Legislature(2023 - 2024)BUTROVICH 205
03/12/2024 03:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SCR9 | |
| SB27 | |
| SB240 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SCR 9 | TELECONFERENCED | |
| *+ | SB 27 | TELECONFERENCED | |
| += | SB 240 | TELECONFERENCED | |
SB 240-SCHOOL DISTRICT MEDICAL ASSISTANCE
4:44:16 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 240
"An Act relating to medical assistance coverage for
rehabilitative, mandatory, and optional services furnished or
paid for by a school district on behalf of certain children."
4:45:17 PM
CHAIR WILSON found there were no questions for the sponsor of SB
240.
4:45:27 PM
CHAIR WILSON solicited a motion.
4:45:29 PM
SENATOR GIESSEL moved to adopt Amendment 1, work order 33-
GS2369\A.2, to SB 240:
33-GS2369\A.2
Bergerud
3/4/24
AMENDMENT 1
OFFERED IN THE SENATE BY SENATOR GIESSEL
TO: SB 240
Page 1, line 1, following "Act":
Insert "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;"
Page 1, following line 3:
Insert new bill sections to read:
"* Section 1. AS 14.30.171 is amended by adding a new
subsection to read:
(c) Notwithstanding (a) of this section,
school personnel may recommend a behavioral health
professional or mental health professional to a
child who is 16 years of age or older. In this
subsection,
(1) "behavioral health professional" has
the meaning given in AS 14.30.174(b);
(2) "mental health professional" has the
meaning given in AS 47.30.915.
* Sec. 2. AS 14.30.174(a) is amended to read:
(a) Notwithstanding AS 14.30.171(a)(3) and
(5), a behavioral or mental health professional
working within a public school system may, in
compliance with federal education law or
applicable state law,
(1) recommend, but not require, a
psychiatric or behavioral health evaluation of a
child; [AND]
(2) recommend, but not require,
psychiatric, psychological, or behavioral
treatment for a child; and
(3) obtain informed consent from and
provide behavioral or mental health services to a
child who is 16 years of age or older.
* Sec. 3. AS 25.20.025(a) is amended to read:
(a) Except as prohibited under AS
18.16.010(a)(3),
(1) a minor who is living apart from the
minor's parents or legal guardian and who is
managing the minor's own financial affairs,
regardless of the source or extent of income, may
give consent for medical and dental services for
the minor;
(2) a minor may give consent for medical
and dental services if the parent or legal
guardian of the minor cannot be contacted or, if
contacted, is unwilling either to grant or to
withhold consent; however, if [WHERE] the parent
or legal guardian cannot be contacted or, when
[IF] contacted, is unwilling either to grant or to
withhold consent, the provider of medical or
dental services shall counsel the minor keeping in
mind not only the valid interests of the minor but
also the valid interests of the parent or guardian
and the family unit as best the provider presumes
them;
(3) a minor who is the parent of a child
may give consent to medical and dental services
for the minor or the child;
(4) a minor may give consent for
diagnosis, prevention, or treatment of pregnancy,
and for diagnosis and treatment of venereal
disease;
(5) a minor who is 16 years of age or
older may give consent to receive outpatient
behavioral or mental health services from a
behavioral health professional or mental health
professional; a behavioral health professional or
mental health professional may not prescribe
medication to a minor receiving services under
this paragraph without the consent of the minor's
parent or guardian; during the course of
treatment, the behavioral health professional or
mental health professional shall contact the
minor's parents and offer to provide services to
the family, unless there are clear clinical
indications that doing so would be harmful to the
minor receiving services, in which case the
behavioral health provider or mental health
provider shall document those concerns in the
counseling record; in this paragraph,
(A) "behavioral health
professional" has the meaning given in
AS 14.30.174(b);
(B) "mental health professional"
has the meaning given in AS 47.30.915 [THE
PARENT OR GUARDIAN OF THE MINOR IS RELIEVED
OF ALL FINANCIAL OBLIGATION TO THE PROVIDER
OF THE SERVICE UNDER THIS SECTION].
* Sec. 4. AS 25.20.025 is amended by adding a new
subsection to read:
(d) The parent or guardian of a minor is
relieved of all financial obligation to the
provider of a service under this section."
Page 1, line 4:
Delete "Section 1"
Insert "Sec. 5"
4:45:33 PM
CHAIR WILSON objected for purposes of discussion.
4:45:36 PM
SENATOR GIESSEL introduced Amendment 1, which would allow minors
aged 16 or older to consent to behavioral and mental health
services and permit school personnel to recommend these
services. She explained that, in her experience as a nurse
practitioner in school-based clinics, many students face
significant mental health challenges, such as depression,
anxiety, and suicidal thoughts, but parental consent often
prevents them from accessing help. She shared reasons why
parents or guardians do not reply or offer consent for their
child to receive care when the child has expressed a desire. She
stressed the importance of increasing access to care for these
students by lowering the age of consent to 16 and noted that 33
states have already implemented similar policies.
4:48:41 PM
SENATOR GIESSEL cited widespread agreement from multiple
organizations she has spoken with over the past two years. She
referenced reports from the U.S. Surgeon General and the Alaska
Department of Health, highlighting the prevalence of adverse
childhood experiences (ACEs) such as parental divorce and
financial hardship, which are common among Alaska's youth. She
shared personal stories from her work, where students face
significant challenges at home and are often left in charge of
siblings, leading to anxiety and depression. She argued that
lowering the age of consent to 16 for behavioral health services
would allow earlier intervention. While 33 states have lowered
the age of consent to 16, three have lowered the age to 12. She
also clarified that while Section 3 allows minors to access
therapy, it restricts the prescription of medication without
parental consent and encourages family involvement in the
treatment process.
4:54:07 PM
SENATOR GIESSEL said commonly, it is family issues that cause
the behavioral health issues that young people experience.
Therefore, family therapy is critical to treating a young
person. Services are offered to the family unless there are
clear clinical indications that doing so would be harmful to the
minor receiving services, in which case the behavioral health
provider or mental health provider shall document the concerns.
She offered Amendment 1 to increase access to care for young
people, particularly through school sites, which are well-suited
for reaching students. She said schools are safe spaces for many
kids and ideal locations for accessing behavioral health
services.
4:55:39 PM
CHAIR WILSON asked who is responsible for paying service and
assessment costs.
4:55:53 PM
SENATOR GIESSEL replied that Section 4 of Amendment 1 states
that the parent or guardian of a minor is relieved of all
financial obligations to the provider of services. She noted
that many young people she sees have private insurance, but the
majority are Medicaid beneficiaries, and Medicaid would be
billed for the services.
4:56:26 PM
CHAIR WILSON asked whether insurance companies would be relieved
of financial obligations or if only state Medicaid would be
responsible for paying medical providers.
4:56:40 PM
SENATOR GIESSEL replied that it would depend on the type of
insurance the young person has, but Amendment 1 allows them to
consent to services.
4:56:50 PM
CHAIR WILSON noted that a similar amendment had already been
addressed in HB 40 [HB 60], which is currently in Senate Rules.
He acknowledged that SB 240 does a good job of providing
educational services and increasing school-based services but
expressed concerns about parental consent. He pointed out that
in cases where clear clinical indicators suggest a child's
parent should not be notified, there are usually deeper issues
that care takers and mandated reporters would address with the
proper authorities. He shared his concern that SB 240 may linger
in Rules, like HB 40 [HB 60]. He wondered if the department held
a position on the matter and suggested moving forward with a
vote.
4:58:00 PM
SENATOR DUNBAR opined that the amendment seems different from
the one offered last year, noting that it appears to include
compromise language addressing concerns from the original
version. He asked if this observation was correct.
4:58:26 PM
SENATOR GIESSEL said it was correct that this amendment is not
the same as the previous, broader amendment. She explained that
Amendment 1 is limited to behavioral and mental health services,
defines the age, and specifically outlines who the healthcare
providers are.
4:58:51 PM
SENATOR DUNBAR expressed support for Amendment 1, acknowledging
the chair's concerns about SB 240 potentially being held in
Rules. He stated his belief that if SB 240 were held in rules
Amendment 1 would not be the reason. He emphasized that SB 240
should still have strong support with the amendment and looked
forward to voting for the overall bill on the floor.
4:59:24 PM
SENATOR KAUFMAN said supporting information included a table
showing the ages of students in other states. He asked whether
there was anecdotal or aggregate data on how other states
managed financial responsibility when a minor incurred an
obligation that might be borne by the parent or another entity.
4:59:53 PM
SENATOR GIESSEL replied she did not have that information.
5:00:05 PM
SENATOR TOBIN stated her support, noting a 14 percent increase
in houseless and homeless youth over the past year. She
emphasized that educators often identify issues with young
people but may sometimes suspend or give negative
recommendations when wraparound services are needed instead. She
said family support services are crucial and that the amendment
addresses the core issues faced by many young people. She
concluded that Amendment 1 would give educators the opportunity
to recommend behavioral and mental health support to students
who need interventions but are unaware of available resources.
5:01:03 PM
CHAIR WILSON asked whether the department had a position on
Amendment 1.
5:01:13 PM
LEAH VAN KIRK, Healthcare Policy Advisor, Department of Health,
Juneau, Alaska, stated the department is still evaluating
Amendment 1 and has not taken a position.
5:01:24 PM
CHAIR WILSON asked whether the amendment would have a fiscal
note attached. He referred to the statement regarding children
on Medicaid, noting that they make up approximately half of the
population of children under 18 in the state. He mentioned that
the state is responsible for paying for these services unless
parental involvement leads to the use of private insurance. He
inquired if there were associated costs with this
responsibility.
5:01:56 PM
MS. VAN KIRK replied that the department would need to evaluate
the information more closely before responding to the committee.
5:02:06 PM
CHAIR WILSON expressed concern about the financial strain placed
on local behavioral health care providers who operate on thin
margins and may not continue offering free assessments for
children due to costs. He acknowledged the possibility of
charities covering the costs but remained uncertain. His concern
stems from the underlying aspect of SB 240, which reminded him
of another bill that was held in Rules for a year. He said that
despite his concern he was willing to vote on SB 240.
5:02:43 PM
SENATOR GIESSEL stated that the avoided cost should be
considered more than the immediate cost. She emphasized the
importance of avoiding costs related to suicide, drug addiction
in emerging adults, and incarceration.
5:03:09 PM
CHAIR WILSON found the objection was maintained and asked for a
roll call vote.
A roll call vote was taken. Senators Giessel, Dunbar, and Tobin
voted in favor of Amendment 1 (A.2) and Senators Kaufman, and
Wilson voted against it. The vote was 3:2.
5:03:30 PM
CHAIR WILSON announced that Amendment 1 (A.2) was adopted on a
vote of 3 yeas and 2 nays.
5:03:33 PM
CHAIR WILSON asked if the department had any closing comments.
5:03:38 PM
MS. VAN KIRK thanked the committee for considering SB 240.
CHAIR WILSON asked if there was a date the department would have
a completed analysis on SB 240, as amended.
MS. VAN KIRK stated the department would follow up with a date.
5:04:01 PM
CHAIR WILSON held SB 240, as amended, in committee.