03/15/2010 09:00 AM Senate FINANCE

SENATE BILL NO. 219                                                                                                           
                                                                                                                                
     "An Act  establishing a traumatic brain  injury program                                                                    
     and  registry  within  the  Department  of  Health  and                                                                    
     Social  Services; and  relating  to medical  assistance                                                                    
     coverage for traumatic brain injury services."                                                                             
                                                                                                                                
9:35:18 AM                                                                                                                    
                                                                                                                                
ESTHER  CHA, STAFF  TO  LESIL MCGUIRE  outlined the  sponsor                                                                    
statement.                                                                                                                      
                                                                                                                                
     The CS for Senate Bill  219E establishes a traumatic or                                                                    
     acquired  brain  injury  program specifically  to  deal                                                                    
     with  brain  injury  and  yet Alaska  has  one  of  the                                                                    
     highest rates in the nation.  Annually, there are about                                                                    
     800  Alaskans  hospitalized   with  a  traumatic  brain                                                                    
     injury  resulting  from  falls, car  crashes,  domestic                                                                    
     violence,  All  Terrain   Vehicle  crashes,  and  show-                                                                    
     machine   crashes,   among  others.   Furthermore,   an                                                                    
     approximately  equal number  of Alaskans  are suffering                                                                    
     from  acquired brain  injuries  resulting from  stroke,                                                                    
     aneurism, or tumors.                                                                                                       
                                                                                                                                
     Alaskan urban  and rural residents,  including military                                                                    
     are  being  discharged  to   their  homes  with  little                                                                    
     understanding  of brain  injury or  access to  in-state                                                                    
     rehabilitation,  severely   impacting  their  families.                                                                    
     Limited education  about the  injury, learning  to cope                                                                    
     with  a person  who  has  changed, overwhelming  stress                                                                    
     form insurance, bureaucracy,  and financial burdens and                                                                    
     change   in   family    roles   may   render   families                                                                    
     dysfunctional.                                                                                                             
                                                                                                                                
     With  appropriate and  available care,  rehabilitation,                                                                    
     community and  family support, even the  individual who                                                                    
     is most  severely injured can  live at home,  return to                                                                    
     school or work, or  engage in meaningful and productive                                                                    
     lives.                                                                                                                     
                                                                                                                                
     Funding a  Traumatic or  Acquired Brain  Injury Program                                                                    
     (T/ABI)  gives authority  to the  Department of  Health                                                                    
     and  Social Services  to collect  data  on the  injured                                                                    
     positioning  the state  to  access  Medicaid funds  for                                                                    
     T/ABI. Medicaid services for T/ABI  will be matched 50%                                                                    
     by  federal funds.  The  bill  allows for  streamlining                                                                    
     department services  and activities that are  unique to                                                                    
     T/ABI.   This   would   better  assist   families   and                                                                    
     individuals  with  T/ABI  in   knowing  how  to  access                                                                    
     services and supports.                                                                                                     
                                                                                                                                
     Early treatment  may reduce  future medical  and social                                                                    
     costs. Without  appropriate services,  some individuals                                                                    
     with T/ABI may  pose a threat to  themselves or others.                                                                    
     Without assistance,  individuals with TBI often  end up                                                                    
     homeless,  in   jail  or  in  nursing   homes.  Service                                                                    
     coordination,  rehabilitation and  appropriate supports                                                                    
     can help to minimize these risks.                                                                                          
                                                                                                                                
9:38:36 AM                                                                                                                    
                                                                                                                                
Senator Olson  asked if  a demented  patient who  suffered a                                                                    
motor  vehicle  accident  and  subsequent  injury  to  their                                                                    
vasculature  would  be  eligible  for the  waiver.  Ms.  Cha                                                                    
responded  that  under  current Medicaid  waivers  a  person                                                                    
suffering from  dementia can already  apply for  a different                                                                    
waiver  and  address the  issue  attached  to the  traumatic                                                                    
brain injury.                                                                                                                   
                                                                                                                                
Co-Chair Stedman pointed out one  zero fiscal note from DHSS                                                                    
showing  an  increased  cost of  $494,600  in  general  fund                                                                    
dollars and $774,400 in federal receipts.                                                                                       
                                                                                                                                
9:40:10 AM                                                                                                                    
                                                                                                                                
ERIC FINE,  ALASKA BIKERS ADVOCATING TRAINING  and EDUCATION                                                                    
(ABATE) OF  ALASKA, KASILOF (via  teleconference), expressed                                                                    
concerns about SB 219. He stated  that he was not opposed to                                                                    
SB  219, but  he recognized  provisions that  might lead  to                                                                    
unintended  consequences.  He  informed  that  Article  5(a)                                                                    
Section  47.80.500, item  3 reads  "evaluation of  standards                                                                    
and  laws pertaining  to the  prevention of  traumatic brain                                                                    
injury into the  treatment care and support  of persons with                                                                    
traumatic brain injury."  He believed that if  it remains as                                                                    
written it might  lead to a call for  a mandatory motorcycle                                                                    
helmet  law.  He  opined  that Alaska  does  not  see  large                                                                    
numbers  of  motorcyclists  becoming  victims  of  traumatic                                                                    
brain injury because we are not required to wear helmets.                                                                       
                                                                                                                                
9:42:54 AM                                                                                                                    
                                                                                                                                
CARL   LIEBES,  ALASKA   BIKERS   ADVOCATING  TRAINING   AND                                                                    
EDUCATION (ABATE)  OF ALASKA, NIKISKI  (via teleconference),                                                                    
testified in opposition to the legislation as worded.                                                                           
                                                                                                                                
BOYD    MCFAIL,   ANCHORAGE,    ABATE    OF   ALASKA    (via                                                                    
teleconference)  echoed  the  testimony  of  the  prior  two                                                                    
testifiers.                                                                                                                     
                                                                                                                                
9:45:47 AM                                                                                                                    
                                                                                                                                
NANCY  BURKE,   AK  MENTAL   HEALTH  TRUST   AUTHORITY  (via                                                                    
teleconference),  testified  in  support   of  SB  219.  She                                                                    
explained that the Mental Health  Trust Authority has worked                                                                    
with partners  such as  the Alaska  Brain Injury  Network to                                                                    
establish a  program to assist survivors  of Traumatic Brain                                                                    
Injury  in  the state.  The  Mental  Health Trust  Authority                                                                    
views the  legislation as a  step forward in  assisting them                                                                    
and documenting  the incidence of brain  injury and learning                                                                    
information about survivors of  brain injury and their needs                                                                    
for service delivery.                                                                                                           
                                                                                                                                
PAT   CHAPMAN,   SELF,   KETCHIKAN   (via   teleconference),                                                                    
testified  in support  of the  legislation. She  stated that                                                                    
she collects the trauma data  for the hospital in Ketchikan.                                                                    
She opined  that the state  must identify the  brain injured                                                                    
person and connect them with a case manager.                                                                                    
                                                                                                                                
9:50:15 AM                                                                                                                    
                                                                                                                                
Senator Olson  noted that  accidents that  involve traumatic                                                                    
brain injuries  equal approximately one percent  of reported                                                                    
accidents.  He asked  for  additional information  regarding                                                                    
the  public  funds  dispensed  for   the  citizens  who  are                                                                    
traumatically injured and then  hospitalized for an extended                                                                    
period of time.                                                                                                                 
                                                                                                                                
CHRISTIE ARTUSO,  DIRECTOR NEUROSCIENCES,  PROVIDENCE ALASKA                                                                    
MEDICAL  CENTER (via  teleconference), testified  in support                                                                    
of SB  219. She pointed  out that the bill  allows statutory                                                                    
authority for  DHSS to  address many  of the  serious issues                                                                    
that  have   already  been   identified  as   affecting  the                                                                    
wellbeing  of  Alaskans.  The  legislation  facilitates  the                                                                    
state's  ability  to  provide   essential  services  to  the                                                                    
population of patients with traumatic  brain injury who have                                                                    
been neglected.                                                                                                                 
                                                                                                                                
KRISTIN  ENGLISH,  CHEIF   OPPERATING  OFFICER,  COOK  INLET                                                                    
TRIBAL  COUNCIL (via  teleconference), testified  in support                                                                    
of  SB  219.  She  believed  that  increased  attention  for                                                                    
traumatic brain  injury would be beneficial.  She cited that                                                                    
46 percent  of the patients  seen in the  detoxification and                                                                    
in  residential substance  abuse  service  self report  some                                                                    
form of traumatic brain injury.                                                                                                 
                                                                                                                                
9:56:21 AM                                                                                                                    
                                                                                                                                
SEAN  MURPHY,   SELF  (via  teleconference),   testified  in                                                                    
support of SB 219. He  explained that he was recovering from                                                                    
a  brain  injury. He  explained  that  he  was in  a  skiing                                                                    
accident  two years  ago where  he  hit a  tree. Three  days                                                                    
following the accident  he woke from the coma  and could not                                                                    
talk, walk,  or feed himself.  He stated that SB  219 allows                                                                    
DHSS  many  specifics  to  address  the  issues  related  to                                                                    
traumatic  brain injury  accidents.  He  believed that  case                                                                    
management  services  would  have   aided  in  his  recovery                                                                    
process.                                                                                                                        
                                                                                                                                
9:59:09 AM                                                                                                                    
                                                                                                                                
MAJOR  WILLIAM  ALLEN,  MARINE CORPS  (via  teleconference),                                                                    
testified  in  support  of   the  legislation.  He  suffered                                                                    
exposure  to  explosive  devices   while  serving  in  Iraq.                                                                    
Effects  on  the brain  when  classified  as mild  can  take                                                                    
months or years to  heal themselves. Following the exposure,                                                                    
he was  able to function at  a high level. The  effects were                                                                    
most apparent  following his return home.  He suffered eight                                                                    
separate blasts and was able to  function at a high level at                                                                    
work, but the symptoms presented  themselves at home when he                                                                    
could relax.  He thought the  additional support would  be a                                                                    
benefit  to  family members  and  veterans  who make  Alaska                                                                    
their residence.                                                                                                                
                                                                                                                                
JILL  HODGES,   EXECUTIVE  DIRECTOR,  ALASKA   BRAIN  INJURY                                                                    
NETWORK, testified  in support of  SB 219. The  Alaska Brain                                                                    
Injury  Network   travels  around   the  state   talking  to                                                                    
community members  who have suffered brain  injuries. Alaska                                                                    
Trauma  Registry  Data  shows  that over  10,000  have  been                                                                    
hospitalized  with  a  severe  traumatic  brain  injury.  Of                                                                    
those, 72  percent go home without  assistance. Occasionally                                                                    
traumatic   brain  injury   becomes   a  chronic,   lifelong                                                                    
condition that  is often manageable.  She stressed  the need                                                                    
for an educational packet  explaining traumatic brain injury                                                                    
and what to expect. She  explained that SB 219 establishes a                                                                    
foundation  to  give  brain  injury   a  home  within  state                                                                    
government  while  providing  proper investment  of  current                                                                    
funding  for behavioral  health and  corrections. She  cited                                                                    
necessary  steps  as  establishing a  registry,  identifying                                                                    
brain   injury   as   a  chronic   longitudinal   condition,                                                                    
establishing  a   home  within  state  government   to  plan                                                                    
directly for the population.                                                                                                    
                                                                                                                                
10:06:42 AM                                                                                                                   
                                                                                                                                
Senator  Olson  expressed  concerns  of  Alaskans  regarding                                                                    
absurd  regulations  resulting  from the  data.  Ms.  Hodges                                                                    
responded that  the bill's  focus is on  those who  have the                                                                    
injuries at  no fault of  their own. Without  the aftercare,                                                                    
there are  limited chances of  full recovery.  She mentioned                                                                    
that the  number one cause of  brain injury in the  state is                                                                    
falling. She  noted the legislation's  focus on  assault and                                                                    
substance abuse prevention.                                                                                                     
                                                                                                                                
10:08:00 AM                                                                                                                   
                                                                                                                                
ANGELA SALERNO, EXECUTIVE  DIRECTOR, NATIONAL ASSOCIATION OF                                                                    
SOCIAL WORKERS  ALASKA CHAPTER,  testified in  opposition to                                                                    
the legislation as written. She  cited Section 2 of the bill                                                                    
which  gives DHSS  the authority  to seek  a Medicaid  state                                                                    
plan amendment  to add case  management services  for people                                                                    
with  traumatic brain  injury. Section  3 shows  a different                                                                    
definition  of case  management  for  people with  traumatic                                                                    
brain injury, which she sees  as problematic. The definition                                                                    
is not  consistent with the  federal definition  of targeted                                                                    
case management and  it could cause the  federal centers for                                                                    
Medicare  and Medicaid  to  deny any  claims  made for  case                                                                    
management services. She  suggested eliminating the language                                                                    
and replacing it with a  reference to the federal definition                                                                    
that  will stop  any  confusion. She  noted  that Section  4                                                                    
requires DHSS  to serve people  with traumatic  brain injury                                                                    
under a  Medicaid waiver.  A fiscal  note was  not developed                                                                    
for a new  waiver because current waivers  serve people with                                                                    
traumatic brain  injury, who  must be  treated in  a nursing                                                                    
home or institution. People with  mild or moderate traumatic                                                                    
brain injury do not meet that level of need.                                                                                    
                                                                                                                                
Co-Chair Stedman noted  that the bill sponsor  is working on                                                                    
a Committee Substitute.                                                                                                         
                                                                                                                                
10:11:48 AM                                                                                                                   
                                                                                                                                
Ms. Cha commented that this  legislation was not intended to                                                                    
serve as a mandatory helmet law.                                                                                                
                                                                                                                                
SB  219  was  HEARD  and   HELD  in  Committee  for  further                                                                    
consideration.