Legislature(2019 - 2020)BUTROVICH 205
02/21/2020 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB134 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 134 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 134-MEDICAID COVERAGE OF LIC. COUNSELORS
1:34:20 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 134,
"An Act relating to medical assistance reimbursement for the
services of licensed professional counselors; and providing for
an effective date."
CHAIR WILSON, speaking as sponsor of SB 134, stated his intent
to hear a sectional analysis and take invited and public
testimony.
1:35:26 PM
GARY ZEPP, Staff, Senator David Wilson, Alaska State
Legislature, began a PowerPoint on SB 134. He read slide 2,
SB134:
SB 134 would add 717 Licensed Professional Counselors
to the Medicaid Optional Services. The concept of the
bill is to expand behavioral health capacity and
utilization for Alaska's most vulnerable population,
our Medicaid population. If behavioral health issues
can be treated in a preventative manner within a
clinical setting, rather than a crisis stage at a
platinum level, the costs lesson and the quality of
the healthcare services improves. This proposed
legislation is a piece of the puzzle for providing
behavioral health services to Alaskans.
MR. ZEPP reviewed slide 3, Behavior Health:
Behavioral health is the scientific study of the
emotions, behaviors, and biology relating to a
person's mental well-being, their ability to function
in everyday life, and their concept of self.
"Behavioral health" is the preferred term to "mental
health." A person struggling with his or her
behavioral health may face stress, depression,
anxiety, relationship problems, grief, addiction,
attention-deficit/hyperactivity disorder or learning
disabilities, mood disorders, or other psychological
concerns. Counselors, therapists, life coaches,
psychologists, nurse practitioners, or physicians can
help manage behavioral health concerns with treatments
such as therapy counseling or medication.
MR. ZEPP said licensed professional counselors (LPCs) are a
valuable, cost effective part of treatment for behavioral
health. This bill provides one piece of the behavioral health
capacity that already includes licensed social workers, Ph.D.
psychologists, prescribing nurse practitioners, and medical
doctors, including psychiatrists and primary care physicians.
MR. ZEPP pointed out that many people are familiar with the term
mental health, which covers many of the same issues as
behavioral health, but that term only encompasses the biological
component of the aspect of wellness. The term behavioral health
encompasses all contributions to mental wellness, including
substance abuse, behavioral issues, habits, and other external
forces.
MR. ZEPP turned to slide 4, Why Medicaid clients and who are
they? He read:
Medicaid provides health coverage and long-term care
services for Alaska's most vulnerable: children,
seniors, people with disabilities, pregnant women, and
very low income or working poor.
Medicaid clients have difficulties finding access to
behavioral health care and often have to wait three to
six months for appointments. So you can imagine a
person in crisis who cannot find behavioral healthcare
access or are told it's available in three or four
months, what are [their] options?
Alaska's emergency room facilities are in a crisis
mode treating behavioral health issues.
SB 134 would directly impact the lives of our most
vulnerable population of citizens, our poor, our
young, and our seniors. Alaska's emergency rooms have
been over-whelmed with volumes of emergency
situations. The leading cause is alcohol disorders and
the associated aliments of alcohol abuse.
Often Medicaid clients have no where else to go due to
access and then the lack of capacity causes patients
to stay much longer in the emergency room than they
should. Patients who have serious behavioral health
issues.
MR. ZEPP reviewed the statistics on slide 5, Adult Untreated
Behavior Health Statistics. He reported that approximately 70
percent of Americans who need behavioral health services do not
receive treatment, and 92 percent of those with substance abuse
disorders and 66 percent of adults with serious mental health
issues go untreated. Untreated behavioral health issues can
increase the risk of cardiovascular disease, diabetes, stroke,
Alzheimer's disease, osteoporosis, pancreatic disease, and
hypertension. When people who need treatment do not receive it,
it often leads to interaction with the police, the court system,
and correctional facilities. Approximately 42 percent of state
prisoners have a mental illness and 20 percent are considered
severely and persistently mentally ill.
MR. ZEPP reviewed the bar charts on slide 6, Children's
Untreated Behavioral Health Statistics. It indicates that boys
are more likely to have a mental, behavioral, or developmental
disorder and children living below poverty line are 22 percent
more likely to have a mental, behavioral, or developmental
disorder.
1:41:46 PM
MR. ZEPP reviewed slide 7, Alaska assessment of behavioral
health care needs, which states:
Mental Health Care Needs
Alaska's suicide rate is among the highest in the
nation, with the prevalence among the Alaska Native
population, particularly in the most remote areas of
the state, surpassing that of the general Alaska
population (figure 1). The 2016 Alaska Behavioral
Health Systems Assessment reported that more than
145,000 adult Alaskans, 20 percent of the state's
population, are in need behavioral health services.
One component necessary to address mental health
issues is a well-trained cadre of mental health care
providers to provide preventive support and treatment.
There are several reasons why individuals needing
mental health services do not receive them. In some
cases, the perceived stigma associated with the
problem or illness prevents the individuals from
seeking help. In other cases, individuals may be more
comfortable seeking help from alternative providers
such as faith-based, traditional/culture-based or
peer-support resources within their community.
Finally, particularly in remote areas, availability
and access to mental health care providers are often
limited.
The most common issues for children are attention
deficit hyperactivity disorder (AHDH), anxiety, and
depression. A child diagnosed with depression has
approximately a 74 [percent] chance of having a
codisorder, like anxiety. If a child diagnosed with
depression and an anxiety disorders, if not treated,
they usually increase over time, and the child's
condition worsens.
MR. ZEPP said mental disorders among children can cause serious
challenges to the way children typically learn, behave, and
handle their emotions, which causes distress and problems
throughout the day. According to the American Foundation for
Suicide Prevention, suicide is the number one cause of death for
ages 15-24 in Alaska. In 2017, nine times as many people died by
suicide in Alaska than in alcohol-related motor vehicle
accidents. Alaska's suicide rate is 52 percent higher than the
national average.
1:42:57 PM
How Many Behavioral Health Care Providers Are Needed?
Despite the number of individuals in need of
behavioral health care services, the ratio of
behavioral health care providers to population is
lower in Alaska than nationally. Furthermore, most
providers work in urban areas, such that the state's
remote areas have even lower provider/population
ratios.
There are many types of behavioral health providers in
Alaska (e.g., psychiatrists, neurologists,
psychologists, counselors, clinicians, technicians,
behavioral nurse practitioners, and behavioral health
aides), though as an example, here we consider only
the shortage of psychiatrists. Two studies estimated
a need for 25.96 and 15.37 psychiatrists per 100,000
adults nationally, with the authors of the second
study noting that the behavioral health care needs of
rural populations may not have been adequately
captured.
National estimates do not account for Alaska's unique
population, geography, and need but can serve as a
benchmark for estimating the number of psychiatrists
needed in Alaska. Based on 2010 Census data, Alaska
needs 184 or 106 psychiatrists, respectively.
MR. ZEPP said understanding the magnitude, composition, and
geographical scope of the mental health provider shortage in
Alaska is seen as the first step in developing effective,
targeted solutions to increase workforce capacity by adding
licensed professional counselors.
1:43:39 PM
MR. ZEPP reviewed the chart on slide 9, titled, "Alaska
Emergency Room Department, Super-Utilizer Facts, and Total
Medicaid Billing charges." He said this chart reflects the total
the state paid to emergency rooms from 2016 through 2019 for
Alaska's Medicaid clients. The costs have increased by $47.1
million, or 21.1 percent, over the last four years. The top
utilizers go to the ER at least ten times a year and sometimes
as many as 50 times per year. The cost of the 2.7 percent or
1,858 top utilizers is $42 million or $22,604 per person per
year. The cost of 11.6 percent or 7,996 of the top utilizers is
$98 million.
MR. ZEPP said the state needs to improve Medicaid programs and
provide increased quality and become more cost efficient. Adding
more licensed professional counseling services can improve these
outcomes. With the federal approval of the 1115 [Behavioral
Health Medicaid Waiver, also known as 1115 waiver], adding LPCs
to the mix of behavioral health professionals offers an
opportunity to expand capacity, increase the quality of care,
lower the cost versus the crisis level costs that the state is
paying. The state has already paid these costs for Medicaid
clients for their behavioral health services.
1:45:28 PM
MR. ZEPP reviewed the statistics on slide 10, "Alaska Emergency
Room Department, Super-Utilizer Facts, Number of Medicaid
Clients." He said the chart shows that from 2016 to 2019, the
number of Medicaid clients has gone down by 9.6 percent, but the
costs are rising. Alcohol-related disorders were the most common
diagnoses for the top 2.7 percent, or 1,609 super utilizers and
the cost was $43.5 million. The four-year average for the top
10.77 percent or 7,204 users was $103.4 million or $14,332 per
person. The top 2.7 percent were likely between 20 and 59 years
old. Of these patients, 61 percent were female and 39 percent
were male.
MR. ZEPP reviewed slide 11, Preventative Behavioral Health Care.
He said the estimated cost for a behavioral health assessment in
Alaska's emergency rooms is $4,300 versus $150 to $250 per hour
for clinical work by a licensed professional counselor. SB 134
has the ability to lower costs for Medicaid clients' behavioral
health services that the state is paying to emergency rooms for
those in a crisis state.
MR. ZEPP displayed the list of supporters of SB 134:
• Alaska State Hospital and Nursing Home
Association
• Providence Health and Services Alaska
• Southeast Alaska Regional Health Consortium
• Alaska Regional Hospital
• Mat-Su Health Foundation
• Alaska Primary Care Association
• Mat-Su Health Services
• Alaska Mental Health Trust Authority
• Alaska Department of Health & Social Services
• Alaska Department of Commerce, Community &
Economic Development
• Discovery Cove Recovery & Wellness Center
MR. ZEPP respectfully asked members to support SB 134.
1:48:56 PM
GENNIFER MOREAU, Director, Division of Behavioral Health,
Department of Health and Social Services (DHSS), Anchorage,
Alaska, said the Division of Behavioral Health stands ready to
assist with this proposed legislation. She highlighted potential
benefits of SB 134, which could expand access to care to
eligible Alaskans statewide, especially for remote, rural
communities and for individuals with mild to moderate
disturbances. The bill could potentially decrease psychiatric
emergency services and acute care hospital services over time.
Licensed professional counselors will be able to provide SBIRT
[screening, brief intervention, and referral to treatment],
which is a key element to the continuum of care. By making this
provider type available to eligible Alaskans, it also provides
families the opportunity to interact in a smaller and more
intimate setting. Families may be more comfortable receiving
services in those settings.
CHAIR WILSON asked how this would be integrated with the 1115
waiver.
MS. MOREAU replied the 1115 waiver is a mechanism to develop a
full continuum of care. The driver behind it is to reduce the
reliance on the acute end of care. Expanding access, especially
for Medicaid recipients who are experiencing mild to moderate
disturbances, including disruptions in social determinants of
health, has the potential to prevent the future need for higher,
more expensive levels of care.
CHAIR WILSON called Jon Zasada to the table.
1:52:16 PM
JON ZASADA, Director, Policy Integration, Alaska Primary Care
Association (APCA), Anchorage, Alaska, said he spent nine years
at the Anchorage Neighborhood Health Center. APCA supports the
operations and development of Alaska's 27 community health
centers. Its members voted to support SB 134. Adding Medicaid
reimbursement for LPCs has been a top priority in its efforts to
expand access to behavioral health for many years. APCA serves
113,000 patients per year through 560,000 visits at 160 clinic
sites around the state. APCA serves 10 percent of Alaskans.
About 85 percent of its patients have incomes at under 200
percent of the federal poverty level. Around 20 percent of
Alaskans enrolled in Medicaid get their primary care at a
community health center. About 10 percent of APCA patients come
in primarily for mild and moderate behavioral health care and 15
percent of all visits in a year are for behavioral health. APCA
employs over 180 behavioral health providers of all types.
MR. ZASADA said LPCs are a valuable, cost-effective component of
team-paced, whole person primary care. Primary care is built
around medical, dental, behavioral health, pharmacy, and support
providers working to ensure patients receive care and help them
manage their chronic conditions. Making LPCs billable under
Medicaid will expand access to care for Alaskans in lower cost,
primary care settings.
MR. ZASADA said the bill is an important component of the
Medicaid reforms that were outlined in the 2016 Senate Bill 74
to expand provider types to increase access to behavioral health
services. LPCs are an important provider type within a
behavioral health team that includes licensed clinical social
workers (LCSWs), psychologists, prescribing nurse practitioners,
and medical doctors. In 2017, APCA health centers reported a
deficit of 12 to 18 behavioral health providers. Conservatively,
they could provide care to 6,000 to 9,000 additional patients.
From a clinical standpoint, LPCs are vital for one-on-one
counseling in conjunction with LCSWs.
1:57:29 PM
MR. ZASADA said community health centers are already using LPCs
in their practice to provide school-based services, counseling
services, and supporting care coordination for patients. The
addition of LPCs will increase overall provider retention and
satisfaction, another challenge to health care in Alaska. All
medical providers are more likely to stay in place when there is
a full care team of professionals working at the top of their
licensure. The full medical team model will gain increased
efficiency by being fully staffed and reimbursed for the first
time. Community health centers have received considerable
federal investments to expand behavioral health services and
support substance use treatment services in the primary care
setting. Health centers are required by federal law to provide
behavioral health that is integrated with medical, dental,
pharmacy, and other services. Adding LPCs to the roster of
billable providers enables health centers to make their services
more sustainable. Now the LPCs that APCA employs are funded by
nonsustainable federal grants and other grants that are not
sustainable funding sources.
MR. ZASADA said mild and moderate anxiety and depression are co-
occurring conditions with chronic conditions including diabetes
and hypertension. LPCs can provide short-term counseling support
to stabilize and improve the health of emergent patients and
assisting them in managing their chronic conditions. LPCs
provide a range of behavioral health services in schools across
the state. Currently, none of that care is reimbursed.
MR. ZASADA said that in an integrated clinical setting, the
attending medical or dental provider of a patient with diabetes
might discover the patient is showing signs of depression or
anxiety that could affect the patient's ability to follow the
treatment plan. At this point an LPC would be called to provide
counseling support for the patient. The LPC will work with the
patient around personal issues affecting overall health, teach
behavioral skills, and address social issues. The goal of the
provider team is to get the patient back on path with a
treatment plan, improve mental health, and avoid emergency care.
2:01:03 PM
MR. ZASADA said that in school-based settings, an LPC might
provide individual counseling, provide behavioral health skills
education, and train teachers in how to support students.
MR. ZASADA said APCA supports SB 134. It addresses the need for
Alaska's response to behavioral health, lends sustainability to
current efforts, and offers another tool to improve care and
lower its costs.
2:02:05 PM
KEVIN MUNSON, Chief Executive Officer, Mat-Su Health Services,
Wasilla, Alaska, said Mat-Su Behavioral is a federally-qualified
community health center. It operates a community behavioral
health program funded by the state. He serves as the chair of
the Alaska Primary Care Association and sits on the executive
committee for the Alaska Behavioral Health Association. He said
he is trained as a marriage and family therapist, but he works
as a licensed professional counselor (LPC). He has practiced for
32 years in Alaska in behavioral health and primary care. It has
been a long-standing desire of his to see LPCs, licensed
marriage and family therapists and other licensed mental health
professionals added to the list.
MR. MUNSON said [SB 134] provides an opportunity to step back
and do some transformational thinking about how to redesign the
system. Many citizens use the emergency rooms to meet their
behavioral health needs because of lack of access to behavioral
health services in traditional settings.
MR. MUNSON said that in terms of Medicaid, LPCs are only allowed
to practice in narrow areas limited to grant-funded entities.
Appropriate professionals need to be in places where citizens
will most likely use them. The suicide rates provide chilling
statistics, such that 54 percent of people who commit suicide
have had a primary care visit in the previous 30 days.
MR. MUNSON said the primary care provider may have asked about
suicidal thought and may have referred the patient to a local
mental health center or counseling agency. Ninety percent of
those referrals do not result in a visit to a counselor and the
patient drops out of the system. Federal qualified community
health centers have integrated care for individuals to receive a
hand off to an existing counselor within the context of primary
care. Several private practices in the state have counselors who
do so. The Mat-Su Behavioral Health Services pays those
counselors but is not reimbursed for Medicaid clients because
LPCs are not eligible providers. It is not an expandable,
replicable model, he said.
MR. MUNSON said he employs six licensed clinical social workers.
Last year it took nine months to find a replacement when the
agency lost a social work. In one month, he had five
opportunities to hire LPCs to fill the slot, which he could have
done if the state had a reimbursable model. His program does not
have grant money to fund the licensed social workers who are
funded by the reimbursable work performed. He offered his view
that since much of his business is Medicaid, if he had a funding
stream for LPCs, he could have replaced that licensed social
worker in 30 to 60 days.
MR. MUNSON highlighted the need to provide citizens with access
to counselors. Usually an acute crisis drives someone to see a
counselor, such as trouble at school, a divorce, a lost job, or
driving while under the influence. Those are the circumstances
in which someone is ready but not necessarily able to get help.
Sometimes that is because the helpers are siloed in places
someone does not think of using or the person cannot get access
because the behavioral health system is designed to take care of
the most impaired, the most at risk, and the most in need. That
leaves individuals who fall in mild to moderate need without
viable resources.
2:10:32 PM
MR. MUNSON said a business model for federally qualified health
centers for counseling programs for primary care and group
practices could take care of the Medicaid population. Removing
the statutory barrier for LPCs [to bill for Medicaid] will
create a path to provide access for citizens who need care. When
people have access to behavioral health care during that initial
crisis, it is possible to salvage marriages and children no
longer face disruptions and can avoid other risks, such as
Adverse Childhood Experiences scores due to intervention. It
could also avoid interventions by the Office of Children
Services, Juvenile Justice, and the courts.
MR. MUNSON said the research shows that the best way to take
care of people is with a primary care team of individuals who
provide wraparound services, one of which is behavioral health.
His center has seen enormous success with individuals by
addressing behavioral health problems, such as anxiety,
parenting issues, lifestyle choices and providing management for
chronic medical conditions.
MR. MUNSON noted that people with diabetes find it hard to make
lifestyle changes. The primary care physician has limited time
and skills to help them, but the behavioral health specialist
can talk to the person about small, incremental changes that
eventually become large, lifestyle changes that will change the
trajectory of that person's diabetic care. Patients get their
A1Cs under control, lose weight, and develop an exercise
program. Since 2013, his center has been operating the
depression management care IMPACT model that involves the
collaboration of the primary care provider, a licensed clinical
social worker, and a consulting psychiatrist. His center has
seen enormous improvements in treatment and has seen people ease
their depression, go back to work, and put relationships back
together because the center was able to provide that level of
intervention.
MR. MUNSON said finally, there is the notion of equity. People
cannot differentiate between the services of a licensed clinical
social worker, a marriage and family therapist, and a counselor.
These professionals are all well trained, experienced, competent
behavioral health professionals. The system recognizes some of
the credentials only because these professions existed at the
time the regulations were drafted. Subsequent professionals have
been excluded from the process.
2:17:08 PM
CHAIR WILSON opened public testimony on SB 134.
PATICK ANDERSON, Chief Executive Officer, RurAL CAP, Anchorage,
Alaska, said RurAL CAP serves the hard to serve individuals in
Anchorage and rural Alaska. RurAL CAP has a grant to provide
behavioral health services and operates 24 Head Start programs.
These children go without basic services because RurAL CAP lacks
licensed professionals in rural Alaska.
MR. ANDERSON said the residents of Karluk Manor and Sitka Place
are hard to serve communities. He supported opening the roles to
add additional counselors. He spent eight years on the American
Indian/Alaska Native task force on suicide prevention. It is
disheartening to see the needs go unserved every day in rural
Alaska. The RurAL CAP board has initiated whole community
healing. RurAL CAP will need professionals and community
engagement to do so. He expressed concern that learned
helplessness will become the norm. He urged the committee to
support the expansion of the ranks with licensed professional
counselors.
2:20:59 PM
SEVILLA LOVE, Integration Coordinator, Alaska Primary Care
Association, Anchorage, Alaska, said she is a licensed clinical
social worker. She has spent her 20-year clinical career in in
primary care clinics in urban and rural Alaska, developing
cutting-edge intervention programs throughout Alaska. She worked
exclusively with suicidal rural patients at Alaska Psychiatric
Institute. Eighty percent of the people she worked with could
have been avoidable with preventative primary care. She has been
the provider capturing the unseen behavioral health patients who
would not otherwise have been seen or been willing to be seen.
MS. LOVE said she currently works as the integration coordinator
for the Alaska Primary Care Association. She provides training
to health centers across Alaska on how to implement a team-based
integrated care model by incorporating behavioral health into
the daily health care services. She said she observes the
struggles health centers have to provide quality care. The
number one problem is lack of access to billable, financially
sustainable behavioral health providers. The clinics she works
with tell her their clinics have sought licensed clinical social
workers throughout the Lower 48. These clinics pay a starting
salary of over $80,000 a year plus loan repayment options, but
still cannot find a licensed clinical social worker or
psychologist to fill the primary care role. Their patients are
desperate for care. However, many LPCs would be willing to fill
the vacancies, but the centers cannot hire them. Further,
medical staff face burnout so the turnover rates kill the
continuity of care. Chronic-care patients also need behavioral
health support to make lifestyle changes to improve their
health.
MS. LOVE said health centers have massive tasks but limited
options to build an integrated behavioral health program. She
said health centers must be allowed to meet behavioral health
needs using LPCs as billable providers in primary care clinics.
2:24:44 PM
ROBIN MINARD, Chief Communications Officer, Mat-Su Health
Foundation, Wasilla, Alaska, said the Mat-Su Health Foundation's
mission is to improve the health and wellness of Alaskans living
in the Mat-Su. SB 134 is crucial because it helps to address an
important health issue facing Mat-Su residents every day: mental
health, and substance abuse problems. Licensed professional
counselors are key behavioral health providers who can help with
these problems.
She reported that in 2013, residents and professionals said the
top five health challenges were alcohol and substance abuse,
children experiencing trauma and violence, depression and
suicide, domestic violence and sexual assault, and lack of
access to behavioral health care. During that same assessment,
the foundation met with school nurses throughout the borough who
said there was a four to eight month waiting list for children
and families on Medicaid to see a counselor. Unfortunately, not
much has changed since then. People need help when problems
arise, not eight months later. She said there are not enough
mental health providers in Mat-Su or Alaska, that there is one
provider for every 860 residents, but in the U.S., the ratio is
one for every 330 residents. Residents need access to behavioral
health providers to obtain care before problems escalate into
the crisis stage.
MS. MINARD said Mat-Su Regional Hospital is inundated with
people in crisis related to behavioral health. In 2016, there
were almost 1,200 residents seen in the emergency department
with a primary behavioral health diagnosis. These patients
comprised 3,000 visits, 46 percent of which were paid by
Medicaid. The top diagnoses were suicidal ideation and self-
harm, alcohol-related disorders, delirium, dementia, and
cognitive disorders. The cost for those visits was $14 million
in facility charges alone. If residents could get immediate
access to care, pain, suffering, and costs would be diminished.
An individual counseling session may average $75 for Medicaid
patients, but an average charge for a behavioral health
emergency room visit is $4,370. The prevalence of substance
abuse and mental health problems in crisis is increasing in Mat-
Su and statewide. SB 134 could bring the appropriate level of
care to people when a problem first presents.
2:29:15 PM
DEBRA HAMILTON, Executive Director, New Hope Counseling Center,
Soldotna, Alaska, said she has been a professional counselor
since 2013. Her counseling center is on the campus of Alaska
Christian College, which serves predominantly young adult Alaska
Natives. It is also open to the community. She has served on the
Board of Professional Counselors since 2013 and is the current
chair. Professional counselors could provide services of great
quality. Licensed professional counselors are master's level
counselors who have extensive training and required coursework.
Currently, there are 732 active licensed professional counselors
in the state with 447 approved supervisors actively training and
supervising the next generation of LPCs. There is a vacuum of
accessible services. She offered her support for SB 134.
2:31:39 PM
ERIC BOYER, Program Officer, Alaska Mental Health Trust
Authority, Anchorage, Alaska, said he serves as the chair of
Alaska Health Care Workforce Coalition. Expanding the number of
health care practitioners who can bill Medicaid will increase
that responsiveness to people experiencing behavioral health
disorders. The Alaska Mental Health Trust Authority
beneficiaries include Alaskans with mental illness, substance
use disorder, developmental disabilities, Alzheimer's and
related dementia, and traumatic brain injury. In partnership
with Department of Health and Social Services (DHSS), the
authority ensures that Alaska has a comprehensive, integrated
system of care to provide the necessary services and support for
beneficiaries as close to home as possible.
2:33:37 PM
DON BLACK, Board Member, Bethel Family Clinic, Bethel, Alaska,
said the clinic employs one licensed clinical social worker and
one licensed professional counselor and has an employee working
toward becoming an LPC in the behavioral health department. The
clinic provides services to teens at the Bethel Youth Facility.
The substance abuse programs are embedded in the community as
well as in the Yukon-Kuskokwim Correctional Facility, where
staff provides individual and group guidance. Youth services are
also delivered to court- and medically-referred patients. The
clinic receives patients from the local community and
surrounding village. As a safety net medical facility, some
services are provided without pay in the clinic's efforts to
maintain the health of the community. Such is the case with
services provided by the clinic's LPC for Medicaid patients,
many of whom are youth from villages where suicide rates are
high, even by Alaskan standards. The clinic's greater mission is
to provide for the health of the community, so sometimes the
clinic does that without pay, but the LPC provides the same
level of care as the licensed clinical social worker. The work
of the LPC is recognized as equivalent to the work of the
licensed clinical social worker and is payable by private
insurers, but this same work is not recognized and payable by
the state's Medicaid policies. In a time of addressing the
opioid crisis, the clinic has one hand tied behind its back. Its
delivery of services is restricted simply because of how the
history of the licensing process for licensed practical
counselor and licensed clinical social worker developed in the
state. SB 134 unties that hand.
2:35:52 PM
JULIE THOMPSON, Licensed Professional Counselor, Bethel Family
Clinic, Bethel, Alaska, said she is a licensed professional
counselor. She graduated with a master's degree in mental health
counseling in 2007. She has 13 years of experience specializing
in trauma-informed interventions for people with a diagnosis of
post-traumatic stress disorder (PTSD) and substance abuse
disorder. She previously worked two years as a clinician at
Yukon Kuskokwim Ayagnirvik Healing Center. She supported
individuals in their efforts toward recovery from a substance
use disorder. Over 90 percent of these clients suffered from
coexisting disorders, usually PTSD, often secondary to trauma
experienced as children growing up in severely dysfunctional
homes due to their parents' unresolved and untreated traumatic
histories. She now works for Bethel Family Clinic as a mental
health clinician. However, since she is not under the Indian
Health Service umbrella, she is not recognized as a clinical
provider by Medicaid. She characterized this as tragic as her
agency is a primary partner with the Child Advocacy Center whose
primary mission is to provide timely interventions to children
who have been identified as victims of sexual abuse and trauma.
The center currently employs two clinicians, herself and a
colleague who is a licensed clinical social worker. The clinic
has been trying to recruit another social worker for over a
year. It is not uncommon for the clinic to have seven referrals
in a week from the Advocacy Center. At this time, the clinic can
respond to none of them. Allowing LPCs access to Medicaid
reimbursement will not only save millions of dollars, money that
is now spent on emergency room visits, medevacked services, or
legal interventions, but will ultimately save lives. "Please
support SB 134 and help us help these children, help us save
their lives," she said.
2:38:15 PM
JEIGH STANTON GREGOR, representing self, Petersburg, Alaska,
said he is an LPC in private practice. He and his wife have
owned True North Counseling and Consultation for seven years. SB
134 will allow the most vulnerable patients the same access to
high-quality mental health services as people with private
insurance or the ability to pay out of pocket. He offered his
belief that a private practice could thrive if its patients were
Medicaid clients. The passage of SB 134 will lead to reductions
in costly emergency room visits and acute mental health crises.
Preventative care is highly effective in mitigating mental
health emergencies. He characterized SB 134 as a win-win. He
wants to help people be well and improve the quality of their
lives.
2:40:21 PM
CHAIR WILSON closed public testimony on SB 134 and held the bill
in committee.