03/18/2009 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Confirmation of Governor's Appointments | |
| SB11 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
| += | SB 11 | TELECONFERENCED | |
| += | SB 27 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 18, 2009
1:31 p.m.
MEMBERS PRESENT
Senator Bettye Davis, Chair
Senator Joe Paskvan, Vice Chair
Senator Fred Dyson
MEMBERS ABSENT
Senator Johnny Ellis
Senator Joe Thomas
COMMITTEE CALENDAR
Confirmation of Governor's Appointments
HEARD
SENATE BILL NO. 11
"An Act relating to health care insurance coverage of a
dependent child who is less than 26 years of age and making a
conforming age amendment in the statute describing health
insurance policies that may be delivered or issued in this
state."
MOVED SB 11 OUT OF COMMITTEE
SENATE BILL NO. 27
"An Act relating to tuition waivers for a child who was in
foster care; relating to eligibility for foster care and subsidy
payments for a hard-to-place child; and amending the definition
of 'child' in certain statutes."
SCHEDULED BUT NOT HEARD
PREVIOUS COMMITTEE ACTION
BILL: SB 11
SHORT TITLE: DEPENDENT HEALTH INSURANCE; AGE LIMIT
SPONSOR(s): SENATOR(s) DAVIS
01/21/09 (S) PREFILE RELEASED 1/9/09
01/21/09 (S) READ THE FIRST TIME - REFERRALS
01/21/09 (S) HSS, L&C, FIN
03/11/09 (S) HSS AT 1:30 PM BUTROVICH 205
03/11/09 (S) Heard & Held
03/11/09 (S) MINUTE(HSS)
03/18/09 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
WILLIAM H. HOGAN, Commissioner-designee
Department of Health and Social Services (DHSS)
POSITION STATEMENT: Gave his background and commented on
appointment.
DR. DAVID MILLER, nominee
State Medical Board
POSITION STATEMENT: Commented on his background relating to the
appointment.
DR. POWERS, nominee
State Medical Board
POSITION STATEMENT: Commented on his appointment.
ED HALL, nominee
State Medical Board, State Medical Board
POSITION STATEMENT: Commented on his reappointment.
CASEY MILLAR, nominee
State Medical Board
POSITION STATEMENT: Commented on her appointment.
MARY JANE MICHAEL, nominee
State Mental Health Trust Board
POSITION STATEMENT: Commented on her appointment.
WILLIAM DOOLITTLE, nominee
Alaska Mental Health Trust Board
POSITION STATEMENT: Commented on his appointment.
TOM OBERMEYER
Staff to Senator Davis
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Commented on SB 11 for the sponsor.
ACTION NARRATIVE
1:31:15 PM
CHAIR BETTYE DAVIS called the Senate Health and Social Services
Standing Committee meeting to order at 1:31 p.m. Present at the
call to order were Senators Paskvan, Dyson and Davis.
^Confirmation of Governor's Appointments
Confirmation of Governor's Appointments
1:32:11 PM
CHAIR DAVIS announced that the Governor's appointments would be
the first order of business.
WILLIAM H. HOGAN, Commissioner-designee, Department of Health
and Social Services (DHSS), said he's been involved in the
health and social services field for nearly 35 years. He grew up
in upstate New York and his first job was on the night shift in
a community mental health facility. One of the things he had the
opportunity to do shortly thereafter in the 70s was to bring 125
people out of New York state psychiatric centers during what was
referred to as "deinstitutionalization." The real intent for
many of these people who had been in hospitals for 35 years was
to develop community programs for them.
Since then, most of his experience has been in the areas of
mental health and substance abuse, although at one point he was
the director of development disabilities for a mental health
center in West Virginia. He has held multiple positions in
several states and prior to coming to work for the State of
Alaska, he was CEO of "Life Quest," the community mental health
center in Wasilla that is now called "Mat-Su Health Services."
He came to work for the DHSS in 2003 as first director of the
Division of Behavioral Health, which integrated the previous
Division of Mental Health and the previous Division of Alcohol
and Drug Abuse. In 2005, he became the deputy commissioner of
DHSS, when Joel Gilbertson went to work for Providence and
Karleen Jackson became the commissioner. Last July the Governor
asked him to become the commissioner, and he has been
functioning in that capacity ever since.
One of the things he has learned as a clinician, therapist and
director is that their business is about the people they serve,
and it is critical that they weigh potential impacts to those
people when making decisions. When running mental health
centers, he found that it isn't easy to run non-profits because
they still have to run like a businesses. He told staff they
have two missions: one is a social mission to the people and
families who receive services, and the other is the business
mission. If you cannot keep your lights and heat on, you can't
provide the other services. That is the philosophy he brought to
the department. When he talks about bringing their programs and
services to the people, he means as "good stewards of the public
dollar."
MR. HOGAN said he feels that integrating the two divisions into
the Division of Behavioral Health was successful. It now
provides a broad array of resources, technical assistance and
leadership to the community. He also began integrating their
service delivery system having discovered that 60 percent of the
people they serve in the mental health and substance abuse
systems have both disorders (called a co-occurring disorder). So
they have created a system where if you have both problems you
are not shuttled back and forth between two agencies; you can
get everything you need from one agency. They have set that goal
as the expectation.
He said he was also very involved in developing the "bring the
kids home project" and he has seen significant progress on that
front. Less than 165 kids are currently in out-of-state
psychiatric treatment centers. When the project was first
started about 3.5 years ago, there were 500 at any one time.
As a deputy, he wanted to highlight the creation of better
integration within the department - asking the department to
focus on families. He also feels good about the grantee
partnership project the department started with the help of the
Rasmussen Foundation, the Mental Health Trust Authority and the
MatSu Health Foundation, to streamline the grant-making process.
They give out 800-plus grants per year to several hundred
different grantees; and it's a pretty darned burdensome process.
Finally, they have worked hard with the Mental Health Trust
Authority and others on the comprehensive integrated mental
health plan, particularly coming up with the first "Alaska Score
Card," a way to measure whether or not they are making an impact
on the general population in Alaska.
Finally, Mr. Hogan said, they had done good job with their
Medicaid budget, which is over $1 billion. Over the last couple
of years, through cost containment efforts and managing their
Medicaid dollars in a better way, they have been able to not ask
for significant increases, but rather have been able to give
some of those dollars back.
1:43:55 PM
SENATOR DYSON asked what he needs to serve his clients and for a
description of what people will say he did really well when they
prepare a citation for his service.
MR. HOGAN answered that regarding the first question, it is a
balance between the resources available and ensuring that the
dollars expended are going to the right place. They'll never
have enough to meet all the needs so they have to be selective
and focus on outcomes.
He hopes his legacy will be some of the things he has discussed
especially bringing the kids home. Also, he hopes if one were to
ask if the department is actually helpful, fair, treats people
with respect, and has integrity, he hopes people would say he
did that.
1:48:10 PM
SENATOR DYSON remembered some years ago working with problems
from the Division of Family and Youth Services (DFYS), that he
got a report saying that although there were a lot of nice
people there, they didn't have the supervisorial experience. Did
he have any suggestions for training existing people or getting
people with those skills? Are there ways to organize the
department better or save time or get more resources to the
front lines?
MR. HOGAN admitted that the bureaucracy can be frustrating, and
the department is constantly working on improvements. He thinks
they have a good managerial team, but would like to see some
leadership development, because many leaders in the department
are older and they need to be growing new ones.
1:50:40 PM
SENATOR PASKVAN complemented Mr. Hogan on his 2009 priorities
list. From that list, he asked if he could lay out some of the
progress that has been made on substance abuse prevention,
intervention and treatment.
MR. HOGAN said he has heard questions from staff and community
members about what the department should be focused on and that
is what prompted development of the priorities in the first
place. Substance abuse affects all sorts of other things and if
something isn't done about it, the quality of life will not be
where it needs to be in Alaska.
In the next two months they are planning a substance abuse
"think tank" with the Rasmussen Foundation, Mental Health Trust
Authority and others to finally get their arms around the
issues. Hundreds of millions of dollars have been spent on this
problem, maybe more; and in spite of spending all those dollars,
they haven't had real success. By identifying it as a priority,
they are indicating how serious they are about solving it. They
have ideas around outcomes but not how to get there. The
incidence of substance abuse-related disease needs to be
reduced; injuries need to be reduced as a result of auto
accidents when someone is intoxicated; domestic violence needs
to be reduced because in many instances substance abuse is a
contributing factor. Better programs have to be provided,
because ninety percent of the people in the Department of
Corrections have a mental health or a substance abuse problem.
"Clearly, the challenge is huge."
1:53:46 PM
SENATOR PASKVAN asked him to describe the status of the
development of the long term care plan.
MR. HOGAN said he has a long term care plan that was developed
by the Home and Community Based Services Strategies Company on
their behalf. Several recommendations make sense to him. When
people think long term care, they think seniors and what's going
to be available for them - including home care, quality assisted
living homes, defining the role of the Pioneer homes going
forward, and quality nursing homes. This plan outlines how they
can create that comprehensive system.
He said the department has recently focused a lot of time
focused on the Mary Conrad Center, but once they are out of
there, the department and all the stakeholders will get serious
about working on the recommendations. He has found that
collaboration is the best way of doing business, even though it
may take longer to accomplish it.
1:56:41 PM
SENATOR PASKVAN asked him to discuss his social service staffing
levels.
MR. HOGAN answered that this latest budget increment will allow
them to get additional front-line social workers for the Office
of Children Services (OCS) and they will be in pretty good
shape. "My two cents - they have the toughest job in state
government!" They make determination on taking kids away from
families.
He said he is always trying not to grow the department, and to
get the services done without large additions of employees. The
department staffing is in pretty good shape, but he is concerned
with the work force, in general. The work they have done around
work force development will show results 5 and 10 years out, but
the problem is now. It is a challenge they are trying to do
something about. Some headway has been made with the University,
Mental Health Trust Authority and other stakeholders.
1:59:26 PM
SENATOR PASKVAN complemented him in getting the number of out-
of-state kids back into state care. What is the next step to
bringing the kids home?
MR. HOGAN answered that instead of trying to sell the
legislature on giving them more money for prevention that might
prove to be worthwhile in 5 or so years, they chose to develop
some in-state residential psychiatric treatment beds and some
smaller group homes or treatment facilities throughout the
state. This budget request includes more money for community
services to keep families at home. They envision the project
being done by 2013, although some kids may still be out of state
then.
2:01:37 PM
SENATOR PASKVAN asked what is happening with the boys and girls
home in Fairbanks.
MR. HOGAN responded that the boys and girls home in Fairbanks is
licensed for 44 residential psychiatric treatment center beds
even though the facility is larger than that and they began to
take children. He explained that the Department of Health and
Social Services (DHSS) routinely goes in to see how things are
going and they found that the home did not have properly
licensed staff. That got their attention and they started
working with the management to make it clear that if they were
going to stay in business, they needed to have sufficient
quality staff. At the same time they began getting calls about
some other things that were supposedly going on there, and some
of them were quite concerning regarding kids in the of OCS and
Juvenile Justice. So the folks in those two divisions began
working with the facility to try to figure out what was going
on, and again it seemed to relate to not having enough qualified
staff. This agency needs to be successful, but enough concerns
have been raised since it opened that they have to make sure it
is providing quality care.
2:05:03 PM
SENATOR PASKVAN wanted to understand the staffing regulations,
and asked if he would consider using waivers for certain people.
MR. HOGAN said some of the regulations are state, but some are
federal and related to Medicaid payments. He would have to read
the regulations regarding waivers, but primarily his duty is to
ensure that the kids are safe and secure - in addition to
getting the treatment.
2:06:32 PM
SENATOR PASKVAN said his feedback from the home is that they
don't know what the department wants them to do.
MR. HOGAN answered that he has tried to communicate expectations
clearly with management. Deputy Commissioner Pat Hefley was on
the phone with them for an hour and a half today. Part of the
problem is having multiple agency regulations and standards -
OCS, Juvenile Justice, Behavioral Health, and Medicaid
regulations - which can be confusing.
2:08:39 PM
SENATOR PASKVAN asked how he would classify adequacy of mental
health treatment in Alaska relative to the current environment.
MR. HOGAN answered that when he was in Wasilla as a provider,
they received "general fund mental health money" from the state;
the notion was that the money was to serve people who didn't
have severe problems. Part of the recent problem is that state
dollars have declined and more Medicaid money is being used. And
when you use Medicaid money, you have to meet "medical necessity
criterion" and the diagnoses have to be much more severe than
you see with people suffering general mental health problems.
Part of the problem is that the community expects them to
intervene early and to work with people before the problems
become too serious; those people are not always eligible for
Medicaid and the amount of GF money is not sufficient to work
with all the families at any one time. That's when you start to
hear about waiting lists and people getting turned away. In that
sense, he couldn't tell them that the state's mental health
treatment is adequate, but he can say they have a "solid array"
of community based providers that do excellent work. He stated
there is a need for money to work with those families that have
less severe problems.
2:11:35 PM
SENATOR DYSON asked him what the turnover rate for child
protective services was.
MR. HOGAN didn't have figures, but recalled that it is in the
mid-to-high 20 percent area and mostly with the newer employees.
SENATOR DYSON said when he "got here" it was 100 percent; so
that's real progress. He asked where the department is regarding
fraud and abuse prevention.
MR. HOGAN replied that they had recentralized those efforts to
be more effective and it is under Medicaid and Health Care
Planning Division.
SENATOR DYSON asked how many people work specifically on fraud
and abuse.
MR. HOGAN replied eight, and Medicaid has a separate Medicaid
fraud control unit in the Department of Law.
SENATOR DYSON asked if each department has a fraud person.
MR. HOGAN explained that compliance functions were centralized
so it was known what the people who went to these facilities
were doing - looking at medical records. What is now in the
division is the technical assistance or support function; this
is how to insure you are going to meet the requirements of
Medicaid and the state's program standards.
2:15:25 PM
SENATOR DYSON asked how many providers have been found to be
abusing the system.
MR. HOGAN replied he was not sure. He thinks most are trying to
do the right thing, but some are trying to rip off the system.
When he has a sense that is happening, they get the name of the
organization to the Medicaid fraud control unit.
SENATOR DYSON asked for a copy their fraud policy.
MR. HOGAS responded that he had already asked someone to get
that together.
SENATOR PASKVAN asked what he sees as the department's role
regarding domestic violence, child abuse, and sexual assault.
2:17:42 PM
MR. HOGAN replied when he was deputy commissioner he sat on the
Board of Directors for the Council on Domestic Violence and
Sexual Assault and therefore has worked very closely with the
Department of Public Safety and particularly that council over
the last couple of years. He also had the good fortune of
serving on the Domestic Violence and Sexual Assault Legislative
Task Force. One of the things that clearly came out of that task
force is that the department needs to spend more resources on
prevention - working with kids in schools around conflict
resolution and working with families that are violent. The
department can also work around batterers' intervention programs
to make sure they are effective. Also, when women go to
shelters, there have to be quality services so they can not only
be safe, but make long-term plans and gain skills if needed.
2:20:09 PM
CHAIR DAVIS said the federal government recently completed an
audit of the OCS and still found areas of concern, and she
wanted to know what has been done to correct those problems. She
was also concerned about what is being done to keep children in
the home and out of protective services as well as what the
plans are for the future.
MR. HOGAN responded that federal review just came out and he
would be happy to schedule an opportunity to discuss that with
the committee. He also agrees that keeping families together is
important and that is an area they are working on. Progress has
been made in their safety assessment so children whose safety is
not at risk are not being removed from their homes.
CHAIR DAVIS asked what their system is called.
MR. HOGAN replied that it is called ORCA.
CHAIR DAVIS asked if there are problems with communications in
that system.
MR. HOGAN answered that one of the things the federal review
highlighted is how well that system works. But, she may be
hearing about some of the issues they have with bandwidth in
rural areas, but he is working on getting small hand held
devices for field workers to use to enter data and that should
help.
2:24:18 PM
CHAIR DAVIS thanked him and said they will be forwarding his
name to the full body for further consideration. Next she asked
Dr. Miller if he had any goals things he wanted to accomplish
while serving on the State Medical Board.
2:24:41 PM
DR. DAVID MILLER, nominee for the State Medical Board, said he
has read through the Alaska state regulations and statutes and
feels they are appropriate and comprehensive.
2:26:14 PM
SENATOR DYSON said every profession struggles with being pulled
in a couple of directions: the American ideal of not ratting out
your buddies and professional ethics and the desire to deal with
malefactors internally to increase public confidence in the
profession. He asked Dr. Miller how he feels about that issue.
DR. MILLER responded that serving on the Bartlett Regional
Hospital's Credentials Committee he has had the opportunity to
review the professional progress reports from many of the
doctors that he serves with and it is his first and foremost
responsibility is to the patient and secondly to the hospital
and finally to the members of his profession. "As long as I can
keep those goals very clear in my mind, I think that I'll make
the right decisions."
2:27:59 PM
SENATOR DYSON asked if he could handle the ostracism that might
result if he makes those difficult decisions.
DR. MILLER replied that it can be difficult, but he has gotten
great support from the community in such instances and has pride
in the professional ethics he upholds.
2:28:51 PM
CHAIR DAVIS asked Dr. Powers to tell them what he wants to
accomplish on this board.
2:29:49 PM
DR. POWERS, nominee, State Medical Board, said he has worked in
rural Alaska for 20-plus years and found that practicing
medicine in rural Alaska presents its own specific challenges
and he feels he can represent those to the board.
2:31:10 PM
ED HALL, nominee, State Medical Board, State Medical Board, said
he is a physician assistant (PA) and has already served on the
Medical Board for four years and he would be happy to serve
another term. He feels it is an advantage to the state's medical
system to have PAs involved throughout the state and it is
beneficial for the Board to have a PA member, which was added
eight years ago.
2:32:57 PM
CASEY MILLAR, nominee, State Medical Board, said she applied to
be a public member. She thinks it is wise to have public
representation to present the public's perspective. She has no
connection with the medical community except as a consumer, and
looks forward to serving and learning whatever is necessary to
do it well.
2:34:45 PM
SENATOR DYSON asked what is it about this particular board that
attracts her attention and what she hopes to accomplish.
MS. MILLAR replied that she hopes to provide a balanced
perspective to ensure the public's protection.
SENATOR DYSON offered that she would be in a group of highly
intelligent and educated people and he told her not to let them
intimidate her. She has a valuable perspective to offer.
2:36:42 PM
MARY JANE MICHAEL, nominee, State Mental Health Trust Board,
said she had experience with the board since the day the trust
was created when she was director (18 years) for the "Arch of
Anchorage." She also oversees real estate services for the city
and she thinks this combination will be an asset to the trust.
She was excited to work with the board.
CHAIR DAVIS thanked her and said her name would be forwarded for
confirmation.
2:37:55 PM
WILLIAM DOOLITTLE, nominee, Alaska Mental Health Trust Board,
said he has been with the Board for five years and is currently
the chair. He very much admired the other trustees and their
accomplishments. His background has been in the practice of
medicine in the Fairbanks area since 1973; he partially retired
in 1997. He is pleased with the mission of the Mental Health
Trust and appreciates the opportunity to serve.
SENATOR PASKVAN said that Dr. Doolittle is his neighbor at Birch
Lake and he wholeheartedly recommends him for this seat. He is a
fine person and an excellent physician.
CHAIR DAVIS thanked him for his service, and said his name would
be forwarded to the full body for confirmation.
At ease at 2:40 p.m.
SB 11-DEPENDENT HEALTH INSURANCE; AGE LIMIT
2:41:38 PM
CHAIR DAVIS announced consideration of SB 11.
TOM OBERMEYER, staff to Senator Davis, sponsor of SB 11, read
the sponsor statement into the record as follows:
SB 11 requires an insurer to enroll, and prohibits
taking off the rolls or eliminating health care
insurance coverage without the consent of the insured,
for a person less than 26 years old who is related to
the insured, unmarried, financially dependent on the
insured, does not have dependents, enrolled in an
institution of higher education, and not insured under
another policy. SB 11 changes the age that a person
is considered a child from 23 years of age to 26 for
purposes of determining who may be insured under the
same policy of health insurance.
Young adults, ages 19-29, are one of the largest
growing segments of the U.S. population without health
insurance. In 2004 almost 14 million young adults
lacked coverage, an increase of 2.5 million since
2000. This rapid change is due in part to their
losing coverage under their parents' policies at 19,
or Medicaid, or State Children's Health Insurance
Program, or graduation from high school or college.
Almost half of college graduates and high graduates
will be uninsured for a substantial time after
graduation.
Age 19 is a crucial year in health insurance
coverage. Both public and private insurance plans
treat this age as a turning point for insurance
coverage. Even if youth go on to college, parents'
insurance plans often stop before graduation. Almost
all private universities and about one fourth of
public universities require health insurance as a
condition of enrollment. Forty percent of part-time
students and non-students, and 20 percent of full-time
students ages 19-23 are uninsured.
Insurance coverage is important for this generally
healthy group of young adults who should be encouraged
to start taking responsibility for their own health
care. It has been found that 14 percent of adults 18-
29 are obese, an increase of 70 percent in the 1990s,
- the fastest rate of increase among all adults. There
are 3.5 million pregnancies each year among the 21
million women ages 19-29. One-third of all diagnoses
of HIV are made among young adults. Emergency room
visits are far more common among young adults than
children or older adults. Most young adults have no
regular doctor, no link to the health care system, and
more than one-third of those who do require medical
attention are often saddled with debt and collection
agencies.
States are taking action to mandate coverage for young
adults, often allowing for targeted policy options.
For example, in 2006 New Jersey required most group
health plans to cover single adult dependents up to
age 30. Massachusetts as part of its expanded health
insurance law in 2006 considered dependents for
insurance purposes up to age 25 or for two years after
they are no longer claimed on their parents' tax
returns. Since 1994 Utah has required coverage through
age 26, and New Mexico provides coverage for unmarried
dependents up to age 25, regardless of school
enrollment. Texas in 2003 allowed full-time students
up to be covered by their parents' insurance plans to
age 25. It is not uncommon, or unreasonable,
therefore, that SB 11 requires offering family health
insurance coverage to dependent children up to age 26.
2:44:59 PM
MR. OBERMEYER explained that states are taking action to mandate
coverage for young adults often allowing for targeted policy
options. For example in 2006, New Jersey required most group
health plans to cover single adult dependents up to age 30;
Massachusetts considered dependents up to age 25 or for two
years after they are no longer claimed on their parents' tax
returns. Since 1994, Utah has required coverage through age 26
and New Mexico provides coverage through age 25 regardless of
school enrollment. Texas in 2003 allowed full-time students to
be covered to age 25. It is not unreasonable that this bill
requires offering family health plans to dependent children up
to age 26.
SENATOR DYSON asked Mr. Obermeyer if state schools no longer
offer health coverage for students.
MR. OBERMEYER answered that most still offer it, but it has
become prohibitively expensive for a lot of students; it might
be $1,800/yr. or more. Schools require it because liabilities
are involved in having students on campus. It has been found
that it is less expensive to retain students on their parents'
policies.
2:47:55 PM
SENATOR DYSON asked if anyone from the insurance industry has
addressed that issue or how much it would cost to carry the kids
longer.
MR. OBERMEYER answered the insurance industry last indicated
that the cost to continue coverage under those existing plans
would not be prohibitive. It might go up several percentage
points.
SENATOR DYSON asked if SB 11 allows an insurance company to
increase the rates as necessary to extend the coverage.
TOM OBERMEYER answered yes, but this bill says that kids cannot
be deleted from a policy.
SENATOR DYSON asked if they've had any feedback from the
insurance companies.
CHAIR DAVIS replied that the only dissenting view came from the
Small Business Association.
2:51:51 PM
SENATOR PASKVAN moved to report SB 11 from committee with
individual recommendations and accompanying fiscal notes. There
being no objection it was so ordered.
2:52:38 PM
There being no further business to come before the committee,
Chair Davis adjourned the meeting at 2:52 p.m.
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