Legislature(1999 - 2000)
02/21/2000 01:35 PM Senate HES
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
SB 191-APPROPRIATIONS: MENTAL HEALTH
MR. JEFF JESSE, Executive Director of the AMHTA, spoke via
teleconference from Anchorage and said he would review the proposed
items in the Governor's budget that were not accepted at the level
recommended by AMHTA.
CHAIRMAN MILLER asked that state agency staff testify first.
MS. JANET CLARKE, Director of Administrative Services at the
Department of Health and Social Services (DHSS), gave the following
overview of a packet of reports from OMB to explain some of the
items that the Governor included in SB 191.
The first page is a summary of the budget items included by the
Governor in the integrated mental health program. Some items are
included as increases because AMHTA and Senate Finance Committee
members agreed that AMHTA would initially fund those items but
eventually they would be funded with general funds. Two of those
items in the DHSS budget are training for residential child care
providers and institutional prevention for community developmental
disabilities grants.
The large increase in general fund items in the DHSS budget is an
increase in the Medicaid program related to the API 2000 Community
Implementation Plan. Services in Anchorage will be reconfigured to
allow community hospitals to pick up some of the services currently
provided by API. Another increase of $100,000 was included for
training of foster parents who care for severely emotionally
disturbed children. Another $100,000 increase is to reopen the
Fahrenkamp Center as a residential facility. That facility was
built over ten years ago and has been used by the community mental
center as office space and for counseling. DHSS has a proposal in
the capital budget to remodel the facility so that it can be used
for residential treatment. The other major general fund item does
not show up in SB 191 but it is related to mental health services.
The Governor has proposed a general fund increment to reduce the
infant learning wait list. Other increments relate to $3.4 million
of AMHTA funds for different activities within DHSS.
MS. CLARKE briefly highlighted some of the projects in the summary
of the Governor's capital budget for DHSS. The total of DHSS's
capital projects amount to $7.5 million. $495,000 was included to
reopen the Fahrenkamp residential facility. Stop-gap repairs in
the amount of $379,000 are required at API until the state can
finalize an agreement to purchase Charter North Hospital. Even if
that agreement is finalized today, API will be used for the next
two years. Many of the other projects are grant programs that are
competitively awarded to different agencies.
Number 0896
ALISON ELGEE, Deputy Commissioner of the Department of
Administration (DOA), discussed DOA's list of budget items for
integrated mental health programs. The general funds in the amount
of $126,000 for the Public Defender Agency (PDA) are new to the
AMHTA bill but it is not new money for the PDA. This format
recognizes that the work done by the PDA when representing indigent
clients in danger of involuntary commitment is an expenditure
related to services for the beneficiaries of the Mental Health
Trust.
The rural long term care development project and innovative respite
project are continuing projects. DOA "backs out" those projects
and then adds them back in each year as a result of AMHTA's funding
decisions.
DOA is looking for an opportunity to upgrade the ability of the
Division of Senior Services to provide quality assurance. DOA has
no comprehensive monitoring function for the variety of services it
licenses and regulates. This money would allow DOA to put some
tools in place so that it could ensure that the services delivered
meet the standards to prevent a crisis.
Day treatment for the Chronically Mentally Ill Elderly Program is
also a continuation of DOA's outreach efforts for the elderly. DOA
is building on that work to focus on outreach to elderly with
substance abuse problems. The mini grants for beneficiaries with
ADRD is a continuing project. The last two projects, funded by the
AMHTA, are a project to develop a comprehensive assessment tool for
long-term care facilities to reduce paperwork and to create
training materials for a family and private guardian member
training program. That increment is also reflected in the general
funds column in the amount of $355,000 for the Office of Public
Advocacy for public guardians. The caseload of Alaska's public
guardians is running twice the recommended national average. Right
now they are unable to perform the statutory requirement to work
with private and family guardian members. The funds would help
them reduce the caseload of public guardians and give them that
capacity.
DEPUTY COMMISSIONER ELGEE noted that two other general fund
requests have been proposed: one expands DOA's care coordination
function from four to six regions, the other is to implement
ongoing training for caregivers in ADRD care techniques.
DEPUTY COMMISSIONER ELGEE pointed out a high priority of AMHTA and
DOA is to increase the general relief daily rate. That money is
being carried in the fiscal note to SB 73. DOA has one capital
project for a data integration project. By combining functions
previously performed by other parts of state agencies, data bases
that were developed for each function will be integrated by the
Division of Senior Services to create a comprehensive tracking
system.
Number 1161
DWAYNE PEEPLES, Director of the Division of Administrative Services
in the Department of Corrections (DOC), discussed DOC's requests.
This year, DOC has three AMHTA operations in the operating budget.
The first two represent third year transitions between AMHTA funds
and general fund mental health funds. The first is an 18-bed
psychiatric unit set up at the Highland Mountain institution,
established in the fall of 1997. This is the final year of the
transition and the total operating cost will be $600,000. The
second item is again a transition from FY 98 from AMHTA to the
general fund for a mental health planner. This position
coordinates services for the AMHTA beneficiaries within DOC. The
last item is a new proposal to establish a men's substance abuse
residential treatment facility within one of DOC's correctional
institutions. The $82.9 is a match for federal money in the amount
of $236.0. The new facility will provide fairly intense treatment
services for 40 to 50 men prior to the end of their incarceration.
The only capital budget item being requested by DOC is for a
collaborative project with DHSS to develop a telepsychiatry program
between 10 rural correctional facilities and 10 mental health
centers and psychiatric units in Anchorage. This program will
decrease travel costs and increase services by allowing video
teleconferencing for diagnosis and treatment with inmates.
SENATOR WILKEN asked if the men's residential substance abuse
treatment program is a new program.
MR. PEEPLES replied it is a new initiative.
SENATOR WILKEN asked that Mr. Peeples provide some detailed
information for the Finance Committee regarding how the program
will be structured and where and how the results will be measured.
DEPUTY COMMISSIONER ELGEE mentioned that DOTPF houses a capital
appropriation for a grant program for coordinated transportation
and vehicles that benefits all four beneficiary groups. All four
groups applied to DOTPF for the money provided through this capital
project.
Number 1353
MR. JESSE referred to a chart entitled "Alaska Mental Health Trust
Authority FY01 Mental Health Trust Operating Budget Recommendations
not accepted by the Governor." The first item on that chart is a
match for the assisted living rate increase. Over $800,000 of
AMHTA income has been committed as a match. The general fund
portion was not placed in the Governor's budget because it is
expected to be funded from the fiscal note to SB 73. Item 5 on the
chart is the DOC Men's Sub-Acute Care Unit in the amount of
$300,000. This program would build on to a successful inpatient
treatment program for the most severely mentally ill inmates at the
Cook Inlet facility. The intent of this increment was to provide a
higher level of care for those men when they are housed with the
general population of inmates. Another item, listed between items
6 and 7, for substance abuse treatment for rural women with
children, contains $500,000 of AMHTA funds but does not include the
$500,000 general fund match. Usually the trustees are concerned
when their proposals to match efforts with the State are not
accepted. The AMHTA match remains in SB 191 because of the
critical nature of the services.
MR. JESSE referred to a chart entitled "FY01 Mental Health Trust
Capital Budget Recommendations not accepted by the Governor" and
pointed out the Governor's capital budget did not include either
the AMHTA $100,000 commitment or the $914,000 general fund
commitment for the Adult Day Care Facility in Juneau. AMHTA will
be approaching the DOA subcommittee to request that at least
$100,000 AMHTA be placed in the budget to allow the planning
process to begin. The Governor's Office is concerned that a false
expectation of assured construction will be created if the planning
money is forthcoming. The $30,000 in item number 3 on the chart is
to make the physical modifications necessary to provide treatment
programs discussed in the operating budget. Modifications include
cell re-configurations and the addition of video equipment to
monitor inmates with serious mental illnesses. Three other
programs not accepted for the Governor's capital budget involve
AHFC programs for mental health trust beneficiaries. He noted that
without housing, many of AMHTA's beneficiaries continue to cycle
through API, the court system, and other expensive treatment
programs. Housing is an essential component when trying to divert
people from the emergency service system.
MR. JESSE commented on a few issues that are not addressed in SB
191 but are critical to a comprehensive mental health program.
Foremost among those issues is the Medicaid budget. There is a
significant increase in that formula program but several of the
Medicaid options would not be funded - eyeglasses, dental care,
hearing aids, and mental health rehabilitation. Those services are
the backbone of Alaska's mental health system. The smaller
hospital at API and the project to redesign the service system for
people with mental health crises are very dependent on the Medicaid
component of the budget. A large portion of the general funds for
the Medicaid budget were originally from grant funds in the
Community Mental Health grant area. AMHTA believes it would be a
monumental disaster to lose those critical services.
SENATOR ELTON asked whether AMHTA staff will be present during
budget subcommittee hearings.
MS. CAREN ROBINSON, Chair of AMHTA, said yes.
SENATOR WILKEN moved SB 191 with its accompanying fiscal note out
of committee with individual recommendations. There being no
objection, the motion carried.
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