Legislature(2003 - 2004)
04/09/2003 01:31 PM Senate HES
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* first hearing in first committee of referral
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= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 157-INPATIENT PSYCHIATRIC SERVICES
CHAIR FRED DYSON announced SB 157 to be up for consideration.
SENATOR LYDA GREEN, sponsor, said SB 157 addresses instate and
out-of-state psychiatric facilities, and is particularly
directed toward the children of the state who are either on
Medicaid or in state custody and must leave Alaska to receive
services. This bill requires that those children be placed
instate for psychiatric care as long as a suitable place can be
found.
SENATOR GRETCHEN GUESS asked if the terms "appropriately
address" and "unavailable" are strong enough words to use to
decide if the clinical diagnosis can be addressed in the state.
SENATOR GREEN replied that she thought they provide a moveable
target for each individual that would require a very personal
evaluation.
CHAIR DYSON said he supports this bill, but it seems that the
department would never send someone out of state if an instate
facility was available and that the bill might be superfluous.
He asked what the bill changes.
SENATOR GREEN explained that currently the department cannot
disallow a person from choosing the facility to which he or she
wishes to go, particularly if the person is receiving health
care through the Denali Kid Care program. A little over 200
individuals have been placed in outside facilities with no
review by a state entity. This bill would require that instate
services be exhausted before they are sent outside. It would
also encourage groups to either add on to a current facility,
like a juvenile psychiatric facility, or do some other form of
instate upgrading.
MR. BILL HOGAN, Director, Division of Mental Health and
Developmental Disabilities, DHSS, supported the concept of SB
157, which affirms the current process the department uses to
ensure that instate options are explored before a child is
placed out of state. They feel the bill supports and enhances
the monitoring of those children once they are placed out of
state to determine if they are ready to come back and, if they
are, that there is an instate option available. It supports the
department's view that children should be served in Alaska, in
their own community and as close as possible to their own
family.
CHAIR DYSON asked why these instate services evolved in the past
and whether this piece of legislation removed some of those
impediments.
MR. HOGAN replied he understands that on occasion, instate
options are available and for some reason they are not being
taken advantage of at the time. Another issue is whether or not
adequate funding is available to build instate capacity.
MR. JOHN DUFFY, Manager, Mat-Su Borough, supported SB 157 for
all the reasons stated. He said the state is presently sending
350 children out of state. SB 157 will save the state large
amounts of money as instate treatment is much less expensive and
improves the chances of success in allowing children to be
closer to their family support networks. In addition, SB 157
will bring jobs back to Alaska and reduces the risk for
additional private sector investment in residential treatment
centers by assuring that the state will consider use of them
before sending children out of state.
CHAIR DYSON asked if he anticipates that a state facility might
be started or enhanced in the Mat-Su Valley.
MR. DUFFY replied that the borough has been approached by at
least two firms that are interested in constructing such
facilities out there.
MS. KATHY CRONIN RAPOPORT, Regional Vice President, Universal
Health Services, supported SB 157. She said she is also
responsible for the Universal Health Care facilities in Utah.
She concurred that there are over 350 children in residential
psychiatric treatment centers in the Lower 48. Northstar
Hospital is their inpatient acute care hospital and has 58
patients. Four of them are pending discharge in the next few
days. All four are children on Alaska State Medicaid who are
being referred to treatment centers outside the state on the
recommendation of their caseworker and the outside placement
committee. This is happening while Northstar has nine available
residential treatment beds. She continued:
Referring these kids to treatment centers outside the
state has devastating long-term impacts on the
children, their families, and ultimately on our state.
Mental health treatment should be provided close to
home where we can have good coordination for follow-up
care with the residential treatment provider and the
outpatient provider who will see the patient after
discharge. Most importantly, treatment should involve
the family. Family treatment is a critical element of
children's mental health treatment. Their treatment in
the local community is good for the children, their
family, and it increases their chances for long-term
success...
MS. RAPOPORT agreed that bringing children home for treatment
will encourage providers in the state to expand existing
residential facilities and services and will encourage new
providers to enter the market.
MS. TERRY KEKLAK said she would answer questions.
CHAIR DYSON asked her how much out-of-state placement costs per
day.
MS. KEKLAK replied that she didn't have any specifics, but most
out-of-state rates are in the $325 per day or lower range. She
knew of one child who had a rate of $600 per day, based on
additional medical needs.
SENATOR DAVIS asked her to comment on why children are placed
out-of-state.
MS. KEKLAK replied that for a service to be paid by the Medicaid
program, an interdisciplinary team is required to review the
placement and make a recommendation regarding what is in the
best interest of the child. They look at whether existing state
services are appropriate for that child. With Medicaid, the
child travels to the closest available facility that is found to
meet their medical needs. All inpatient stays are authorized by
an outside contractor who is looking at all the criteria before
an out-of-state admission would be approved for payment.
SENATOR DAVIS asked if the available instate facility can be
turned down in lieu of outside placement and still be covered.
MS. KEKLAK replied no.
SENATOR GUESS asked if they use the same process for state
custody children.
MS. KEKLAK replied that those children have a placement
committee in addition to the Medicaid requirements.
MR. RICHARD RAINERY, Executive Director, Alaska Mental Health
Board, stated that the amendment is in concert with the Board's
philosophy that the community should be involved with the mental
health system.
SENATOR GREEN moved to adopt Amendment 1.
23-LS0179\D.1
Lauterbach
12/1/04
A M E N D M E N T
OFFERED IN THE SENATE BY SENATOR GREEN
TO: SB 157
Page 2, following line 12:
Insert a new subsection to read:
"(c) When determining whether to authorize admission
of a person under 21 years of age to a psychiatric hospital
facility or residential psychiatric treatment center,
either located within the state or outside the state, the
department shall include in its consideration the
recommendations of a person selected by the Alaska Mental
Health Board established by AS 47.30.661 who is selected
for this duty by the board on the basis of being
knowledgeable about the availability of beds in the state
for inpatient psychiatric services for persons under 21
years of age. The board may not select an employee of the
department for this duty."
Page 3, following line 10:
Insert a new subsection to read:
"(m) When determining whether to authorize admission
of a person under 21 years of age to a psychiatric hospital
facility or residential psychiatric treatment center,
either located within the state or outside the state, the
department shall include in its consideration the
recommendations of a person selected by the Alaska Mental
Health Board established by AS 47.30.661 who is selected
for this duty by the board on the basis of being
knowledgeable about the availability of beds in the state
for inpatient psychiatric services for persons under 21
years of age. The board may not select an employee of the
department for this duty."
There were no objections and it was adopted.
MR. RAINERY pointed out that one of the reasons the state
doesn't have facilities like this is because sending kids out-
of-state is a relatively recent phenomenon and, also, the number
of children being sent is no longer a question.
SENATOR GUESS moved to pass CSSB 157(HES) from committee with
individual recommendations and zero fiscal note. There were no
objections and it was so ordered.
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