Legislature(2003 - 2004)
05/08/2003 03:14 PM House HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 157-INPATIENT PSYCHIATRIC SERVICES CHAIR WILSON announced that the next order of business would be CS FOR SENATE BILL NO. 157(HES), "An Act relating to inpatient psychiatric services for persons who are under 21 years of age and are either eligible for medical assistance or are in the custody of the Department of Health and Social Services." Number 0243 SENATOR LYDA GREEN, Alaska State Legislature, as sponsor of SB 157, explained the purpose of the bill and answered questions from the members. She told the committee that SB 157 addresses the need and concern about psychiatric facilities for juveniles. Too many juveniles need services at psychiatric facilities, and currently there is a tendency to send these children out of state. Senator Green said it is her desire to place greater emphasis on determining if there is a place in state for these students where they can remain closer to their homes and parents, and allow them to reassimilate into the community when the time comes. Having treatment in state would allow for assistance to the families and other auxiliary needs that might be required when a child requires psychiatric services. SENATOR GREEN pointed out the key provisions on the sponsor statement, which says that the Department of Health and Social Services will not grant assistance or pay for inpatient psychiatric care for children under the age of 21 who are placed in an out-of-state facility unless adequate services are unavailable in the state. The department will evaluate the types of services available in state and subsequently transfer these students back to Alaska when a room becomes available, unless the transfer would be detrimental to the student's health, therapeutic relationship, or clinical needs. This bill would also encourage those who provide these services to create local facilities so these kids can stay at home. Number 0410 SENATOR GREEN told the committee that the bill identifies two classes of individuals. Section 1 primarily deals with Medicaid recipients "in custody and non-custody." Sections 2 and 3 deal with kids who are in state custody. For a child is who is on Medicaid there is one standard, and for a child who is in the custody of the state there is another standard. She said she believes that the review process should be consistent. State regulation currently mandates the review process and sets up a review team. It is a fairly rigorous system, and a variety of people are required to examine, review, and determine what is in the best interest of the child. It is not an arbitrary decision. Nor should it be. There are many steps that are taken before a child is determined to be institution bound. Some of these include foster care, special care, medical treatment, and group therapy. There are many steps, including assistance for the family and the child, to work through before institutionalization is determined necessary. These provisions are part of the legislation. Number 0508 CHAIR WILSON commented that the state has already gone through several steps and that those options have already been implemented before this point [institutionalization] is reached. SENATOR GREEN replied that there is an inpatient disciplinary team that would parallel, for example, an individual education program (IEP) that is designed for student education. They review and determine what is needed, what must be done, and what cannot be allowed to happen. The team would assist in determining what is the best treatment for that child. Number 0576 REPRESENTATIVE CISSNA commented that this bill addresses the numbers of youth who have been sent out of state relatively recently, as in the last ten years. She asked whether the Alaska Youth Initiative (AYI) program relates to any of this. Number 0626 SENATOR GREEN responded that AYI is an in-state option. REPRESENTATIVE CISSNA commented that AYI was historically an extraordinarily successful in-state option and it is tragic that it is not available. She said she is concerned about the language in the fiscal note [under Analysis] where it says that "this bill addresses the perception that our mental health and residential treatment service system relies too heavily on out- of-state placement". Representative Cissna said that those who have been deeply involved in the issue concerning kids' suddenly being transferred out-of-state do not share the perception that it is a fact. She asked Senator Green to comment on this point. Number 0684 SENATOR GREEN replied that she could not speak to the fiscal note or the language, but she said that there has been an incredible increase, probably an anomaly, since the advent of Denali KidCare. Children are being transferred outside of Alaska without the interdisciplinary team focused as fully as would be desired. REPRESENTATIVE CISSNA asked if this is being for paid by Medicaid funds. SENATOR GREEN responded that is correct. Medicaid funding needs to be tightened up as well. This legislation will determine the appropriate way of handling these issues. SENATOR GREEN noted that Representative Seaton was leaving the hearing and before he went she wanted to address a question that he asked her staff about this legislation. She told the committee that Medicaid determines how much will be paid for treatment. If a request is made for something that is more expensive, for example, treatment that requires that the student stay here versus sending the student out of state, Medicaid determines the rate. Senator Green reiterated that Alaska does not have any control over the rate. Number 0804 KATHY CRONEN, Regional Vice President, Universal Health Services (UHS), testified in support of SB 157, and answered questions from committee members. She told the committee that UHS [recently acquired] North Star Behavioral Health System ("North Star"). Prior to her current position she was the chief executive officer (CEO) at North Star for the past 18 years. She said she has been involved daily with/in decisions related to sending kids outside of Alaska to treatment centers in the Lower 48 states. Currently there are 300 to 400 Alaskan children in residential treatment centers in the Lower 48. This has devastating long-term impacts on these children, on the families, and ultimately on our state. Last year the House and Senate unanimously passed SCR 21. This bill [SB 157] is a formalization of that resolution to complete the good work the legislature started last year. Mental health treatment and follow-up care should be done close to home, she said. Coordination between the residential treatment provider and the ongoing outpatient treatment provider is essential. Ms. Cronen reiterated that it needs to be done in close proximity. Treatment should involve families because the family's treatment is critical to children's long-term success. Family treatment that is delivered over the telephone is just not as effective as treatment that is done face-to-face. Number 0923 MS. CRONEN told the committee that the legislature's support of this bill will encourage providers like North Star, Providence, or any long-term treatment provider to expand the number of beds because there will be a commitment to keep kids in state. Valuable Medicaid dollars are currently being sent to the Lower 48, and the state is losing jobs. If North Star were to expand beds in Alaska to meet the needs of the number of kids that are outside, there would be an additional 400 jobs created. This is good public policy, she said. It is good for the kids' treatment; it is good for families; it keeps Medicaid dollars in state; and it creates jobs. Ms. Cronen said it is a win for everyone, and she encouraged the members to support the bill. Number 0949 REPRESENTATIVE GATTO said that he would like to discuss the fiscal note for the record. He pointed out that if the state sends kids outside of Alaska, the state has to pay for their education; if the state keeps the kids here at home, the state pays for their education. He said he does not know which is more or less expensive. He asked how the legislature knows which is more expensive, since the fiscal note says zero? MS. CRONEN responded that she can provide some firsthand experience because she is responsible for the UHS facility in Provo, Utah. She said that 30 percent of the student population in that facility is Alaskan kids. The price at Provo Canyon School is less than the price here, but it does not include transportation, nor does it take into consideration the treatment outcome of the kids. The costs can be slightly lower, but when adding in the costs of transportation and education the price is comparable. She said she believes the department agrees because it has provided a zero fiscal note. Number 1027 REPRESENTATIVE GATTO said that he has had discussions about prisoner transfers to out-of-state facilities where a number of factors are evaluated including the cost, transportation, and the opinion that there is a better result if the prisoners are kept at home. Is there any evidence that kids that stay in Alaska do better than those sent out of state? CHAIR WILSON responded that all the members have to do is think about how they would feel if it was their child being sent out of state. Would anyone want his/her child to get treatment where the parent could not take part? She said she thinks it is important to look at this legislation as a policy issue, and not look at the finances. She said she believes it is better for the kids and the families to have interaction, go through treatment together, and try to work things out. She pointed out that in some instances, parents do not even have the money to go see the kids. Chair Wilson asked the committee to look at this legislation in that light. Number 1093 SENATOR GREEN pointed to this year's supplemental budget wherein there was approximately [$366,000] to [$400,000] supplemental request for educational fees for out-of-state facilities. She told the committee that there was $663,000 in fiscal year 2002 (FY 02) and it is expected to be $866,000 to $870,000 for FY 03. The average cost is $5,160 per student for an average of 78.5 education days. Education costs charged by facilities range from $38 per day to $102 per day in some of these facilities. So if the $102 rate is multiplied by the required 180 school days, one can make the leap very quickly that it is multiples of what the state is providing for the education of Alaska's children in state. The proposal is $500,000 for FY 04, but with the continuing increase of children going out of state, that number will continue to rise and certainly will be more than this year's authorized and supplemental budget of $900,000. Number 1179 REPRESENTATIVE CISSNA commented that she served on the Finance Subcommittee on Education in 1999 when this issue was looked at. At that time it was more expensive per child partly because the school district absorbed the students in Alaska, but in cases where they are sent Outside, the money must be sent out. She said she was shocked at that time. REPRESENTATIVE GATTO asked how many of the children that are sent Outside are returned. MS. CRONEN responded that she believes that is a clinical decision based on where the kids are in treatment and if they are eligible to be returned. REPRESENTATIVE GATTO commented that there are some cases where it is better to take the child away from the family. MS. CRONEN replied that it is not just the families that the kids need to be attached to. There are many people in communities that kids respond to, for instance, their teachers, school counselor, pastor or minister, or a neighbor. It is important to keep kids connected to the healthy people in their lives. She said if it is not their families, and unfortunately oftentimes it is not, then it is important to make sure it is someone in their local community. Number 1313 SENATOR GREEN asked the members to look at page 2, paragraph (b), on line 3, where it says: "The department shall, on a monthly basis, evaluate what types of services are available in the state for inpatient psychiatric care" SENATOR GREEN said on the same page and paragraph on line 11 it says that the transfer cannot be detrimental to the person's health. If that were the case, the student would not be transferred. For example, if there is an established therapeutic relationship or a clinical need for the student to be Outside, then the student would not be transferred. There would be a complete review. She told the committee the other factor that needs to be considered in all of this is that there is space available in Alaska. Number 1359 REPRESENTATIVE WOLF moved to report CSSB 157(HES) out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, CSSB 157(HES) was reported out of the House Health, Education and Social Services Standing Committee.
| Document Name | Date/Time | Subjects |
|---|