03/19/1997 09:05 AM Senate HES

                                                                               
          SB  48 APPROPRIATION: MENTAL HEALTH PROGRAM                         
                                                                              
  CHAIRMAN WILKEN  introduced  SB 48  as the final order of business           
 before the committee.                                                         
                                                                               
  JEFF JESSEE , Executive Director of the Alaska Mental Health Trust           
 Authority (AMHTA), informed the committee that the primary mission            
 of the Trust Authority is to manage the trust in perpetuity to                
 enhance the lives of its beneficiaries.  Mr. Jessee began his                 
 review of the FY98 Mental Health Budget Overview document.  (See              
 Attachment A)  Mr. Jessee identified the beneficiaries of the                 
 Trust, which represent a broad group not limited to mental illness.           
 The comprehensive mental health program is broader than the                   
 beneficiaries.  Mr. Jessee emphasized that prevention is essential            
 for a long term strategy which is evident in the Trust's budget               
 recommendations.                                                              
                                                                               
 Mr. Jessee explained that the AMHTA income account consists of                
 three percent of the Trust fund balance at the Alaska Permanent               
 Fund Corporation plus 100 percent of Trust land income.  The Trust            
 land office is $300,000 over the projected income for FY97 which              
 totals $1.3 million.  Mr. Jessee reviewed the sheet in Attachment             
 A which specifies where the funds go.  The colored sheet in                   
 Attachment A clarifies how the Trust develops budget                          
 recommendations per the existing structure of planning.                       
 Recommendations from various groups are made to the Trust who then            
 develops a strategic funding plan.                                            
                                                                               
  TAPE 97-29, SIDE A                                                           
                                                                               
 Number 008                                                                    
                                                                               
 Mr. Jessee explained that the separate appropriation bill for                 
 mental health is basically program budgeting.  Separate programs              
 for each beneficiary group was created which allowed focus on the             
 specific technology and funding mechanisms to meet that group's               
 needs.  However the negative impact of that separation was the loss           
 of the ability to integrate the services between populations.  For            
 example, dual diagnosis such as a person with alcoholism and a                
 mental illness could lead to that persons exclusion from one                  
 portion of the treatment.  A program budget attempts to obtain a              
 comprehensive view of the services and then integrate the services            
 which result in budget recommendations.                                       
                                                                               
 Mr. Jesse reviewed the funding priorities listed in Attachment A.             
 The closure of the Harborview Developmental Center is a high                  
 priority.  The difficulty in transitioning out of institutional               
 care is that the end result is apparent, but that transition                  
 requires double funding.  The institution must be run at full                 
 capacity while building up the community alternatives.  With                  
 Harborview, the Trust used Trust income to facilitate the                     
 transition to the community based delivery system.  Therefore,                
 general fund monies were freed to be placed into community                    
 programs.  Now that the population of Harborview decreases so does            
 the Trust's income support.  In FY98, everyone should be                      
 transitioned from Harborview.  Mr. Jessee believed that a similar             
 strategy should be utilized with the downsizing of API.                       
                                                                               
 Number 091                                                                    
                                                                               
 Mr. Jessee also mentioned the consumer outcome funding priority.              
 The trustees want to quantify the effect of the funding.  For                 
 example if there is an employment program, how many people were               
 placed into jobs.  Therefore some of the projects attempt to obtain           
 that outcome information.  Once that information is available, the            
 Trust and the Legislature has the basis to make rational funding              
 decisions based on the outcomes.                                              
                                                                               
 Mr. Jessee continued with the AMHTA budget recommendations included           
 in Attachment A.  Mr. Jessee stated that the AMHTA Authorized                 
 Receipts column are for important areas not extras as some believe.           
 The General Fund/Mental Health column illustrates the focus on                
 building the infrastructure which the state needs to provide for a            
 comprehensive program.  Mr. Jessee pointed out that Alaska has a              
 huge aging population which can be illustrated in the money                   
 requested for case management and increased respite care for                  
 seniors.  This is an attempt to avoid the more costly institutions.           
 The suggestions for the general fund are focused on strategic                 
 improvements in the manner in which services are delivered.                   
                                                                               
 Mr. Jessee turned to the Capital Budget recommendations included in           
 Attachment A.  Again the Trust has tried to partner with the state;           
 to use the Trust's funds as often as possible to match general                
 funds.  Mr. Jessee believed the match process worked well because             
 it ensures that there is a consistent direction.                              
                                                                               
 Number 159                                                                    
                                                                               
  SENATOR WARD  asked if the $50,000 for the UN Conference would be            
 utilized for providers to come or for people from Native                      
 communities to come.   JEFF JESSEE  clarified that the money will             
 attempt to get people from rural areas, primarily consumers, to               
 participate in that conference.  Mr. Jessee stressed that the                 
 intent is not to subsidize providers.                                         
                                                                               
  SENATOR WARD  asked if any of the appropriations went out to RFPs.           
  JEFF JESSEE  explained that virtually all of the money flowing from          
 the Trust goes to administrative agencies, either the DHSS or the             
 Commission on Aging.  The majority of those dollars are placed on             
 a RFP for competitive grants.  In further response to Senator Ward,           
 Mr. Jessee clarified that under the settlement AMHTA could freely             
 spend funds without legislative appropriation.  Mr. Jessee did not            
 want to create a set of grant administrators that would duplicate             
 the grant administrators that already exist within state                      
 government.  Therefore, AMHTA is working with those agencies as               
 surrogate administrators.  Mr. Jessee pointed out that grants under           
 $10,000 that are awarded three times a year are decided upon by the           
 staff, off budget.  Mr. Jessee discussed the outcomes measures area           
 which are done off budget in order to ensure that the trustees have           
 control.                                                                      
                                                                               
  SENATOR ELLIS  requested that Mr. Jessee explain the $1 million              
 offer to Medicaid services and comment regarding the cuts proposed            
 by the House to Medicaid services.                                            
                                                                               
  JEFF JESSEE  explained that the trustees have tried to assist the            
 state in turning on Medicaid options such as vision and dental.               
 AMHTA is offering $1.5 million Trust income to match a similar                
 amount from the state to access a similar amount from the federal             
 government.  With regards to the proposed Medicaid reductions, Mr.            
 Jessee expressed concern that would eliminate the possibility for             
 the state and the Trust to work together to turn on those options.            
                                                                               
  CHAIRMAN WILKEN  said that he would entertain a motion.                      
                                                                               
  SENATOR GREEN  moved to report SB 48 out of committee with                   
 individual recommendations.  Without objection, it was so ordered.            
                                                                               
 There being no further business before the committee, the meeting             
 was adjourned at 10:55 a.m.