Legislature(2023 - 2024)BUTROVICH 205
03/12/2024 03:30 PM Senate HEALTH & SOCIAL SERVICES
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| 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 | |
SCR 9-MENTAL HEALTH/SUBSTANCE ASSISTANCE PARITY
3:33:36 PM
CHAIR WILSON announced the consideration of SENATE CONCURRENT
RESOLUTION NO. 9 Recognizing the need for parity in the
provision of mental health and substance use disorder medical
assistance benefits in the state; and urging the Department of
Health to adopt regulations that ensure parity in the provision
of mental health and substance use disorder medical assistance
benefits in the state.
3:33:51 PM
SENATOR FORREST DUNBAR, District J, Alaska State Legislature,
Juneau, Alaska, sponsor of SCR 9 gave the following statement:
Senate Concurrent Resolution (SCR) 9 emphasizes the
importance of behavioral health care within our health
systems and calls for Alaska to adopt national parity
standards. These standards ensure that behavioral
health services receive fair and equal access and
coverage compared to other medical treatments. By
following these guidelines, we can remove barriers
that prevent individuals from accessing necessary care
and ensure treatment for behavioral health issues
receives equitable treatment, just like treatment for
any other health issues.
SENATOR DUNBAR acknowledged the committee's strong commitment to
behavioral health issues. He noted that the resolution includes
discussion of the Paul Wellstone and Pete Domenici Mental Health
Parity and Addiction Equity Act of 2008 (MHPAEA), as well as
non-quantitative treatment limitations (NQTLs). Instead of
elaborating further on SCR 9, he asked to defer to the invited
testimony, starting with Mr. John Solomon from the Eagle Health
Association.
3:35:21 PM
CHAIR WILSON announced invited testimony on SCR 9.
3:35:35 PM
JOHN SOLOMON, CEO, Alaska Behavioral Health Association, Eagle
River, Alaska, stated that he represents the Alaska Behavioral
Health Association, a member organization for approximately 90
provider organizations across the state. These providers range
from large hospital systems to small regional providers,
primarily in the behavioral health field. He added that the
association also includes Federally Qualified Health Centers
(FQHCs)
MR. SOLOMON shared that he is a licensed professional counselor
who initially came to Alaska to provide behavioral health care
in rural villages. He later became a quality assurance
supervisor, responsible for training therapists and ensuring
quality care that met accreditation standards. He then advanced
to director of behavioral health, where he designed programs,
managed funds, and worked to expand access to behavioral health
care in the Northwest Arctic.
MR. SOLOMON also shared his personal story of being in long-term
recovery for over 13 years, having previously struggled with
substance use, including methamphetamine and alcohol, and facing
homelessness and legal issues. Additionally, he revealed that he
has bipolar I disorder, which, as he explained, has both
behavioral and medical implications, requiring lifelong
treatment. He emphasized that access to behavioral health care
is crucial to him, both professionally and personally.
3:37:44 PM
MR. SOLOMON moved to slide 2 of the presentation Behavioral
Health Parity and explained that he would discuss parity in the
context of SCR 9, noting that the term can be misunderstood or
conflated with other issues. In healthcare and legislative
terms, parity refers to ensuring that behavioral health
treatment receives the same access and coverage as medical and
surgical treatments. He clarified that the resolution aligns
with national standards and would direct the state to remove
barriers, ensuring that behavioral health care is treated under
the same terms and conditions, regardless of diagnosis,
severity, or cause.
3:38:35 PM
MR. SOLOMON moved to slides 3 and explained that barriers to
behavioral health care can take many forms, often stemming from
outdated regulations based on past clinical practices. He noted
that when clinical care is written into regulations, they
require updates, which hasn't always happened in the behavioral
health fielda relatively newer area of healthcare. He
highlighted that some regulations involve extensive paperwork
and administrative burdens, which may reflect the stigma around
being a behavioral health provider. He pointed out that
behavioral health providers are sometimes scrutinized in ways
that physical health providers are not. He stated these examples
of barriers need addressing.
3:39:22 PM
MR. SOLOMON moved to slide 4 and explained parity from a
client's perspective. He gave the example of visiting a
community health center for elbow pain, where in one
appointment, a patient can get an intake, a brief assessment,
immediate treatment for symptoms, and a plan for further care,
including potential referrals. This efficient process is common
in physical health care.
3:40:04 PM
MR. SOLOMON moved to slide 5 and contrasted this with the
experience at community behavioral health centers. A client
seeking behavioral health care would first go through an intake
and screening, then schedule a second appointment for a full
biopsychosocial assessment, which could take hours. The third
appointment would involve creating an ongoing treatment plan.
This process, often taking months, delays treatment. While there
is faster access during a crisis, the system currently offers
two extremes: crisis care or a lengthy wait for treatment. He
stressed that this structure doesn't address the urgency for
those needing behavioral health care before reaching a crisis
point.
3:41:10 PM
MR. SOLOMON moved to slide 6 and stated that community
behavioral health centers handle many Medicaid enrollments,
claims adjudication, and documentation standards, which are
necessary but applied more strictly than in physical health
care. This leads to longer wait times, providers moving to
private pay, organizations refusing Medicaid due to workflow
differences, and rising service costs from increased
administrative time. He expressed concern that budgets are
shifting towards hiring more administrative staff instead of
clinical staff, which was discouraging as a director. He
emphasized the need to focus on outcomes rather than audits when
building behavioral health systems.
3:42:09 PM
MR. SOLOMON moved to slide 7 a matrix of non-qualitative
treatment limiters regarding enrollment and said explained that
the Behavioral Health Association examined national standards
and parity legislation, seeking a resolution to meet these
parity standards. The goal is to ask the Department of Health
and its division to address the different burdens and barriers
between healthcare and behavioral health. He mentioned they
created a matrix to highlight these issues, starting with
Medicaid enrollments, noting that community behavioral health
often requires 18 different enrollments compared to just one or
two in primary care settings like pediatricians.
3:42:59 PM
MR. SOLOMON moved to slide 8-9 a matrix of non-qualitative
treatment limiters regarding Medicaid claims adjudication
processes, documentation standards, reporting requirements,
accreditation requirements, state departmental review
requirements, rate setting methodologies and service
authorizations. He emphasized that community behavioral health
follows healthcare documentation standards, which consist of one
page of regulations, but adds an extra seven pages specific to
behavioral health, along with hundreds of pages in the
administrative service manuals, which are entered into
regulation. This complexity increases audit risk for providers.
He shared that even errors, such as typos in service manuals,
have left providers in difficult situations, where they must
choose between proper clinical care or adhering to a mistake in
regulation, knowing audits could hold them accountable. He
proposed creating a committee to review standards and
regulations to ensure behavioral health is as accessible as
healthcare, while allowing for necessary differences in a
thoughtful manner.
3:44:32 PM
MR. SOLOMON moved to slide 10 on parity legislation that ensures
access and discussed the Mental Health Parity and Addiction
Equity Act, passed in 2008 and updated in 2022, noting that 37
states follow it. He explained that states are allowed to pass
their own legislation or match parity standards. He mentioned
that Wyoming was the most recent state to pass parity
legislation in 2019.
3:45:04 PM
MR. SOLOMON moved to slide 11 on real world outcomes the Alaska
solution. He explained that the proposed resolution aims to
align Alaska Medicaid regulations with federal standards and
involve the Department of Health, the division, the Alaska
Behavioral Health Association (ABHA), and partners in primary
and hospital care. The group would work collaboratively to
identify areas for improvement and support the division in
enhancing care. He highlighted the importance of acting now,
citing strong leadership and shared vision within the
department. By building a solid framework for behavioral health
in Alaska, he anticipated more efficient care, reduced reliance
on emergency rooms and correctional facilities, and shorter wait
times. He noted that hospitals and primary care often struggle
to transfer patients to community behavioral health,
particularly those with higher acuity needs.
3:47:08 PM
MR. SOLOMON moved to slide 12 on legislation. He stated that SCR
9 emphasizes the importance of parity legislation and references
non-quantitative treatment limiters (NQTLs). He explained that
NQTLs refer to regulatory and system barriers preventing easy
access to care. The resolution highlights these issues and
reinforces legislative support for improving behavioral health
care access by aligning with federal standards. Solomon stressed
the need for collaboration with providers to establish a strong
foundation for the future of behavioral health care in Alaska.
3:48:27 PM
SENATOR TOBIN expressed curiosity about the absence of a call
for parity in travel access within the resolution, despite its
relevance to a 2018 Disability Law Center case. She asked for
clarification on whether this issue falls under the purview of
the resolution or if it was unintentionally overlooked in the
materials she reviewed.
3:49:04 PM
MR. SOLOMON responded by noting that one of the non-quantitative
treatment limiters (NQTLs) involves barriers to care created by
regional differences. He explained that the inability to access
care due to location is a barrier the parity standards aim to
address. He emphasized that the resolution is a collaborative
effort with the Department and the division to find solutions
together, rather than imposing them. Issues like travel would be
included as part of the NQTLs addressed through this
partnership.
3:49:58 PM
At ease
3:50:06 PM
CHAIR WILSON reconvened the meeting.
3:51:10 PM
CODY CHIPP, Ph.D., Social Project Support, Alaska Behavioral
Health Association, Anchorage, Alaska, shared that while states
cannot weaken federal parity laws, they can strengthen them,
which is an important consideration. He noted that Alaska's
Medicaid plan is exempt from federal parity requirements because
it operates as a fee-for-service state. The resolution is not
calling for legislation but seeks to partner with the Department
of Health and Division of Behavioral Health to address non-
quantitative treatment limiters (NQTLs), which create barriers
to care. One significant example is the inefficiency of written
treatment plans, which differ from medical counterparts who can
adjust care plans at each appointment. In behavioral health,
changes to treatment plans require amending multiple documents,
which could be a warning sign of not meeting federal parity
requirements. He also acknowledged the need to address travel
barriers, particularly for emergency and non-emergency
behavioral health services, as a priority in collaboration with
the department and other partners if the resolution moves
forward.
3:54:36 PM
CHAIR WILSON concluded invited testimony and opened public
testimony on SCR 9.
3:55:09 PM
DARCI NEVZUROFF, Director of Operations, Behavioral Services
Division, Southcentral Foundation, Anchorage, Alaska, testified
in support of SCR 9. She stated that Southcentral Foundation
(SCF), a tribal health organization serving over 70,000
Alaskans, is one of the largest behavioral health providers in
the state, offering over 20 behavioral health and substance use
programs. She highlighted the significant administrative and
clinical documentation burdens for behavioral health providers,
which contribute to long waitlists and hinder access to care.
Intake, assessment, and treatment plans for billing purposes can
take three to eight non-clinical hours, preventing providers
from delivering care. She compared this to medical doctors who
do not face similar burdens for longstanding diagnoses like type
2 diabetes, questioning why behavioral health should be treated
differently. She urged support for the resolution to align
behavioral health care with other healthcare providers and to
meet the goals of the 1115 [Behavioral Health Medicaid] Waiver
in improving access and quality of care for Alaskans.
3:57:14 PM
RONTO RONEY, Director of Behavioral Health, Manilliq
Corporation, Kotzebue, Alaska, testified in support of SCR 9. He
said he represents tribal health and emphasized the need for
parity in behavioral health care access. He noted that while
Alaska has made progress in reducing stigma, excessive paperwork
still prevents immediate access to care. He called for
prioritizing treatment when individuals seek help, handling
documentation later, and compared this to how primary care for
his children is delivered without delay. He stressed that
reducing bureaucracy, especially for youth, will improve access
to timely and effective care and urged the committee to
streamline the process for all Alaskans.
3:59:30 PM
LANCE JOHNSON, COO, Alaska Behavioral Health Association, Eagle
River, Alaska, testified in support of SCR 9. He expressed
strong support for the initiative and gratitude for the
testimony shared. He noted that efforts to improve access to
behavioral health services have been ongoing for over 30 years
in Alaska and emphasized that now is the time for action. He
highlighted the opportunity to collaborate effectively with the
Department and Division of Behavioral Health to improve access,
pointing out that many people in need are currently accessing
services through jails, emergency rooms, and crisis centers. He
stressed the importance of providing easier and immediate access
to treatment, similar to primary care.
4:00:50 PM
DAN BIGLEY, CEO, Denali Family Services, Anchorage, Alaska,
testified in support of SCR 9. He stated that in the 21 years he
has worked in the behavioral health field he has not seen Non-
Quantitative Treatment Limitations (NQTLs) provide a benefit to
youth and families. The use of NQTLs creates barriers to care,
burdens providers with administrative tasks, and leads to
burnout. He expressed concern that these limitations reduce
provider willingness to accept Medicaid, increasing strain on
those seeking services. He opined that regulations should not
dictate care; rather, best practices in training and education
should guide care. He looked forward to quality assurance
departments focusing on care quality and evidence-based
practices instead of regulatory compliance.
4:03:13 PM
CHAIR WILSON closed public testimony on SCR 9.
MR. WILSON asked if the department is already working on
implementing regulations to reduce burdens and paperwork while
increasing parity in medical services. He requested
clarification on what actions the department is currently taking
and what future plans exist regarding this issue.
4:04:09 PM
TRACY DOMPELING, Director, Division of Behavioral Health,
Department of Health, Juneau, Alaska, stated that the Department
of Health has been working on reducing administrative burdens
since she took her position last June. Prior efforts were
already underway, especially under the leadership of the
commissioner and deputy commissioner. The department used the
public health emergency to temporarily suspend service
authorizations for the state plan and 1115 services. On February
2, the 1115 regulation package went into effect, eliminating
most service authorizations and limits for outpatient treatment.
4:04:57 PM
MS. DOMPELING noted that the department held listening sessions
with providers to discuss eliminating service authorizations for
outpatient behavioral health services under the state plan, with
hopes of finalizing those changes before the public health
emergency ends in May. The department has worked closely with
the Alaska Behavioral Health Association to identify regulatory
changes to improve parity. She added that the division recently
reallocated a position to the regulations section, increasing
the team from one to three people to focus on regulatory work
and other tasks. She emphasized that while much has been
accomplished, significant work remains.
4:06:18 PM
SENATOR DUNBAR thanked the previous testifiers and the director,
expressing his belief that great progress is being made in the
department. He stated that the department is moving in the right
direction, which is why he supports a resolution encouraging
continued efforts, rather than pursuing a complex statutory or
regulatory fix. He commended the department for its work and
expressed hope that the resolution would pass, benefiting the
Behavioral Health Association.
CHAIR WILSON [held SCR 9 in committee.]