Legislature(2025 - 2026)BUTROVICH 205
01/28/2025 03:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB45 | |
| SB44 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 44 | TELECONFERENCED | |
| *+ | SB 45 | TELECONFERENCED | |
SB 45-MEDICAID MENTAL HEALTH PARITY
3:31:45 PM
CHAIR DUNBAR announced the consideration of SENATE BILL NO. 45
"An Act relating to medical assistance services; relating to
parity in mental health and substance use disorder coverage in
the state medical assistance program; and providing for an
effective date."
3:32:42 PM
ARIELLE WIGGIN, Staff, Senator Forrest Dunbar, Alaska State
Legislature, Juneau, Alaska, gave a brief overview of the
sponsor statement for SB 45 stating the legislature has an
opportunity to increase access to behavioral health care in a
way that will deeply impact many communities. She noted that
nearly a quarter of Alaska residents participate in some form of
Medicaid or have a family member who does. She emphasized that
the difficulty of accessing behavioral health care is affecting
families, communities, and schools across the state.
3:33:01 PM
SENATOR TOBIN joined the meeting.
3:33:29 PM
MS. WIGGIN paraphrased the sectional analysis for SB 45:
[Original punctuation provided.]
SECTIONAL ANALYSIS
SB 45: MEDICAID MENTAL HEALTH PARITY
Section 1: The state must provide equal coverage and
access to treatment for behavioral health issues as
for other medical conditions. This is a new subsection
(i) to the state statute that governs services
provided to Medicaid recipients (AS 47.7.030). The new
subsection says the department of health must follow
federal behavioral health parity statutes, which are
listed in the bill.
Section 2: The commissioner of health will comply with
relevant parts of the federal behavioral health law,
and investigating complaints about behavioral health
coverage and checking on possible unequal coverage
including:
1. Reviewing state Medicaid regulations to ensure they
don't cause unequal coverage of behavioral
healthcare. Examples of potential regulations are
listed.
2. Comparing how Medicaid coverage works for
behavioral health coverage versus physical health
coverage. This is a new section to State Medicaid
statute (AS 47.07). The new section is 47.07.033
Parity in mental health and substance use disorder
benefits.
Section 3: Creates a new reporting requirement for
behavioral health and mental health parity. It
instructs the Department to send a report by March 1
each year to the legislature. The report will:
1. Describe their process for what "medical necessity"
means for both physical and behavioral health
coverage.
2. List the rules limiting behavioral healthcare and
physical healthcare, numerical or nonnumerical.
3. Decide whether the criteria, numerical and non-
numerical, for behavioral health are comparable to
physical health benefits, and if they are applied
equally. This includes:
a. Decisions behind treatment limitations,
including limitations that were rejected.
b. Evidence used to choose treatment limitations.
c. Comparisons between physical and behavioral
health care showing that in practice the
treatment limitations are evenly applied.
d. Share findings that indicate whether the state
Medicaid system is complaint with federal
parity laws.
This is a new subsection (d) to the section of state
statute on reports that the Department of Health must
periodically give to the legislature (AS 47.07.076)
Section 4: requires the Commissioner of Health to
submit a one-time report to the legislature by March
1, 2026. The report must: 1. Explain the methodology
used to evaluate if Alaska's Medicaid program complies
with federal behavioral health parity law. 2.
Summarize market review conducted for parity
compliance. 3. Describe any steps taken to fix issues
or provide education to improve compliance. 4. Be
written in non-technical, plain language. 5. Be made
publicly available online. This is a new section in
the uncodified law.
Section 5: requires the Department of Health to submit
any necessary amendments to the federal government for
approval to update Alaska's Medicaid program to comply
with federal behavioral health parity requirements.
This is a new section in the uncodified law.
Section 6: This section specifies that Sections 1
through 4 will only take effect if the federal
Department of Health and Human Services approves the
state's Medicaid plan amendments by December 31, 2025.
The Commissioner of Health must notify the revisor of
statutes within 30 days of receiving federal approval.
Section 7: If the federal government approves the
Medicaid plan amendments, Sections 1 through 4 will
take effect the day after the federal Department of
Health and Human Services grants approval.
3:35:46 PM
CHAIR DUNBAR [opened invited testimony on SB 45.]
3:36:23 PM
LANCE JOHNSON, Chief Operating Officer, Alaska Behavioral Health
Association, Eagle River, Alaska, testified by invitation on SB
45. He introduced himself.
3:36:45 PM
At ease.
3:37:53 PM
CHAIR DUNBAR reconvened the meeting on SB 45.
3:38:09 PM
MR. JOHNSON said that over the last couple of years, the
[legislature] has discussed parity, and he expressed
appreciation for the opportunity to revisit the issue. He noted
that several individuals were on the phone to offer testimony,
including Dustin Larna, who was expected to join the conference
call. He also introduced John Solomon, CEO of the Alaska
Behavioral Health Association. For the record, he clarified that
although he was introduced as the Vice President of the
association, he is actually the Chief Operating Officer (COO).
He then invited John Solomon to introduce himself.
3:38:54 PM
JOHN SOLOMON, Chief Executive Officer, Alaska Behavioral Health
Association, Eagle River, Alaska, testified by invitation on SB
45. He provided background on the Alaska Behavioral Health
Association, stating that the organization represents
approximately 109 member organizations across the state, most of
which are direct service providers and primarily involved with
Medicaid. He shared that he is a licensed professional counselor
and previously worked as a quality assurance supervisor,
training clinicians on regulations, and later served as Director
of Behavioral Health at Maniilaq in Kotzebue. He added that he
is also a person in long-term recovery, giving him a broad and
varied perspective on behavioral health. He said the
presentation would take a basic look at what parity is and is
not.
3:40:45 PM
MR. SOLOMON moved to slide 2, What is Parity, and shared that
parity ensures that behavioral health treatment has the same
access and coverage as medical and surgical treatments. He said
parity becomes more complex because behavioral health services
occur in various settings, including hospitals, Federally
Qualified Health Centers (FQHCs), and community behavioral
health settings. He explained that the legislation specifically
focuses on behavioral health services delivered in community
settings.
3:41:18 PM
MR. SOLOMON moved to slide 3, What It Isn't, and explained that
parity legislation does not limit the state's ability to
regulate or manage the Medicaid program. Instead, it asks the
state to analyze how it manages behavioral health services
compared to how it manages medical services within Medicaid. He
emphasized that the legislation does not remove oversight,
accreditation standards, or change clinical practices. Any
changes to work processes would aim to align standards and
improve consistency. He stated that the primary goal is to help
the state identify and remove barriers to care through this
analysis.
3:42:10 PM
MR. SOLOMON moved to slide 4, What Do We Mean by Barriers, and
said that many barriers to care in community behavioral health
stem from outdated regulations rooted in the earlier model of
grant-based care. Before behavioral health services could be
billed to Medicaid, care was guided by prescriptive grant
language that has not kept up with the shift to evidence-based,
clinically driven treatment. He noted that required paperwork,
oversight, and documentation standards often do not align with
current clinical practices or decision-making in behavioral
health.
MR. SOLOMON referred to a concept in parity legislation called
non-quantitative treatment limitations restrictions that are
not based on a set number of services but instead include
administrative or regulatory hurdles. He explained that these
limitations often make it more difficult to access community
behavioral health care compared to community health care. At a
high level, he said, this stems from lingering stigma that
requires behavioral health providers to justify their decisions
more rigorously than other health professionals.
MR. SOLOMON emphasized that the goal is not to abandon clinical
best practices but to better align regulations with actual
clinical practice, provider scope, and licensure requirements.
He noted that Alaska has been flagged in a federal "warning
signs" document for specific Medicaid practices and said the aim
of the legislation is to give the state the ability to develop
tools, regulate appropriately, and report back to the
legislature on its progress.
3:44:30 PM
MR. SOLOMON moved to slide 6, Physical Health, and said he did
not want to overly simplify the issue but wanted to illustrate
how current regulations affect a client walking in the door for
behavioral health services. He explained that in a typical
physical health setting, such as a community health center or
Federally Qualified Health Center (FQHC), a patient can often
receive multiple services in a single visit. For example, if
someone arrives with a hurt elbow, they can complete an intake,
receive a brief assessment, potentially receive immediate
treatment, and begin developing a plan for ongoing careall in
one appointment. In contrast, at a community behavioral health
centersometimes located just across the street or in the same
buildingthe process is far more rigid due to existing
regulations. Clients must first complete an intake and
screening, followed by a full biopsychosocial assessment. That
assessment informs the treatment plan, which is a 90-day plan
and includes specific signature requirements depending on
whether the client is a minor or an adult. This may involve
obtaining signatures from guardians or school personnel. He
emphasized that only after completing all these steps is a
client finally able to begin receiving treatment. He said it
often takes four appointments to get to treatment.
3:45:21 PM
MR. SOLOMON moved to slide 6, Behavioral Health Community
Behavioral Health Centers, and said he did not want to overly
simplify the issue but wanted to illustrate how current
regulations affect a client walking in the door for behavioral
health services. He explained that in a typical physical health
setting, such as a community health center or Federally
Qualified Health Center (FQHC), a patient can often receive
multiple services in a single visit. For example, if someone
arrives with a hurt elbow, they can complete an intake, receive
a brief assessment, potentially receive immediate treatment, and
begin developing a plan for ongoing careall in one appointment.
In contrast, at a community behavioral health centersometimes
located just across the street or in the same buildingthe
process is far more rigid due to existing regulations. Clients
must first complete an intake and screening, followed by a full
biopsychosocial assessment. That assessment informs the
treatment plan, which is a 90-day plan and includes specific
signature requirements depending on whether the client is a
minor or an adult. This may involve obtaining signatures from
guardians or school personnel. He emphasized that only after
completing all these steps is a client finally able to begin
receiving treatment.
3:47:39 PM
MR. JOHNSON illustrated the contrast between physical and
behavioral health care by stating that, for many people, it is
easier to go to the emergency room to receive help because
accessing behavioral health services is too difficult due to
regulatory barriers. He shared a real-world example from his 11
and a half years as Behavioral Health Services Director at an
agency in Nome. During that time, a psychiatrist working on the
community behavioral health side was subject to the same
documentation requirements as a master's level clinicianand in
some cases, a behavioral health aidedue to regulatory
standards. To improve access the psychiatrist was moved to the
medical side of the clinic, where patients could be seen almost
immediately and where documentation requirements were
significantly less burdensome. This shift allowed more people to
access care efficiently compared to the heavily regulated
community behavioral health side.
MR. JOHNSON also shared his personal experience with depression
and anxiety. He noted that he sees a psychiatrist on the medical
side for medication management, bypassing community behavioral
health services because of the very barriers he described.
However, he acknowledged that this setup limits access to the
talk therapy he needs, which is only available on the behavioral
health side. This results in two different providers operating
under two different systems, creating a confusing and difficult
experience for clients trying to navigate care.
3:50:06 PM
MR. JOHNSON moved to slide 6, Behind the Scenes, and discussed
the challenges behavioral health providers face on the
administrative side, particularly around Medicaid enrollment. He
stated that enrolling in Medicaid for community behavioral
health services is a convoluted process involving numerous hoops
and various provider types that must be considered. He
contrasted this with the medical and surgical side, where claims
adjudication is often more straightforward. He explained that
for behavioral health services, especially in agencies offering
both medical and behavioral care, the systems are so different
that it becomes burdensome to operate under both.
MR. JOHNSON noted that because of the documentation demands, he
could not allocate too much of the clinicians' time to
administrative work. To manage the state's required data entry,
he had to hire three full-time administrative staff, which meant
reducing clinical resources. This need to balance documentation
standards with client care created significant operational
strain. He further explained that providers operating as both a
Federally Qualified Health Center (FQHC) and a community
behavioral health services provider must navigate two distinct
systems of care. In addition to Medicaid complexity, he cited
other behind-the-scenes challenges, such as state reporting
requirements and mandatory accreditation for behavioral health
providersan unfunded mandate that can be both time-consuming
and costly.
3:51:35 PM
MR. JOHNSON shared that during his last accreditation survey in
Nome, he worked 31 consecutive days to prepare, noting that the
process was even more complicated due to COVID-19. While he
acknowledged that accreditation strengthened the organization
and is valuable, he emphasized that it adds another layer of
difficulty to delivering clinical services effectively.
3:52:21 PM
MR. JOHNSON moved to slides 8-10, Matrix of Non-Quantitative
Treatment Limitations (AKA Admin Burden), and explained that
the red column represents the regulatory and documentation
requirements for community behavioral health services, while the
green columns represent requirements for Federally Qualified
Health Centers (FQHCs) and health professional groups (HPGs). He
noted that although this comparison was created before the
state's transition to Optum as the Medicaid managed care
contractor, much of the information remains accurate.
MR. JOHNSON emphasized the significant disparity in regulatory
burden, pointing out that the red column is noticeably longer
than the green columns, illustrating the greater number of
requirements imposed on community behavioral health providers.
He stated that behavioral health providers must review
approximately 117 pages of service manuals for 1115 Medicaid
waiver services, along with the corresponding regulations, to
ensure compliance with both implementation guidelines and
documentation standards. In contrast, he explained that the
medical and surgical side operates under a far simpler set of
documentation rules. For example, regulation 7 AAC 105.230,
which applies to medical providers, is only about a page and a
half long. While behavioral health providers can also follow
that regulation, they are additionally subject to a more complex
set of rules under Chapter 135, which outlines further
documentation obligations.
MR. JOHNSON concluded by saying that this layered and compounded
regulatory structure creates administrative burdens that serve
as barriers to care, diverting time and resources away from
clinical service delivery.
3:53:47 PM
MR. JOHNSON moved to slide 11, Ensuring Access, Why Now, and
said that the federal Mental Health Parity and Addiction Equity
Act of 2008 outlined several standards meant to eliminate
barriers to behavioral health care, particularly through what
are called non-quantitative treatment limitations. He noted that
Mr. Solomon had previously mentioned this concept, which
includes practices like time-based treatment plans and service
authorizationsboth of which the law discourages because they do
not enhance care and often act as access barriers.
3:54:23 PM
MR. JOHNSON explained that service authorizations are not
clinically necessary and do not provide clinical value; they are
mainly used to check for fraud or waste. He commended the state
for removing the requirement for service authorizations during
COVID and praised the Division for continuing to limit them for
most services. Time-based treatment plans, he said, also lack
clinical relevance. While treatment plans themselves are
importantsimilar to care plans on the medical sidemandating
them at fixed intervals (e.g., every 90 days) does not align
with clinical needs. He noted that many providers update
treatment plans at each visit anyway, but under regulation, they
are forced to meet rigid timeframes. If a client cannot return
in timefor example, due to being away for subsistence
activitiesthe provider may miss the window, resulting in the
inability to bill for services provided, which ultimately
reduces care availability.
3:55:45 PM
MR. JOHNSON emphasized that Alaska is not pioneering these
efforts; other fee-for-service states like Wyoming, New Mexico,
and Maine have already aligned their Medicaid systems with the
federal parity law. He pointed out that while Alaska is not
federally required to comply due to its payment structure, it
can choose to align its Medicaid regulations with the federal
parity standards. He explained that this effort builds on
momentum from last year, when a parity resolution passed
encouraging the state to pursue parity reforms. The reason for
introducing a bill now, he said, is twofold. First, the Alaska
Behavioral Health Association has a strong working relationship
with the Department of Health and the Division of Behavioral
Health, and both sides acknowledge the need for change after 25
to 30 years of stagnation. Second, he stressed the importance of
codifying progress in legislation so that it outlasts individual
administrators and political transitions, preventing the loss of
progress if leadership changes. He said the legislation ensures
the work continues even after those currently serving have moved
on, supporting long-term structural reform in Alaska's
behavioral health system.
3:57:52 PM
MR. JOHNSON moved to slide 12, Real World Outcomes, Efficient
Accessible the Alaska Solution, and said that in the long run,
achieving parity and improving access to services would reduce
administrative burdens and decrease reliance on emergency rooms,
which are costly and not well-suited to addressing many
behavioral health issues. He highlighted the impact on the
correctional system, citing data from the Norton Sound region.
Three years ago, 95 percent of individuals entering Anvil
Mountain Correctional Center were incarcerated for substance-
related violationsa figure based on data, not anecdote.
MR. JOHNSON noted the facility cost $141 per day per bed, with
128 beds, totaling $6.6 million in annual costs. At 95 percent,
roughly $6.3 million of that amount was spent on individuals who
were not receiving the treatment they needed. He emphasized that
people struggling with substance use often have only a narrow
window of willingness to enter treatment, and delays can cause
that opportunity to be lost. He concluded by stating that if
people are diverted into treatment sooner, significant resources
across the system could be freed up.
3:59:13 PM
MR. SOLOMON moved to slide 13, Components of Parity Legislation,
said SB 45 allows the state to ensure compliance with standards
and to make decisions based on medical necessity and appropriate
oversight as it relates to medical care. He stated that this is
the goal of the legislation. He expressed appreciation to the
sponsor for bringing the bill forward and offered to answer any
questions.
4:00:05 PM
CHAIR DUNBAR stated that the ultimate goal of SB 45 is simple
but the implementation is challenging.
4:00:49 PM
CHRIS CONSTANT, Chair, Anchorage Assembly, Anchorage, Alaska,
testified by invitation on SB 45. He introduced himself stating
his extensive experience with behavioral health care in Alaska,
including Akeela. He stated that Akeela has been providing care
for the past 50 years and clarified for the record that while he
is speaking on behalf of the Assembly, he would be referencing
his professional experience with Akeela.
MR. CONSTANT expressed strong support for SB 45, stating that it
would ensure mental health and substance use disorder benefits
under Medicaid are treated with the same fairness as physical
health benefits. He illustrated the real-world impact by
describing Akeela's Stepping Stones program for pregnant and
parenting women with young children, where mothers can remain
with their children during residential treatment. Historically,
treatment in this program could last six to eighteen months.
However, under the managed care model, participants are limited
to 90-day service authorizations, which he argued is
insufficient for stabilization, treatment, and lasting recovery.
4:02:33 PM
MR. CONSTANT described the extensive intake process mothers must
complete and emphasized the difficulty of expecting them,
especially those dealing with opioid addiction, to achieve
lasting change within 90 days. He said this harms not just the
mother, but also the child and the community. He praised the
1115 Medicaid waiver for expanding provider participation and
increasing access to services but noted that the waiver alone
does not guarantee equitable treatment across physical and
behavioral health care. SB 45, he argued, is a necessary next
step in creating a truly comprehensive and equitable behavioral
health system.
MR. CONSTANT noted that SB 45 would help eliminate
discriminatory barriers and ensure that behavioral health care
receives the same priority as physical health care. It would
improve mental health outcomes across the state by increasing
access and reducing the number of people turned away. He pointed
out that in Anchorage, the most common "waiting room" for
behavioral health servicesbesides jailsis the streets and
parks, underscoring the urgency of the crisis.
4:05:21 PM
MR. CONSTANT recalled his early career experience during the
2015 "summer of spice," when people were cycling between
shelters and hospitals multiple times a day, and drew parallels
to the underinvestment in community-based supports that followed
the construction of the Alaska Psychiatric Institute (API).
While the hospital was successfully established, he said, the
promised expansion of community support services never fully
materialized. He stated that SB 45, combined with the 1115
waiver, brings the state closer to fulfilling that promise.
MR. CONSTANT emphasized the importance of reducing stigma,
explaining that the complexity of accessing servicessuch as
requiring four appointments just to begin treatmentcan be
overwhelming, especially for those new to the system. He cited
Akeela's recent effort to offer "after-hours assessments"
through opioid mitigation funding as an example of trying to
meet people where they are, noting that no other provider
currently offers assessments after 5 p.m. or on weekends.
4:07:27 PM
MR. CONSTANT said SB 45 would also benefit providers by
streamlining oversight and compliance, reducing burdensome
administrative requirements, and preventing situations like
those under the Xerox billing system, when Akeela had to take
out a $1 million line of credit to stay operational. He noted
that aligning behavioral health regulations with those governing
physical health care would improve efficiency and
accountability.
MR. CONSTANT added that SB 45 would also help grow Alaska's
behavioral health workforce by reducing the administrative
burden that drives away clinical professionals. He explained
that current staffing challenges are not about lacking physical
space or beds, but about lacking professionals to operate them.
He spoke to the bill's benefits for local governments, saying
untreated behavioral health needs place significant strain on
public systems, including emergency response, shelters, and
jails. SB 45, by ensuring timely access to treatment, would help
reduce those pressures and generate long-term cost savings.
MR. CONSTANT concluded by saying the bill would position Alaska
to align with federal parity laws, potentially increasing
federal funding and improving transparency in how Medicaid
dollars are spent. He urged the passage of SB 45, noting that
while there may be differences between the administration and
legislature, collaboration and thoughtful review of the
regulations can improve the outcome. He stated that the SB 45
will make Alaska's streets safer and improve quality of life for
all residents.
4:13:11 PM
DUSTIN LARNA, Chief Executive Officer, Residential Youth Care,
Ketchikan, Alaska, testified by invitation on SB 45. He voiced
clear support for SB 45 and shared his background in providing
children's behavioral health services in Ketchikan for over 20
years, working with youth and families from across Alaska. He
noted his experience with multiple administrations and
initiatives, such as Bring the Kids Home, aimed at improving
behavioral health care. He stated his belief that SB 45 has the
potential to make a greater impact on behavioral health access
and services than anything he has previously been involved in.
4:14:43 PM
MR. LARNA emphasized the importance of evaluating parity,
describing current regulations as outdated and rooted in a time
when mental health and substance use services were stigmatized
and often viewed as ineffective. He said many of these rules
were developed during an era when people were reluctant to seek
help and mental health was not part of an open public
conversation. While incremental updates have been made, he
argued that the current approach has not been effective in
producing meaningful change.
4:15:45 PM
MR. LARNA stated that SB 45 presents an opportunity to reexamine
the foundational regulations, asking whether certain rules
actually contribute to the delivery of quality care. This would
help uncover non-quantitative treatment limitations that hinder
access and effectiveness. He provided an example from his
experience: the extensive documentation requirements for
providing behavioral health services to youth and families. He
explained that these burdensome requirements significantly
increase costs, discourage providers from accepting Medicaid,
and in some cases, reduce service quality.
4:17:31 PM
MR. LARNA focused in particular on treatment plans, calling them
a long-standing concern. He explained that current Medicaid
rules require treatment plans to include detailed information
such as every specific service to be provided, the number of
units, and billing codesoften resulting in documents up to 15
pages long. He said such plans are not meaningful to youth and
families, who are asked to sign off on them, and that the
documents primarily serve as compliance tools for audits rather
than communication tools for care.
4:18:50 PM
MR. LARNA further pointed to the low number of private practice
behavioral health providers who accept Medicaid in Alaska
reportedly just eight out of more than 300 licensed providers.
He called this alarming, particularly given the known shortage
of behavioral health services in the state. He attributed the
lack of Medicaid participation to low reimbursement rates and
administrative burdens, including enrollment and billing
processes. He concluded by saying this disconnect in the system
reflects serious structural problems that SB 45 seeks to
address.
4:20:11 PM
SENATOR GIESSEL said she would like to verify the last statistic
that was mentioned.
4:20:25 PM
TRACY DOMPELING, Director, Division of Behavioral Health,
Department of Health, Juneau, Alaska, answered questions on SB
45. She said she was unsure of the accuracy of the specific
statistic mentioned but stated that her office could provide the
committee with the number of behavioral health providers
currently operating in Alaska. She acknowledged that Medicaid
reimbursement rates are indeed lower than what most private
organizations receive for comparable services, and that this is
a barrier to provider participation. She added that simply being
a Medicaid provider exposes individuals and organizations to
potential audits, and noted that providers face the risk of
having funds "clawed back" if inaccuracies are later found in
claims. These challenges, she stated, are particularly difficult
for private providers, though not unique to Alaska.
4:21:22 PM
SENATOR GIESSEL said the state is undergoing [Medicaid] rebasing
and asked how close the process it to completion and when the
new fee and reimbursement schedules will be established.
4:21:34 PM
MS. DOMPELING said that within the next month or two, the
department expects to have updated numbers available for
behavioral health, which can then be shared with providers and
reviewed internally. She noted that the original goal was to
have those numbers ready before the legislative session began.
However, feedback from the Alaska Behavioral Health Association
indicated that the surveys and other data collection tools sent
to providers were lengthy and detailed, and providers faced
competing priorities at the time. Because of this, providers
requested additional time to complete the information. She
explained that although the department had hoped to use that
data earlier to build momentum during the session, it ultimately
chose to prioritize supporting providers and ensuring the
collection of comprehensive information for the rate methodology
review.
4:22:36 PM
SENATOR GIESSEL asked if the [Department of Health] said it
could provide the committee with the number of available
clinicians.
MS. DOMPELING replied she could share with the committee the
number of behavioral health Medicaid providers currently
enrolled.
4:22:53 PM
SENATOR GIESSEL asked whether it would be possible to provide
the number of behavioral health providers broken down by
category, such as clinical counselors, social workers, and
advanced practitioners.
4:23:02 PM
MS. DOMPELING responded yes, and noted that the breakdown could
likely go even further due to the structure of the 1115
demonstration waiver. She explained that in addition to clinical
counselors, social workers, and advanced practitioners, the
provider categories also include behavioral health clinical
associates and individuals certified and enrolled as peer
support specialists. She confirmed that the department can
provide a detailed breakdown across these categories.
4:23:40 PM
MR. LARNA said the current administration has been supportive
but emphasized the importance of moving forward with the
legislation. He stated that SB 45 provides a necessary framework
to ensure the effort continues beyond the current administration
and through future leadership transitions.
4:24:23 PM
SENATOR HUGHES said the topic is both compelling and timely but
expressed concern that the issue has been left unaddressed for
so long, noting that federal parity laws have been in place for
17 years. She found it striking that the state is only now
confronting noncompliance and acknowledged that there are
systemic problems with reimbursement and processing. She
mentioned hearing from the medical side earlier in the day about
unresolved reimbursement issues dating back to 2022 and
emphasized that, while this legislation is not a cure-all, it is
a necessary stepespecially given the urgency of youth
behavioral health needs.
4:25:11 PM
SENATOR HUGHES acknowledged and appreciated the sponsor's
efforts but pointed out that SB 45 essentially directs
compliance with a federal law that has already been in effect
for nearly two decades. She summarized the bill's requirements
as mandating a one-time report, followed by annual reports, with
reviews of existing regulations and the need to seek changes
through the state Medicaid plan. She asked the director whether
this bill is truly necessary to solve the problem or whether the
department could haveand should havebeen making these
adjustments over the past 17 years.
SENATOR HUGHES also raised concerns about the fiscal note, which
includes an annual cost of approximately $325,000 to support
assessments and reporting. She questioned whether this amount
would be sufficient in the first year, given that the one-time
report also includes a more comprehensive market analysis. She
asked whether additional resources might be required initially,
since the first report involves more work than the annual
reports that follow.
4:26:43 PM
MS. DOMPELING responded that the key question is whether the
legislation is necessary to do the work, and she acknowledged
that, technically, it is not. However, she said she understands
the concerns raised by providersnamely, that while she,
Commissioner Hedberg, and Deputy Commissioner Ricci are all
currently committed to this issue, leadership could look very
different in two years. For that reason, she recognized the
desire to codify the Department's obligation to evaluate parity
through statute. She explained that part of the complexity lies
in the federal parity regulations being based on a Medicaid
managed care organization structure, whereas Alaska operates
under a fee-for-service Medicaid model. This creates challenges
in applying the federal parity framework directly, especially
when attempting to go line by line, since not all elements are
comparable between the two systems. She said the chair has asked
the Department to work closely with the Alaska Behavioral Health
Association to identify priorities and to thoroughly review the
regulations. The goal is to pinpoint areas where amendments
could strengthen and formalize the state's commitment to
continuing this work, both now and in the future.
4:28:38 PM
SENATOR HUGHES asked whether the $325,000 allocated for the
annual reports is sufficient to cover the additional work
required for the one-time report.
MS. DOMPELING said that at this point, the department does
consider the current funding sufficient. She explained that they
reached out to two contractors who assist with Medicaid-related
activitiesone provided a lower estimate and the other a higher
one, so the department used a mid-range figure for the fiscal
note. She stated that, based on her understanding of the SB 45,
the report in question is a one-time report. For that reason,
she believes the funding is adequate for a full, in-depth
review. However, if the reporting is intended to continue in
future years, she noted that the amount may need to be updated.
4:29:31 PM
SENATOR DUNBAR held SB 45 in committee.