Legislature(2019 - 2020)DAVIS 106
03/10/2020 03:00 PM HEALTH & SOCIAL SERVICES
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HB 86-MENTAL HEALTH HOSPITAL: CONTRACTS/BIDS 3:08:23 PM CHAIR ZULKOSKY announced that the first order of business would be HOUSE BILL NO. 86, "An Act relating to a state-owned inpatient mental health treatment hospital; and providing for an effective date." [Before the committee was the committee substitute (CS) for HB 86, Version 31-LS0623\U, Marx, 3/26/19, adopted as work draft on 3/5/20.] 3:09:30 PM CHAIR ZULKOSKY opened public testimony on HB 86. 3:09:56 PM VIKKI JO KENNEDY testified that she is in support of HB 86 and offered that privatizing Alaska Psychiatric Institute (API) may be the right solution. She relayed that the patients of API are some of the neediest people in society. She stated, "A society who forgets its needy people is a society itself that will soon be forgotten." 3:11:41 PM The committee took a brief at-ease. 3:12:38 PM FAITH MYERS, Mental Health Advocate, expressed her belief that API should remain a state-owned and -managed psychiatric hospital. She opined that the "openness of API, including available statistics" gave API a unique opportunity to set a high standard of patient care in Alaska. She shared statistics from 30 private psychiatric units: In 2011, the Disability Law Center (DLC) of Alaska reported that patients at API could not file grievances in a fair way. In 2016, the [U.S. Centers for Medicare and Medicaid Services (CMS), U.S. Department of Health and Social Services (HSS)], "Medicaid" and "Medicare", reviewed patient complaints at API and found serious problems with how management handled them. In 2019, the Alaska State Ombudsman ("Ombudsman") office reported that a female patient at API was sexually assaulted in the television (TV) room; at some point, staff intervened; the woman was left half naked by herself before wandering back to her room; the perpetrator was released without being charged; the woman did not receive proper assistance. She cited AS 47.30.660(b)(13) and said that the Department of Health and Social Services (DHSS) must delegate its responsibility for caring for psychiatric patients to mostly private facilities and units. She maintained that the legislature should require a specific state-patient standard of care in a separate bill. She offered to the committee reference information regarding the substance of such legislation to establish a state standard of care and protection for psychiatric patients. 3:15:10 PM CHAIR ZULKOSKY, after ascertaining that there was no one else who wished to testify, closed public testimony. 3:15:24 PM REPRESENTATIVE PRUITT moved to adopt Amendment 1, [labeled 31- LS0623\U.2, Marx, 3/4/20], which read: Page 1, line 6, following "section": Insert "unless the Department of Health and Social Services has been notified by the Joint Commission on Accreditation of Healthcare Organizations or the United States Centers for Medicare and Medicaid Services that there is an immediate risk that the hospital will lose its certification" Page 1, line 9, following "section": Insert "unless the Department of Health and Social Services has been notified by the Joint Commission on Accreditation of Healthcare Organizations or the United States Centers for Medicare and Medicaid Services that there is an immediate risk that the hospital will lose its certification" Page 3, line 18, following "hospital": Insert "unless the department has been notified by the Joint Commission on Accreditation of Healthcare Organizations or the United States Centers for Medicare and Medicaid Services that there is an immediate risk that the hospital will lose its certification" REPRESENTATIVE SPOHNHOLZ objected for discussion purposes. 3:15:37 PM REPRESENTATIVE PRUITT explained that under the proposed amendment, DHSS would be allowed to contract for the ownership or management of an inpatient mental health treatment hospital if it had been notified by the Joint Commission, which accredits facilities that serve CMS patients that it is at risk of losing [accreditation]. He relayed that in 2019, DHSS hired an outside consulting firm when it had been notified that API would lose accreditation. Currently API is not at risk due to improvements at the facility. He maintained that in a situation in which the state is struggling to manage API, it should have every tool at its disposal to ensure that API does not lose accreditation. 3:17:46 PM REPRESENTATIVE SPOHNHOLZ stated that she opposed Amendment 1. She relayed that what was learned last year  through a series of hearings on the privatization of API was that privatization is a process that should not be taken in an emergent, rushed fashion; there are a myriad of considerations that should be methodically addressed; among those considerations are whether a private organization could improve outcomes or meet Joint Commission or other regulatory agency standards. She maintained the reason API struggled was that it was chronically underfunded and chronically understaffed. The API governance board, which was functional up to 2016, was disbanded; therefore, there was no oversight. She stated the current administration, with the support of the legislature, has reconstituted the governance board, secured additional funding, augmented staff, and brought in contract expertise to train staff. The result is an organization that is "back on step." She asserted that the organization did not need privatization, but funding and oversight to enable it to function. She said, "Even a brand-new Mercedes will not drive if it doesnt have fuel in it." She emphasized that functionally API was like a car with no fuel in it. 3:19:21 PM REPRESENTATIVE TARR commented that she did not mind the intent of Amendment 1. She offered that for Alaska, with such a fragile health care system and just one facility [for psychiatric care], a high-risk situation is problematic. She pointed out that it took six to eight years to get to where API currently is, under multiple administrations and legislatures. She said that "immediate risk" is not well defined; that decline occurs in phases; therefore, it was difficult to evaluate what phase would constitute immediate risk and warrant action under the proposed amendment. She expressed her belief the department could act in an emergency, but if not, then the point of acting should be more clearly defined. She said, "I just dont want this to be so gray that it basically nullifies the intent of the bill." 3:21:30 PM REPRESENTATIVE JACKSON said that Alaska had options. She expressed it was heart-wrenching for Alaska to be in a position of losing accreditation [for API] as a state-operated institution. She emphasized, "We should never come close to that ever again." She stated she supported Amendment 1 minus the "immediate risk" - because Alaska should never wait until the loss of accreditation to recognize a crisis. She said both the patients and the public employees were important. She expressed all opportunities and resources should be available to the state to care for the API population. 3:26:06 PM REPRESENTATIVE ZACK FIELDS, Alaska State Legislature, reiterated testimony that the proposed amendment could provide a loophole that nullified Version U; that an administration with an objective to privatize API could manufacture a crisis and use [the provision in the amendment] to privatize it. He stated he does not support the proposed amendment. 3:26:50 PM REPRESENTATIVE CLAMAN stated he opposed the proposed amendment. He expressed his belief that the risk of losing accreditation last year was very low due to access to care; if the federal government closed API, there would be nowhere else for patients to go. He said his interpretation of the notices from the federal government was that Alaska had problems and needed to fix them; the pressure would increase, and if the situation became bad enough, there may be federal lawsuits. He agreed the language in Amendment 1 was vague, ambiguous, and invited uncertainty, that it provided a loophole, and that it may encourage the lack of commitment to providing good services in the long term. 3:28:31 PM CHAIR ZULKOSKY offered that API was a state-operated institution; that Wellpath [Recovery Solutions] merely provided consulting services to API; therefore, the state had a direct relationship with the accrediting agencies. She said it was for that reason she did not support the proposed amendment. 3:29:40 PM REPRESENTATIVE PRUITT suggested changing the language to address concerns. He offered when an institution finds itself in a place in which the most vulnerable people in the state are not just in jeopardy, but are being harmed, limiting the options and insisting that API be operated by the "people who failed" is not the right thing to do. He asserted that narrowing the state's options and maintaining that the state "knew best" went against the evidence collected by the Ombudsman. 3:31:07 PM REPRESENTATIVE SPOHNHOLZ maintained her objection to Amendment 1. 3:31:11 PM A roll call vote was taken. Representatives Jackson and Pruitt voted in favor of Amendment 1. Representatives Tarr, Claman, Drummond, Spohnholz, and Zulkosky voted against it. Therefore, Amendment 1 failed to be adopted by a vote of 2-5. 3:31:54 PM REPRESENTATIVE SPOHNHOLZ moved to report the CS for HB 86, Version 31-LS0627\U, Marx, 3/26/19, out of committee with individual recommendations and the accompanying fiscal notes. 3:32:11 PM REPRESENTATIVE JACKSON objected. She maintained that the mission of the committee was to look out for the well-being of the patients. She acknowledged all committee members cared about the patients. She asked the committee to change the amendment language to "secure the state and secure the well- being of the patients," and thereby better serve the state. 3:33:23 PM REPRESENTATIVE SPOHNHOLZ restated her motion, and moved to report the CS for HB 86, Version 31-LS0623\U, Marx, 3/26/19, out of committee with individual recommendations and the accompanying fiscal notes. 3:33:42 PM REPRESENTATIVE JACKSON objected. 3:33:48 PM REPRESENTATIVE PRUITT expressed he did not understand why committee members would support eliminating any options, which may be necessary for ensuring the most vulnerable people could be protected. He said that the state failed, and the proposed legislation suggested that the state was the best entity to operate API. He maintained every option should be available regardless of the administration in power. He stated there was no testimony from patients and family members. He maintained those who had bad experiences at API would not care what entity was operating the facility; they would only care the problems were corrected. He said, "Now we're going to say we're the best person, and we should never have the option for someone else." He asserted it manifested poor judgement. He continued by saying if the concern were for employees, there was no intent to eliminate the employees. He offered the proposed legislation was bad policy if legislators were truly concerned with helping the most vulnerable people under its charge. 3:36:06 PM REPRESENTATIVE TARR mentioned the topic under discussion was one that could be in a special session if time allowed. She mentioned the many related challenges. She said the intent of Version U was to force the state to do a better job and not shirk its responsibility to manage API. She offered she tended to err on the side of the public-operated facility. She expressed the importance of legislative oversight. 3:37:28 PM REPRESENTATIVE SPOHNHOLZ clarified supporting the bill did not suggest committee members did not care about patients at API. She stated she has spent a great deal of time ensuring API was as successful and as functional as was possible; she understood the vulnerability of the patients; their illnesses often made it impossible for them to advocate for themselves. The disagreement [in committee] was about how to approach a solution and not lack passion for the issue or commitment to the patients. She reiterated she fundamentally believed API failed due to lack of oversight - which was why she has introduced legislation to codify in law the governance board - and due to inadequate funding. For six years there was no increase in fulltime employees (FTEs) at API. The needs at API were not being met. The state faced fiscal challenges at the time, and no one was advocating for API; therefore, API suffered from neglect. It was not intentional but had real consequences. She mentioned a patient advocate testified that it was important to keep API in the public trust; she agreed with that sentiment and supported Version U. 3:40:10 PM REPRESENTATIVE JACKSON maintained her objection. 3:40:18 PM A roll call vote was taken. Representatives Spohnholz, Tarr, Claman, Drummond, and Zulkosky voted in favor of reporting CSHB 86, Version 31-LS0623\U, Marx, 3/26/19, out of committee. Representatives Pruitt and Jackson voted against it. Therefore, CSHB 86(HSS) was reported from the House Health and Social Services Standing Committee by a vote of 5-2.