Legislature(2019 - 2020)ADAMS 519
03/19/2020 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB290 | |
| HB247 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 290 | TELECONFERENCED | |
| + | HB 247 | TELECONFERENCED | |
| += | HB 131 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE BILL NO. 290
"An Act establishing an alternative to arrest
procedure for persons in acute episodes of mental
illness; relating to emergency detention for mental
health evaluation; and relating to licensure of crisis
stabilization centers."
1:37:25 PM
Co-Chair Johnston requested a bill introduction from the
sponsor and staff.
REPRESENTATIVE MATT CLAMAN, SPONSOR, introduced the bill
with prepared remarks:
Those living with serious mental health disorders are
subject to periodic recurrent psychiatric emergencies
or crises that require prompt medical attention and
stabilization. Factors such as the lack of timely
access to essential services and supports, substance
abuse disorders, unstable housing and homelessness,
and poverty exacerbate these crises.
In Alaska and across the nation we face challenges in
how we address people in crisis. Current treatment
options for those in crisis are largely concentrated
at either end of the behavioral health continuum of
care, with long-term outpatient treatment options at
one end of the spectrum and intensive inpatient
treatment options at the other. When comprehensive
community-based mental health services are
insufficient, the burden of dealing with those in
crisis often falls on individuals and organizations
whose primary duties lay outside the traditional scope
of psychiatric stabilization. Police officers,
hospital emergency departments, correctional
facilities, and social service providers are often on
the frontline of dealing with those experiencing a
behavioral health crisis. These individuals and
organizations are already at capacity in dealing with
their primary functions in public safety and health
services.
House Bill 290 is the first step in adding a much
needed intermediate treatment option for those
suffering from a mental health crisis. Created by the
National Association of State Mental Health Directors,
the National Council for Behavioral Health, RI
International, and Suicide Prevention Groups and known
as the "Crisis Now" model, crisis stabilization
centers are community-based interventions to better
serve those experiencing intermediate mental health
crises.
These facilities are open 24 hours a day, 7 days a
week, 365 days a year; are staffed by mental health
professionals; have a no wrong door approach; and are
designed to provide prompt mental health evaluation
and stabilization. Crisis stabilization centers have
already proved to be a successful community tool in
other states including Arizona and Washington.
1:40:27 PM
Representative Claman noted that the Alaska Mental Health
Trust Authority (AMHTA) paid to bring a number of people to
take a tour in Arizona. He acknowledged that Co-Chair
Johnston had attended the tour. He shared that he had been
in Arizona on other matters and had done a tour himself. He
reported that the facility in the Phoenix suburb of Peoria
was operated by a private group. He stated it had been
inspiring to see how well the facility worked and to hear
from police officers about how satisfied they were with the
option for dealing with people with a mental health crisis
and as an alternative to dealing with people they may have
to otherwise arrest. He continued reading from prepared
remarks:
No facilities currently exist in Alaska. HB 290
authorizes the Department of Health and Social
Services to write regulations to permit and license
crisis stabilization centers in Alaska. Once the
regulations are in place, it is anticipated that
interested providers will open crisis stabilization
centers in Alaska's communities.
House Bill 290 also gives our public safety
professionals an essential alternative to improve
public safety. It amends the Code of Criminal
Procedure to allow police officers who have probable
cause to arrest an individual to elect to take the
person to a crisis stabilization center as an
alternative to jail. Using the crisis stabilization
alternative would require the police officer to find
that the person was experiencing a mental health or
substance abuse crisis and that treatment at a crisis
intervention center would lead to a better outcome
from both a treatment and public safety perspective.
House Bill 290 ensures that even if a person is taken
to a crisis stabilization center, they can still be
prosecuted for alleged criminal activity.
Representative Claman thanked AMHTA for committing
resources to urge getting crisis stabilization centers in
Alaska. His office had worked with the Department of Health
and Social Services, particularly Deputy Commissioner Al
Wall. He reported that a number of changes had been made to
the original bill version to address concerns raised by the
Department of Law, Criminal and Civil Divisions. His office
had long discussions with the Alaska Network on Domestic
Violence and Sexual Assault and had made adjustments to the
bill in regard to their concerns. Additionally, they had a
number of calls with the Anchorage Police Department. He
shared that all of the groups were supportive of the bill.
He asked his staff to present the sectional analysis.
1:43:04 PM
SOPHIE JONAS, STAFF, REPRESENTATIVE MATT CLAMAN, reviewed a
sectional analysis (copy on file):
Section 1
AS 12.25.030. Grounds For Arrest By Private Person or
Peace Officer Without Warrant
Amends AS 12.25.030 by adding a new section providing
peace officers with an alternative to arrest. An
officer may, at their discretion, deliver a person to
a crisis stabilization center or evaluation facility
instead of arresting them if the officer believes that
the person is suffering from an acute episode of
mental illness or if the person voluntarily agrees to
be taken to a crisis stabilization center or
evaluation facility. Taking an individual to a crisis
stabilization center or evaluation facility, as
provided for in this section, does not bar prosecution
of the individual for alleged criminal activity or on
charges for the original grounds for arrest.
Section 2
AS 18.65.530 Mandatory Arrest For Crimes Involving
Domestic Violence, Violation of Protective Orders, and
Violation of Conditions of Release. Amends AS
18.65.530(c) by adding a subsection providing that a
peace officer is not required to make an arrest under
AS 18.65.530(a) if the officer has authorization from
a prosecuting attorney in the jurisdiction in which
the offense under investigation arose to deliver the
person to a crisis stabilization center or an
evaluation facility as provided in AS 12.25.031(b)
because the person is subject to involuntary
commitment under AS 47.30.705.
Section 3
AS 18.65.530 Adds a new subsection (g) to AS 18.65.530
that requires a peace officer who delivers a person to
a crisis stabilization center or evaluation facility
to leave their contact information with the crisis
stabilization center or evaluation facility and, if
notified of a release from crisis stabilization under
AS 12.25.031(d), to make reasonable efforts to inform
the victim of a crime under (a)(1) and (2) of AS
18.65.530.
Section 4
AS 47.30.705 Mental Health Emergency Detention for
Evaluation Amends AS 47.30.705 by clarifying that a
person who is gravely disabled or suffering from
mental illness and poses immediate harm to self or
others may be delivered to a crisis stabilization
center or to an evaluation center pursuant to AS
47.30.700.
1:45:31 PM
Ms. Jonas continued to review the sectional analysis:
Section 5
AS 47.30.710 Mental Health Examination
Amends AS 47.30.710(a) to provide for an examination
by a medical professional within three hours for those
brought to crisis stabilization centers.
Section 6
AS 47.32.010 Centralized Licensing and Related
Administrative Procedures Purpose and Applicability
Amends AS 47.32.010(b) to allow licensing of crisis
stabilization centers under Chapter 32.
Section 7
AS 47.32 Centralized Licensing and Related
Administrative Procedures
Amends AS 47.32.900 to expand the definition of crisis
stabilization centers to include 23-hour crisis
stabilization, crisis residential centers, and sub-
acute facilities.
Section 8
Uncodified Law of the State of Alaska
Amends sec. 6 of this act to allow the Department of
Health and Social Services, before a crisis
stabilization center is licensed under AS
47.32.010(b), to issue a provisional license to or
reimbursement to a crisis stabilization center.
Ms. Jonas thanked the committee for the opportunity to
present.
1:46:31 PM
Co-Chair Johnston asked members to hold questions until
after hearing from invited testifiers.
STEVE WILLIAMS, CHIEF FINANCIAL OFFICER, ALASKA MENTAL
HEALTH TRUST AUTHORITY (via teleconference), spoke in
support of the bill. He read from a prepared statement:
The trust supports HB 290. As you are aware, Alaska's
psychiatric continuum of care is not a full continuum.
It currently relies on the most expensive level of
care, API, and at other times expensive and
inappropriate levels of care, hospital emergency rooms
and Alaska jails, to address the needs of Alaskans who
are in acute psychiatric crisis. This is not the best
way to expend the state's limited financial resources
or provide care to Alaskans in a medical crisis.
Currently, the Department of Health and Social
Services, law enforcement agencies, local hospitals
and nonprofit behavioral health providers, tribal
health organizations and the trust, and many others,
are collaborating to develop community-based
psychiatric crisis service components. These
components are based on the best practice model called
Crisis Now and those components include a 24-hour
crisis call center, a 24/7 mobile crisis team, and
crisis stabilization centers that operate 24 hours per
day, 365 days a year, and accept all persons with a
no-refusal policy.
These crisis stabilization centers provide law
enforcement an option to divert someone in a
psychiatric crisis to a location with trained
professionals and peers who can address their needs
rather than having a law enforcement officer wait for
hours at an emergency room or have a person handcuffed
in the back of their patrol car for hours until
treatment services are available or they might end up
inappropriately in a jail. Rather, the officer can
appropriately and efficiently meet the needs of the
individual in psychiatric crisis by taking them to a
psychiatric stabilization center, allowing the officer
to return to the street to perform more traditional
public safety duties and minutes.
HB 290 provides some of the critical policy tools for
law enforcement and the healthcare system to
effectively implement these much needed services to
dramatically enhance our psychiatric crisis continuum
of care. The trust believes HB 290 will help the State
of Alaska move forward with implementation of
community solutions to better respond to individuals
in a mental health or substance use related crisis to
get them to the proper services to receive the
appropriate interventions by individuals appropriately
trained. If you're interested in learning more about
the Crisis Now model, I would encourage members to go
to crisisnow.com and on their homepage there's a short
two to three minute video that explains the model and
how it operates.
1:50:12 PM
Representative Sullivan-Leonard referenced the fiscal note.
She asked if AMHTA was in a position to financially assist
with the endeavor.
Mr. Williams answered that AMHTA had historically committed
funding and would continue to financially assist in the
development and implementation of the model. Trustees had
allocated over $2 million to the effort and the trust was
committed for the long haul to ensure the services were
available in Alaska.
Representative Carpenter had questions related to the
victim of a crime.
Representative Claman requested to hold the constitutional
questions until invited testimony was completed.
AL WALL, DEPUTY COMMISSIONER, DEPARTMENT OF HEALTH AND
SOCIAL SERVICES (via teleconference), discussed that the
Department of Health and Social Services (DHSS) had put
forward an 1115 Medicaid waiver. He detailed that the
waiver was in part to fill in the gaps in the continuum of
care for behavioral health. The efforts for the 1115 waiver
would need the structure of things like crisis
stabilization in order for its implementation, which he
believed was supported by the legislation. He noted that
the department had been happy to work with the bill
sponsor.
Mr. Wall communicated that crisis stabilization was an
essential piece of any continuum of care and it would
successfully shift the bulk of the efforts currently
underway. He elaborated that behavioral health efforts were
generally focused on crisis and acuity. He explained that
because there were some gaps in service in the behavioral
health continuum of care, they tended to wait until an
individual was in absolute crisis and showed up in the back
of a squad car or in the emergency room before they
received any care. The incident typically resulted in the
person being arrested or in need of inpatient psychiatric
care. Crisis stabilization centers would be a step toward
stabilization in community, which was less expensive to
care for individuals and had been proven to be better care.
Historically, the more stabilization focused care provided
in community for people, the better the outcomes had been.
1:53:59 PM
Mr. Wall addressed the department's two fiscal notes. The
first note was related to regulatory oversight of a new
type of license. He elaborated that any facility that
touched Medicaid or had patients, needed oversight for
licensure. The department did surveys and investigation of
harm if needed, which required personnel that needed to be
funded. There was also the implementation of billing codes
in the MMIS [Medicaid Management Information System]
computer system for the new provider type. He highlighted
that significant savings were anticipated through the
effort. He explained that the longer the state waited until
a person was in absolute need of acute inpatient
psychiatric care, the more it cost the state and the
individual. He reported that the care at an instate
psychiatric hospital was much more expensive and typically
involved an emergency room visit and/or court time, lawyer
fees, and jailtime. He reiterated that savings were
expected, but he did not have a specific amount to include
in the fiscal note.
1:55:35 PM
Representative Knopp asked if there were any positions in
DHSS funded through AMHTA. He was skeptical of any more
unrestricted general funds (UGF) going to any positions. He
stated he would be more receptive to the idea if they were
funded through AMHTA. He asked if it would be feasible to
incorporate the crisis stabilization center on the grounds
at the Alaska Psychiatric Institute (API). He asked what
the statewide plan would be. He wondered if there would be
a crisis center in multiple regions throughout the state.
Mr. Wall replied that AMHTA helped fund a number of
positions in DHSS related to various issues. He elaborated
that typically AMHTA funded half a position, with the other
half funded by the state. In regard to the bill topic, the
effort was not isolated. He explained that coexisting with
a crisis stabilization center there would need to be
coordination and communication regarding which patients
were going were. The coordination may or may not be
directly in the crisis stabilization center, meaning it
likely not a person in a specific crisis stabilization
center, but there would still need to be someone "directing
traffic."
Mr. Wall detailed that if a crisis stabilization center had
a person who needed to go to inpatient psychiatric care
there would have to be a coordinator assisting with the
process. He shared that the position was part of the Morse
Plan and was partially funded through the trust. He noted
that it was not specifically in the bill, but the efforts
of crisis stabilization were not isolated - the issue
required coordination across DHSS and with the Department
of Corrections and the Department of Public Safety as well.
Mr. Wall cautioned against thinking the bill would result
in a "light switch approach" where on July 1 all of a
sudden there would be crisis stabilization centers all over
the state and everything would be fixed. He underscored
that would not occur. The efforts would be phased in over
time with the first efforts focusing on the more populated
areas where the highest need existed. He referenced an RI
International study focused on Anchorage and Fairbanks and
relayed that the initial phase of the work would be on
Anchorage. He highlighted that the plan was adaptable to
other areas including rural areas.
Mr. Wall shared that the trips to Arizona had demonstrated
that the approach worked if modified, not only in rural
areas, but also with tribal organizations. If the bill
passed, the department planned on rolling out the 1115
services beginning with crisis stabilization centers in the
state's more populous urban areas. Subsequently, there
would be modifications made to accommodate a regional
approach.
1:59:38 PM
Representative Knopp relayed that earlier in the day the
committee had considered legislation related to
administering psychotropic drugs. He asked if there was a
need for advanced practice registered nurses (APRN) or
registered nurses in the crisis intervention centers. He
asked if that was the case in the facilities in Arizona.
Mr. Wall answered that Arizona and the Crisis Now model
(utilized by RI International) used licensed independent
practitioners. There were advanced nurse practitioners and
physician assistants that worked in the particular field.
He explained that the crisis med bill [SB 120] discussed
earlier in the day had to do with involuntary commitments
and individuals who are administered medications
involuntarily. He clarified that the crisis stabilization
center setting would be voluntary.
2:01:12 PM
Representative Wool thanked the bill sponsor, AMHTA, and
DHSS for bringing the legislation forward. He noted that
the committee had heard a presentation on the Arizona model
from AMHTA earlier in the year. He believed the approach
was a step in the right direction. He remarked on the
testimony that someone could not be held against their will
in one of the centers. He reasoned it was not like being
arrested and put in jail while law enforcement figured out
where the person should go. He asked for confirmation that
a person had to be willing to go stay in one of the
facilities even if they needed inpatient psychiatric care.
Representative Claman made a correction to Mr. Wall's
testimony. He clarified that the provisions of the bill
allowed a voluntary placement in the crisis stabilization
center, but an officer also had the authority to admit
someone subject to involuntary commitment into a crisis
stabilization center for a limited time.
Representative Wool referenced bill language about a
23-hour crisis observation stabilization center. He asked
if the 23 hours reflected the legally allowable timeframe.
Representative Claman replied in the affirmative.
Representative Wool referenced bill language specifying
that only a small number may need long-term services
through a subacute residential crisis center or inpatient
psychiatric care. He stated that API was the only option
available in Alaska. He detailed that the facility had 50
beds and was expensive. He asked if the state had a
subacute residential crisis center.
Mr. Wall made clarifying remarks pertaining to involuntary
medication. He was aware the bill allowed for involuntary
commitment to the crisis center. His remarks had pertained
to the involuntary administration of medication addressed
by other legislation [SB 120]. He moved to Representative
Wool's question and confirmed there was a necessary full
continuum of care. He highlighted that the RI International
model had four pillars including a call center, crisis
response teams, crisis stabilization center, and continuum
of care. He explained that there was a broader application,
the effort was not isolated. He confirmed that subacute
care or "step down units" were needed - the availability in
the state was extremely limited.
Representative Wool spoke to involuntary administering of
psychotropic or antipsychotic drugs. He thought it sounded
like a physician assistant or APRN could prescribe dosages
against a person's will for a limited period of time under
a separate piece of legislation [SB 120]. He referenced
Mr. Wall's testimony that the practice would not be allowed
at the crisis stabilization centers. On the contrary, he
thought that it would be a policy call for each center if
the other legislation passed. He noted he was not weighing
in on whether it was a good or bad idea. He reasoned it may
be what was needed. He asked if the issue was addressed in
either of the bills [HB 290 or SB 120].
2:06:01 PM
Mr. Wall did not believe the topic of involuntary
medication was addressed in HB 290, nor did he believe the
specific location was addressed in SB 120. He would have to
speak with the department's attorney Steven Bookman and
follow up with the committee.
Representative Wool clarified that he was not taking a
position on the issue and reasoned that it may be what was
needed in the facilities.
Representative Josephson stated that the bill created a
definition called a crisis stabilization center and he was
confident that Senator Cathy Giessel's bill [SB 120] did
not refer to that. However, he wondered if someone in acute
crisis taken to a crisis stabilization center could be
involuntarily administered a drug.
Mr. Wall responded that he would speak to the department's
legal team and would follow up. He highlighted the system
they had visited in Arizona and detailed that their entire
system was built around de-escalation and stabilization. He
explained that at the point on the service spectrum where
people needed involuntary commitment and involuntary meds,
the number of people needing services became a smaller and
smaller. Currently, there were two outcomes for individuals
taken to an emergency room and given a psychiatric
evaluation due to their state of mind. He detailed that
either the person was a danger to themselves or others and
gravely disabled and they needed to be committed to care or
they were not.
Mr. Wall explained that the crisis stabilization center
instituted another level of care focused on actual de-
escalation and stabilization of their crisis in place. He
addressed why he had been talking about not isolating the
crisis stabilization center from the rest of the system of
care. He detailed that the call center in Arizona was the
first of the four pillars of the RI International study and
it had been found to stabilize the vast majority of calls
prior to getting to a crisis stabilization team. Likewise,
when a crisis stabilization team was needed, the team
stabilized a large percentage of cases before there was a
need for going to a crisis stabilization center. Those
individuals who went to a crisis stabilization center had
an ever reducing percentage need for inpatient care. For
example, Arizona had a far larger population than Alaska
and it only had one inpatient psychiatric hospital as well
with a slightly higher capacity than API.
Mr. Wall stressed the effectiveness of the approach of
stabilizing individuals in community without needing
inpatient psychiatric care. He recognized there would be a
percentage of the population that would need inpatient care
due to the severity of their illness, but the crisis
stabilization center in Arizona had proven extremely
effective in reducing the incidence rates of inpatient
psychiatric need and stabilizing individuals in community.
2:10:10 PM
Representative Josephson asked for a repeat of the four
pillars.
Mr. Wall replied that the four pillars included a call
center, crisis response teams, crisis stabilization center,
and continuum of care. He elaborated that the call center
acted as an air traffic control center for a region or
entire state. The crisis response teams were comprised of a
behavioral health technician and a peer or individual who
had a behavioral health crisis in their past and had been
trained to intervene with other people. The crisis
stabilization center was a drop off center with "no wrong
door" in terms of admittance. He elaborated that a person
could walk in or be brought in by ambulance, police, or
relatives. The fourth pillar was a more robust continuum of
care that linked into the crisis stabilization center and
looked like a handoff - called a "warm handoff" -
specifically centered around the needs of the individual
being stabilized. Some individuals had a stronger substance
abuse need, while others had a stronger mental health need,
and some individuals may have a stronger social determinate
need.
2:11:51 PM
ROBIN MINARD, CHIEF COMMUNICATIONS OFFICER, MAT-SU HEALTH
FOUNDATION, WASILLA (via teleconference), testified in
strong support of the bill. She read from prepared remarks:
Foundation shares ownership in Mat-Su Regional Medical
Center and we invest our share of the profits back
into the community to promote health and wellness of
Alaskans living in Mat-Su. I'm testifying today in
strong support of House Bill 290 to change Alaska
statute to allow for creation of crisis stabilization
services as an alternative to arrest.
We support this legislation because it paves the way
for some of our most vulnerable residents to receive
medical evaluation and care and lower cost settings
than hospital emergency departments. This results in
better outcomes and tremendous cost savings.
As was mentioned earlier by Representative Claman,
there's a crisis stabilization in Maricopa County,
Arizona, similar to what could be created in Alaska
and it's had stunning results over ten years' time.
They've seen savings equivalent to 37 full-time law
enforcement officers because it's less labor intensive
to take people to a crisis stabilization drop off
center than to book them into jail. They've had a
reduction of 45 cumulative years of psychiatric
boarding in hospital emergency departments and that
represents a savings of $37 million in cost and
they've had a reduction of $260 million in potential
state-paid acute care inpatient expenses. Since the
prevalence of mental health and substance use problems
is increasing in our community and statewide, just
think about what savings like that could mean to
Alaska.
The average annual growth rate for visits to the Mat-
Su Regional Medical Center Emergency Department by
patients with a behavioral health diagnosis grew 20
percent from 2015 to 2017 due in part to the opioid
epidemic and a shortage of outpatient treatment
access. Additionally, from 2014 to 2017, the number of
behavioral health assessments required for patients in
crisis in the ED grew from 349 to more than 1,000.
HB 290 will allow police to bring patients to a crisis
stabilization center instead of a hospital emergency
room or jail and will result in more humane treatment
and great cost savings. In 2013, with our Mat-Su
community health needs assessment, Mat-Su residents
ranked health issues they were concerned about. The
top five were all related to mental health and
substance use. As a follow up to that assessment, we
conducted a behavioral health environmental scan where
we looked at policies that could address barriers to
care and improve the behavioral health system
challenges we're facing. One recommendation from that
report was to add a crisis stabilization center to the
behavioral health continuum of care; however, current
state statute does not allow this to happen. HB 290
will change that.
2:14:51 PM
Ms. Minard continued to read from a prepared statement:
System change, such as what this legislation allows,
will alleviate suffering for people experiencing
behavioral health crisis while delivering significant
cost savings, especially under Alaska's Medicaid
program. The Mat-Su Health Foundation is in strong
support and we urge you to pass this important
legislation.
Ms. Minard thanked the committee for its time.
Representative Sullivan-Leonard thought the Mat-Su Regional
Hospital ER had a triage system to evaluate patients in
crisis mode. She mentioned the expansion of the hospital's
third floor for behavioral health. She asked if there was a
system in place where patients were triaged and then moved
on to inpatient or outpatient behavioral health services at
the hospital.
Ms. Minard answered, "Sort of." She elaborated that the 16
behavioral health beds were open; however, there was no
outpatient care or crisis center. She explained that a
person could come in, but they were trying to avoid costly
inpatient treatment. She detailed that if there was a
crisis stabilization center where a person could go for 24
hours to be assessed, it may be determined the person did
not need inpatient care versus immediately putting them
into that costly limited setting.
2:16:30 PM
Representative Sullivan-Leonard asked if there was a
backlog of patients in the emergency room as they were
triaged and possibly held for inpatient admittance or
referral to another facility.
Ms. Minard replied she could follow up with the
information. She confirmed there were times when the
emergency department was overwhelmed by people with
behavioral health and other needs. The bill would allow the
backlog to be alleviated somewhat.
Representative LeBon thanked Ms. Minard for her testimony.
He asked if the Mat-Su Health Foundation would be ready,
willing, and able to assist in covering financial costs for
a crisis stabilization center.
Ms. Minard could not currently commit to covering future
operating costs. She shared that the subject was a high
priority for the foundation, and it had already committed
financial resources to get the project to its current
point.
Co-Chair Johnston believed Mr. Wall had an answer to an
earlier question.
Mr. Wall communicated that he had spoken with the DHSS
legal team and followed up on questions by Representative
Wool and Representative Josephson about whether a crisis
stabilization center would be able to administer crisis
involuntary medication under SB 120, which had been
discussed earlier in the day. He explained that it depended
on the designation of the crisis stabilization center. He
elaborated that could be administered at a designated
evaluation and treatment center or a designated evaluation
and stabilization center. The centers were regulated by the
state with very specific psychiatric credentials and
training. He expounded that if a crisis stabilization
center went the extra step to become a designated
evaluation and treatment center it would be possible to
administer involuntary medication at the location.
2:19:00 PM
Representative Wool thought it sounded like the crisis
stabilization centers were not really set up for different
levels of care and intervention. He believed a considerable
amount of staff would be needed to involuntarily administer
medication. He thought a person may be taken to a
psychiatric facility if the situation escalated to that
level. He surmised it would depend on a facility's
certification level.
Mr. Wall agreed. He detailed that crisis stabilization
centers were focused on de-escalation and stabilization to
the greatest extent possible. There was a small percentage
of the population whose severity of illness would require
them to receive inpatient psychiatric care. Crisis
stabilization centers would be able to refer and follow the
proper procedure to get their patients into inpatient care
if needed. He explained that because the stabilization
centers would be keeping so many patients out of inpatient
psychiatric care, it would take the pressure off the system
of designated evaluation and treatment centers including
API and would give more flexibility and availability of
beds. The long-term goal of the crisis stabilization
centers was to take the pressure off the inpatient
psychiatric system (as proven in other states). The
conversation would stop being about the lack of beds and
become one of stabilization and community. The department
believed the best route would be to relieve pressure from
inpatient psychiatric hospitals.
Representative Wool referenced the language highlighted by
the bill sponsor that the centers would provide an
alternative to arrest. He stated his understanding that
being taken to a center by the police was not the only way
a person could end up there. Additionally, a person could
walk in or be brought in by a family member. He asked for
verification it would be like going to the emergency room
or an urgent care clinic, but the center would be for
psychiatric evaluation.
Mr. Wall agreed. He added that if done properly the crisis
centers, as evidenced in Arizona, had a more significant
impact on the substance abuse population. There was no
wrong door, regardless of a person's issue, ability to pay,
or how they arrive at a facility.
2:22:10 PM
Representative Josephson referenced the testimony that the
facilities could be allowed to administer drugs if they
were designated evaluation and treatment centers. He
thought it sounded like a term of art. He reasoned a
facility could do so if it achieved the status in
accordance with some regulation or statutory definition. He
was trying to keep track of who was administering drugs. He
asked if his understanding was accurate.
Mr. Wall responded that the bill previously heard by the
committee, SB 120, related to the involuntary administering
of medications in crisis allowed at a designated evaluation
and treatment center or designated evaluation and
stabilization center. The designation was given by DHSS to
hospitals it had an agreement with that had specific
psychiatric professional capability and oversight.
Hospitals included Fairbanks Memorial Hospital, Bartlett
Regional Hospital, API, and more. There was a designated
evaluation and stabilization designation for a couple of
beds in PeaceHealth Medical Center in Ketchikan and a
couple of beds in the Yukon-Kuskokwim Health Corporation in
Bethel. The department had the designated evaluation and
treatment center or designated evaluation and stabilization
center oversight agreements with specific facilities. He
explained that if a crisis stabilization center went the
extra step to get the professional oversight and capacity
needed to become a designated evaluation and treatment
center, the facility could enter into an agreement with the
state to do so.
2:24:23 PM
Co-Chair Johnston requested a review of the fiscal notes
beginning with DOL.
KACY SCHROEDER, ASSISTANT ATTORNEY GENERAL, CRIMINAL
DIVISION, DEPARTMENT OF LAW (via teleconference), shared
that the fiscal note from the DOL Criminal Division was
zero. The division did not anticipate an increased caseload
as a result of the legislation. She noted that the
legislation may actually result in some caseload
diversions.
2:25:15 PM
CORNELIUS SIMMS, LIEUTENANT, ALASKA STATE TROOPERS,
DEPARTMENT OF PUBLIC SAFETY (via teleconference), addressed
the Department of Public Safety's indeterminate fiscal
note. He explained that because the centers did not
currently exist, the Alaska State Troopers did not know the
cost of potentially having to transport someone from rural
Alaska to one of the centers. He highlighted the mindset of
treating all Alaskans equally regardless of where they
lived; individuals should be given the same opportunities
for alternative to arrest.
Representative Josephson asked if the committee had the
specific fiscal note.
Co-Chair Johnston responded in the affirmative.
Representative Tilton remarked that the fiscal note
referred to a provision in the bill allowing alternatives
to arrest for a person a peace officer believed in good
faith was suffering from an acute episode of mental
illness. She asked for the definition of the term.
Mr. Simms deferred the question to the bill sponsor.
Co-Chair Johnston would hold the question until the fiscal
note review was complete.
2:27:27 PM
GENNIFER MOREAU, DIRECTOR, DIVISION OF BEHAVIORAL HEALTH,
DEPARTMENT OF HEALTH AND SOCIAL SERVICES (via
teleconference), was available for questions. The fiscal
note associated with the services was part of the Medicaid
projection because the services as described through the
1115 waiver would be funded by Medicaid. Therefore, the
fiscal note did not include the Medicaid services.
2:28:23 PM
Representative Josephson referenced earlier testimony that
that the bill was not a light switch. He noted he did not
expect it to be. He asked if the bill would require a
serious capital budget at some point.
Representative Claman replied that it was his understanding
that AMHTA was supportive of providing funding for the
capital side. He noted that he did not speak for AMHTA. He
relayed that existing facilities may provide some of the
space. For example, the Fairbanks hospital group had
suggested they may not need to construct a new building,
but they may dedicate a certain amount of square footage in
their existing facilities. He spoke to the fiscal side of
the cost. He highlighted that in Arizona, the cost was
associated with fees for services that could be billed to
insurance and Medicaid. He reported that providers had
found that the model paid for itself.
Representative Josephson asked if the facility would be
staffed with public or private workers.
Representative Claman replied that the expectation was for
the centers to be staffed with private workers.
Representative Josephson asked if it [the employment of
private workers] reflected the typical Arizona model.
Representative Claman replied that Arizona centers were
staffed with private workers. He elaborated that the
Arizona building housed a crisis stabilization center and
two sub-acute facilities. There was initially only one sub-
acute facility, but due to the volume of incoming clients,
a second sub-acute area had been built. He added that the
cost was all paid with fee for services.
2:30:38 PM
Representative Carpenter highlighted constitutional
considerations. He provided a scenario where an individual
experiencing an episode committed a crime and law
enforcement got to decide whether to make an arrest or,
with the individual's consent, take them to a crisis
stabilization center. He asked how the victim's
constitutional rights that required due process were
considered. He listed the constitutional provisions of
condemnation, rights of a victim, and restitution, all of
which had to go before a judge to adjudicate or decide.
Representative Claman replied that the question applied to
three areas of the law. At present, an officer had
discretion to arrest or not arrest. He provided a scenario
where a person committed a felony level assault and an
officer believed the individual was gravely disabled. An
officer was trained to make the determination and commit
someone under Title 47 and had the discretion to bring the
individual to the psychiatric hospital or jail. The victim
notification requirements came into play after charges were
filed. He detailed that in the same sense that a prosecutor
would contact a victim if they were going to decline
prosecution, there was not further notice required to a
victim. The primary victim notification provisions came
into play once a charge was in place and there were
criminal charges going forward. None of the statute would
limit the prosecution's ability to charge somebody even if
they went to crisis stabilization. He noted that two
different places in the legislation referred specifically
to the issue.
Representative Claman continued that the third area
involved domestic violence protective situations under
Title 18. He detailed that a domestic violence call to a
police officer was one of the only areas with a mandatory
arrest in statute. Currently, when a police officer went to
a house with a domestic violence complaint, the officer
could get permission from the prosecutor to not arrest if
the officer did not believe they had probable cause. He
explained it was the reason there were on-call prosecutors
available to receive the calls. He recommended speaking to
Ms. Schroeder [with the DOL Criminal Division) to learn how
frequently the calls occurred. Under current statute, if a
prosecutor gave authorization, the officer would not be
required to make an arrest.
Representative Claman furthered that Title 18 had notice
provisions related to domestic violence that were different
than the criminal code. Under the bill, with regard to
Title 18 domestic violence circumstances, two areas had
been identified with real potential where there could be a
call in a domestic violence setting. The first was with an
Alzheimer's and dementia type population where a family
called the police because they were having trouble
controlling a family member. Under the circumstances, the
family may say the individual needed help and did not need
to go to jail. He explained that the ability to take the
individual to a crisis stabilization center could be what
the family was looking for.
Representative Claman detailed that the second environment
involved an individual under long-term psychiatric
treatment who may have fallen off their medication and may
be having an acute episode. He provided a scenario where a
twenty to thirtysomething was having an episode while
living at home with their parents. He elaborated that the
family had tried everything and had called the police, but
with the desire to send the individual to a crisis center
because jail would only exacerbate the crisis. He explained
that the police officer would have the authority to arrest
to take them to the crisis stabilization center. Under the
legislation, the officer would be required to get
permission from the prosecutor to take the individual to
the stabilization center. He relayed that if an individual
was taken under Title 18 domestic violence circumstances,
the officer was required to have the crisis stabilization
center provide notice to the officer. He added that it was
limited in Title 18 to involuntary commitment
circumstances.
2:36:19 PM
Representative Carpenter had a question about the concept
of a crime being committed but not arrested for. He thought
Representative Claman was saying that when a crime was
committed and no arrest was made, it meant there was no
follow up with the victim because there was no arrest. He
thought it meant there were no victim rights and they were
technically not the victim because there was no arrest.
Representative Claman did not believe the statement was
accurate. He clarified that what triggered the victim
notification was the filing of charges. He stated that
arrest was not required. For example, an individual could
be involved in a bar fight and could be issued a summons by
the police officer to come to court in a week. There were a
number of crimes where there was never an arrest because
officers knew there was no bail requirement or if an
individual could post $200 on the spot they were not
arrested. He reiterated it was not the arrest that
triggered the victim rights, it was the filing of charges.
2:37:50 PM
Representative Carpenter asked for verification the bill
did not preclude a request for filing of charges at some
point in time by the victim.
Representative Claman answered that only a prosecutor had
the right to file charges because the charges were on
behalf of the state. He added that, unrelated to the bill,
in a domestic violence scenario, a person could be arrested
and brought to jail and a prosecutor could decline to
prosecute for some reason. Under the scenario, the victim
had the right to go to court to obtain a domestic violence
restraining order, which was a civil order.
Representative Carpenter asked if the bill set aside
involuntary commitment under Title 47 and was not included
as part of the legislation.
Representative Claman pointed to Section 1(b) of the
legislation pertaining to involuntary commitment authority.
He detailed that an officer had the ability to enter into a
voluntary agreement and not arrest. Additionally, an
officer had the ability to require an individual go to
crisis stabilization under the officer's power to hold
someone for involuntary commitment.
Representative Carpenter stated that Title 47 required the
involuntary commitment to involve a judge.
Representative Claman agreed. He elaborated that an
involuntary commitment was sometimes referred to as a
72-hour hold. He detailed that if a person was deemed to be
a danger to themselves or others, a police officer could
take them in to be placed in a 72-hour hold for evaluation.
He explained that if an officer took the individual to a
crisis stabilization center first, there would be an
examination in the first 24 hours. He expounded it was
quite possible the person would be stabilized during the
first 24 hours and would not require holding for the
remaining 48 hours.
2:40:24 PM
Representative Carpenter asked if the evaluation [in a
crisis stabilization center] would be medical.
Representative Claman highlighted the important distinction
between an examination and an evaluation. The evaluation
was a psychiatric evaluation performed by a psychologist or
psychiatrist. The examination done in the first three hours
at a crisis stabilization center would be performed by a
nurse for an initial determination. The examination would
not be the psychiatric finding that would allow the state
to hold an individual on involuntary commitment past the 72
hours.
Representative Carpenter explained that he was trying to
understand the due process component. He stated that the
judicial branch was supposed to look out for individuals'
due process. He stated that currently in statute there was
a requirement for a judge to be involved if a person was
taken involuntarily. He did not see that in the bill. He
believed the bill allowed a person to be put involuntarily
in a crisis stabilization center without a judge's order.
Representative Claman answered that it was not included in
the bill because there was no change to that specific
structure. He provided a scenario where a Mr. Smith was
having an acute psychiatric episode and was a danger to
himself or others - possibly off his medication. Currently,
an officer in Anchorage would take the individual to API
and there would be hearings within a 72-hour period where a
judge would hear testimony and determine whether there was
probable cause to hold the person for a period. He
explained that taking an individual to API triggered the
process where a hearing took place within a three-day
period. The bill enabled an initial placement at a crisis
stabilization center for the first 23-hour period. He
explained that if a person was brought in on an involuntary
basis, they would have the same statutory rights for the
72-hour evaluation and examination by a judge. He detailed
it was quite possible the person may stabilize soon enough
to negate the need for future hearings. By the time the
court was ready to convene the individual may feel much
better and the treatment staff may communicate there was no
longer a basis to hold the individual longer. The bill did
not change the current 72-hour cycle. The bill provided an
alternative for the first 23 hours where someone was held.
He detailed that if a person was not stabilized within that
timeframe they would have to go to a facility that could
hold them longer - API in Anchorage and potentially a
subacute facility in Arizona for a longer hold that was not
as extensive as API. Alaska did not have the subacute
option.
2:43:42 PM
Representative Tilton asked about the definition for acute
episode of mental illness. She believed substance abuse
could be different from having an acute mental illness
episode.
Representative Claman answered that acute behavioral health
crisis in the bill title was one of the changes his office
had worked through with the DOL Civil Division. The
language had been used because it was already defined in
statute and/or regulations. It was his understanding was
the language encompassed both. He deferred to DOL for
additional detail.
Ms. Schroeder deferred to the question to the department's
Civil Division.
Representative Claman relayed that he would coordinate a
response with the department.
Representative Josephson asked if law enforcement could
file a charge and take a person to a crisis stabilization
center.
Representative Claman answered in the affirmative. He
anticipated the sequence would be dropping a person off at
the center first, followed by filing charges.
Representative Josephson thought the system would lend
itself to a mature, intelligent, sophisticated officer
thinking about defenses to crimes under Title 11 and
looking at the facts. He asked if an officer could chart a
person "all day long," but they could be found not guilty
for one reason or another.
2:46:16 PM
Representative Claman supposed everything was possible at
some level. Based on his conversations with Anchorage
police about their interest in crisis stabilization, it was
his understanding that there was a certain group of
individuals seen with some frequency who commit crimes
including shoplifting, non-felony assault behavior, and
various property crimes. He elaborated that the officers
knew some repeat offenders who they knew to be people with
significant substance and mental health issues. He believed
it was more likely that an officer would look at the
individuals and consider that it may be better to take them
to a crisis stabilization center to get into a better
health position rather than taking them to jail where they
would likely continue the cycle of being picked up by
officers in the future. He continued that a prosecutor may
choose not to prosecute, or the person may do well at
crisis stabilization and the officer may be comfortable not
prosecuting. Additionally, the victim may be comfortable
not prosecuting because they had seen the people before as
well. He thought it was the more likely scenario where
repeat offenders going round and round without improvement,
could benefit from the stabilization centers.
2:47:49 PM
Representative Wool asked about a scenario where a person
had not committed any crime, but they were at a bus stop
talking to themselves and making people feel uncomfortable.
He reasoned it may be a scenario where someone called the
cops and the person obviously needed some help. He asked if
it would be a situation where the cops could tell the
person they did not want to arrest them or take them to the
emergency room, but they could suggest going to the crisis
stabilization center to potentially get on the road toward
getting some medication and so forth.
Representative Claman replied it was a circumstance. He
clarified that it would not be an alternative to arrest
because at some level the officer would need probable cause
to arrest before the alternative to arrest came into play,
but the officer would have the ability to give a person a
ride to the crisis stabilization center. He added the
option would be available for de-escalating the bus stop
scenario [provided by Representative Wool] where people
were nervous about a person's behavior. He added that the
option would be available to firefighters as well. He
believed that in the crisis stabilization model described
by Mr. Williams and Mr. Wall, the first call would be to
the crisis hotline. He detailed that a mobile crisis team
may be sent if the call did not de-escalate the situation.
He explained that the crisis team was sent prior to a
police officer being called and the team may be able to de-
escalate the situation without a trip to the crisis
stabilization center. The team could take the individual to
the center if they were unable to de-escalate the
situation.
Representative Wool considered the rule where a person
could be held involuntarily for up to 23 hours. He asked
how long a person could remain in a center voluntarily
prior to getting moved to the next stage. He asked if the
same timeframe pertained to voluntary stays as well.
Representative Claman replied that the time limit was
23 hours, which pertained partly to how services were
billed with insurance and Medicaid. He stated that one of
the hallmarks of the facilities was there were no beds,
only recliners.
2:50:18 PM
Representative Knopp asked for verification a person could
not be held against their will at one of the facilities for
any period of time.
Representative Claman responded that under Section 1(a) of
the bill, placement was voluntary as an alternative to
arrest. He clarified that Section 1(b) pertained to
involuntary commitment where a person could be prevented
from walking away. For example, if an officer delivered an
individual to a crisis stabilization center and would fill
in the required paperwork specifying the commitment was
involuntary, the person would not have the ability to walk
away. He added that police officers had communicated that
for the idea to work they would need the ability to place
individuals in centers both voluntarily and involuntarily.
Co-Chair Johnston set an amendment deadline for the
following day at noon.
HB 290 was HEARD and HELD in committee for further
consideration.
2:51:44 PM
AT EASE
2:54:54 PM
RECONVENED
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 247 Explanation of Changes ver. A to U 3.19.20.pdf |
HFIN 3/19/2020 1:30:00 PM |
HB 247 |
| HB 247 Sectional Analysis - ver. U 3.19.20.pdf |
HFIN 3/19/2020 1:30:00 PM |
HB 247 |
| HB 247 Support Doc - Stocking FAQ 2.19.2 (002).pdf |
HFIN 3/19/2020 1:30:00 PM |
HB 247 |
| HB 247 Support Doc - Surcharge Revenue Breakdown 3.4.20.pdf |
HFIN 3/19/2020 1:30:00 PM |
HB 247 |
| HB 247 Transmittal Letter ver. A 2.12.20.pdf |
HFIN 3/19/2020 1:30:00 PM |
HB 247 |
| HB 290 Sectional Analysis v. E 3.16.2020.pdf |
HFIN 3/19/2020 1:30:00 PM |
HB 290 |
| HB 290 Sponsor Statement v. E 3.16.2020.pdf |
HFIN 3/19/2020 1:30:00 PM |
HB 290 |
| HB 290 Supporting Document - RI Crisis Now Consultation Report 12.13.2019.pdf |
HFIN 3/19/2020 1:30:00 PM |
HB 290 |
| HB 290 Supporting Document - Letters Received by 3.16.2020.pdf |
HFIN 3/19/2020 1:30:00 PM |
HB 290 |