Legislature(2019 - 2020)DAVIS 106
03/10/2020 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB86 | |
| HB183 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 86 | TELECONFERENCED | |
| += | HB 183 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 86-MENTAL HEALTH HOSPITAL: CONTRACTS/BIDS
3:08:23 PM
CHAIR ZULKOSKY announced that the first 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 was the committee substitute (CS) for HB
86, Version 31-LS0623\U, Marx, 3/26/19, adopted as work draft on
3/5/20.]
3:09:30 PM
CHAIR ZULKOSKY opened public testimony on HB 86.
3:09:56 PM
VIKKI JO KENNEDY testified that she is in support of HB 86 and
offered that privatizing Alaska Psychiatric Institute (API) may
be the right solution. She relayed that the patients of API are
some of the neediest people in society. She stated, "A society
who forgets its needy people is a society itself that will soon
be forgotten."
3:11:41 PM
The committee took a brief at-ease.
3:12:38 PM
FAITH MYERS, Mental Health Advocate, expressed her belief that
API should remain a state-owned and -managed psychiatric
hospital. She opined that the "openness of API, including
available statistics" gave API a unique opportunity to set a
high standard of patient care in Alaska. She shared statistics
from 30 private psychiatric units: In 2011, the Disability Law
Center (DLC) of Alaska reported that patients at API could not
file grievances in a fair way. In 2016, the [U.S. Centers for
Medicare and Medicaid Services (CMS), U.S. Department of Health
and Social Services (HSS)], "Medicaid" and "Medicare", reviewed
patient complaints at API and found serious problems with how
management handled them. In 2019, the Alaska State Ombudsman
("Ombudsman") office reported that a female patient at API was
sexually assaulted in the television (TV) room; at some point,
staff intervened; the woman was left half naked by herself
before wandering back to her room; the perpetrator was released
without being charged; the woman did not receive proper
assistance. She cited AS 47.30.660(b)(13) and said that the
Department of Health and Social Services (DHSS) must delegate
its responsibility for caring for psychiatric patients to mostly
private facilities and units. She maintained that the
legislature should require a specific state-patient standard of
care in a separate bill. She offered to the committee reference
information regarding the substance of such legislation to
establish a state standard of care and protection for
psychiatric patients.
3:15:10 PM
CHAIR ZULKOSKY, after ascertaining that there was no one else
who wished to testify, closed public testimony.
3:15:24 PM
REPRESENTATIVE PRUITT moved to adopt Amendment 1, [labeled 31-
LS0623\U.2, Marx, 3/4/20], which read:
Page 1, line 6, following "section":
Insert "unless the Department of Health and
Social Services has been notified by the Joint
Commission on Accreditation of Healthcare
Organizations or the United States Centers for
Medicare and Medicaid Services that there is an
immediate risk that the hospital will lose its
certification"
Page 1, line 9, following "section":
Insert "unless the Department of Health and
Social Services has been notified by the Joint
Commission on Accreditation of Healthcare
Organizations or the United States Centers for
Medicare and Medicaid Services that there is an
immediate risk that the hospital will lose its
certification"
Page 3, line 18, following "hospital":
Insert "unless the department has been notified
by the Joint Commission on Accreditation of Healthcare
Organizations or the United States Centers for
Medicare and Medicaid Services that there is an
immediate risk that the hospital will lose its
certification"
REPRESENTATIVE SPOHNHOLZ objected for discussion purposes.
3:15:37 PM
REPRESENTATIVE PRUITT explained that under the proposed
amendment, DHSS would be allowed to contract for the ownership
or management of an inpatient mental health treatment hospital
if it had been notified by the Joint Commission, which accredits
facilities that serve CMS patients that it is at risk of losing
[accreditation]. He relayed that in 2019, DHSS hired an outside
consulting firm when it had been notified that API would lose
accreditation. Currently API is not at risk due to improvements
at the facility. He maintained that in a situation in which the
state is struggling to manage API, it should have every tool at
its disposal to ensure that API does not lose accreditation.
3:17:46 PM
REPRESENTATIVE SPOHNHOLZ stated that she opposed Amendment 1.
She relayed that what was learned last year [2019] through a
series of hearings on the privatization of API was that
privatization is a process that should not be taken in an
emergent, rushed fashion; there are a myriad of considerations
that should be methodically addressed; among those
considerations are whether a private organization could improve
outcomes or meet Joint Commission or other regulatory agency
standards. She maintained the reason API struggled was that it
was chronically underfunded and chronically understaffed. The
API governance board, which was functional up to 2016, was
disbanded; therefore, there was no oversight. She stated the
current administration, with the support of the legislature, has
reconstituted the governance board, secured additional funding,
augmented staff, and brought in contract expertise to train
staff. The result is an organization that is "back on step."
She asserted that the organization did not need privatization,
but funding and oversight to enable it to function. She said,
"Even a brand-new Mercedes will not drive if it doesnt have
fuel in it." She emphasized that functionally API was like a
car with no fuel in it.
3:19:21 PM
REPRESENTATIVE TARR commented that she did not mind the intent
of Amendment 1. She offered that for Alaska, with such a
fragile health care system and just one facility [for
psychiatric care], a high-risk situation is problematic. She
pointed out that it took six to eight years to get to where API
currently is, under multiple administrations and legislatures.
She said that "immediate risk" is not well defined; that decline
occurs in phases; therefore, it was difficult to evaluate what
phase would constitute immediate risk and warrant action under
the proposed amendment. She expressed her belief the department
could act in an emergency, but if not, then the point of acting
should be more clearly defined. She said, "I just dont want
this to be so gray that it basically nullifies the intent of the
bill."
3:21:30 PM
REPRESENTATIVE JACKSON said that Alaska had options. She
expressed it was heart-wrenching for Alaska to be in a position
of losing accreditation [for API] as a state-operated
institution. She emphasized, "We should never come close to
that ever again." She stated she supported Amendment 1
minus the "immediate risk" - because Alaska should never wait
until the loss of accreditation to recognize a crisis. She said
both the patients and the public employees were important. She
expressed all opportunities and resources should be available to
the state to care for the API population.
3:26:06 PM
REPRESENTATIVE ZACK FIELDS, Alaska State Legislature, reiterated
testimony that the proposed amendment could provide a loophole
that nullified Version U; that an administration with an
objective to privatize API could manufacture a crisis and use
[the provision in the amendment] to privatize it. He stated he
does not support the proposed amendment.
3:26:50 PM
REPRESENTATIVE CLAMAN stated he opposed the proposed amendment.
He expressed his belief that the risk of losing accreditation
last year was very low due to access to care; if the federal
government closed API, there would be nowhere else for patients
to go. He said his interpretation of the notices from the
federal government was that Alaska had problems and needed to
fix them; the pressure would increase, and if the situation
became bad enough, there may be federal lawsuits. He agreed the
language in Amendment 1 was vague, ambiguous, and invited
uncertainty, that it provided a loophole, and that it may
encourage the lack of commitment to providing good services in
the long term.
3:28:31 PM
CHAIR ZULKOSKY offered that API was a state-operated
institution; that Wellpath [Recovery Solutions] merely provided
consulting services to API; therefore, the state had a direct
relationship with the accrediting agencies. She said it was for
that reason she did not support the proposed amendment.
3:29:40 PM
REPRESENTATIVE PRUITT suggested changing the language to address
concerns. He offered when an institution finds itself in a
place in which the most vulnerable people in the state are not
just in jeopardy, but are being harmed, limiting the options and
insisting that API be operated by the "people who failed" is not
the right thing to do. He asserted that narrowing the state's
options and maintaining that the state "knew best" went against
the evidence collected by the Ombudsman.
3:31:07 PM
REPRESENTATIVE SPOHNHOLZ maintained her objection to Amendment
1.
3:31:11 PM
A roll call vote was taken. Representatives Jackson and Pruitt
voted in favor of Amendment 1. Representatives Tarr, Claman,
Drummond, Spohnholz, and Zulkosky voted against it. Therefore,
Amendment 1 failed to be adopted by a vote of 2-5.
3:31:54 PM
REPRESENTATIVE SPOHNHOLZ moved to report the CS for HB 86,
Version 31-LS0627\U, Marx, 3/26/19, out of committee with
individual recommendations and the accompanying fiscal notes.
3:32:11 PM
REPRESENTATIVE JACKSON objected. She maintained that the
mission of the committee was to look out for the well-being of
the patients. She acknowledged all committee members cared
about the patients. She asked the committee to change the
amendment language to "secure the state and secure the well-
being of the patients," and thereby better serve the state.
3:33:23 PM
REPRESENTATIVE SPOHNHOLZ restated her motion, and moved to
report the CS for HB 86, Version 31-LS0623\U, Marx, 3/26/19, out
of committee with individual recommendations and the
accompanying fiscal notes.
3:33:42 PM
REPRESENTATIVE JACKSON objected.
3:33:48 PM
REPRESENTATIVE PRUITT expressed he did not understand why
committee members would support eliminating any options, which
may be necessary for ensuring the most vulnerable people could
be protected. He said that the state failed, and the proposed
legislation suggested that the state was the best entity to
operate API. He maintained every option should be available
regardless of the administration in power. He stated there was
no testimony from patients and family members. He maintained
those who had bad experiences at API would not care what entity
was operating the facility; they would only care the problems
were corrected. He said, "Now we're going to say we're the best
person, and we should never have the option for someone else."
He asserted it manifested poor judgement. He continued by
saying if the concern were for employees, there was no intent to
eliminate the employees. He offered the proposed legislation
was bad policy if legislators were truly concerned with helping
the most vulnerable people under its charge.
3:36:06 PM
REPRESENTATIVE TARR mentioned the topic under discussion was one
that could be in a special session if time allowed. She
mentioned the many related challenges. She said the intent of
Version U was to force the state to do a better job and not
shirk its responsibility to manage API. She offered she tended
to err on the side of the public-operated facility. She
expressed the importance of legislative oversight.
3:37:28 PM
REPRESENTATIVE SPOHNHOLZ clarified supporting the bill did not
suggest committee members did not care about patients at API.
She stated she has spent a great deal of time ensuring API was
as successful and as functional as was possible; she understood
the vulnerability of the patients; their illnesses often made it
impossible for them to advocate for themselves. The
disagreement [in committee] was about how to approach a solution
and not lack passion for the issue or commitment to the
patients. She reiterated she fundamentally believed API failed
due to lack of oversight - which was why she has introduced
legislation to codify in law the governance board - and due to
inadequate funding. For six years there was no increase in
fulltime employees (FTEs) at API. The needs at API were not
being met. The state faced fiscal challenges at the time, and
no one was advocating for API; therefore, API suffered from
neglect. It was not intentional but had real consequences. She
mentioned a patient advocate testified that it was important to
keep API in the public trust; she agreed with that sentiment and
supported Version U.
3:40:10 PM
REPRESENTATIVE JACKSON maintained her objection.
3:40:18 PM
A roll call vote was taken. Representatives Spohnholz, Tarr,
Claman, Drummond, and Zulkosky voted in favor of reporting CSHB
86, Version 31-LS0623\U, Marx, 3/26/19, out of committee.
Representatives Pruitt and Jackson voted against it. Therefore,
CSHB 86(HSS) was reported from the House Health and Social
Services Standing Committee by a vote of 5-2.
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