Legislature(2023 - 2024)DAVIS 106
04/30/2024 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s):|| Board of Social Work Examiners | |
| SB240 | |
| HB363 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | HB 363 | TELECONFERENCED | |
| + | SB 240 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
SB 240-SCHOOL DISTRICT MEDICAL ASSISTANCE
3:18:46 PM
CHAIR PRAX announced that the next order of business would be CS
FOR SENATE BILL NO. 240(HSS), "An Act allowing minors 16 years
of age or older to consent to behavioral health and mental
health services; authorizing school personnel to recommend a
behavioral health or mental health professional to a child 16
years of age or older; and relating to medical assistance
coverage for rehabilitative, mandatory, and optional services
furnished or paid for by a school district on behalf of certain
children."
3:19:32 PM
EMILY RICCI, Deputy Commissioner, Department of Health, on
behalf of the bill sponsor, Senate Rules by request of the
governor, introduced SB 240 to the committee. She explained
that Section 5 of CSSB 240(HSS) is identical to HB 343, which
the House Health and Social Services Standing Committee heard
earlier in the current legislative session. She said that CSSB
240(HSS) would remove the existing requirement that Medicaid may
only reimburse schools for services that are covered in an
eligible student's individualized education plan (IEP). She
emphasized that the intent of CSSB 240(HSS) was to expand the
number of services for which a school might be able to seek
Medicaid reimbursement.
3:20:46 PM
SENATOR CATHY GIESSEL, Alaska State Legislature, on behalf of
the bill sponsor, Senate Rules by request of the governor,
shared her experience working as a nurse practitioner within
high schools and middle schools in Anchorage. She explained
that one of her most pertinent tasks in those schools is to
screen the students for mental health conditions like anxiety,
depression, or suicidal ideation and said that she is able to
refer that student for behavioral health support if any of those
screening tools indicate a positive diagnosis. She clarified
that she was describing background information as a means to
explain the amendment she was about to recommend to the
committee and emphasized that mental health needs have risen
since she had started providing care in the Anchorage School
District (ASD) nine years ago. She provided specific examples
of personal situations that might affect a student's mental
health and said that often, parental consent is a major barrier
to proper treatment of a student's mental health condition. She
emphasized that one out of five students in Alaska have reported
a suicide attempt and explained that the amendment she was
recommending to the committee was the result of her experience
working as a clinician in the district. She read through a
series of proposals that could be made with the amendment and
described their necessity. She shared a series of prepared
statements by various mental health entities in Alaska and
emphasized that the amendment to CSSB 240(HSS) would empower
both children and parents to improve Alaska's collective mental
health.
3:41:56 PM
REPRESENTATIVE FIELDS asked how age 16 was chosen instead of age
14 or lower.
SENATOR GIESSEL answered that 16 was a more palatable age for
practitioners in Alaska.
3:42:55 PM
REPRESENTATIVE SADDLER asked why 16-year-old Alaskans shouldn't
be allowed to be prescribed their own mental health medication.
SENATOR GIESSEL replied that it is her philosophical belief as a
clinician that children are being medicated too much and said
that counseling is extremely effective.
REPRESENTATIVE SADDLER asked which was more effective:
counseling or mental health medication.
SENATOR GIESSEL answered that there is no comparison between
counseling and mental health medication.
3:47:08 PM
REPRESENTATIVE MINA commented her affirmation of the value of
counseling, especially for people who are not experiencing a
crisis and asked what percentage of at-home abusers are, for
example, parents, caregivers, and foster parents.
SENATOR GIESSEL said that she does not have that information.
3:48:28 PM
REPRESENTATIVE RUFFRIDGE asked where schools are going to find
mental health professionals to employ, given a declining public
school budget and a lack of qualified professionals in Alaska.
SENATOR GIESSEL answered that schools in Alaska would hire
clinicians and pass the cost off to Medicaid. She said that the
primary intention of SB 240 was to increase the amount of social
workers in public schools without any extra cost to the schools.
REPRESENTATIVE RUFFRIDGE asked how CSSB 240(HSS) would help
rural students in Alaska experiencing mental health problems.
SENATOR GIESSEL replied that the state would work
collaboratively with tribal health entities and provide
telehealth services to students in need of them.
3:55:10 PM
REPRESENTATIVE SADDLER asked whether there is evidence to
support that behavioral health intervention lowers the rate of
suicide.
SENATOR GIESSEL answered that there is no way to track the
number of suicides prevented and explained that behavioral
health treatment is meant as an intervention to stop mental
health issues before they develop into suicidal ideation.
3:59:49 PM
REPRESENTATIVE FIELDS commented on Representative Saddler's
question by referencing a meta-analysis found through an online
search engine and other studies that find that talk therapy
reduces the risk of suicide.
4:00:58 PM
REPRESENTATIVE RUFFRIDGE said that he has reservations with the
age of consent being 16 with regard to a child's agency in their
own medical decisions and asked what the barrier to proper
children's mental health treatment in Alaska is.
SENATOR GIESSEL answered that the main barrier to proper mental
health treatment of a child is often the parents' inaction and
the child's reluctance to receive any treatment at all. She
explained that there are many adverse consequences that come
from a child who might not have access to behavioral health
services and said that the goal of CSSB 240(HSS) is to prevent a
child from "going over the waterfall" of mental health.
REPRESENTATIVE RUFFRIDGE recalled that he had things that he
didn't want to share with his parents and shared his concern
that a barrier might still exist in CSSB 240(HSS) for kids to
trust the process of mental health treatment.
4:07:37 PM
The committee took an at-ease from 4:07 p.m. to 4:09 p.m.
4:09:03 PM
CHAIR PRAX opened public testimony on SB 240.
4:09:24 PM
STEVEN PEARCE, Director, Citizens Commission on Human Rights,
testified in opposition to SB 240. He explained his background
in mental health advocacy and psychiatric care. He shared his
belief that it would be dangerous to allow students aged 16 and
older to make their own psychiatric decisions.
4:13:15 PM
HEATHER IRELAND, Executive Director, Anchorage School Based
Centers, testified in support of SB 240. She said that the
bill's provision to allow for students aged 16 and older to
consent for their own psychiatric care is important and urged
the committee's support of the proposed legislation.
4:15:25 PM
The committee took an at-ease from 4:15 p.m. to 4:16 p.m.
4:16:19 PM
CHAIR PRAX, after ascertaining that there was no one else who
wished to testify, closed public testimony on SB 240.
4:16:59 PM
CHAIR PRAX moved to adopt Amendment 1 to CSSB 240(HSS), labeled
33-GS2369/B.1, Bergerud, 4/30/24, which read as follows:
Page 1, lines 1 - 3:
Delete "allowing minors 16 years of age or older
to consent to behavioral health and mental health
services; authorizing school personnel to recommend a
behavioral health or mental health professional to a
child 16 years of age or older; and"
Page 1, line 7, through page 3, line 17:
Delete all material.
Page 3, line 18:
Delete "Sec. 5"
Insert "Section 1"
REPRESENTATIVE FIELDS objected.
REPRESENTATIVE FIELDS explained that there are multiple
circumstances where it might not make sense or be feasible to
get consent from a minor's parents to get care. He noted that
the current language in CSSB 240(HSS) directs a healthcare
provider that is providing services for someone aged 16-18 to
contact the minor's parents regardless of the proposed
amendment.
4:21:14 PM
REPRESENTATIVE RUFFRIDGE asked whether parental consent was
required for the billing of Medicaid services.
MS. RICCI answered that SB 240 does not address federal
requirements related to the Family Educational Rights Privacy
Act (FERPA).
REPRESENTATIVE RUFFRIDGE asked whether a clinician providing
services to 16- and 17-year-old students would be allowed to be
reimbursed by Medicaid if Amendment 1 were not adopted.
MS. RICCI replied that the school district would not be able to
bill Medicaid for any confidential services provided.
4:24:27 PM
REPRESENTATIVE SUMNER asked who would pay for the services
provided if Medicaid does not reimburse the service.
MS. RICCI explained that it would depend on how the school is
providing the service and said that it would most likely fall on
the district.
4:25:49 PM
CHAIR PRAX asked whether a school might end up with legal
liability if a parent does not consent to the services provided
to a student.
LAURA RUSSELL, Assistant Attorney General, Human Services
Section, Civil Division (Anchorage), Department of Law, answered
that there are a variety of structures related to behavioral
health services and explained that it would be conjecture for
her to speculate on which entity might absorb the financial
liability of the services that a student has received.
CHAIR PRAX asked who would be liable to the parent if a child is
not eligible for Medicaid and the school is a legal provider.
MS. RUSSELL explained that the statute addressed in sections
three and four of CSSB 240(HSS) provide five exceptions in which
a student is exempt from obtaining parental consent.
4:29:42 PM
REPRESENTATIVE FIELDS directed the committee members' attention
to language on page 3, line 15 of CSSB 240(HSS) and explained
that the parental consent language would be maintained
regardless of whether or not the proposed amendment is adopted.
REPRESENTATIVE SADDLER asked who would be responsible for the
cost of mental health treatment outside of Medicaid services and
asked whether CSSB 240(HSS) would address only children who are
covered by Medicaid.
MS. RICCI replied that she didn't want to speculate on how the
services might be paid for and explained that the proposed
amendment is not limited to children covered by Medicaid.
REPRESENTATIVE SADDLER asked why the proposed legislation should
be passed if there is an uncertainty as to who is meant to pay
for the services outlined by the law.
MS. RICCI explained that who might pay for the services is
greatly dependent on the child, school district, and behavioral
health provider and said that it would ultimately come down to
whatever contract agreement was reached between the clinician
and the school district.
4:34:10 PM
REPRESENTATIVE RUFFRIDGE asked whether counseling services are
currently funded by public education funding.
SHARON FISHEL, School Health and Safety, Innovation and
Education Excellence, Department of Education, answered that
there is no other funding available beside public school
funding.
4:35:55 PM
REPRESENTATIVE SADDLER asked how many behavioral health
professionals are working within the public school system and
what it means for a mental health professional to work within a
school system.
MS. FISHEL answered by giving a number of examples related to
statistics surrounding mental health services in public schools.
4:38:34 PM
CHAIR PRAX asked whether there could be liability for a mental
health clinician not responding to a known problem of mental
health just because the student's parents didn't consent to the
treatment.
MS. RUSSEL answered that CSSB 240(HSS) and Amendment 1 would
neither mandate provisions of services nor create an affirmative
duty to provide services, rather the two would provide
permissive language to allow a school to provide services if it
so pleases.
CHAIR PRAX asked whether a mental health clinician would be
required to report a parent that doesn't allow their child to
seek mental health treatment to the Office of Children's
Services (OCS).
MS. RUSSEL explained that the proposed legislation and the
proposed amendment would not change existing obligations
surrounding mandatory reporting.
4:43:57 PM
MS. RICCI noted that page three, lines 6 through 8 of CSSB
240(HSS) are addressed by the proposed amendment and require
that a clinician note in a student's file any concerns regarding
their mental health.
REPRESENTATIVE SADDLER pointed to page 2, line 29 of CSSB
240(HSS) and shared his concern that the proposed legislation
would allow for Alaskans aged 16 and 17 to give consent.
MS. RICCI replied that Section 5 of the proposed legislation
would ensure that the extent of the consent a 16- or 17-year-old
would be allowed to give would encompass only their own mental
health treatment.
4:46:02 PM
MS. RUSSEL affirmed that Ms. Ricci's answer was correct.
4:46:51 PM
CHAIR PRAX asked whether the proposed amendment would create a
greater risk of someone being reported to OCS.
MATT DAVIDSON, Legislative Liaison, Department of Family &
Community Services (DFCS), answered that the proposed amendment
would not change anything related to the duty to report to OCS.
4:48:33 PM
REPRESENTATIVE SADDLER questioned where the line is drawn
between a parent's responsibility to care for their children and
the state's obligation to step in and help students.
REPRESENTATIVE MCCORMICK opined that young people are perfectly
capable of recognizing mental health issues that they might be
facing.
4:52:39 PM
REPRESENTATIVE MINA expressed her intention to vote against
Amendment 1 and shared her belief that lowering the age of
consent for behavioral health services is a good idea. She
shared her concern for a scenario in which a child might not be
able to get access to care because of a barrier created by the
proposed amendment.
4:54:56 PM
REPRESENTATIVE RUFFRIDGE shared his support for Amendment 1 to
CSSB 240(HSS) and said that he thinks that while CSSB 240(HSS)
is not the answer to how to help young people experiencing
mental health issues, it is a good place to start.
REPRESENTATIVE MCCORMICK proffered that the idea that parents
should be involved [in a minor's decisions regarding their own
mental health treatment and services] comes from a very
privileged perspective.
5:00:05 PM
REPRESENTATIVE FIELDS said that if the proposed amendment were
to be passed, the legislature would effectively be denying care
to children who are living in circumstances of neglect or abuse.
5:00:43 PM
REPRESENTATIVE SADDLER shared his understanding that the
proposed amendment would not make informed consent mandatory.
REPRESENTATIVE FIELDS corrected his previous statement on
Amendment 1 and said that it would not be mandatory for a school
report.
5:01:57 PM
The committee took an at-ease from 5:01 p.m. to 5:07 p.m.
5:07:59 PM
REPRESENTATIVE RUFFRIDGE moved to table Amendment 1 to CSSB
240(HSS).
REPRESENTATIVE PRAX asked Representative Sumner if he had any
objection to Amendment 1.
REPRESENTATIVE SUMNER [objected to the motion to table Amendment
1].
5:08:41 PM
The committee took a brief at-ease at 5:08 p.m.
5:08:58 PM
REPRESENTATIVE SUMNER removed his objection to the motion to
table Amendment 1 to CSSB 240(HSS). There being no further
objection, Amendment 1 was tabled.
5:09:32 PM
REPRESENTATIVE MCCORMICK asked Chair Prax if there could be an
extension of the amendment deadline.
CHAIR PRAX said that he would be okay with an extension of the
amendment deadline.
5:09:47 PM
The committee took two consecutive at-eases from 5:09 p.m. to
5:11 p.m.
[CSSB 240(HSS), with Amendment 1 tabled, was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| Anne Wells Social Work Resume_Redacted.pdf |
HHSS 4/30/2024 3:00:00 PM |
Governor's Appointee |
| Anne Wells Social Work App_Redacted.pdf |
HHSS 4/30/2024 3:00:00 PM |
Governor's Appointee |
| SB 240 Fiscal Note DOH-MAA.pdf |
HHSS 4/30/2024 3:00:00 PM |
SB 240 |
| SB 240 Fiscal Note DOH-MS.pdf |
HHSS 4/30/2024 3:00:00 PM |
SB 240 |
| SB 240 Fiscal Note EED-SSA.pdf |
HHSS 4/30/2024 3:00:00 PM |
SB 240 |
| SB 240 Letter of Support - ACT.pdf |
HHSS 4/30/2024 3:00:00 PM |
SB 240 |
| SB 240 Sectional Analysis Version B.pdf |
HHSS 4/30/2024 3:00:00 PM |
SB 240 |
| SB 240 Sponsor Statement Version A.pdf |
HHSS 4/30/2024 3:00:00 PM |
SB 240 |
| SB 240 Trust LOS 2.26.24.pdf |
HHSS 4/30/2024 3:00:00 PM |
SB 240 |
| SB 240 Version B.pdf |
HHSS 4/30/2024 3:00:00 PM |
SB 240 |
| SB240 Summary Version A.pdf |
HHSS 4/30/2024 3:00:00 PM |
SB 240 |
| HB 363 Amendment S.1 #1.pdf |
HHSS 4/30/2024 3:00:00 PM |
HB 363 |
| SB 240 Amendment B.1 #1.pdf |
HHSS 4/30/2024 3:00:00 PM |
SB 240 |
| HB 363 Kwinghagak v. OCS Court Case.pdf |
HHSS 4/30/2024 3:00:00 PM |
HB 363 |
| HB 363 Amendment S.2 #2.pdf |
HHSS 4/30/2024 3:00:00 PM |
HB 363 |
| HB 363 Amendment S.3 #3.pdf |
HHSS 4/30/2024 3:00:00 PM |
HB 363 |
| HB 363 Amendment S.4 #4.pdf |
HHSS 4/30/2024 3:00:00 PM |
HB 363 |
| HB 363 Roque Support.pdf |
HHSS 4/30/2024 3:00:00 PM |
HB 363 |
| SB 240 ANC School Testimony.pdf |
HHSS 4/30/2024 3:00:00 PM |
SB 240 |
| HB 346 Sponsor Follow Up.pdf |
HHSS 4/30/2024 3:00:00 PM |
HB 346 |