Legislature(2003 - 2004)
04/25/2003 09:06 AM FIN
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
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." This was the first hearing for this bill in the Senate Finance Committee. Co-Chair Green, the bill's sponsor, explained that this bill would require the Department of Health and Social Services to provide, when available, in-State psychiatric services to individuals under the age of 21, who are in State care and require or need those services. She stated that, while this requirement is currently in regulation, it is not being implemented. She expounded on the benefits of providing in-State care as: it "would stabilize the environment so that the State can attract and assure care providers in this field that in-State providers would be considered first" before a person would be sent out-of-State for treatment; would reduce the demand on the State to pay for expensive out-of-State treatment; and would keep individuals closer to family. She noted that the Denali KidCare program has contributed to the growth in the numbers of individuals identified as requiring treatment. JOHN DUFFY Borough Manager, Mat-Su Borough, testified via teleconference from Mat-Su in support of this legislation, and he urged the Committee to support it. He stated that allowing children to receive treatment close to home and to family members would "increase the probability of treatment success." In addition, he noted that provisions of this legislation would remove "uncertainty from the private sector" and allow for more in-State treatment centers. This, he asserted, would benefit individuals, positively impact the economy, and provide jobs. He affirmed that in-State treatment is less expensive than out-of-State treatment, and that "it makes sense that Alaskan dollars remain in Alaska" to support the State's economy. KATHY CRONEN, Chief Executive Officer, Fairbanks NorthStar Hospital, testified via teleconference from an offnet site in support of bringing Alaskan children "home for treatment.' She informed that 300-plus children were treated out-of-state last year, and she opined that this "has devastating impact of these children and their families, as well as on the State because we are not supporting our kids." She stressed that mental health care should be provided closer to home, that follow-up care is critical to a child's long-term success, and, she asserted, treatment should involve a child's family. Ms. Cronen furthered that this legislation would be good for the State as it would allow in-State treatment programs to expand, would create hundreds of new jobs, and would keep Medicaid dollars in the State. She urged the Committee to pass this legislation. Senator Olson asked the staffing situation at the Northstar Hospital, particularly whether the hospital is able to attract board-certified psychiatrists and other support staff as, he understands, there is a shortage of personnel in these fields of practice. Ms. Cronen confirmed that "staffing and recruitment is always a challenge for any health care provider;" however, she informed that, while the hospital has at times experienced nursing and psychiatrist staff shortages, the hospital has been successful in the long-term. She voiced the need to provide job security, and she contended that legislation of this nature would provide the foundation. Senator Taylor moved to adopt CS SB 157 (HES) as the working document. There being no objection, the (HES) committee substitute was adopted as the working document. JODY SIMPSON, Member Mat-Su Borough Assembly, testified via teleconference from Mat-Su and voiced that the Mat-Su Borough supports this bill. She voiced that out-of-state treatment removes Alaskan children from their families as well as sends Alaska dollars elsewhere thereby resulting in a loss of in-State job opportunities. ROBERT BUTTCANE, Programs/Administration, Division of Juvenile Justice, Department of Health and Social Services informed that the Department supports this legislation and its goal of establishing "adequate in-State resources to meet the treatment needs of young people." He informed that the Division is committed to working with providers to develop the needed capabilities. However, he noted that some complicating factors must be addressed to include the fact that parents of children who are not in the State's custody have the right to decide whether their child would receive in-State or out-of-State treatment. He furthered that another factor is that few Alaskan facilities provide "secured, locked care" which is required in some situations. However, he attested that the provision requiring an assessment to be conducted on each child is an appropriate one as it would enable the Division to compile a facility needs list that would propel the State's system to evolve as necessary with the goal that eventually the State's resources would meet all needs. Co-Chair Green asserted that even though a child might not be in State custody, the fact that the child might be a Medicaid recipient would provide the State with the right to determine where the child might receive treatment. Mr. Buttcane concurred. Co-Chair Green furthered that a recent Medicaid audit [copy not provided] recommended that requests for out-of-state and in-state travel for medical necessities should be accompanied by written justification. She reiterated that this legislation is taking what is currently in regulation and putting it into statute to assure that the regulations would be implemented. Senator Hoffman asked how rural children would benefit from this legislation as, he communicated, and they would still be removed from their small communities and their families to receive care. Mr. Buttcane responded that this is a valid concern as individuals from rural areas would continue to experience upheaval, and he stated that "there is no easy answer" to the situation. He suggested that, "the next step" to address this scenario would be to provide more in-state care options to keep the "children at least that much closer to their communities." He stated that further action from Native Health organizations, State, federal, and private, non-profit entities could assist in providing better service to young people. Senator Hoffman allowed that this bill would enable rural children to be one step closer to home; however, he concluded that the needs of rural children are still being addressed. Co-Chair Green agreed that Senator Hoffman has a good point. She stated that this bill would allow for small, private care facilities with perhaps as few as eight employees to locate in rural areas where there is a need. She stressed that through legislation such as this, the emphasis would be to keep youth in- State "to create the synergy and the energy and the numbers" required to encourage the private sector to service smaller communities. She predicted that there would be "a gradual growth" in this direction. Senator Olson asserted that mental health treatment is a complicated process, and he asked how the decision regarding the proper course of treatment and whether the State has adequate facilities to provide that treatment would be determined. Mr. Buttcane told of "a shared process of review by a interdisciplinary team" comprised of medical and psychology doctors, social workers, and care providers who would conduct an inventory of State's programs and the needs of child, before rendering a recommendation, and he furthered that funding would be determined by Medicaid. He stated that were someone to determine that the outcome of the review was improperly derived at; there would be an opportunity for a review. Senator Olson asked whether a physician or psychiatrist would be on the staff of the review board. Mr. Buttcane clarified that there is a psychiatrist on staff. SFC 03 # 65, Side B 09:54 AM Co-Chair Green responded that the current regulations specify that a licensed psychiatrist, a physician, a clinical social worker, a registered nurse, an occupational therapist, a psychological associate, and representatives from the Division of Family & Youth Services and the Division of Juvenile Justice would comprise the members of the review board. Co-Chair Wilken informed the Committee that a question arose in the Senate Health Education and Social Services Committee hearing as to whether bringing children who are currently being treated out-of- state back to the State would increase the State's Medicaid expenses. He stated that the answer is no, it would not. He noted that this information is provided in fiscal note #1. Co-Chair Green moved to report the bill from Committee with individual recommendations and accompanying fiscal note. There being no objection, CS SB 157 (HES) was REPORTED from Committee with previous fiscal note #1 from the Department of Health and Social Services. RECESS TO THE CALL OF THE CHAIR 9:55 AM / 1:25 PM Co-Chair Green chaired the remaining portion of the meeting.