Legislature(1997 - 1998)
04/30/1997 09:16 AM Senate HES
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* first hearing in first committee of referral
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SCR 14 PARITY FOR MENTAL HEALTH TASK FORCE
Number 161
CHAIRMAN WILKEN announced that SCR 14 would be the next order of
business before the committee.
WALTER MAJOROS , Executive Director of the Alaska Mental Health
Board (AMHB), noted that AMHB requested that legislation regarding
mental health parity in Alaska be introduced. The AMHB is the
state planning and advocacy organization for seriously mentally ill
and emotionally disturbed children and adults in Alaska. The AMHB
strongly endorses SCR 14. Mr. Majoros explained that parity refers
to parity of insurance practices for mental health services to
receive parity with those receiving physical health services
through insurance coverage.
Mr. Majoros estimated that since 1995, 31,000 Alaskans, adults and
children, suffer from serious mental illnesses and emotional
disturbances. Many of these people require a range of mental
health treatment services, from counseling, medication, case
management, rehabilitation, crisis intervention, assessment,
hospitalization, evaluation, etc. In most cases, private insurance
does not cover mental health services and in the case that it does,
the services are very inadequate and the restrictions are greater
than that imposed on physical health services. Mr. Majoros stated
that the AMHB believes this to be a form of bias and discrimination
against those with mental illnesses and emotional disturbances.
There has been tremendous change in the efficacy of mental health
treatment. Mental health treatment now parallels physical health
treatment in terms of the ability to diagnose and treat. Further,
the developments of recent years provide a more cost effective
method of treatment.
Number 224
Mr. Majoros informed the committee that many mentally ill persons
have testified that they cannot afford to get a job because they
would have to go off Medicaid which funds mental health services.
Mr. Majoros pointed out that the mental health system supports
remaining on public assistance, Medicaid. If these individual's
had the opportunity to receive basic coverage through private
insurance, then there would not be the dependence on public
programs. Parity would decrease the reliance on public assistance
as well as creating a greater partnership between the public and
private sector in terms of meeting mental health needs in Alaska.
Mr. Majoros noted that much of SCR 14 is based on the federal
legislation, the Mental Health Parity Act of 1996. The Mental
Health Parity Act is the first national parity legislation that has
been passed. Furthermore, the Mental Health Parity Act establishes
a requirement for parity on lifetime and annual dollar limits for
expenditures for mental health services for recipients of all
insurance programs, but with many exceptions. Mr. Majoros
mentioned that small businesses of 50 or less employees are exempt
from the program. Furthermore, there is no requirement to have
mental health coverage; an employer could choose not to have such
coverage or drop that coverage. Employers can adjust co-insurance,
deductibles, service and medical necessity definitions all of which
can be different from those for physical health services. If
employers can document that the net increase in premiums are
greater than one percent, the employer can be exempt. Mr. Majoros
believed that this could be the beginning of parity, but recipients
of mental health services are not parallel with recipients of
primary health care services. Therefore, Mr. Majoros indicated the
necessity for a task force to review the federal legislation.
Number 274
Mr. Majoros informed the committee that 13 states have passed or
proposed mental health parity laws and in total 35 states are
considering this issue. SCR 14 is an opportunity to create a
public-private partnership to transfer some of the cost for mental
health services to the private sector which can save money. The
present situation is an obstacle for mental health consumers and
beneficiaries to become independent. Currently, those folks are in
a double bind, in other words, those folks cannot get off Medicaid
coverage nor can they get a job because there is no private sector
insurance to meet their needs. SCR 14 would eliminate the view
that mental health services are different than primary health care,
it is part of primary health care.
SENATOR WARD inquired as to who was responsible for drafting SCR 14
and who determined the make-up of the group. WALTER MAJOROS
explained that he was part of a group of people reviewing drafts.
The make-up of the task force was determined by the group, not
anyone specific. Currently, the trend is to have as many mental
health consumers on the task force. This resolution was modelled
somewhat after resolutions in other states.
Number 319
SENATOR GREEN informed the committee of a conflict due to her
husband's employment and requested that she not be required to
vote. SENATOR WARD objected. Therefore, Senator Green will be
required to vote.
SENATOR GREEN noted that her staff had discussed with the AMHB the
possibility of the AMHB creating its own task force, to which there
did not seem to be a problem. Senator Green said that when she was
on the Governor's Council for Handicapped & Gifted, the council
dealt with many issues that were similar to this. The council
joined with other boards to report on health care; is that possible
with this? WALTER MAJOROS agreed that there are many issues that
AMHB and the Governor's Council take up independently. The task
force was chosen because it is a national model. Furthermore, it
is difficult to generate a consensus on major mental health issues.
Mr. Majoros emphasized the importance of having the Legislature's
involvement and endorsement from the start in order to increase the
likelihood of passing the legislation and building consensus.
SENATOR GREEN believed that the task force could be accomplished
through the AMHB without a resolution. Senator Green suggested
that course be taken.
In response to Chairman Wilken, WALTER MAJOROS stated that he was
the Executive Director of the AMHB.
CHAIRMAN WILKEN noted that SCR 14 does not expect any General Fund
money to be provided for the task force. Is there federal or other
state money available for those expenses? WALTER MAJOROS deferred
to Jeff Jessee from the Alaska Mental Health Trust Authority.
Several discussions have occurred with the authority who supports
the task force, although there is no guarantee that the authority
would be involved with the cost of the task force. Mr. Majoros
mentioned that the AMHB will do a formal proposal to the authority
during its budget process this year.
Number 381
JAN MCGILLIVARY , CEO of the Alaska Mental Health Association(AMHA),
informed the committee that she was the Coordinator for the
Building Bridges Campaign for mental health. The coalition
represents about 40 community based mental health services which
are grantees of the Division of Mental Health & Developmental
Disabilities. Ms. McGillivary supported SCR 14 and the attempt to
join the national movement on this issue. Ms. McGillivary was sure
that the task force will find that overall use of medical benefits
will drastically decrease once discrimination is eliminated from
the insurance benefits arena.
PETER BRAVEMAN , Family Centered Services of Alaska, informed the
committee that he had a mentally ill sister in another state and
would be speaking from that perspective as well as a provider.
Current insurance company practices discriminate against consumers
which perpetuates the stigma consumers and families live with. Mr.
Braveman stated that his sister receives woefully inadequate
services, costly, and crisis driven services. Often his family
does not interrupt a crisis for his sister because insurance
benefits will run out or the insurance does not cover actions until
in crisis.
As a provider, Mr. Braveman sees consumers that do not have a
choice when the insurance ends and the consumer must use publicly
funded grantees and have limited access to other community
providers. Such situations tax public mental health providers.
Mr. Braveman supported SCR 14.
Number 427
DON DAPCEVICH , Executive Director of the Advisory Board on
Alcoholism & Drug Abuse, noted that the Advisory Board on
Alcoholism & Drug Abuse has an interest in being part of the task
force. This issue is equally important for chemical dependency
programs as for mental health programs. Mr. Dapcevich indicated
that the Mental Health Trust Authority would be interested in
chemical dependency being added to the task force. Mr. Dapcevich
encouraged the committee to include chemical dependency as a
participant in the task force. During this era of welfare reform,
quality services both in the private and public sector are
necessary and SCR 14 would be a vehicle for that. Private sector
involvement in chemical dependency has significantly diminished in
Alaska due to the insurance practices of the predominant carriers.
The predominant carriers have severely restricted access to the
resources of insurance companies for third party payments.
Mr. Dapcevich noted that this would require minimal costs. In
terms of insurance premiums to include mental health and chemical
dependency treatment services, Mr. Dapcevich had received two
different studies which reported that the cost ranges from .4
percent to .7 percent increase in premiums. This is a minimal cost
when considering the quality of services and the decrease in
dependency on public funded services. Mr. Dapcevich reiterated the
need to include chemical dependency and noted that he would provide
the committee with a letter with the specific language changes to
the resolution to include chemical dependency.
RAY GILLESPIE , Charter North Star Behavior Health Systems,
supported SCR 14. Gathering the facts about parity is good public
policy. Mr. Gillespie said that he did not have any preconceived
notions regarding the findings, conclusions, or resulting public
policy recommendations. With regard to why this task force could
not be done by a private organization, Mr. Gillespie believed that
the findings would be more credible if the findings came from a
group such as the Parity Task Force established by the Legislature.
CHAIRMAN WILKEN announced that SCR 14 will be held to the next
scheduled meeting. With regard to Senator Ward's question about
the authors of SCR 14, Chairman Wilken informed the committee that
those involved were Mr. Majoros from the AMHB, Ms. Macklen from the
Coalition of Mental Health Organizations, and Mr. Jessee from the
Mental Health Trust Authority.
JEFF JESSEE , Alaska Mental Health Trust Authority, said that the
trustees are supportive of exploring mental health parity. The
resolution may allow the possibility to review strategic options
for introducing parity legislation. SCR 14 has the potential to
significantly increase the availability of mental health services.
The trustees view the resolution as a way to spread some of the
risk across a larger constituency and perhaps, reduce the fiscal
demands on both the state General Fund and on the Trust Authority
funds.
CHAIRMAN WILKEN said that SCR 14 would be held.
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