ship them out."
4:18:52 PM
REPRESENTATIVE PRUITT clarified that the state still did manage
the facility with WP as a consultant.
4:19:33 PM
REPRESENTATIVE SPOHNHOLZ pointed out API was still a public
institution. There had been a contract last year for the
takeover of the hospital which had not been awarded. A look at
the records, she continued, showed Centers for Medicare &
Medicaid Services (CMS) citations at API had started to rise in
2015 and coincided with many years of tough fiscal situations.
Costs had to be cut in many areas and the budget had to be
managed, she imparted, and API had been under-resourced,
especially when taking into consideration the high level of
training needed to support patients. Representative Spohnholz
asked whether there was any language in HB 86 that would prevent
API from contracting with experts to help improve outcomes.
4:21:15 PM
REPRESENTATIVE FIELDS replied there was not.
4:21:19 PM
CHAIR ZULKOSKY asked about the status of the new feasibility
study being conducted by API on privatization and state
management.
4:21:50 PM
CLINTON LASLEY, Deputy Commissioner, Office of the Commissioner,
Department of Health and Social Services, replied the
feasibility study was due to DHSS March 9. He said it had four
focal points: maintaining a state-run facility with
enhancements to try to get back to the 80-bed capacity; looking
at privatization, whether through a for-profit or non-profit
organization; providing an option for public corporation while
remaining a state-owned facility; and contracting out some
services, as was currently done.
4:23:24 PM
CHAIR ZULKOSKY asked when DHSS began the feasibility study Mr.
Lasley referenced.
MR. LASLEY replied the contract had been awarded in October
[2019] and had been due to be finalized at the end of February,
but the contractor did ask for some additional information, and
an extension had been granted until March 9.
4:23:48 PM
REPRESENTATIVE SPOHNHOLZ asked what DHSS was seeking to
understand or learn after a privatization study which consisted
of 98 pages had just been done in 2017.
4:24:22 PM
MR. LASLEY replied there were now four options, which was a
different approach. Instead of "just a typical privatization
study," the feasibility study at hand looked at the best
mechanism to run the hospital, he stated.
REPRESENTATIVE SPOHNHOLZ asked how many state psychiatric
hospitals in the U.S. were privately run.
MR. LASLEY replied he did not know.
REPRESENTATIVE SPOHNHOLZ asked whether there was a model in
other places DHSS was trying to follow or if it was on a general
fact-finding mission.
4:25:52 PM
ALBERT WALL, Deputy Commissioner, Office of the Commissioner,
Department of Health and Social Services, regarding why another
privatization study would be done in such quick succession,
stated that the older study, began in 2016 and published in
2017, showed that beginning in 2013 there had been a series of
state-run hospitals having the same problems as API. There were
laws which required states to care for inpatient psychiatric
patients in a timely fashion, and many states had been failing
in that regard. Because of these failures, many states were
experiencing lawsuits. Mr. Wall related that in a presentation
to the Senate Health and Social Services Standing Committee in
February 2019, new findings, court orders, and rulings across
different states had been revealed. Other states, through U.S.
Department of Justice injunctions, had been appointed court
monitors for their state-run hospitals, and DHSS had wanted to
take this into account in a privatization study to bring it up
to date.
4:28:03 PM
REPRESENTATIVE FIELDS noted that in the 2017 feasibility study
PCG did look at eight privatization options, and PCG's letter to
the committee did address privatization in different states and
proclaimed it a "disaster."
4:28:56 PM
BESSE ODOM, Staff, Representative Zack Fields, Alaska State
Legislature, on behalf of Representative Fields, prime sponsor,
presented the Sectional Analysis for the proposed committee
substitute (CS) for HB 86, labeled 31-LS0623\U, Marx, 3/26/19,
[included in members' packets], which read as follows [original
punctuation provided]:
Section 1. This section amends AS 36.30.300, the
statute on Single Source Procurements, to add a new
subsection, (f) that prohibits creation of contracts
relating to the ownership or management of an
inpatient mental health treatment hospital established
under AS 47.30.660 (c) (see Section 4)
Section 2. This section amends AS 36.30.310, the
statute on Emergency Procurement, to add a new
subsection, (b) that prohibits the use of these
statutes to create contracts relating to the ownership
or management of an inpatient mental health treatment
hospital established under AS 47.30.660 (c) (See
Section 4)
Section 3. This section amends AS 47.30.660 (b) to
correspond with a new subsection in AS 47.30.660 (c),
that is established in Section 4.
Section 4. This section amends AS 47.30.660 to add a
new subsection, (c), that requires the Department of
Health and Social Services manage an "inpatient mental
health treatment hospital" in the State. It prohibits
the state from delegating or contracting for the
ownership or management of such a facility. It also
defines "inpatient mental health treatment hospital"
for the purposes of this section.
Section 5. This section amends the uncodified law of
the State of Alaska to define the applicability of new
subsections established in Section 1, Section 2,
Section 3 and Section 4, to contracts entered into,
amended, extended or renewed after the effective date
of this Act.
Section 6. This section amends the uncodified law of
the State of Alaska to state if this Act takes effect
after February 1st 2019, it is retroactive to February
1st 2019.
Section 7. This section provides for an effective
date; it would take effect immediately on passage
under AS 01.10.070 (c).
4:31:52 PM
CHAIR ZULKOSKY removed her objection to the [renewed] motion to
adopt the proposed committee substitute (CS) for HB 86, Version
31-LS0623\U, Marx, 3/26/19, as the working draft. There being
no further objection, Version U was [once again] before the
committee.
CHAIR ZULKOSKY announced that HB 86 would be held over.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Fiscal Summary for Settlement of 3AN-18-09814CI.pdf |
HHSS 3/5/2020 3:00:00 PM |
Addressing Gaps in the Crisis Psychiatric Response System |
| Addressing Gaps in the Crisis Psychiatric Response System--2 page overview.pdf |
HHSS 3/5/2020 3:00:00 PM |
Addressing Gaps in the Crisis Psychiatric Response System |
| HB183 ver M Supporting Document Combined Letters of Support 3.3.2020.pdf |
HHSS 3/5/2020 3:00:00 PM |
HB 183 |
| HB 183 v.S.pdf |
HHSS 3/5/2020 3:00:00 PM |
HB 183 |
| CSHB 86 ver U Letters of Support 3.28.19.pdf |
HHSS 3/5/2020 3:00:00 PM |
HB 86 |
| Addressing Gaps in the Crisis Psychiatric Response System.PDF |
HHSS 3/5/2020 3:00:00 PM |
Addressing Gaps in the Psychiatric Response System |
| HB 86 Version U Amendment 1.pdf |
HHSS 3/5/2020 3:00:00 PM |
HB 86 |
| HB 183 Version S Amendment 1.pdf |
HHSS 3/5/2020 3:00:00 PM |
HB 183 |