Legislature(2019 - 2020)BUTROVICH 205
02/26/2020 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB173 | |
| SB134 | |
| SJR13 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SJR 13 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 173 | TELECONFERENCED | |
| += | SB 134 | TELECONFERENCED | |
SB 134-MEDICAID COVERAGE OF LIC. COUNSELORS
1:34:36 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 134, "An Act relating to
medical assistance reimbursement for the services of licensed
professional counselors; and providing for an effective date."
He noted that he is the prime sponsor of SB 134. The bill was
presented on February 21, 2020 and public testimony was taken.
This is the second hearing on the bill.
1:35:16 PM
DAVE WALLACE, Chief Executive Officer, Mat-Su Regional Medical
Center, Palmer, Alaska, said Mat-Su Regional is a 125-bed acute
care hospital in the fastest growing service area in Alaska. The
Medicaid coverage for licensed professional counselors is
important because it is part of the continuum of care for
behavioral health. He expressed concern on the lack of
behavioral health services in Mat-Su and throughout the state.
Mat-Su Regional seeks to have care provided at the most
appropriate level. If more counselors are paid to see Medicaid
patients with behavioral health needs, it will keep the patients
from going to a higher, more expensive level of care, such as
the emergency department.
MR. WALLACE said Mat-Su Regional works with the Mat-Su Health
Foundation to reduce the overuse of the emergency department
through the High Utilizer Mat-Su project [HUMS]. HUMS targets
patients who have used the emergency department at least five or
more times in a year. He reported that 68 percent of over
utilizers are Medicaid recipients. The majority of these
patients suffer from a primary or secondary diagnosis related to
behavioral health. His counterparts at Mat-Su Health Foundation
have testified that this program has reduced costs.
MR. WALLACE said the number of patients served is relatively
small but Mat-Su Regional estimates it has saved over $1 million
dollars by reducing the number of emergency room (ER) visits by
overutilizers. Sixty percent of ER patients have a behavioral
health diagnosis and would benefit from counseling. Allowing
counselors to serve behavioral health patients will result in
additional savings to the state for Medicaid services. With
passage of SB 134, Mat-Su Regional's primary care clinic can use
its licensed professional counselor to serve Medicaid patients.
SB 134 will enhance the continuum of care.
1:39:12 PM
ELIZABETH RIPLEY, Chief Executive Officer, Mat-Su Health
Foundation, Wasilla, Alaska, said SB 134 is crucial because it
will help address Mat-Su residents' mental health and substance
use disorders. Licensed professional counselors are key
behavioral health providers for these issues. Mat-Su residents
identified prominent issues in the Mat-Su Health Foundation's
last three community needs assessments. In 2013, residents and
professionals indicated the top five health challenges were
alcohol and substance abuse, children experiencing trauma and
violence, depression and suicide, domestic violence and sexual
assault, and lack of access to behavioral health care.
Counseling services can address these issues. SB 134 would
expand the health care professions by including professional
counseling services to residents on Medicaid.
MS. RIPLEY said the prevalence of mental health and substance
use disorders and crises is increasing in the Mat-Su region and
statewide. The average annual growth rate for Mat-Su Regional
emergency department visits for patients with behavioral health
diagnoses was 20 percent from 2015 to 2017. This increase is
largely due to the opioid epidemic and lack of access to
treatment. She said Mr. Wallace reported that Mat-Su Regional
has an inpatient unit, but up until last year the hospital did
not provide behavioral health care treatment. Passage of SB 134
will help address behavioral health issues by providing patients
with the appropriate level of care at the onset of the problem,
before their behavior health issues escalate. Mat-Su Regional is
inundated with behavioral health patients in crisis. In 2016,
3,443 residents seen by the ER had a primary behavioral health
diagnosis. Of the 3,443 patients using the ER 8,400 times, 46
percent were on Medicaid. The top diagnoses for these patients
were suicidal ideation and self-harm, alcohol-related disorders,
delirium, dementia, and cognitive disorders. These ER visits
cost $43.8 million dollars solely for facility charges. The
average charge per visit was $5,216 and the average per patient
cost totaled $12,725. Clearly, the emergency department is the
least cost effective method to treat behavioral health problems.
Early intervention with more immediate patient access to a
behavioral health providers can reduce costs for the hospital
and the state and reduce patient pain and suffering.
1:44:22 PM
MS. RIPLEY said access remains a problem. Very few primary care
practices employ behavioral health providers. She indicated that
two of the many primary care practices in Mat-Su, outside of
federally qualified health centers, employ a behavioral health
clinician. One reason there is so little integration of
behavioral health in these practices is that providers cannot
bill Medicaid for professional counseling services. Another
reason is due to a shortage of psychiatrists to supervise
behavioral health providers. She noted that Senator Giessel
sponsored Senate Bill 169, which passed the legislature in 2018,
allows behavioral health care providers to be supervised by any
physician.
MS. RIPLEY said Senate Bill 105 authorized Medicaid
reimbursement for marriage and family counselors. The next step
is to add Medicaid reimbursement to behavioral health providers,
which will meet patient needs and make behavioral health
services sustainable in physician offices.
MS. RIPLEY noted that Mr. Wallace referenced HUMS. The Mat-Su
Foundation started HUMS as a way to provide care coordination
and access to community supports for high utilizers, defined as
residents who had five or more visits in the emergency system in
a year and who were unable to independently access consistent
and appropriate care and support in the community. Mr. Wallace
mentioned the dramatic cost savings of more than one million
dollars a year. The Mat-Su Foundation is entering the third year
of the project. It also has alleviated significant trauma for
not just the patients, but for the health care providers and
family who often suffer trauma along with the patients.
MS. RIPLEY said there would be far less need for programs like
HUMS if people had access to care and support before their needs
become a crisis. The project has had more than $2.168 million in
cost savings. The project has a third party evaluator who tracks
its progress and any need for course correction. In 2018,
$347,288 in emergency room charges was saved by the top three
utilizers alone. That same year seven patients who enrolled in
HUMS did not use the emergency department at all.
She said the age of the super utilizers ranges from 16 to 82.
Seventy-two percent have Medicaid coverage. She related a story
of a young adult who had 17 visits to the emergency department
before enrolling in HUMS. Most of his emergency visits led to
inpatient admission and he seemed to have little to no interest
in improving his situation. The HUMS team built a rapport with
the client and he did want to change. He is now sober, his
diabetes is managed, he is working full time, and has a great
relationship with his primary care provider. He has years to
live to make a positive difference.
1:50:47 PM
JARED KOSIN, President and Chief Executive Officer, Alaska State
Hospital and Nursing Home Association, Anchorage, Alaska, said
SB 134 is good policy. People talk about cutting costs and
investing in the continuum of care at the community level, where
it is a lot cheaper, and reserving those higher level, more
expensive settings for people who actually need it is the way to
do so. This is a very practical step forward.
1:51:46 PM
CHAIR WILSON solicited a motion.
1:52:01 PM
SENATOR VON IMHOF moved to report SB 134, version 31-LS1261\A,
from committee with individual recommendations and attached
fiscal notes.
There being no objection, SB 134 was reported from the Senate
Health and Social Services Standing Committee.