05/01/2025 03:30 PM Senate HEALTH & SOCIAL SERVICES

              SB  45-MEDICAID MENTAL HEALTH PARITY                                                                          
                                                                                                                                
3:52:24 PM                                                                                                                    
CHAIR   DUNBAR  reconvened   the   meeting   and  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."                                                                                  
                                                                                                                                
3:52:34 PM                                                                                                                    
CHAIR DUNBAR  stated SB 45 was  first heard in the  Senate Health                                                               
and  Social Services  Standing Committee  meeting on  January 28,                                                               
2025,  and on  April  24, 2025,  when  committee substitute  (CS)                                                               
version I  was adopted. He stated  he is bringing SB  45, version                                                               
A, back before  the committee and intends to solicit  the will of                                                               
the committee in reporting version A from committee.                                                                            
                                                                                                                                
3:52:55 PM                                                                                                                    
ARIELLE  WIGGIN,  Staff,  Senator Forrest  Dunbar,  Alaska  State                                                               
Legislature, Juneau,  Alaska, offered the sectional  analysis for                                                               
SB 45, version A:                                                                                                               
                                                                                                                                
[Original punctuation provided.]                                                                                                
                                                                                                                                
     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.                                                                                
                                                                                                                                
3:54:21 PM                                                                                                                    
MS. WIGGIN continued with the sectional analysis for SB 45:                                                                     
                                                                                                                                
     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.                                                                                 
                                                                                                                                
3:56:52 PM                                                                                                                    
CHAIR DUNBAR opened public testimony on SB 45.                                                                                  
                                                                                                                                
3:57:10 PM                                                                                                                    
LANCE JOHNSON, Chief Operating  Officer, Alaska Behavioral Health                                                               
Association, Talkeetna,  Alaska, testified  in support of  SB 45.                                                               
He stated  that Alaska's Medicaid  program, as  a fee-for-service                                                               
state,   must  follow   federal  parity   laws,  though   current                                                               
behavioral  health  documentation   standards  are  outdated  and                                                               
overly burdensome.  He said these requirements  delay care unlike                                                               
medical treatment  and apply even when  providers bill commercial                                                               
insurance. SB 45 seeks to  align behavioral health standards with                                                               
medical care over time, ensuring  uniform and timely access while                                                               
addressing  systemic  issues  that, if  uncorrected,  worsen  the                                                               
behavioral health crisis.                                                                                                       
                                                                                                                                
4:00:20 PM                                                                                                                    
MAXWELL   MERCER,   Grants   Director,   Community   Connections,                                                               
Ketchikan, Alaska, testified in support  of SB 45. He highlighted                                                               
that  the  program  provides  intensive,  Medicaid-funded  mental                                                               
health  services  for youth  at  risk  of out-of-home  placement,                                                               
aiming   to  keep   them  in   the   community,  support   family                                                               
reunification,  and  improve  outcomes.  However,  administrative                                                               
burdens  limit their  capacity, allowing  them to  serve only  20                                                               
percent of referred families.                                                                                                   
                                                                                                                                
4:02:40 PM                                                                                                                    
CHAIR DUNBAR closed public testimony on SB 45.                                                                                  
                                                                                                                                
4:02:47 PM                                                                                                                    
CHAIR DUNBAR solicited the will of the committee.                                                                               
                                                                                                                                
4:02:51 PM                                                                                                                    
At ease.                                                                                                                        
                                                                                                                                
4:03:25 PM                                                                                                                    
CHAIR DUNBAR reconvened the meeting.                                                                                            
                                                                                                                                
4:03:28 PM                                                                                                                    
SENATOR GIESSEL  moved to report  SB 45, work  order 34-LS0146\A,                                                               
from  committee  with  individual  recommendations  and  attached                                                               
fiscal note(s).                                                                                                                 
                                                                                                                                
4:03:54 PM                                                                                                                    
CHAIR DUNBAR found  no objection and SB 45 was  reported from the                                                               
Senate Health and Social Services Standing Committee.