Legislature(2003 - 2004)

04/25/2003 09:06 AM FIN

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= 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                                                            
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                                                            
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                                                            
Senator  Taylor  moved to  adopt  CS SB  157  (HES) as  the  working                                                            
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                                                            
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.                                                                    

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