Legislature(2019 - 2020)DAVIS 106

03/10/2020 03:00 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved CSHB 86(HSS) Out of Committee
-- Invited & Public Testimony --
Moved CSHB 183(HSS) Out of Committee
-- Invited & Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
          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                                                               
3:09:30 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                                                                    
     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                                                                    
     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                                                                    
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 [2019]  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                                                               
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                                                               
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.                                                                                   

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