Legislature(2019 - 2020)ADAMS 519

03/22/2020 11:00 AM House FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Continued from 03/21/20 --
+ SB 155 EXPLORATION & MINING RIGHTS; ANNUAL LABOR TELECONFERENCED
Heard & Held
-- Public Testimony --
+ SB 55 APPOINTMENTS TO COURT OF APPEALS TELECONFERENCED
Heard & Held
-- Public Testimony --
+ SB 134 MEDICAID COVERAGE OF LIC. COUNSELORS TELECONFERENCED
Heard & Held
-- Public Testimony --
+ SB 172 EXTENDING THE STATE MEDICAL BOARD; AUDIT TELECONFERENCED
Heard & Held
-- Public Testimony --
+= SB 115 MOTOR FUEL TAX; EV REG. FEE TELECONFERENCED
Heard & Held
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
SENATE BILL NO. 134                                                                                                           
                                                                                                                                
     "An Act relating to medical assistance reimbursement                                                                       
     for the services of licensed professional counselors;                                                                      
     and providing for an effective date."                                                                                      
                                                                                                                                
1:42:38 PM                                                                                                                    
                                                                                                                                
SENATOR DAVID WILSON, SPONSOR, indicated  that SB 134 was an                                                                    
act  relating to  medical assistance  reimbursement for  the                                                                    
services of licensed professional  counselors. The bill also                                                                    
benefited  all  Alaskans in  need  of  behavioral health  by                                                                    
expanding its  capacity. The legislation would  add licensed                                                                    
professional  counselors  (LPCs)  to the  Medicaid  optional                                                                    
services. The concept  of the bill was  to expand behavioral                                                                    
health   capacity   and   utilization  for   Alaskas    most                                                                    
vulnerable population.                                                                                                          
                                                                                                                                
Senator  Wilson  continued  that Medicaid  clients  and  all                                                                    
Alaskans had difficulty finding  access to behavioral health                                                                    
care  often waiting  3 to  6 months  for appointments.  In a                                                                    
state of  crisis, they utilized the  most expensive platinum                                                                    
level  of care  there  was -  Alaskas   emergency rooms.  He                                                                    
asserted that in  current times, it was not  where they need                                                                    
to be. He  reported that it cost on average  about $4360 for                                                                    
behavioral  health assessment  in  Alaskas  emergency  rooms                                                                    
versus  about  $200  in  a  clinical  setting.  Adding  more                                                                    
counselors to  provide services in a  clinical setting would                                                                    
provide  Alaska  with improved  health  care  outcomes at  a                                                                    
lower cost. The bill would  provide the appropriate level of                                                                    
care  with an  appropriate level  of health  care providers.                                                                    
Costs  were rising  at an  unsustainable rate  and something                                                                    
needed   to  be   done  differently   to  stop   the  trend.                                                                    
Essentially,  Alaska  needed  to retool  its  factories  and                                                                    
systems  to  get more  productive  and  better outcomes  for                                                                    
Alaskan  citizens.  He  asserted that  SB  134  complimented                                                                    
HB 290,  SB 120  and  many other  pieces  of legislation  in                                                                    
terms of the 1115 waiver  to help provide a cost containment                                                                    
reduction  increasing   access  for  Alaskans   with  better                                                                    
outcomes  of behavioral  health services.  He believed  that                                                                    
other healthcare  providers in Alaska agreed,  as there were                                                                    
letters of  support and people  waiting to testify  in favor                                                                    
of the legislation. His staff,  Mr. Zepp, would be reviewing                                                                    
a PowerPoint Presentation for the committee.                                                                                    
                                                                                                                                
1:45:16 PM                                                                                                                    
                                                                                                                                
GARY ZEPP, STAFF,  SENATOR DAVID WILSON, began  with slide 2                                                                    
of  the  PowerPoint  presentation  titled "SB  134  "An  Act                                                                    
relating  to   medical  assistance  reimbursement   for  the                                                                    
services of licensed  professional counselors; and providing                                                                    
for an effective date" dated  March 22, 2020 (copy on file).                                                                    
He  relayed  that SB  134  would  add licensed  professional                                                                    
counselors to  the Medicaid  optional services.  The concept                                                                    
of  the  bill was  to  expand  capacity and  utilization  of                                                                    
behavioral health  care in  a clinical  preventative setting                                                                    
versus a state of crisis in Alaska's emergency rooms.                                                                           
                                                                                                                                
Mr. Zepp  continued that the expansion  of behavioral health                                                                    
care was  projected to  reduce waiting  for services  and to                                                                    
improve  the quality  of care  by providing  the appropriate                                                                    
care  by the  appropriate healthcare  provider. He  reported                                                                    
that  it  would  cost  less than  behavioral  healthcare  in                                                                    
emergency  rooms across  the  state.  In conversations  with                                                                    
stakeholders, he heard about wait  times for substance abuse                                                                    
disorders,  suicide, depression,  trauma from  violence, and                                                                    
serious  mental  illness of  anywhere  from  3-6 months  for                                                                    
Medicaid  clients. It  was due  to a  workforce shortage  of                                                                    
behavioral  healthcare professionals  who were  available to                                                                    
see Medicaid clients.                                                                                                           
                                                                                                                                
Mr. Zepp  thought everyone had  seen examples  of behavioral                                                                    
healthcare  shortages that  had  been  revealed in  peoples                                                                     
daily  lives  and through  stories  in  the media.  Licensed                                                                    
professional counselors were  a valuable cost-effective part                                                                    
of  treatment  for  behavioral  health  care.  The  proposed                                                                    
legislation was  a piece of  the behavioral  health capacity                                                                    
puzzle that already included  marital and family therapists,                                                                    
licensed  social  workers,  PhD  psychologists,  prescribing                                                                    
nurse practitioners, and  medical doctors like psychiatrists                                                                    
and primary  care physicians.  There were  approximately 717                                                                    
active   licensed  professional   counselors  available   in                                                                    
Alaska.                                                                                                                         
                                                                                                                                
Mr.  Zepp turned  to slide  3  regarding behavioral  health.                                                                    
Many  people were  familiar with  the term  "mental health."                                                                    
Mental health covered many of  the same issues as behavioral                                                                    
health,  but  the  term   only  encompassed  the  biological                                                                    
component  of  the aspect  of  wellness.  He read  from  the                                                                    
slide:                                                                                                                          
                                                                                                                                
     Behavioral  health  is  the  scientific  study  of  the                                                                    
     emotions,   behaviors,  and   biology  relating   to  a                                                                    
     person's mental  well-being, their ability  to function                                                                    
     in   everyday  life,   and  their   concept  of   self.                                                                    
     "Behavioral health"  is the  preferred term  to "mental                                                                    
     health."   A  person   struggling  with   his  or   her                                                                    
     behavioral   health   may  face   stress,   depression,                                                                    
     anxiety,   relationship  problems,   grief,  addiction,                                                                    
     attention-deficit/hyperactivity  disorder  or  learning                                                                    
     disabilities,  mood disorders,  or other  psychological                                                                    
     concerns.   Counselors,   therapists,   life   coaches,                                                                    
     psychologists, nurse  practitioners, or  physicians can                                                                    
     help manage behavioral  health concerns with treatments                                                                    
     such as therapy counseling or medication.                                                                                  
                                                                                                                                
Representative LeBon  asked what the  minimum qualifications                                                                    
were  to  become  a  licensed   provider  of  mental  health                                                                    
services  to be  eligible  for  Medicaid reimbursement.  Mr.                                                                    
Zepp deferred  to the various  people online to  address the                                                                    
question.  Senator Wilson  thought Deputy  Commissioner Wall                                                                    
could answer Representative LeBons question.                                                                                    
                                                                                                                                
1:49:11 PM                                                                                                                    
                                                                                                                                
ALBERT   WALL,  DEPUTY   COMMISSIONER,  DHSS,   JUNEAU  (via                                                                    
teleconference),   responded  that   the  requirements   for                                                                    
licensure  rested with  occupational licensing.  An academic                                                                    
and professional background check  and a test were required.                                                                    
After making application and all  that was entailed a person                                                                    
would become  professionally licensed  in the state.  In the                                                                    
state  plan for  Medicaid,  the states   agreement with  the                                                                    
federal  government as  to how  it  handled Medicaid,  there                                                                    
were specific  definition of health care  provider types. He                                                                    
indicated that part of the  lengthy process of getting a new                                                                    
provider type  into the system  could be addressed  with the                                                                    
federal  government  after  a   bill  was  passed  with  the                                                                    
provider  type.  He  was describing  a  multi-step  process.                                                                    
First, a  provider had to  become an enrollable  provider in                                                                    
statute.  Second,  the state  had  to  add the  professional                                                                    
licensure to  Alaskas  state plan with  Centers for Medicare                                                                    
and Medicaid Services (CMS). Third,  regulations had to come                                                                    
after the  fact to put  together the framework in  which the                                                                    
new  license   type  could  bill   Medicaid.  There   was  a                                                                    
professional  licensure  board  that  had  oversite  of  the                                                                    
license. The  definition was included in  the agreement with                                                                    
the   federal  government   and   the   state  would   craft                                                                    
regulations in which to bill through.                                                                                           
                                                                                                                                
Mr. Zepp considered  slide 4: "Why Medicaid  clients and who                                                                    
are they?" He read from a prepared statement:                                                                                   
                                                                                                                                
                                                                                                                                
     "Why  Medicaid  clients  and  who  are  they?  Medicaid                                                                    
     provides  health coverage  and long-term  care services                                                                    
     for  Alaska's   most  vulnerable:   children,  seniors,                                                                    
     people with disabilities, pregnant  women, and very low                                                                    
     income or working poor.                                                                                                    
                                                                                                                                
     Medicaid  clients have  difficulties finding  access to                                                                    
     behavioral healthcare  and often have to  wait three to                                                                    
     six  months for  appointments.  So, you  can imagine  a                                                                    
     person  in crisis  or someone  who is  ready to  accept                                                                    
     behavioral  healthcare  services  and there  isn't  any                                                                    
     access  or are  told it's  available in  three or  four                                                                    
     months. So, what are  their options? Alaska's emergency                                                                    
     rooms.                                                                                                                     
                                                                                                                                
     SB  134 would  directly impact  the lives  of our  most                                                                    
     vulnerable  population  of   citizens,  our  poor,  our                                                                    
     young, and  our seniors. Alaska's emergency  rooms have                                                                    
     been  overwhelmed  with  volumes of  Medicaid  client's                                                                    
     emergency situations in need  of behavioral health. The                                                                    
     leading cause  of emergency room  visit are  related to                                                                    
     alcohol  disorders  and   the  associated  aliments  of                                                                    
     alcohol abuse.                                                                                                             
                                                                                                                                
     Often Medicaid clients  have nowhere else to  go due to                                                                    
     the  lack of  access  and the  lack  of capacity  which                                                                    
     causes patients  to stay much  longer in  the emergency                                                                    
     room than they should.  Typically, if a Medicaid client                                                                    
     is in a stage of crisis  and there is not access to the                                                                    
     appropriate  care,  they  leave the  facility  and  the                                                                    
     cycle  repeats  itself.  They  will   be  back  at  the                                                                    
     emergency room  because they are  open 24 hours  a day,                                                                    
     seven days a week."                                                                                                        
                                                                                                                                
Mr. Zepp moved to slide  5: "Adult Untreated Behavior Health                                                                    
Statistics."  He indicated  that  the  following few  slides                                                                    
reflected  some of  the statistics  concerning  the lack  of                                                                    
behavioral health  care, both nationally and  within Alaska.                                                                    
He read from a prepared statement:                                                                                              
                                                                                                                                
     Approximately,  70  percent   of  American's  who  need                                                                    
     behavioral  health services  do not  receive treatment.                                                                    
     For substance use disorders it's  about 92 percent that                                                                    
     typically  do not  receive treatment;  and adults  with                                                                    
     serious   mental   health  issues,   approximately   66                                                                    
     percent, do not receive behavioral health treatment.                                                                       
                                                                                                                                
     Without treatment  in a timely  manner, this  often can                                                                    
     lead  to  interactions  with   the  police,  the  court                                                                    
     systems,  and the  correctional  facilities within  our                                                                    
     state.                                                                                                                     
                                                                                                                                
     According  to  the   "Bureau  of  Justice  Statistics",                                                                    
     approximately 51.4  percent of prisoner have  a serious                                                                    
     psychological  distress and/or  a history  of a  mental                                                                    
     health  problem    20 percent  of those  are considered                                                                    
     "severely and persistently" mentally ill.                                                                                  
                                                                                                                                
Mr. Zepp discussed children  untreated for behavioral Health                                                                    
on  slide 6.  He relayed  that  the chart  showed levels  of                                                                    
depression, anxiety, and behavioral  health disorders by age                                                                    
for children. He read from a prepared statement:                                                                                
                                                                                                                                
     "As you can see, children  are very much susceptible to                                                                    
     behavioral  health  issues.  Common  behavioral  health                                                                    
     issues   that    our   children    experience   include                                                                    
     depression,  anxiety,  behavioral  disorders,  and  the                                                                    
     most  common  which is  attention-deficit/hyperactivity                                                                    
     disorder (ADHD). A child  diagnosed with depression has                                                                    
     approximately  a  74 percent  chance  of  having a  co-                                                                    
     disorder, like  anxiety. If a  child is  diagnosed with                                                                    
     depression and anxiety disorders,  if not treated, they                                                                    
     usually increase over time,  and the child's behavioral                                                                    
     health condition worsens.                                                                                                  
                                                                                                                                
     Boys  are more  likely  than girls  to  have a  mental,                                                                    
     behavioral,  or  developmental  disorder  and  children                                                                    
     living below  the poverty line  have a 22  percent more                                                                    
     likelihood  of a  mental, behavioral,  or developmental                                                                    
     disorder.                                                                                                                  
                                                                                                                                
     SB   134  can   expand  the   capacity  of   behavioral                                                                    
     healthcare  in our  schools, our  communities, and  our                                                                    
     healthcare facilities."                                                                                                    
                                                                                                                                
1:54:35 PM                                                                                                                    
                                                                                                                                
Mr. Zepp continued to slide 7 which discussed the Alaska                                                                        
assessment of behavioral health care needs. He read from a                                                                      
prepared statement:                                                                                                             
                                                                                                                                
     Mental  disorders  among  children  can  cause  serious                                                                    
     changes in  the way  children typically  learn, behave,                                                                    
     or handle  their emotions,  which causing  distress and                                                                    
     problems throughout the day.                                                                                               
                                                                                                                                
     This is absolutely tragic, and  you have probably heard                                                                    
     this   previously,  but   according  to   the  American                                                                    
     Foundation  for Suicide  Prevention, the  Alaska Bureau                                                                    
     of Vital  Statistics, and the  State of  Alaska, Office                                                                    
     of Epidemiology:                                                                                                           
                                                                                                                                
     Alaska has  the highest rate  of suicide per  capita in                                                                    
     the country;                                                                                                               
                                                                                                                                
     In Alaska, suicide  is the number one  leading cause of                                                                    
     death for ages 10-64;                                                                                                      
                                                                                                                                
     Alaska rate is 21.8 suicides  per 100,000 people and in                                                                    
     rural Alaska it is 35.1 per 100,000;                                                                                       
                                                                                                                                
     There  was a  13 percent  increase in  suicides between                                                                    
     2013-2017, as compared to 2007-2011;                                                                                       
                                                                                                                                
     Toxicology results  following suicides since  2015 show                                                                    
     70  percent  involved  one  or  more  substances,  most                                                                    
     frequently alcohol;                                                                                                        
                                                                                                                                
     More than 90 percent of  people who die by suicide have                                                                    
     depression   or   diagnosable,  treatable   mental   or                                                                    
     substance abuse disorder."                                                                                                 
                                                                                                                                
Mr. Zepp turned to slide 8: "Alaska assessment of                                                                               
behavioral health care needs." He continued to read from a                                                                      
prepared statement:                                                                                                             
                                                                                                                                
     "Later in  our presentation, the expert  testimony will                                                                    
     be able  to shed a  light on the workforce  shortage of                                                                    
     behavioral healthcare  professional available  to treat                                                                    
     Medicaid clients and Alaskans in general.                                                                                  
                                                                                                                                
     The  2016 Alaska  Behavioral Health  Systems Assessment                                                                    
     Report estimated that 145,790  adult Alaskans   roughly                                                                    
     20% of the state's  population - need behavioral health                                                                    
     services. Despite the estimated  need for mental health                                                                    
     care in  Alaska, the ratio  of mental  health providers                                                                    
     to population is low compared to national levels.                                                                          
                                                                                                                                
     Also,  most  behavioral  health professionals  work  in                                                                    
     urban  areas and  in remote  areas of  the state,  they                                                                    
     have even lower provider/population ratios."                                                                               
                                                                                                                                
Mr. Zepp moved to the chart on slide 9: "Alaska Emergency                                                                       
Room Department Super-Utilizer Facts Total Medicaid Billed                                                                      
Charges." He read from his prepared statement:                                                                                  
                                                                                                                                
     "The  chart  above reflects  the  total  cost that  the                                                                    
     State  of  Alaska  has  paid  to  emergency  rooms  for                                                                    
     Medicaid   clients  throughout   our  state   over  the                                                                    
     previous four years.                                                                                                       
                                                                                                                                
     As  you can  see, in  2016  the total  costs were  $233                                                                    
     million + and that amount  has risen over the last four                                                                    
     years by $47.1 million dollars or 21.1 percent.                                                                            
                                                                                                                                
     As an example, in 2019,  the top 2.9 percent of "super-                                                                    
     utilizers" consumed 16.3 percent  of the charges at $46                                                                    
     million dollars  (1,301 clients at  an average  cost of                                                                    
     $35,357  annually).  They had  10  visits  or more  per                                                                    
     year, some as much as 50 visits per year.                                                                                  
                                                                                                                                
     If we count the  top 10.03 percent of "super-utilizers"                                                                    
     (6,250 Medicaid clients) costs  $114.0 million or 40.67                                                                    
     percent of  the total  charges annually  (6,250 clients                                                                    
     at an  average cost  of $18,240  annually). They  had 5                                                                    
     visits or more per year.                                                                                                   
                                                                                                                                
     Costs are rising  at an unsustainable rate  and we have                                                                    
     to do something  different to stop this  trend. We need                                                                    
     to  improve  Medicaid  programs and  provide  increased                                                                    
     quality  and become  more cost  efficient. We  believe,                                                                    
     and  other healthcare  providers  in  Alaska agree,  by                                                                    
     adding more LPC counseling services, we have a chance                                                                      
     to improve these outcomes.                                                                                                 
                                                                                                                                
1:58:31 PM                                                                                                                    
                                                                                                                                
Representative  Josephson  asked   what  was  typically  the                                                                    
reason  for  an appointment.  Mr.  Zepp  responded that  the                                                                    
majority of Medicaid clients were  seen in Alaska  emergency                                                                    
rooms   for   substance  abuse   disorders.   Representative                                                                    
Josephson assumed people were going through withdrawals.                                                                        
                                                                                                                                
Co-Chair  Johnston indicated  there were  some folks  online                                                                    
that  would likely  be answering  Representative Josephsons                                                                     
question.                                                                                                                       
                                                                                                                                
Representative  Wool  asked  if  the  increase  in  Medicaid                                                                    
billed charges for emergency room  services in 2018 and 2019                                                                    
was due to  Medicaid expansion. He had  heard from hospitals                                                                    
prior  to Medicaid  expansion that  they had  several people                                                                    
going to  the emergency room,  as it was their  only option.                                                                    
The  hospitals were  not billing  because  Medicaid was  not                                                                    
available at  the time.  He suspected  that the  increase in                                                                    
charges was  a result  of an  increase in  Medicaid patients                                                                    
through  the   expansion.  Mr.   Zepp  deferred   to  Deputy                                                                    
Commissioner Wall.                                                                                                              
                                                                                                                                
Representative  LeBon   asked  how  emergency   room  repeat                                                                    
customers  were intercepted  and directed  to providers.  If                                                                    
people were  to continue  the pattern of  showing up  to the                                                                    
emergency room, the  hospital would not refuse  to treat the                                                                    
patients.                                                                                                                       
                                                                                                                                
Senator Wilson  responded that the Mat-Su  Health Foundation                                                                    
had the  High Utilizer  Mat-Su (HUMS) Project.  He indicated                                                                    
members likely  had an information  sheet in  their packets.                                                                    
It  reflected  an  intensive  case  management  program.  He                                                                    
believed Providence had  a similar program in  place and had                                                                    
seen  a significant  drop  in expenses.  In  talks with  the                                                                    
Mat-Su  Foundation  and  Providence,   he  found  that  they                                                                    
diverted  patients  for  which   they  could  not  bill  for                                                                    
services.  He  also  noted another  information  sheet  that                                                                    
talked about  Medicaid super utilizers and  why they entered                                                                    
emergency rooms,  many of which were  experiencing substance                                                                    
abuse or behavioral health issues.                                                                                              
                                                                                                                                
Mr.  Zepp continued  with his  prepared statement  regarding                                                                    
slide 9:                                                                                                                        
                                                                                                                                
     "With the  federal approval of state's  1115 waiver for                                                                    
     behavioral healthcare  services and  by adding  LPCs to                                                                    
     the  mix  of  behavioral  healthcare  professionals  it                                                                    
     offers an opportunity to  expand capacity, increase the                                                                    
     quality  of care,  lower the  costs  versus the  crisis                                                                    
     mode at  the platinum  level costs  that the  state has                                                                    
     already paid.                                                                                                              
                                                                                                                                
     I'll repeat, the amounts shown  above is what the state                                                                    
     has  already  paid on  behalf  of  Medicaid clients  in                                                                    
     Alaska  for emergency  room visits  over the  last four                                                                    
     years."                                                                                                                    
                                                                                                                                
2:02:29 PM                                                                                                                    
                                                                                                                                
Mr.  Zepp  continued to  slide  10:  "Alaska Emergency  Room                                                                    
Department   Super-Utilizer   Facts   Number   of   Medicaid                                                                    
Clients." He read from a prepared statement:                                                                                    
                                                                                                                                
     "The  chart above  shows that  the  number of  Medicaid                                                                    
     clients in  our emergency rooms have  not increased but                                                                    
     the costs have.                                                                                                            
                                                                                                                                
     The  most  common diagnoses  for  the  top 2.7  percent                                                                    
     super-utilizers are  alcohol-related disorders  and the                                                                    
     associated ailments;                                                                                                       
                                                                                                                                
     The top 2.7 percent  of "super-utilizers" are likely to                                                                    
     be between  20-59 years  old &  61 percent  are females                                                                    
     and 39 percent are males."                                                                                                 
                                                                                                                                
Representative Tilton  posed a question about  how to change                                                                    
a  persons   behavior  who was  consistently  going  to  the                                                                    
emergency  room because  it was  what they  knew to  do. Mr.                                                                    
Zepp suggested  that in  a few  minutes the  committee would                                                                    
hear  from  the  Mat-Su  Health Foundation  and  from  Jared                                                                    
Kosin,  the CEO  of the  Alaska State  Hospital and  Nursing                                                                    
Home Association  (ASHNA). Currently, they had  two programs                                                                    
that  had been  in  practice  for about  2  years that  were                                                                    
experiencing  success in  rerouting patients  away from  the                                                                    
emergency  room to  a clinical  setting.  Both programs  had                                                                    
achieved health improvements and cost savings.                                                                                  
                                                                                                                                
Representative  Tilton  asked  if the  bill  would  increase                                                                    
availability   of  substance   abuse  providers.   Mr.  Zepp                                                                    
responded affirmatively.  He noted that in  2018 the Senator                                                                    
had sponsored  SB 105 which  added licensed,  marital family                                                                    
therapists  to the  Medicaid optional  services. He  thought                                                                    
there was a stereo type  in place regarding licensed marital                                                                    
therapists  and  licensed  professional  counselors     that                                                                    
their  scope  was  limited  in  terms  of  what  they  could                                                                    
provide.  However,  the  counselors  could  provide  a  wide                                                                    
variety of  services up to, but  excluding, the prescription                                                                    
of drugs.  Licensed therapists could handle  many modalities                                                                    
including:  substance  abuse, anxiety,  schizophrenia,  mood                                                                    
disorders, and depression.                                                                                                      
                                                                                                                                
Mr.  Zepp continued  to slide  11: "Preventative  behavioral                                                                    
health  care can  reduce costs."  He  continued reading  his                                                                    
prepared statement:                                                                                                             
                                                                                                                                
     "There is  good news however.  Since the passage  of SB
     105,   which   added   licensed  martial   and   family                                                                    
     therapists to  the Medicaid Optional  Services. Several                                                                    
     programs  aimed  at  diverting  Medicaid  clients  from                                                                    
     emergency  rooms  into more  comprehensive  coordinated                                                                    
     care models are in practice right now.                                                                                     
                                                                                                                                
     As you'll hear from Mr.  Jared Kosin, the President and                                                                    
     CEO  of  the Alaska  State  Hospital  and Nursing  Home                                                                    
     Association  and  hopefully   from  the  Mat-Su  Health                                                                    
     Foundation  ladies,  Ms.  Elizabeth  Ripley  and  Robin                                                                    
     Minard. Programs  are diverting  "Super-Utilizers" from                                                                    
     our  emergency  rooms  in  Alaska   to  a  clinical  or                                                                    
     coordinated care setting and  it does save money. These                                                                    
     two are examples  that are working in  Alaska right now                                                                    
     and  achieving significant  results. Most  importantly,                                                                    
     the Medicaid clients are  receiving improved quality by                                                                    
     the   appropriate   healthcare   professions   but   at                                                                    
     substantially  reduced costs.  This saves  the Medicaid                                                                    
     program  money!   By  adding  capacity   with  Licensed                                                                    
     Professional  Counselors  to   assist  with  behavioral                                                                    
     healthcare  issues,  this  enhances those  programs  as                                                                    
     well as other private practice clinical settings too.                                                                      
                                                                                                                                
     We  did want  to  touch  on the  fiscal  note from  our                                                                    
     friends  at   the  Department  of  Health   and  Social                                                                    
     Services.   It's  understood   they  have   to  provide                                                                    
     estimates of  what programmatic  changes may  costs but                                                                    
     we believe there is more to the story."                                                                                    
                                                                                                                                
Mr. Zepp  thanked the stakeholders that  supported the bill.                                                                    
He revealed a list of the stakeholders on the final slide.                                                                      
                                                                                                                                
Co-Chair  Johnston  thanked  the presenters  and  encouraged                                                                    
invited testimony to begin.                                                                                                     
                                                                                                                                
2:08:52 PM                                                                                                                    
                                                                                                                                
JARED KOSIN,  PRESIDENT AND CHIEF EXECUTIVE  OFFICER, ALASKA                                                                    
STATE HOSPITAL AND NURSING  HOME ASSOCIATION, ANCHORAGE (via                                                                    
teleconference), indicated  the association  fully supported                                                                    
SB 134  and thought it was  smart policy and a  smart use of                                                                    
resources. He suggested the  legislation would reduce visits                                                                    
to emergency rooms. Utilization would  be reduced in 2 ways.                                                                    
First,  it  would  create  direct  access  to  care  in  the                                                                    
community. In  response to Representative  Tiltons  question                                                                    
regarding how  to change behavior, he  suggested that people                                                                    
would  have   an  option   other  than   going  to   a  high                                                                    
level-of-care  emergency  department.   He  thought  it  was                                                                    
reasonable to think people would  go to another provider for                                                                    
care.  For those  people that  were hard-wired  to go  to an                                                                    
emergency room,  they could be  redirected via  a successful                                                                    
discharge  from an  emergency  department.  He relayed  that                                                                    
currently in  the system of  care, with the  capacity issues                                                                    
at Alaska  Psychiatric Institute (API), patients  were going                                                                    
to  the  emergency  room  in   crisis,  being  converted  to                                                                    
Title 47 ex-parte  patients, and were boarding  at emergency                                                                    
departments  for days  at a  time while  they waited  for an                                                                    
inpatient bed. Patients would then  be discharged from their                                                                    
inpatient  bed and  would show  back up  at emergency  rooms                                                                    
perpetuating a vicious cycle.  The legislation would provide                                                                    
emergency  departments  with the  option  of  making a  warm                                                                    
handoff  to  a counselor  in  the  community. The  counselor                                                                    
could then  take the  patient working with  them on  a long-                                                                    
term basis. Such capacity was  currently non-existent or, if                                                                    
it did  exist, it was  on a very  low level. The  bill would                                                                    
allow  for more  continuity of  care. He  sincerely believed                                                                    
SB 134  would   decrease  health  care  costs   rather  than                                                                    
increase  them. Ultimately,  the bill  would save  the state                                                                    
money. He urged members to support the bill.                                                                                    
                                                                                                                                
2:13:00 PM                                                                                                                    
                                                                                                                                
Representative  Tilton  referenced   Mr.  Kosins   statement                                                                    
about  the  bill  allowing   hospitals  to  make  successful                                                                    
discharges because  they would  have the  ability (currently                                                                    
not  in existence)  to handoff  patients  to providers.  She                                                                    
asked if  capacity of providers  or the lack of  the ability                                                                    
to bill Medicaid influenced  why behavioral health providers                                                                    
were not presently used.                                                                                                        
                                                                                                                                
Mr. Kosin  responded that both  applied. He used  the Mat-Su                                                                    
Regional  Medical Center  as an  example. It  had a  private                                                                    
family practice  as part of  its network of  services called                                                                    
Solstice Family  Care. Solstice Family  Care had  a licensed                                                                    
clinician   who   could   provide  services   for   Medicaid                                                                    
recipients.  However, currently  there  was no  way to  bill                                                                    
Medicaid  for its  services. He  asserted  that without  the                                                                    
ability to bill  for services, the entity could  not stay in                                                                    
business  for very  long. The  bill  would allow  for a  new                                                                    
avenue   for  discharging   patients   from  the   emergency                                                                    
department to  the clinician at  Solstice Family  Care, work                                                                    
with the  patient on  a plan  of care  to help  them through                                                                    
episodes  that  would  otherwise   land  them  back  in  the                                                                    
emergency room,  and bill Medicaid.  The cost for  15 visits                                                                    
to the  clinician would  equal approximately  the same  as a                                                                    
single  visit  to the  emergency  room.  The economics  were                                                                    
justifiable.                                                                                                                    
                                                                                                                                
Representative  Carpenter  asked  about the  likelihood  the                                                                    
federal  government  would approve  professional  counseling                                                                    
services.  He wondered  if there  were already  other states                                                                    
that include it in their services.                                                                                              
                                                                                                                                
Mr.  Zepp  reported  having  reached  out  to  the  National                                                                    
Council  of State  Legislatures  to do  some research.  They                                                                    
found  that about  6 states  including Montana,  Washington,                                                                    
and   Oregon,  had   already  added   licensed  professional                                                                    
counselor services to their Medicaid optional services.                                                                         
                                                                                                                                
2:15:55 PM                                                                                                                    
                                                                                                                                
ROBIN  MINARD,   MAT-SU  HEALTH  FOUNDATION,   WASILLA  (via                                                                    
teleconference),   relayed   that  the   Foundation   shared                                                                    
ownership  in   the  Mat-Su  Regional  Medical   Center  and                                                                    
invested its  profits back  into the  community in  order to                                                                    
improve  the  health  and wellness  of  Alaskans  living  in                                                                    
Mat-Su. She was testifying in  strong support of SB 134. The                                                                    
bill was crucial because it  would help address an important                                                                    
health  issue facing  Mat-Su residents  every  day -  mental                                                                    
health  and substance  use  problems. Licensed  professional                                                                    
counselors were  key behavioral  health providers  who could                                                                    
help with the mental health and substance use issues.                                                                           
                                                                                                                                
Ms.  Minard  continued that  the  Foundation  was aware  the                                                                    
issues were difficult for Mat-Su  residents because they had                                                                    
stated  as much  in the  previous 3  community health  needs                                                                    
assessments.  She  reported  that   in  2013  residents  and                                                                    
professionals stated  that the  top 5 challenges  they faced                                                                    
were  alcohol  and  substance abuse,  children  experiencing                                                                    
trauma  and  violence,   depression  and  suicide,  domestic                                                                    
violence  and   sexual  assault,  and  lack   of  access  to                                                                    
behavioral health  care. Residents  with the list  of issues                                                                    
could be helped with access  to counseling. School nurses in                                                                    
the  same  survey  were  seeing waiting  lists  as  long  as                                                                    
4-8 months for  children and families  that had  Medicaid to                                                                    
get into  see a counselor -  much too long to  have to wait.                                                                    
It  was   crucial  that  Alaska  residents   had  access  to                                                                    
behavioral health  providers for care before  their problems                                                                    
escalated to the state of crisis.                                                                                               
                                                                                                                                
Ms.  Minard continued  that Mat-Su  Regional Medical  Center                                                                    
and the  community was  inundated by  residents who  were in                                                                    
crisis related  to behavioral health  issues. In  2016, 3443                                                                    
residents  were  seen in  the  emergency  department with  a                                                                    
primary behavioral  health diagnosis,  and those  people had                                                                    
8400 visits  costing $43.8 million in  facility charges. The                                                                    
cost  did   not  include  the  costs   associated  with  law                                                                    
enforcement  or emergency  transportation. The  average cost                                                                    
per visit was  over $5000 and, the average  cost per patient                                                                    
was almost $13,000.                                                                                                             
                                                                                                                                
Ms.  Minard noted  the senator  mentioning the  HUMS Program                                                                    
earlier  in  the meeting.  She  explained  that HUMS  was  a                                                                    
program  supported  by  the Mat-Su  Health  Foundation,  the                                                                    
program was  started as a  way to provide  care coordination                                                                    
and  access to  community support  for high  utilizers. High                                                                    
utilizers were defined  as residents who have had  5 or more                                                                    
visits to  the emergency department  in a year and  who were                                                                    
unable to independently  access consistent, appropriate care                                                                    
in the community.  The HUMS program had  already resulted in                                                                    
dramatic cost  savings. It  had also  alleviated significant                                                                    
trauma for  patients as  well as  health care  providers and                                                                    
families who  often suffered trauma along  with the patient.                                                                    
She urged members, as they delved  into the data, to keep in                                                                    
mind that  if people had  access to care before  their needs                                                                    
became a crisis, there would be  far less need for a program                                                                    
such as HUMS.                                                                                                                   
                                                                                                                                
Ms. Minard relayed  some of the results of  the HUMS Program                                                                    
to-date. She reported a cost  savings of $2.168 million over                                                                    
2 years. In 2018, the top  3 utilizers saved $340,288 by not                                                                    
making  emergency department  visits.  In the  same year,  7                                                                    
patients  did  not visit  the  emergency  department at  all                                                                    
after they  enrolled in the  HUMS Program. She  relayed that                                                                    
enrollment was  voluntary for  the patient.  The age  of the                                                                    
patients ranged from  16-82, and 72 percent  had Medicaid as                                                                    
their  health insurance.  She reiterated  the importance  of                                                                    
Medicaid  clients having  access to  the whole  continuum of                                                                    
care.  The  program  had  an   external  evaluator  and  the                                                                    
Foundation was  still learning and  tweaking the  program to                                                                    
make it more effective and less expensive as time passed.                                                                       
                                                                                                                                
Ms.  Minard shared  a  couple of  success  stories from  the                                                                    
program thus  far. The first  was a young adult  client that                                                                    
had had 17  visits to the emergency department  in the prior                                                                    
year.  They  had poorly  managed  diabetes  and a  substance                                                                    
abuse disorder.  Most of  their emergency  department visits                                                                    
lead  to inpatient  admission into  the intensive  care unit                                                                    
(ICU). They had  a long history of IV drug  use and was non-                                                                    
compliant  with  primary  care appointments.  She  continued                                                                    
that when the  person was referred to the  HUMS Program, the                                                                    
outlook was  poor, and HUMS  staff were told the  client had                                                                    
little  or no  interest in  improving their  situation. With                                                                    
time and  a listening  ear, the HUMS  staff built  a rapport                                                                    
with  the person  and  it quickly  became  obvious that  the                                                                    
desire for a healthier life  existed. She was happy to share                                                                    
that  the client  was currently  sober;  their diabetes  was                                                                    
well  managed;  they  had  a  driver's  license;  they  were                                                                    
working a full-time  job; and they had  a great relationship                                                                    
with the primary providers office.                                                                                              
                                                                                                                                
Ms. Minard  presented a second  example. Another  client had                                                                    
been  extremely  proactive  with their  care  and  improving                                                                    
their own  quality of life.  They had been able  to maintain                                                                    
sobriety  for  over  6  months  and  enrolled  in  parenting                                                                    
classes to become a better  parent in the hopes of regaining                                                                    
custody of  their child. The program  assisted with housing,                                                                    
getting  them into  substance  use  disorder treatment,  and                                                                    
with  purchasing  needed  hygiene and  clothing  items.  The                                                                    
person  had gained  and maintained  steady  employment at  a                                                                    
restaurant in walking  distance of where they  lived so they                                                                    
could get to work. The  client was currently saving money to                                                                    
get  their  own  apartment.  She  concluded  that  the  HUMS                                                                    
Program showed  great promise. However, even  more promising                                                                    
was the idea  that if there was more  behavioral health care                                                                    
available earlier on,  the HUMS program might  not be needed                                                                    
in the  future. The  hope was  for people to  get care  in a                                                                    
lower cost  setting. She understood there  was concern about                                                                    
adding  costs  to the  Medicaid  System.  She asserted  that                                                                    
SB 134  would do  the opposite;  it  would allow  behavioral                                                                    
health  care to  be provided  in the  least costly  setting,                                                                    
thus, avoiding  all of  the more  expensive care  later. She                                                                    
thanked members for their time.                                                                                                 
                                                                                                                                
2:22:15 PM                                                                                                                    
                                                                                                                                
Co-Chair Johnston OPENED Public Testimony.                                                                                      
                                                                                                                                
JON  ZASADA,  POLICY  INTEGRATION DIRECTOR,  ALASKA  PRIMARY                                                                    
CARE ASSOCIATION,  ANCHORAGE (via teleconference),  spoke in                                                                    
support of SB 134. He read from a prepared statement:                                                                           
                                                                                                                                
     "Alaskas    2   federally  qualified   health   centers                                                                    
     actively support  SB 134 adding  Medicaid reimbursement                                                                    
     for  LPCs has  been a  top priority  in our  efforts to                                                                    
     expand access  to behavioral  health services  for many                                                                    
     years.                                                                                                                     
                                                                                                                                
     Community  health centers  are  already  using LPCs  in                                                                    
     their  practices  to   provide  school-based  services,                                                                    
     individual   counseling   services,   substance   abuse                                                                    
     disorder    treatment,   and    in   supporting    care                                                                    
     coordination   activities.   And  this   does   include                                                                    
     individual coaching on basic  health and hygiene issues                                                                    
     such as  were  addressing now with  the COVID epidemic.                                                                    
     However,  these  services  provided  by  LPCs  are  not                                                                    
     currently  reimbursable. They  are  currently paid  for                                                                    
     through  earned  income,   federal  and  private  grant                                                                    
     funds. This is not sustainable.                                                                                            
                                                                                                                                
     Health  centers  have   received  considerable  federal                                                                    
     funding  to expand  behavioral health  services in  the                                                                    
     primary  care setting.  They  are  required to  provide                                                                    
     behavioral healthcare that  is integrated with medical,                                                                    
     dental, pharmacy,  and other  services. Adding  LPCs to                                                                    
     the  roster   of  billable  providers   enables  health                                                                    
     centers to  make their services more  sustainable. This                                                                    
     is the national best practice.                                                                                             
                                                                                                                                
     LPCs are a valuable,  cost-effective component of team-                                                                    
     based   whole-person   care.   This   is   particularly                                                                    
     important right now as we  are doing everything that we                                                                    
     can  to  keep  patients  out  of  emergency  rooms  and                                                                    
     hospitals.  Mild and  moderate  anxiety and  depression                                                                    
     are  co-occurring  conditions with  chronic  conditions                                                                    
     including diabetes  and hypertension.  LPS are  a vital                                                                    
     provider  type that  can  typically provide  short-term                                                                    
     counseling  support that  enhances  the  work of  other                                                                    
     medical,   dental,  and   pharmacy   team  members   in                                                                    
     stabilizing  and  improving   the  health  of  emergent                                                                    
     patients  and   assisting  them  in   managing  chronic                                                                    
     conditions over time.                                                                                                      
                                                                                                                                
     Finally,  in 2017,  Alaska  health  centers reported  a                                                                    
     deficit  of  12-18  behavioral  health  providers  that                                                                    
     could  expand   access  to  6000  to   9000  additional                                                                    
     patients. We  support SB 134.  It addresses a  key need                                                                    
     in  Alaskas   response   to  behavioral  health,  lends                                                                    
     stability  to  efforts  already  underway,  and  offers                                                                    
     another  tool in  our response  to  improving care  and                                                                    
     lowering the overall cost of care."                                                                                        
                                                                                                                                
Mr. Zasada thanked the committee for its time.                                                                                  
                                                                                                                                
2:25:24 PM                                                                                                                    
                                                                                                                                
DON BLACK, EXECUTIVE DIRECTOR, BETHEL FAMILY CLINIC, BETHEL                                                                     
(via teleconference), introduced himself and read a                                                                             
prepared statement:                                                                                                             
                                                                                                                                
     "Our clinic  employs one  licensed clinical  worker and                                                                    
     one licensed  professional counselor in  our behavioral                                                                    
     health  department.   When  I   last  spoke,   we  were                                                                    
     providing  services  to  teens   at  the  Bethel  Youth                                                                    
     Facility  in  efforts  to  reverse  destructive  habits                                                                    
     while  these students  are still  young. Our  substance                                                                    
     abuse programs  were embedded in the  community as well                                                                    
     as  at the  Yukon-Kuskokwim  Correctional Center  where                                                                    
     our staff provided group and individualized guidance.                                                                      
                                                                                                                                
     All that  is gone  while we  hunker down.  Although our                                                                    
     delivery  has   changed,  our  services   continue.  We                                                                    
     continue  in more  individualized  services and,  where                                                                    
     possible,  by  electronic medium.  More  individualized                                                                    
     services stretch  our staff thin, but  limited Medicaid                                                                    
     billable  staff   stretches  us  even   thinner.  Were                                                                     
     venturing  into  the unknown.  We  have  no numbers  to                                                                    
     support where we  are going. We just know,  we just all                                                                    
     know, we are going there.                                                                                                  
                                                                                                                                
     Look   around  the   room,  or   if  you   are  meeting                                                                    
     electronically as  I am, imagine youre   looking around                                                                    
     the room.  See not just  the faces of  your colleagues.                                                                    
     See  not just  the names  of your  colleagues. See  the                                                                    
     person. We  are all  gathering on a  Sunday, not  as an                                                                    
     ordinary  day  but as  a  day  to accomplish  important                                                                    
     business in the time  remaining this session Meanwhile,                                                                    
     there is a wave coming. We  dont  know how hard it will                                                                    
     hit. We dont  know when it  will hit. We just know that                                                                    
     it will  hit, and there  is nothing  we can do  to stop                                                                    
     it. And we  cant  even swim, just  float. This stressor                                                                    
     just entered all of our lives.                                                                                             
                                                                                                                                
     Some of  those people around  the room or  virtual room                                                                    
     will  cope with  this stressor  better than  others. It                                                                    
     doesnt  matter how  we cope or appear to cope  it was a                                                                    
     stressor  for   everyone.  Many  of  you   have  coping                                                                    
     mechanisms to help you relax    a morning cup of coffee                                                                    
     and  a  newspaper at  the  local  coffee shop.  Closed.                                                                    
     Church  closed. A  relaxing dinner  with loved  ones or                                                                    
     friends after  a long day    closed. A trip to  the gym                                                                    
     or local pool to work  off some anxiety, relax, and re-                                                                    
     center   all  closed. We are helping  our clients build                                                                    
     mental  and emotional  tools to  help them  address the                                                                    
     stressors  in  their  own  lives. Now  we  have  a  new                                                                    
     stressor  to  add  to  the  list.  We  anticipate  more                                                                    
     individualized time will be  needed. We also anticipate                                                                    
     a  potential flood  in demand  of  these services.  For                                                                    
     those in the Medicaid world,  we may have to triage and                                                                    
     choose between  which services  are billable  and which                                                                    
     services are not.                                                                                                          
                                                                                                                                
     I just  closed my  dental office on  Friday and  am re-                                                                    
     purposing as  many staff as  possible to assist  in the                                                                    
     increased needs in other areas  of our clinic. With the                                                                    
     reduction  in some  services, the  revenue  to run  the                                                                    
     clinic  becomes more  of  a concern.  When  I triage  a                                                                    
     behavioral  health patient,  part of  that formula  may                                                                    
     have  to  include  the sustainability  of  the  overall                                                                    
     clinic  when  it should  be  the  greater need  of  the                                                                    
     patient. Passing SB 134 allows  me to focus more on the                                                                    
     patients   needs  and  less  on  the  financial  needs.                                                                    
     Passing SB  134 allows me  to have access to  a broader                                                                    
     range  of billable  behavioral health  specialist labor                                                                    
     pool. It amazes me how  an entire globe is pivoting all                                                                    
     in the  same direction all  at this very same  point in                                                                    
     time. SB  134 has become  something different to  me in                                                                    
     the past few weeks. It has become our essential part                                                                       
     of that pivot."                                                                                                            
                                                                                                                                
2:29:15 PM                                                                                                                    
                                                                                                                                
ERIC  BOYER, PROGRAM  OFFICER,  ALASKA  MENTAL HEALTH  TRUST                                                                    
AUTHORITY,  ANCHORAGE  (via  teleconference),  indicated  he                                                                    
also  served   as  the  chair  for   the  Alaska  Healthcare                                                                    
Workforce Coalition.  The Coalitions   primary focus  was to                                                                    
increase  the workforce  in the  healthcare industry  across                                                                    
Alaska. The Trust  and the Coalition supported SB  134 to be                                                                    
able   to   expand   the   number   of   behavioral   health                                                                    
practitioners  who could  bill for  Medicaid services  which                                                                    
would   increase  the   responsiveness  of   the  healthcare                                                                    
community. People  experiencing behavioral  health disorders                                                                    
could be treated when they  needed the help versus being put                                                                    
on a waitlist.                                                                                                                  
                                                                                                                                
Mr.  Boyer continued  that the  Alaska  Mental Health  Trust                                                                    
Authority (AMHTA)  was concerned about  Trust beneficiaries'                                                                    
lives being  improved. Beneficiaries included  Alaskans with                                                                    
mental    health    issues,   substance    use    disorders,                                                                    
developmental disabilities, Alzheimer's  Disease and related                                                                    
dementia, and  traumatic brain  injury. In  partnership with                                                                    
the  Department of  Health and  Social  Services, the  Trust                                                                    
ensured Alaska had a comprehensive  and integrated system of                                                                    
care  to provide  the necessary  services  and supports  for                                                                    
beneficiaries in their community of  choice and in the least                                                                    
restrictive setting  possible. The legislation  would create                                                                    
a  more equitable  distribution of  health professionals  in                                                                    
Alaska.  It  would  expand  options  for  behavioral  health                                                                    
treatment and  care, decrease the wait  times experienced by                                                                    
many  who  were  seeking  behavioral  health  services,  and                                                                    
prioritize  helping out  the  most vulnerable  beneficiaries                                                                    
across  the  state.  He  reiterated  that  the  Trust  fully                                                                    
supported SB 134.                                                                                                               
                                                                                                                                
2:31:22 PM                                                                                                                    
                                                                                                                                
SEVILLA LOVE,  INTEGRATION COORDINATOR, ALASKA  PRIMARY CARE                                                                    
ASSOCIATION,  ANCHORAGE  (via  teleconference),  had  direct                                                                    
insight  from  her  service in  the  healthcare  field.  She                                                                    
alluded to  the failing  attempt that Alaska  health centers                                                                    
were  currently  facing  because  they could  not  meet  the                                                                    
behavioral  health needs  of their  communities  due to  the                                                                    
limitations  barring them  from hiring  qualified behavioral                                                                    
health providers known  as licensed professional counselors.                                                                    
She noted  the bio, psycho,  social, and economic  impact of                                                                    
COVID-19  which would  only exponentiate  the  dire need  to                                                                    
prioritize the passage of SB 134.                                                                                               
                                                                                                                                
Ms. Love continued that the  behavioral health issues on the                                                                    
system  came at  an  exorbitant cost  to  state and  federal                                                                    
funding. All  of the conditions  were preparing to  swamp an                                                                    
already  over-burdened  emergency  and  acute  response  and                                                                    
social service system in the wake of COVID-19.                                                                                  
                                                                                                                                
Ms. Love  reported there were  LPCs available to go  to work                                                                    
presently, but  health centers  were not  able to  hire them                                                                    
due to not  being able to bill Medicaid.  She indicated that                                                                    
when patients  were sick,  they went  to their  primary care                                                                    
provider. She referred to an  article that reported up to 45                                                                    
percent  of people  who died  by suicide  had visited  their                                                                    
primary  care  provider  within  a  month  of  their  death.                                                                    
Additional  research  suggested that  up  to  67 percent  of                                                                    
individuals who  attempted suicide received medical  care as                                                                    
a  result of  their attempt.  She concluded  that given  the                                                                    
statistics  she  provided,  primary  care  had  an  enormous                                                                    
potential  to prevent  suicide and  connect people  with the                                                                    
needed healthcare they required.                                                                                                
                                                                                                                                
Ms.  Love continued  that by  capturing  patients when  they                                                                    
presented to  primary care, providers  could help  them. She                                                                    
advocated removing  all barriers between driving  down costs                                                                    
while  meeting the  increasing behavioral  health issues  of                                                                    
individuals and families  on their way into  the system. She                                                                    
argued that  prevention was needed immediately  before state                                                                    
social youth and family  services and psychiatric admissions                                                                    
were necessary.  All of the  issues were  most appropriately                                                                    
prevented, met,  and treated in primary  healthcare centers.                                                                    
The licensed professional counselor  workforce was needed to                                                                    
reduce future financial burdens and to save lives.                                                                              
                                                                                                                                
2:34:25 PM                                                                                                                    
                                                                                                                                
PRENTICE   PEMBERTON,   COUNSELING  SOLUTIONS   OF   ALASKA,                                                                    
ANCHORAGE (via teleconference), spoke  in support of SB 134.                                                                    
He  provided  a brief  work  history.  He was  currently  in                                                                    
private practice  and owned Counseling Solutions  of Alaska.                                                                    
He had  23 therapists  who worked for  him in  Anchorage and                                                                    
Eagle River.  He was  calling on  behalf of  all of  them in                                                                    
support of the  bill. Changing the rule  that a psychiatrist                                                                    
had to  supervise LPCs and licensed  clinical social workers                                                                    
(LCSWs)  was  long  overdue.  He  responded  to  an  earlier                                                                    
question   about   qualifications.   Licensed   professional                                                                    
counselors need  the same qualifications to  provide therapy                                                                    
as  those  required  for LCSWs  and  licensed  marriage  and                                                                    
family  therapists (LMFTs).  The  qualifications included  a                                                                    
graduate  degree, 2  years  of  supervised work  experience,                                                                    
passing a  licensing exam,  and taking  continuing education                                                                    
credits. They  were as qualified  to provide therapy  as any                                                                    
other LPSCs, LPSWs, or LMFTs.                                                                                                   
                                                                                                                                
Mr.  Pemberton  conveyed  that  the  preferred  approach  to                                                                    
treating  kids  and  teens  was  psychotherapy  first,  then                                                                    
referral  for  evaluation  by  a  psychiatrist.  He  thought                                                                    
things were currently done in  reverse order. He argued that                                                                    
supporting  families   and  kids  in  their   community  and                                                                    
allowing  problem  solving  was  the way  to  avoid  further                                                                    
hospitalizations  and the  use  of  valuable emergency  room                                                                    
resources. He suggested that Medicaid  kids were some of the                                                                    
most vulnerable  citizens Alaska  had, yet they  were denied                                                                    
reasonable access to much needed  mental health services for                                                                    
them and their families.                                                                                                        
                                                                                                                                
Mr. Pemberton  continued that as  a community  mental health                                                                    
provider  and  medical social  worker,  one  of his  largest                                                                    
frustrations was  not being able to  find quality outpatient                                                                    
services.  As  a  provider  in   private  practice,  he  was                                                                    
contacted frequently  by doctors, pediatricians,  and family                                                                    
doctors looking for providers who  would take their Medicaid                                                                    
clients,  as  they  could  not get  them  in  anywhere.  The                                                                    
emergency room was their last  hope. Families were desperate                                                                    
to help  their kids  in crisis. He  surmised that  the state                                                                    
would pay  for the  care of  todays  children.  The question                                                                    
was would  the investment occur  in the near term  by paying                                                                    
for their  health and  wellness, or would  it be  in several                                                                    
years   by   paying   for  their   institutionalization   or                                                                    
incarceration.  He  thought much  of  the  backlog could  be                                                                    
alleviated.                                                                                                                     
                                                                                                                                
2:38:29 PM                                                                                                                    
                                                                                                                                
Co-Chair Johnston CLOSED Public Testimony.                                                                                      
                                                                                                                                
Co-Chair Johnston  asked someone to walk  through the fiscal                                                                    
note.                                                                                                                           
                                                                                                                                
2:39:09 PM                                                                                                                    
                                                                                                                                
GENNIFER  MOREAU-JOHNSON, DIRECTOR,  DIVISION OF  BEHAVIORAL                                                                    
HEALTH,  DEPARTMENT  OF  HEALTH  AND  SOCIAL  SERVICES  (via                                                                    
teleconference),  spoke in  support  of the  bill. The  bill                                                                    
could   expand  access   to  care   for  eligible   Alaskans                                                                    
statewide. She also noted the  potential for expanded access                                                                    
for care  in rural communities for  individuals experiencing                                                                    
mild to moderate disturbances. There  was also the potential                                                                    
decrease  overtime  of  psychiatric emergency  services  and                                                                    
acute care services.  Licensed professional counselors would                                                                    
also be  able to provide screening,  grief intervention, and                                                                    
referral  to  treatment  which  was a  key  element  of  the                                                                    
continuum of care.                                                                                                              
                                                                                                                                
Co-Chair Johnston interrupted  Ms. Moreau-Johnson. She asked                                                                    
if  she could  walk  through the  fiscal  note. Ms.  Moreau-                                                                    
Johnson deferred to Melissa Hill.                                                                                               
                                                                                                                                
MELISSA  HILL, ADMINISTRATIVE  OPERATIONS MANAGER,  DIVISION                                                                    
OF  HEALTH CARE  SERVICES, DEPARTMENT  OF HEALTH  AND SOCIAL                                                                    
SERVICES  (via  teleconference),  reviewed the  fiscal  note                                                                    
[OMB  Component  3234]. The  fiscal  note  showed a  $55,900                                                                    
services request  to complete modifications to  the Medicaid                                                                    
Management Information  System (MMIS)  that would add  a new                                                                    
provider type and adjust associated business rules.                                                                             
                                                                                                                                
Co-Chair  Johnston set  the bill  aside. She  confirmed that                                                                    
the  amendments  for another  bill  had  been sent  out  via                                                                    
email.                                                                                                                          
                                                                                                                                
SB  134  was  HEARD  and   HELD  in  committee  for  further                                                                    
consideration.                                                                                                                  
                                                                                                                                
2:42:55 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
2:56:38 PM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                

Document Name Date/Time Subjects
SB 115 ver. E Amendments 1-4 3.22.2020.pdf HFIN 3/22/2020 11:00:00 AM
SB 115
SB 155 - Explanation of Changes 2 24 2020 Version G_ (003).pdf HFIN 3/22/2020 11:00:00 AM
SB 155
SB 155 - Sponsor Statement - 2 24 2020 Version G.pdf HFIN 3/22/2020 11:00:00 AM
SB 155
SB155 - PowerPoint Presentation - 2 24 2020 Version G.pdf HFIN 3/22/2020 11:00:00 AM
SB 155
SB155 - Sectional - 3 19 2020 Version G.pdf HFIN 3/22/2020 11:00:00 AM
SB 155
SB 155 Letter of Support - Alaska Chamber 03.11.20.pdf HFIN 3/22/2020 11:00:00 AM
SB 155
SB 155 Letter of Support - Fairbanks Chamber of Commerce 3.2.20.pdf HFIN 3/22/2020 11:00:00 AM
SB 155
SB 155 Letter of Support - The Alliance 3.11.20.pdf HFIN 3/22/2020 11:00:00 AM
SB 155
SB 155 Letter of Support - First Things First Alaska Foundation 2.28.20.pdf HFIN 3/22/2020 11:00:00 AM
SB 155
SB 55 - Explaination of Changes U to S 2.24.2020.pdf HFIN 3/22/2020 11:00:00 AM
SB 55
SB 55 - Sectional Summary v S 3.10.2020.pdf HFIN 3/22/2020 11:00:00 AM
SB 55
SB 55 - Sponsor Statement v S 3.10.2020.pdf HFIN 3/22/2020 11:00:00 AM
SB 55
SB 134 - LPCs to Medicaid Optional Services - House Finance Committee - 3.22.20.pdf HFIN 3/22/2020 11:00:00 AM
SB 134
SB 134 Alaska ER Report_2016 032120.pdf HFIN 3/22/2020 11:00:00 AM
SB 134
SB 134 Alaska ER Report_2017 032120.pdf HFIN 3/22/2020 11:00:00 AM
SB 134
SB 134 Alaska ER Report_2018 032120.pdf HFIN 3/22/2020 11:00:00 AM
SB 134
SB 134 Alaska ER Report_2019 032120.pdf HFIN 3/22/2020 11:00:00 AM
SB 134
SB 134 MatSu Health Foundation 032020.pdf HFIN 3/22/2020 11:00:00 AM
SB 134
SB 134 Sponsor Statement v. A 032120.pdf HFIN 3/22/2020 11:00:00 AM
SB 134
SB 134 Support Letter - Board of Professional Counselors (3.20.2020).pdf HFIN 3/22/2020 11:00:00 AM
SB 134
SB134 Sectional Analysis v.A 032120.pdf HFIN 3/22/2020 11:00:00 AM
SB 134
SB 172 Explanation of Changes v. A to M 3.4.2020.pdf HFIN 3/22/2020 11:00:00 AM
SB 172
SB 172 Sponsor Statement 3.11.2020.pdf HFIN 3/22/2020 11:00:00 AM
SB 172
SB 172 Supporting Document - Audit of DCCED State Medical Board w responses 04.16.2020.pdf HFIN 3/22/2020 11:00:00 AM
SFIN 3/11/2020 9:00:00 AM
SB 172
SB 134 - Mat-Su Health Foundation HUMS Summary.pdf HFIN 3/22/2020 11:00:00 AM
SB 134
SB 115 ver. E Amendments 1-4 3.22.2020.pdf HFIN 3/22/2020 11:00:00 AM
SB 115
SB 155 Public Testimony Rec'd by 032120.pdf HFIN 3/22/2020 11:00:00 AM
SB 155