Legislature(2009 - 2010)CAPITOL 106
03/16/2010 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB284 | |
| HR14 | |
| HB328 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | HR 14 | TELECONFERENCED | |
| *+ | HB 328 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 284 | TELECONFERENCED | |
HB 328-TRAUMATIC BRAIN INJURY:PROGRAM/MEDICAID
3:37:04 PM
CO-CHAIR HERRON announced that the final order of business would
be HOUSE BILL NO. 328, "An Act establishing a traumatic or
acquired brain injury program and registry within the Department
of Health and Social Services; and relating to medical
assistance coverage for traumatic or acquired brain injury
services."
JEANNE OSTNES, Staff to Representative Craig Johnson, Alaska
State Legislature, read from the sponsor statement:
House Bill 328 establishes a traumatic or acquired
brain injury program and registry in the Department of
Health and Social Services. Alaska has no program
specifically to deal with brain injury and yet Alaska
has one of the highest rates in the nation. Annually,
there are 800 Alaskans hospitalized with a traumatic
brain injury each year resulting from falls, car
crashes, domestic violence, All Terrain Vehicle
crashes, and snowmachine crashes, among others. There
are an approximately equal number of Alaskans
suffering from acquired brain injuries resulting from
stroke, aneurism, or tumors.
Alaska urban and rural residents, including military
are being discharged to their homes with little
understanding of brain injury or access to in-state
rehabilitation, severely impacting their families.
Limited education about the injury, learning to cope
with a person who has changed, overwhelming stress
from insurance, bureaucracy, and financial burdens and
change in family roles may render families
dysfunctional.
With appropriate and available care, rehabilitation,
community and family support, even the individual who
is most severely injured can live at home, return to
school or work, or engage in meaningful and productive
lives.
Funding a Traumatic or Acquired Brain Injury (T/ABI)
Program gives authority to the department to collect
data on the injured, positioning the state to access
Medicaid funds for T/ABI. Medicaid services for T/ABI
will be matched 50% by federal funds. The bill allows
for streamlining department services and activities
that are unique to T/ABI. This would better assist
families and individuals with T/ABI in knowing how to
access services and supports.
Early treatment may reduce future medical and social
costs. Without appropriate services, some individuals
with T/ABI may pose a threat to themselves or others.
Without assistance, individuals with TBI often end up
homeless, in jail or in nursing homes. Service
coordination, rehabilitation, and appropriate supports
can help to minimize these risks.
3:40:53 PM
REPRESENTATIVE T. WILSON asked if there would be any costs for
the new registry.
MS. OSTNES directed attention to the fiscal note, which stated
that 60 percent of the cost was covered by Medicaid.
3:41:39 PM
CO-CHAIR HERRON noted that there were still questions on the
fiscal note.
3:42:52 PM
JESSI CHAPMAN, speaking through a dyna box, related that she had
suffered a TBI in 2006 and was now a mute and a quadriplegic.
She said that after her accident she was not given much chance
for any recovery. She relayed that her grandmother brought her
home, and nursed her until she came out of her coma many months
later. At that point, she had to return to Seattle many times
for surgery and therapy, as neither was available in Alaska.
She noted that she was still classified as a child, so that a
waiver was available. She said that her age, and her
grandmother's strong advocacy for her, was the only reason that
the therapies became available. She indicated that her injuries
were neurological, and because of waivers, she was now able to
move her extremities and speak a little. She pointed out that
it was necessary to have a case manager, as you could not get
appointments without referrals. She pointed out that, if you
have no resources and limited cognitive capabilities, it was
extremely difficult to get any help. She shared that
neurological testing was not available in Alaska. She stated
her support for HB 328.
3:46:46 PM
PAT CHAPMAN (Jessi's grandmother) informed the committee that
she collected the data on brain injuries and other traumas and
that she worked in the emergency room. She stressed the
importance of getting services to people who had suffered TBI,
especially those who were not hospitalized, so that they could
return to being contributing members of the community.
3:48:23 PM
BOYD MACFAIL, Legislative Affairs Coordinator, said that ABATE
would support HB 328, but that there was some language to which
they were opposed on page 4, lines 7 - 8. He asked that "to the
prevention of traumatic or acquired brain injury and" be removed
from the bill. ABATE was concerned that this would become a
means for the legislature to impose mandatory helmet laws on
motorcyclists. He stated that ABATE was not opposed to the use
of helmets, and advised riders to wear helmets; however, ABATE
was opposed to the idea of mandatory helmet laws. He offered
his belief that the mandatory helmet laws would not prevent
brain injuries because of the impact to the brain upon sudden
contact. He stated support by ABATE for HB 328, if that section
was removed.
3:51:31 PM
ROBERT LADA, Neurologist, Providence Alaska Medical Center,
stated that a more coordinated effort for TBI patient care and
options was necessary. He reported that most TBI patients were
not hospitalized and received little follow up care. He pointed
out that, when injuries were not obvious, it resulted in an
inability to find treatment and therapy. He declared a need for
better initial evaluation for a greater success to recovery. He
stated the need for the collection of more data. He offered his
support for HB 328.
3:53:58 PM
ELENA RATH, Board Member, Alaska Brain Injury Network, explained
that the Alaska Brain Injury Network was a statewide group
working to help people find the necessary resources, and to help
set goals for the best brain injury practices in Alaska. She
shared her personal experiences with brain injuries. She
supported the increase of case managers and data collection in
HB 328.
3:55:33 PM
KRISTIN ENGLISH, Chief Operating Officer, Cook Inlet Tribal
Council (CITC), said that CITC supported HB 328 and the creation
of a traumatic brain injury program in Alaska. She cited that
TBI often resulted in long term disability and a loss of
socially appropriate behavior. She noted a strong correlation
between TBI and substance abuse. She pointed out that 46
percent of the patients at the residential treatment program
were reported with some sort of TBI. She said that this was
consistent with statewide records. She opined that HB 328 would
establish an information data base and a funding mechanism to
access federal funds.
3:58:34 PM
CHRISTIE ARTUSO, Director Of Neuro Science Services, Providence
Alaska Medical Center, reported that HB 328 would facilitate the
collaborative efforts of the Alaskan health providers to provide
services for TBI patients whose needs had been somewhat
neglected. She estimated that 10,000 people may have mild to
moderate brain injury not requiring hospitalization. She said
that the estimate for those requiring care this year was more
than 1,000 patients. She said that it was necessary for case
managers to coordinate care, community reentry, cognitive
therapy, and a supportive environment. She stated her support
for HB 328.
4:00:29 PM
The committee took an at-ease from 4:00 p.m. to 4:01 p.m.
4:01:42 PM
JILL HODGES, Executive Director, Alaska Brain Injury Network
(ABIN), said that HB 328 established a longitudinal registry
which establishes brain injury as an acute and chronic long term
condition. This would allow measurement of brain injuries over
time, and a determination of which services had helped each
individual. It would also establish a statewide traumatic brain
injury program, which would allow direct support for TBI
patients. She pointed out that this would immediately allow for
coordinated case management of 360 Alaskans, would contribute
federal funding, and would serve both urban and rural Alaskans.
She directed attention that case management would now be
delivered by non-profit, community providers. She noted the
increased workforce enhancement for coordinated care. She
established that TBI patients could recover for a meaningful
life, given the proper treatment and support. She stated that
"HB 328 is the mechanism to help families move forward with life
after brain injury."
4:07:24 PM
JOANNE GIBBENS, Deputy Director, Central Office, Division of
Senior and Disabilities Services, Department of Health and
Social Services, in response to Co-Chair Herron, said that the
administration's position on HB 328 was neutral. She relayed
that an upcoming amendment would address concerns that the
definition of case management meet the federal definition. She
reported that HB 328 allowed HHSS to bill for case management
services for individuals with TBI and Acquired TBI. She stated
that the fiscal note was a projection for the number of new
people that would be served, and the case management services
for those currently being served. She said that there was
currently a waiver service for about 100 TBI patients. She
pointed out that this was referred to as targeted case
management by Medicaid.
4:09:49 PM
REPRESENTATIVE T. WILSON asked for an explanation to a waiver
service.
4:09:58 PM
MS. GIBBENS said that the federal government allowed states to
apply for services to populations that waive other federal
requirements. These waivers meet specific criteria for levels
of care and financial eligibility, and they enable specialized
populations to receive specialized services which are not
available to everyone on Medicaid. She gave an example of a
nursing facility level of care waiver.
4:11:37 PM
REPRESENTATIVE T. WILSON directed attention to the fiscal note,
and asked if the physicians were paid.
MS. GIBBENS explained the funding, and pointed out that, in this
case, the department already had the existing staff.
4:12:44 PM
REPRESENTATIVE HOLMES, noting the increased Medicaid
projections, stated that the legislature was struggling with the
mandatory versus the optional Medicaid services. She proposed
that it might be necessary to ask Department of Health and
Social Services to prioritize any Medicaid budget cuts. She
questioned the accuracy of the fiscal note.
4:15:03 PM
MS. GIBBENS, in response to Representative Holmes, said that it
was difficult to know the costs in advance, but she believed
that existing resources would allow for the projected cost.
4:15:49 PM
CO-CHAIR KELLER asked to clarify that the expanded Medicaid
costs would be split, with the federal government paying 60
percent. He asked if the projected cost division of 50 percent
from the federal government was because of the stimulus money.
4:16:20 PM
MS. GIBBENS agreed.
4:16:27 PM
CO-CHAIR KELLER asked to clarify that the costs per capita on
the fiscal note were low because HB 328 only reflected the
increased cost for case management.
4:17:23 PM
CO-CHAIR KELLER asked if this would lead to additional services
for TBI patients.
MS. GIBBENS replied that HB 328 focused on case management, and
did not add any additional services.
4:18:14 PM
CO-CHAIR KELLER agreed with Representative Holmes that it would
become necessary to determine a level of future funding.
4:19:11 PM
MS. GIBBENS, in response to Representative T. Wilson, said that
DHSS had determined $250 for case management services to be the
per month per patient cost.
4:20:39 PM
MS. GIBBENS, in response to Representative T. Wilson, replied
that the $100 was per existing patient, as opposed to new
patients, who would need ongoing case management.
4:21:41 PM
MS. GIBBENS, in response to Representative T. Wilson, pointed to
the fund source section and explained that the 39 percent state
match was listed in the general fund. She explained that the
total amount was for the case management and that the difference
in the subsequent years was due to the different federal dollar
match.
4:23:23 PM
REPRESENTATIVE SEATON asked if the state currently had Medicaid
case management for other diseases.
MS. GIBBENS offered her belief that targeted case management
existed for pregnant women, and for early infant learning.
4:24:19 PM
JON SHERWOOD, Medicaid Special Projects, Office of the
Commissioner, Department of Health and Social Services (DHSS),
added that targeted case management also included behavioral
health for severely emotionally disturbed children, substance
abuse, and severely chronically mentally ill. He offered to
supply the complete list of targeted case management.
4:24:59 PM
REPRESENTATIVE SEATON asked whether autism and diabetes were
also included.
MR. SHERWOOD said that he was not aware of targeted case
management for these groups specifically, and he would report
whether either was included within another group.
4:25:28 PM
REPRESENTATIVE SEATON asked if being in statute guaranteed a
priority status during a budget reduction.
MR. SHERWOOD replied that the current statute for cost control
was discretionary in allowing DHSS to make reductions in
"amount, duration, and scope of services." He shared that there
was no longer a priority list of services. He noted that DHSS
had discretion to make reductions in amounts of service
available. He pointed out that if HB 328 was not in statute, it
might not become a service, but that it would not have a
priority.
4:27:23 PM
CO-CHAIR HERRON commented that DHSS did not need all the
registries.
4:27:58 PM
REPRESENTATIVE HOLMES, referring to the two new DHSS staff,
asked what their responsibilities would be if the bill did not
pass.
MS. GIBBENS replied that both had other care coordination
responsibilities.
4:28:41 PM
CO-CHAIR HERRON closed public testimony.
4:28:50 PM
CO-CHAIR HERRON moved to adopt Amendment 1, labeled 26-
LS1355\E.3, Mischel, 3/2/10, which read:
Page 2, line 25, through page 3, line 6:
Delete all material.
Insert "services furnished to assist individuals
who reside in a community setting or who are
transitioning to a community setting to gain access to
needed medical, social, educational, and other
available services;"
4:29:11 PM
REPRESENTATIVE SEATON objected for discussion.
4:29:20 PM
MS. OSTNES explained that Amendment 1 allowed the case
management definition to conform to federal language for federal
funding purposes.
4:29:56 PM
REPRESENTATIVE SEATON removed his objection.
There being no objection, it was so ordered.
4:30:12 PM
CO-CHAIR KELLER moved to adopt Amendment 2, labeled 26-
LS1355\E.l, Mischel, 3/1/10, which read:
Page 4, lines 7 - 8:
Delete "and laws pertaining to the prevention of
traumatic or acquired brain injury and"
Insert "pertaining"
CO-CHAIR HERRON objected for discussion.
CO-CHAIR KELLER offered his belief that there was no value in
the deleted passage.
4:31:14 PM
REPRESENTATIVE SEATON agreed that prevention was important, and
asked if the evaluation of the laws was in the purview of the
Alaska Brain Injury Network (ABIN).
4:32:09 PM
MS. OSTNES acknowledged that the ABIN did research for other
data regarding the TBI population. She did not know if ABIN
reviewed the laws. She suggested a possible conceptual
amendment to only delete "traumatic."
4:32:50 PM
REPRESENTATIVE SEATON reflected that his desire was to ensure
that the law and other mechanisms for prevention were not
neglected. He removed his objection.
4:33:46 PM
CO-CHAIR HERRON asked for the sponsor's position.
4:33:53 PM
MS. OSTNES responded that Representative Johnson agreed with
Amendment 2.
4:34:06 PM
REPRESENTATIVE HOLMES expressed agreement with Representative
Seaton, and stated that she did not read the proposed passage
for deletion in Amendment 2 as a law for the passage of helmets.
She suggested a review of the current laws for a broader
encouragement of prevention.
4:34:50 PM
CO-CHAIR KELLER offered his belief that this statement was not
an appropriate part of the program that was being established.
He declared that the amendment was not "a statement against
evaluating laws pertaining to prevention."
4:35:22 PM
A roll call vote was taken. Representatives Cissna, Holmes, T.
Wilson, Lynn, Seaton, and Keller voted in favor of Amendment 2.
Representative Herron voted against it. Therefore, Amendment 2
was adopted by a vote of 6-1.
4:36:44 PM
REPRESENTATIVE T. WILSON expressed concern with the fiscal note.
She declared that this was "opening up another door that
eventually we may have to tell people we can't afford to do any
longer." She expressed appreciation for the bill with a concern
for its maintenance.
4:37:05 PM
REPRESENTATIVE SEATON reminded the DHSS about its commitment to
respond about the priority of retention for services.
4:38:12 PM
CO-CHAIR KELLER moved to report HB 328, as amended, out of
committee with individual recommendations and the accompanying
fiscal notes. There being no objection, CSHB 328 (HSS) was
reported from the House Health and Social Services Standing
Committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HR14_packet.pdf |
HHSS 3/16/2010 3:00:00 PM |
|
| HB328_packet.pdf |
HHSS 3/16/2010 3:00:00 PM |
HB 328 |