03/21/2012 01:30 PM Senate HEALTH & SOCIAL SERVICES

        SB 118-MEDICAID REIMBURSEMENT FOR FAMILY THERAPY                                                                    
                                                                                                                                
2:05:21 PM                                                                                                                    
CHAIR DAVIS stated that SB 118 was before the committee.                                                                        
                                                                                                                                
CELESTE HODGE, staff, Senator Bettye Davis, sponsor of SB 118,                                                                  
introduced the bill. She read from the following sponsor                                                                        
statement:                                                                                                                      
                                                                                                                                
     SB 118 is  a simple bill that  adds counseling services                                                                    
     provided by a licensed  marital and family therapist to                                                                    
     the list  of optional  services covered by  the Medical                                                                    
     Assistance  Program  in  the  state  of  Alaska.  Under                                                                    
     current  Alaska   law,  licensed  marital   and  family                                                                    
     therapists   are  not   eligible   to  receive   direct                                                                    
     reimbursement  for   services  provided   to  Medicaid-                                                                    
     eligible clients.  Community behavioral  health service                                                                    
     providers  and mental  health physicians'  clinics that                                                                    
     are enrolled  with the Medicaid  program and  employ or                                                                    
     contract  with licensed  family and  medical therapists                                                                    
     may receive Medicaid reimbursement for those services.                                                                     
                                                                                                                                
     The Department  of Health and Social  Services will pay                                                                    
     for  behavioral health  services provided  by a  mental                                                                    
     health  physician's clinic,  only if  the services  are                                                                    
     for treatment and a  diagnosable mental health disorder                                                                    
     and the services  are provided by a  psychiatrist or by                                                                    
     one of  the following  licensed professionals  who work                                                                    
     under  the  direct  supervision  of  the  psychiatrist.                                                                    
     Those  professional individuals  include psychologists,                                                                    
     psychological  associates,   clinical  social  workers,                                                                    
     physician  assistants,  advanced  nurse  practitioners,                                                                    
     psychiatric nursing  clinical specialists,  marital and                                                                    
     family  therapist,  or   professional  counselors.  For                                                                    
     community  behavior  health service  providers,  clinic                                                                    
     services must be provided by  a member of the community                                                                    
     behavior  health  service  provider's staff  who  is  a                                                                    
     physician,  a  physician's  assistant,  advanced  nurse                                                                    
     practitioner, or  mental health  professional clinician                                                                    
     under the general direction  of a physician. Otherwise,                                                                    
     the  only independent  providers  who  are eligible  to                                                                    
     bill directly  for Medicaid behavioral  health services                                                                    
     are licensed psychologists and physicians.                                                                                 
                                                                                                                                
     According  to the  Kaiser Family  Foundation, about  47                                                                    
     percent of  Alaska's population, or 334,975  are living                                                                    
     in mental  health professional shortage areas.  Of that                                                                    
     group, Kaiser estimates that over  38 percent are under                                                                    
     served. In  September of 2011, the  Alaska Primary Care                                                                    
     Association  issued  a resolution  supporting  Medicaid                                                                    
     licensed marriage and  family therapists, among others,                                                                    
     in  order  to address  the  shortage  of mental  health                                                                    
     providers and  to improve  access to  behavioral health                                                                    
     services in the state.                                                                                                     
                                                                                                                                
SENATOR DAVIS opened public testimony.                                                                                          
                                                                                                                                
2:08:35 PM                                                                                                                    
KEN MCCARTY, Marriage and Family  Therapist, spoke in favor of SB
. He discussed the lack of  family therapists in the state. He                                                               
described some  of the  frustrations from  this issue  and shared                                                               
examples in Kodiak, Barrow, and  Nome. He explained that American                                                               
Family Therapists  can provide mental  health work  and substance                                                               
abuse treatment.  Adding them  to the list  under Title  47 would                                                               
give the state more resources to provide for community needs.                                                                   
                                                                                                                                
2:11:20 PM                                                                                                                    
MICHAEL WEINGARTEN,  Marriage and Family Therapist,  testified in                                                               
support of  SB 118. He  shared his  experience with all  types of                                                               
clients. He  related that very  few Medicaid clients show  up for                                                               
counseling  without  a  referral  from some  agency,  person,  or                                                               
court.  Many children  in residential  treatment are  required to                                                               
have  family  treatment.  Most  Medicaid  patients  show  up  for                                                               
treatment because  they must.  He spoke  in favor  of independent                                                               
therapists being included  on the list of  providers, as included                                                               
in this bill.                                                                                                                   
                                                                                                                                
2:17:16 PM                                                                                                                    
JANA MINER-COLLINS,  Marriage and Family Therapist,  testified in                                                               
support of  SB 118.  She spoke  of the  possibility of  having to                                                               
turn Medicaid  clients away  because of the  loss of  a physician                                                               
who provided  those services. Those  clients will not be  able to                                                               
receive services  because therapists are not  currently listed as                                                               
Medicaid providers.                                                                                                             
                                                                                                                                
LINDA KING, President, Alaska Association  of Marriage and Family                                                               
Therapy,  testified  in  support  of  SB  118.  She  related  her                                                               
experience in a  clinic that turns away  Medicaid clients because                                                               
therapists are  not currently considered providers.  She reported                                                               
that Alaska has  a high number of child neglect  and abuse cases,                                                               
and there  is a problem with  lack of therapy services  for these                                                               
children, leading  to a  cycle of abuse.  She reported  that most                                                               
states  allow  licensed  marital  and  family  therapists  to  be                                                               
included as Medicaid providers.                                                                                                 
                                                                                                                                
2:22:52 PM                                                                                                                    
CHAIR DAVIS requested  someone from the Department  of Health and                                                               
Social Services to testify on the bill.                                                                                         
                                                                                                                                
JON   SHERWOOD,  Medicaid   Special  Projects,   Office  of   the                                                               
Commissioner, Department of Health  and Social Services, provided                                                               
information  about a  fiscal note  for SB  118 regarding  medical                                                               
assistance  administration.  He  related  information  about  the                                                               
changes to  the claims  payment system.  He estimated  a one-time                                                               
cost of $275,000 of which $68,800 would be general funds.                                                                       
                                                                                                                                
CHAIR DAVIS asked  if family therapists would be an  asset to the                                                               
state under Medicaid.                                                                                                           
                                                                                                                                
2:25:17 PM                                                                                                                    
TERI   KEKLAK,  Section   Manager,   Program  Integrity   Section                                                               
Division, Department  of Behavioral Health, Department  of Health                                                               
and Social Services, provided information  related to SB 118. She                                                               
reported that the division is  neutral on the bill. She explained                                                               
that when a  new provider is added to the  Medicaid system, there                                                               
are  issues to  work on  before implementation  of a  new service                                                               
category can be  added. She stated that adding a  new provider to                                                               
Medicaid improves access to clients.                                                                                            
                                                                                                                                
CHAIR DAVIS said the bill would  be going to Senate Finance next.                                                               
She opined that the bill  was needed. She asked committee members                                                               
for their opinions.                                                                                                             
                                                                                                                                
2:27:36 PM                                                                                                                    
SENATOR DYSON shared that he did  not have a conflict of interest                                                               
now that  his wife has retired  as a licensed marital  and family                                                               
therapist.                                                                                                                      
                                                                                                                                
DIXIE HOOD,  Marriage and Family  Therapist, urged  the committee                                                               
to support  SB 118. She  said she the  bill would allow  for more                                                               
options for  patients seeking counseling services,  especially in                                                               
areas  with  limited mental  health  providers.  She opined  that                                                               
including  therapists under  Medicaid  would save  money from  no                                                               
longer having  psychiatrists and psychologists travel  to provide                                                               
those  services.  Passage  of  SB 118  would  also  provide  fair                                                               
reimbursement to therapists.                                                                                                    
                                                                                                                                
She shared  her experience of  providing a sliding fee  scale for                                                               
Medicaid  patients in  order  to  serve them.  She  spoke of  the                                                               
qualifications  to be  a licensed  therapist, her  wide range  of                                                               
experience,  and  the   unfairness  of  not  being   able  to  be                                                               
reimbursed for Medicaid.                                                                                                        
                                                                                                                                
2:35:12 PM                                                                                                                    
CHAIR  DAVIS thanked  Ms. Hood  for her  work. She  closed public                                                               
testimony.                                                                                                                      
                                                                                                                                
CHAIR DAVIS stated that she felt the bill was needed.                                                                           
                                                                                                                                
SENATOR  EGAN  moved  to  report   SB  118  from  committee  with                                                               
individual  recommendations and  the  accompanying fiscal  notes.                                                               
There being  no objection,  SB 118 was  reported from  the Senate                                                               
Health and Social Services Standing Committee.