Legislature(2019 - 2020)ADAMS ROOM 519

05/21/2019 01:30 PM FINANCE

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Audio Topic
01:29:39 PM Start
01:30:04 PM HB1001
01:32:04 PM SB19
01:37:07 PM Presentation: Substance Use and Mental Health Response in Anchorage
02:24:53 PM Presentation: Southcentral Foundation
03:07:28 PM Presentation: Mat-su Health Foundation
03:48:12 PM HB1001
03:49:18 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Failed to Move Out of Committee
Heard & Held
Substance Abuse Treatment Programs:
- Municipality of Anchorage
- Southcentral Foundation
- Norton Sound Health Corp.
- Mat-Su Health Foundation
- Set Free Alaska
                  HOUSE FINANCE COMMITTEE                                                                                       
                   FIRST SPECIAL SESSION                                                                                        
                       May 21, 2019                                                                                             
                         1:29 p.m.                                                                                              
1:29:39 PM                                                                                                                    
CALL TO ORDER                                                                                                                 
Co-Chair Wilson  called the House Finance  Committee meeting                                                                    
to order at 1:29 p.m.                                                                                                           
MEMBERS PRESENT                                                                                                               
Representative Neal Foster, Co-Chair                                                                                            
Representative Tammie Wilson, Co-Chair                                                                                          
Representative Jennifer Johnston, Vice-Chair                                                                                    
Representative Dan Ortiz, Vice-Chair                                                                                            
Representative Ben Carpenter                                                                                                    
Representative Andy Josephson                                                                                                   
Representative Gary Knopp                                                                                                       
Representative Bart LeBon                                                                                                       
Representative Kelly Merrick                                                                                                    
Representative Colleen Sullivan-Leonard                                                                                         
Representative Cathy Tilton                                                                                                     
MEMBERS ABSENT                                                                                                                
ALSO PRESENT                                                                                                                  
Representative  Chuck Kopp;  Nancy  Burke, Housing  Services                                                                    
Coordinator, Municipality of  Anchorage; Sean Case, Captain,                                                                    
Anchorage Police  Department; Representative  Ivy Spohnholz,                                                                    
Chair,  Health and  Social Services  Committee; April  Kyle,                                                                    
Vice   President,    Division   of    Behavioral   Services,                                                                    
Southcentral Foundation;  Elizabeth Ripley,  chief Executive                                                                    
Officer, Mat-Su  Health Foundation; Dr.  Melissa Kemberling,                                                                    
Vice  President  of   Programs,  Mat-Su  Health  Foundation;                                                                    
Representative Geran Tarr; Representative Sharon Jackson.                                                                       
PRESENT VIA TELECONFERENCE                                                                                                    
Natasha  Pineda,  Director,   Anchorage  Health  Department;                                                                    
Lance Johnson,  Behavioral Health Services  Director, Norton                                                                    
sound Health Corporation; Philip Licht, Executive Director,                                                                     
Set Free Alaska.                                                                                                                
CSSSSB 19 (FIN)                                                                                                                 
          APPROP: CAPITAL BUDGET; SUPPLEMENTAL                                                                                  
          CSSSSB 19 (FIN) was HEARD and HELD in committee                                                                       
          for further consideration.                                                                                            
HB1001    APPROP: 2020 EDUCATION FUNDING/REPEAL                                                                                 
          HB 1001 was HEARD and HELD in committee for                                                                           
          further consideration.                                                                                                
PRESENTATION: SUBSTANCE USE and MENTAL HEALTH RESPONSE IN                                                                       
PRESENTATION: SOUTHCENTRAL FOUNDATION                                                                                           
PRESENTATION: MAT-SU HEALTH FOUNDATION                                                                                          
Co-Chair Wilson reviewed the agenda for the meeting.                                                                            
HOUSE BILL NO. 1001                                                                                                           
     "An Act making appropriations for public education and                                                                     
     transportation of students; repealing appropriations;                                                                      
     and providing for an effective date."                                                                                      
1:30:04 PM                                                                                                                    
Co-Chair Wilson asked about the will of the committee.                                                                          
Vice-Chair Johnston MOVED to report HB 1001 out of                                                                              
Committee with individual recommendations.                                                                                      
Co-Chair Wilson OBJUECTED.                                                                                                      
Representative Knopp opposed the legislation. He wanted to                                                                      
see the issue addressed in the judicial system.                                                                                 
A roll call vote was taken on the motion.                                                                                       
IN FAVOR:   LeBon, Merrick, Sullivan-Leonard, Tilton,                                                                           
OPPOSED:    Knopp,   Ortiz,  Josephson,   Johnston,  Wilson,                                                                    
Representative Carpenter was absent from the vote.                                                                              
The MOTION FAILED (4/6).                                                                                                        
CS FOR SPONSOR SUBSTITUTE FOR SENATE BILL NO. 19(FIN)                                                                         
     "An  Act   making  appropriations,   including  capital                                                                    
     appropriations,       supplemental      appropriations,                                                                    
     reappropriations,  and  other appropriations;  amending                                                                    
     appropriations;  making  appropriations  to  capitalize                                                                    
     funds; and providing for an effective date."                                                                               
1:32:04 PM                                                                                                                    
REPRESENTATIVE  CHUCK KOPP  had been  asked to  provide some                                                                    
opening comments. He noted that  the legislature had adopted                                                                    
public safety legislation  to toughen the laws  on crime. He                                                                    
spoke  to  drug  treatment.   He  addressed  the  underlying                                                                    
reasons for crime and noted  that substance abuse and mental                                                                    
health issues  were the  drivers of over  80 percent  of the                                                                    
state's incarcerated population.  He stressed the importance                                                                    
of addressing  the issues that  were tearing  apart families                                                                    
and  communities.  He  related   that  the  governor's  drug                                                                    
advisor,  Andy Jones,  had recently  testified to  the House                                                                    
Heath  and Social  Service Committee.  He recounted  that in                                                                    
the  prior  4  years  the  legislature  began  to  seriously                                                                    
address the issue via funding  in recognition of the crisis.                                                                    
Recently, the legislature supplemented  Medicaid grants by a                                                                    
ratio of  1 to 3.  He indicated that  in 2015 the  state had                                                                    
$62.5  million  in grants  and  $38.4  in leveraged  funding                                                                    
amounting  to  $101  million that  served  approximately  20                                                                    
thousand  Alaskans.  In  2018,  Alaska had  $54  million  in                                                                    
grants and $150  million in  Medicaid  billing totaling $205                                                                    
million that served approximately  38 thousand Alaskans. The                                                                    
state was currently  serving twice as many  people but still                                                                    
had a huge  demand for services. He  provided statistics for                                                                    
a  Department  of  Health and  Social  Services  (DHSS)  in-                                                                    
treatment  waitlist.  He  reported   that  the  waitlist  in                                                                    
Fairbanks was  60 days, in  Juneau the waitlist  amounted to                                                                    
30  days,  on the  Kenai  the  wait  time  was 2  weeks,  in                                                                    
Dillingham the wait  period was 1 month, and  in Wasilla the                                                                    
waitlist was  up to  2 months. He  delineated that  DHSS was                                                                    
currently completing  a gap  analysis of  services necessary                                                                    
for   addiction   treatment.   The  1115   Medicaid   Waiver                                                                    
application  to  the  Center  for  Medicaid  Services  (CMS)                                                                    
stated that the  state needed another 200  treatment beds in                                                                    
addition to  the 325 already  established representing  a 62                                                                    
percent  increase.  The  same document  stated  that  Alaska                                                                    
needed 23 withdrawal management  programs and 28 out-patient                                                                    
treatment programs. He believed  that the programs served in                                                                    
the interest  of public  safety and  offender rehabilitation                                                                    
and that early intervention  could prevent incarceration. He                                                                    
announced that the following  presentation would reveal that                                                                    
addiction was  fueling crime and the  state lacked treatment                                                                    
options. The  state had shovel ready  projects with matching                                                                    
grants  to incentivize  communities to  invest in  treatment                                                                    
centers.  He   maintained  that  accessible   treatment  was                                                                    
necessary in order to "get though on crime."                                                                                    
Co-Chair  Wilson  explained  that she  intended  to  include                                                                    
treatment funding in  the capital budget and  the reason the                                                                    
issue was presently under discussion.                                                                                           
^PRESENTATION: SUBSTANCE  USE and MENTAL HEALTH  RESPONSE IN                                                                  
1:37:07 PM                                                                                                                    
NANCY BURKE,  HOUSING SERVICES COORDINATOR,  MUNICIPALITY OF                                                                    
ANCHORAGE,  introduced herself.  She shared  that she  was a                                                                    
clinically trained social worker  and previously helped with                                                                    
the development of the Alaska  Mental Health Trust Authority                                                                    
(AMHTA)   predevelopment    program   that    examined   the                                                                    
infrastructure  needs  of   treatment  services  across  the                                                                    
NATASHA PINEDA,  DIRECTOR, ANCHORAGE HEALTH  DEPARTMENT (via                                                                    
teleconference),  provided  her  background  information  in                                                                    
public health  prevention. She had  worked on  health policy                                                                    
with  the Department  of Administration  (DOA), served  as a                                                                    
program officer  for AMHTA for  substance abuse,  and worked                                                                    
for  the Department  of Health  and Social  Services (DHSS),                                                                    
Division of Behavioral  Health as a grant  manager and Chair                                                                    
of the Alaska Committee to prevent underage drinking.                                                                           
SEAN CASE, CAPTAIN,  ANCHORAGE POLICE DEPARTMENT, introduced                                                                    
the  PowerPoint  presentation:  "Substance  Use  and  Mental                                                                    
Health Response in Anchorage."                                                                                                  
Captain  Case began  with  slide 2:  Drug  Impact on  Police                                                                    
Services." He reported that  the Anchorage Police Department                                                                    
(APD) made 1700 arrests with  drug seizures annually and 650                                                                    
drug only  arrests. He  noted that  roughly 6.5  arrests per                                                                    
day were associated with drugs.  The department responded to                                                                    
over 30 overdose  deaths, which did not  represent the total                                                                    
number of overdoses in Anchorage.                                                                                               
Vice-Chair  Johnston  asked   whether  Narcan  was  helpful.                                                                    
Captain Case  reported that APD  did not use  Narcan because                                                                    
they  could  quickly  respond along  with  the  Alaska  Fire                                                                    
Department  (AFD) and  employ  other  readily available  and                                                                    
effective methods.                                                                                                              
Vice-Chair Johnston  asked whether the fire  department used                                                                    
Narcan.  Captain Case  responded in  the affirmative.  Vice-                                                                    
Chair  Johnston deduced  that the  concerted efforts  of the                                                                    
police  and fire  department saved  lives but  HIPPA [Health                                                                    
Insurance Portability and  Accountability Act] prevented the                                                                    
statistical data  collection regarding  the number  of lives                                                                    
saved. Captain  Case replied  that he  was unable  to answer                                                                    
the HIPPA  question but concurred  that the  combined effort                                                                    
saved more lives. Vice-Chair Johnston  suggested that if the                                                                    
Anchorage Fire Department  did not use NARCAN  the number of                                                                    
overdose deaths  could be higher.  Captain Case  answered in                                                                    
the affirmative.                                                                                                                
Representative  Merrick asked  Captain Case  how many  total                                                                    
arrests the APD  had in one year. Captain Case  did not know                                                                    
the answer to her question but could provide it.                                                                                
1:41:48 PM                                                                                                                    
Captain Case pointed to the graph  on the far right of slide                                                                    
2.  He indicated  that  the graph  showed  clearly what  the                                                                    
police department  was up against daily.  The graph included                                                                    
three   types   of   drug   categories:   Amphetamines   and                                                                    
Methamphetamines,   Heroin,  and   Prescription  Drugs.   He                                                                    
delineated  that  prescription  drugs  that  were  illegally                                                                    
obtained or  possessed were the  most commonly  seized drugs                                                                    
and  the numbers  were on  the rise  over the  last 5  years                                                                    
except  for 2018.  Methamphetamines was  the second  largest                                                                    
seizure and  rose steadily over  the last 5 years.  He added                                                                    
that other jurisdictions  reported that Methamphetamines had                                                                    
played a substantial  role in bush communities  more so than                                                                    
heroine. He noted that heroine  seizure was on the rise over                                                                    
the last  5 years.  He related  that the  APD had  started a                                                                    
criminal diversion  process. However, due to  drug addiction                                                                    
problems and the lack of  availability of drug treatment the                                                                    
diversion process proved challenging.                                                                                           
1:44:23 PM                                                                                                                    
Representative  Sullivan-Leonard asked  about the  statistic                                                                    
regarding  the various  arrests. She  was aware  that SB  91                                                                    
"created  an  open-door policy."  She  hoped  that with  the                                                                    
passage  of  HB  49  -  Crimes;  Sentencing;  Drugs;  Theft;                                                                    
Reports  [2019] it  would provide  additional tools  for the                                                                    
law  enforcement community.  Captain Case  responded in  the                                                                    
affirmative.  He  believed  that tougher  sentencing  forced                                                                    
treatment, which had been effective.                                                                                            
Co-Chair  Wilson remarked  that  imposing stiffer  sentences                                                                    
without treatment  availability created  the open  door. She                                                                    
noted that some  offenders were unable to  get the treatment                                                                    
they   sought.   Captain   Case  confirmed   that   stricter                                                                    
sentencing  without  treatment  created a  criminal  justice                                                                    
cycle. He  concurred that not  only did the  law enforcement                                                                    
system need  the additional  tools of  HB 49,  treatment was                                                                    
necessary  for a  holistic approach.  Co-Chair Wilson  asked                                                                    
whether  there  were  other  states  that  had  examples  of                                                                    
treating the offender on the  "front side" early on in their                                                                    
sentence  versus the  "back side,"  which took  place before                                                                    
release but  after a length  of incarceration.  She wondered                                                                    
if  data  was  available  regarding which  option  was  more                                                                    
successful. Captain Case relayed that  the answer was not in                                                                    
his area  of expertise  but acknowledged  that the  point in                                                                    
the  criminal  justice  process   when  treatment  was  more                                                                    
efficacious  was  prior  to incarceration.  Co-Chair  Wilson                                                                    
surmised that treatment could be part of a plea deal.                                                                           
1:48:01 PM                                                                                                                    
Representative  Carpenter wanted  to  better understand  the                                                                    
use of the term,  "forced treatment." Captain Case explained                                                                    
that he was  referring to treatment that was part  of a plea                                                                    
deal  for  a reduced  sentence  or  treatment that  occurred                                                                    
during custody.                                                                                                                 
Captain  Case  moved to  slide  3:  "Mobile Response  (March                                                                    
2019)." He  explained that the  table applied to  the number                                                                    
of mental health clients the  APD had been involved with. He                                                                    
noted  that  out of  821  total  police reports  related  to                                                                    
mental  health  issues  the   department  had  provided  173                                                                    
transports to  hospitals. He  reported that  out of  the 173                                                                    
people,  approximately  40  needed emergency  mental  health                                                                    
care.   He  ascertained   that   transporting  roughly   143                                                                    
individuals with  mental health  issue and no  other support                                                                    
or options was  problematic for the APD  and emergency rooms                                                                    
(ER). He  thought that delivering  people to the ER  did not                                                                    
provide  "an affordable  early  response"  and offered  that                                                                    
approximately 60 to  65 of the individuals  would respond to                                                                    
"street level intervention."                                                                                                    
Co-Chair Wilson asked what reasons  the 173 individuals were                                                                    
picked up by the APD  under Title 47. Captain Case explained                                                                    
that  the 173  individuals were  not under  arrest but  were                                                                    
being  transported  from  a Department  of  Corrections  DOC                                                                    
facility. The  problem in the  policing world where  a loved                                                                    
one or friend threatened suicide,  required the APD to place                                                                    
the  suicidal  person  in  a  safe  environment  such  as  a                                                                    
Representative  Carpenter asked  for an  explanation of  the                                                                    
"No  Action" line  on the  table that  numbered 84.  Captain                                                                    
Case replied that 84 mental  health related calls lead to no                                                                    
arrest or action of any kind by the APD.                                                                                        
1:52:27 PM                                                                                                                    
Ms.  Pineda  continued  with   slide  4:  "Substance  Misuse                                                                    
Summary of Findings."                                                                                                           
     ? Alcohol is the substance of highest use and misuse                                                                       
     in Anchorage                                                                                                               
         Compared   to   all   other   substances,   alcohol                                                                    
     contributes to the most deaths, EMS ambulance                                                                              
     transports, hospitalizations, OCS intakes                                                                                  
Ms. Pineda  relayed that  over the  past year  the Anchorage                                                                    
Health  Department   (AHD)  conducted  a   substance  misuse                                                                    
assessment. She highlighted the  findings. She reported that                                                                    
initially,  the AHD  assessed opioid  and prescription  drug                                                                    
misuse  but discovered  that a  much broader  assessment was                                                                    
necessary. She  elaborated that alcohol was  the most common                                                                    
form of substance use and  abuse and contributed to many AFD                                                                    
emergency transports and  hospitalizations. Alaska's rate of                                                                    
consumption  and  binge  drinking   was  in  line  with  the                                                                    
national average.  However, the age adjusted  mortality rate                                                                    
was twice as high as the rest  of the country. The AHD saw a                                                                    
serge in polly substance use,  which involved the use of two                                                                    
or  more  substances  concurrently.  She  noted  that  polly                                                                    
substance  use was  particularly  dangerous  because of  the                                                                    
possibility  of   drug  interaction  leading   to  overdose.                                                                    
Sometimes  substance  users were  unaware  that  one of  the                                                                    
drugs was  mixed with another  drug that users might  not be                                                                    
aware of  i.e. fentanyl.  She reported  that in  response to                                                                    
Rep.  Johnston's query,  Anchorage  had  51 opioid  overdose                                                                    
deaths in  2017 that dropped  to 25  in 2018. The  number of                                                                    
Narcan kits distributed  in Anchorage in 2017  was 1,510 and                                                                    
in 2018 the number was 3,511.                                                                                                   
Representative Sullivan-Leonard  wanted to know how  AHD had                                                                    
compiled her  data. She asserted  that the statistic  on the                                                                    
table on the right side of  slide 4 showed heroin use at 0.5                                                                    
percent of  Alaskans 18 plus  years old who used  or misused                                                                    
in  the past  year or  month. She  thought it  was confusing                                                                    
when the opioid epidemic was  widely reported. She asked how                                                                    
the data  was compiled. Ms.  Pineda responded that  the data                                                                    
was derived from the National  Survey on Drug Use and Health                                                                    
2016-2017 and was self-reported.  She admitted that the data                                                                    
could be an underreporting error and was not AHD data.                                                                          
1:57:02 PM                                                                                                                    
Representative Sullivan-Leonard asked  whether Anchorage had                                                                    
undertaken  its own  polling. Ms.  Pineda answered  that the                                                                    
national  survey had  included a  variety of  different data                                                                    
sources  that included  state and  local data  that provided                                                                    
more  complete data  on how  substance  abuse was  impacting                                                                    
Anchorage;  however, she  was unable  to include  additional                                                                    
information in the slide.                                                                                                       
Ms. Pineda  advanced to slide  5: "Substance  Misuse Summary                                                                    
of Findings."                                                                                                                   
     ? Methamphetamine use is increasing                                                                                        
     ?    2013-2018:     methamphetamine-related    overdose                                                                    
     mortality rate increased 233%. All other drug                                                                              
     mortality rates declined in this period.                                                                                   
Ms.  Pineda revealed  that methadone  use was  increasing in                                                                    
Anchorage and it  was expected to be the  next epidemic. The                                                                    
number  of  AFD  Emergency  Services  (EMS)  Methamphetamine                                                                    
Transports  steadily  increased  from   2016  to  2018.  She                                                                    
discerned that some  of the increase in meth use  may be due                                                                    
to polly  substance use or  the use  of opioids can  lead to                                                                    
use  of methamphetamine.  She reported  that 3.5  percent of                                                                    
Anchorage  high school  students  reported  ever using  meth                                                                    
versus 2.5  percent nationwide. The  reported use  is higher                                                                    
in female students than male  students and from 2015 to 2017                                                                    
she noted a 153 percent  increase in the percent of lifetime                                                                    
use in  female students  compared to  a 24  percent increase                                                                    
among male students.  She reported that the  second graph on                                                                    
the slide  depicted the number  of "AFD EMS: Total  Calls by                                                                    
Primary Impression."  The graph highlighted  that Behavioral                                                                    
Health  Disorder  was  the most  common  primary  impression                                                                    
followed   by   alcohol.    The   category   that   included                                                                    
"Poisoning/Drug  Ingestion  and  Substance/Drug  Abuse"  was                                                                    
less predictable  and increased  or decreased over  4 years.                                                                    
She  pointed  that that  the  categories  were not  mutually                                                                    
exclusive and could co-occur. She  elaborated that the graph                                                                    
illuminated  that alcohol  misuse was  a consistent  problem                                                                    
and behavioral  health disorders  were present  with greater                                                                    
frequency at  acute emergency levels. She  surmised that the                                                                    
increase  could  represent  a lack  of  "more  comprehensive                                                                    
systems of care."  The AFD thought that  the alcohol numbers                                                                    
could  be  higher  if  the data  included  EMS  response  to                                                                    
alcohol  related injuries  and  the number  would likely  be                                                                    
staggering. She  added that  Alaska had  one of  the highest                                                                    
rates  of  traumatic  brain injuries  in  the  country.  She                                                                    
recommended solutions that  helped the vulnerable population                                                                    
through  treatment  and  recovery  and through  a  focus  on                                                                    
Ms. Burke  advanced to slide  6: "Filling Treatment  Gaps in                                                                    
     Projected capacity to serve up to 250 people annually                                                                      
     Residential (In-patient) Treatment Program:                                                                              
     Program capacity: 18 individuals with 9 double                                                                           
     double occupancy bedrooms                                                                                                
     Length of stay: 90 days                                                                                                  
     Population served: adult males                                                                                           
       Ambulatory Withdrawal Management Capacity: 8                                                                         
     Length of Stay: 15 days                                                                                                  
       Transitional Housing: Capacity: 44 individuals                                                                       
     Length of Stay: Average 6 months                                                                                         
       Out-patient Treatment Program:                                                                                         
     Program capacity: Variable based on staffing capacity                                                                    
     Length of program: 60 days                                                                                               
     Days per week operated: 4                                                                                                
Ms. Burke indicated that Anchorage  had a treatment facility                                                                    
located near the Anchorage airport  that fell into disrepair                                                                    
and  needed replacement.  The building  housed a  successful                                                                    
treatment program  for individuals with  co-occurring mental                                                                    
illness and substance use. She  discussed that Anchorage was                                                                    
a  place  where  people  had higher  needs,  and  many  were                                                                    
reflected in  the homeless population.  She offered  that 70                                                                    
percent  of  the   homeless  population  experienced  mental                                                                    
illness or substance  abuse issues and 53 percent  of the 70                                                                    
percent had traumatic brain injuries.  She suggested that to                                                                    
fill  the  gap,  Anchorage  was proposing  a  new  treatment                                                                    
facility with a mix of  services that mirrored new treatment                                                                    
options  available  under  the  1115  Medicaid  Waiver  that                                                                    
allowed step  up and step  down services and  ensured people                                                                    
were  stable before  they left  the  treatment facility.  In                                                                    
addition  to  offering  specific treatment  for  individuals                                                                    
with  cognitive  disorders  along with  mental  illness  and                                                                    
substance  abuse  issues.  The  city  was  hoping  to  begin                                                                    
construction by the spring of 2020.                                                                                             
Representative   Merrick   asked    how   the   municipality                                                                    
determined   that   the   current   treatment   center   was                                                                    
successful. Ms. Burke answered that  the facility was run by                                                                    
a  non-profit  via a  service  contract  with the  state  of                                                                    
Alaska  and was  located on  municipal land.  The transition                                                                    
out of  the program  was reportedly  successful but  she did                                                                    
not have the data and would provide it later.                                                                                   
2:06:10 PM                                                                                                                    
Representative Knopp  had heard her mention  the 1115 waiver                                                                    
and asked for  more information about the  waiver. Ms. Burke                                                                    
explained that the  1115 waiver  was a  mechanism to utilize                                                                    
Medicaid  that  allowed  more  flexibility  to  provide  for                                                                    
different  levels of  need for  those  with substance  abuse                                                                    
issues.  The waiver  was  a tool  used  by many  communities                                                                    
across  the  country   to  stabilize  people in  residential                                                                    
services   and  provide   further  services   upon  release.                                                                    
Representative  Knopp  asked  if  the  waiver  was  part  of                                                                    
Medicaid expansion. Ms. Burke responded in the affirmative.                                                                     
2:07:25 PM                                                                                                                    
REPRESENTATIVE  IVY  SPOHNHOLZ,  CHAIR,  HEALTH  AND  SOCIAL                                                                    
SERVICES COMMITTEE, explained the  1115 waiver. She reported                                                                    
that  the 1115  was  a "state  innovation  waiver" that  the                                                                    
state applied for with the  federal government. She detailed                                                                    
that  the  state had  strict  guidelines  for the  kinds  of                                                                    
services that  was covered under  Medicaid. The  state found                                                                    
that the  allowable services were  not meeting the  needs in                                                                    
Alaska.  The  waiver allowed  the  state  to experiment  and                                                                    
offer  more   lower  cost  more  effective   strategies  for                                                                    
delivering care  in Alaska. The strategies  were employed in                                                                    
other  areas  of  healthcare  but  were  restricted  in  the                                                                    
substance abuse arena.                                                                                                          
Representative Josephson asked  whether the current facility                                                                    
was due to close in  the following month. Ms. Burke answered                                                                    
the facility was damaged by  the earthquake and the city was                                                                    
indefinitely  extending its  lease to  allow the  program to                                                                    
remain in  the building.  Representative Josephson  asked if                                                                    
the state were to invest  in the new treatment facility what                                                                    
the  cities   portion  of  the  investment  was.  Ms.  Burke                                                                    
responded  that   municipal  funds  were  included   in  the                                                                    
anticipated  bond  package  for   the  following  year.  The                                                                    
Municipality of  Anchorage recognized the need  for the more                                                                    
costly services.  Representative Josephson  wondered whether                                                                    
the people of Anchorage were  willing to make the investment                                                                    
at a cost of $4.5 million.                                                                                                      
2:10:44 PM                                                                                                                    
Ms.   Burke   moved   to    slide   7:   "Construction   and                                                                    
Infrastructure Costs" in order to answer the question.                                                                          
     Design Costs and Timeline                                                                                                  
          Design cost estimate - ~$1.2 million                                                                                  
          ? Current timeline:                                                                                                   
          ? August  September 2019  RFP released and                                                                            
            Contract awarded                                                                                                    
          ? September  January 2020  Design completed                                                                           
          ? Design includes:                                                                                                    
          ? Residential (in-patient) treatment                                                                                  
          ? Out-patient treatment                                                                                               
          ? Transitional Supportive Housing                                                                                     
          ? Administrative office space                                                                                         
     Construction Costs and Timeline                                                                                            
          Infrastructure improvement cost - ~$2.85 million                                                                      
          ? Improvements will be made to the road, water,                                                                       
            sewer, and gas utilities.                                                                                           
            Funding will come from 2020 MOA bond                                                                                
          ? Timeline:                                                                                                           
          ? Improvements will coincide with construction of                                                                     
            treatment center.                                                                                                   
          ? Total Treatment Center construction estimate                                                                        
            ~$17.9 million                                                                                                      
          ? Proposed timeline:                                                                                                  
         ? March 2020  Construction permit issued                                                                               
          ? May 2020  Construction begins                                                                                       
          ? Outstanding amount to complete construction                                                                         
            $14.5 million                                                                                                       
Representative  Josephson  asked  Captain  Case  whether  an                                                                    
individual  was  compelled to  treatment  due  to an  active                                                                    
criminal case,  or if  individuals just  wanted to  "get off                                                                    
the street."  Captain Case  observed that  he had  seen both                                                                    
Vice-Chair  Ortiz  asked  if  alcohol  abuse  treatment  was                                                                    
offered  in the  treatment facility.  Ms. Burke  answered in                                                                    
the affirmative  and confirmed that alcohol  was the largest                                                                    
substance abused.  Vice-Chair Ortiz asked  whether treatment                                                                    
for  alcohol  abuse  was sought  voluntarily.  Captain  Case                                                                    
responded  that the  criminal  cases  could require  alcohol                                                                    
treatment such as domestic violence.                                                                                            
Representative  Sullivan-Leonard asked  about the  inception                                                                    
of the  project. She  noted that  it appeared  much planning                                                                    
had been  done. Ms. Burke  responded that the  current phase                                                                    
of  the  project  began in  2015.  Representative  Sullivan-                                                                    
Leonard asked if  the people of Anchorage  would support the                                                                    
bond package in 2020. She  assumed the bond would cover much                                                                    
of  the  construction  costs  and  design  work.  Ms.  Burke                                                                    
replied that  $1.2 million depicted  on the slide  was grant                                                                    
funding currently  in the city's  possession and  would move                                                                    
forward  with  design  work. She  reported  that  the  $2.85                                                                    
million  of  bond funds  would  be  used for  the  necessary                                                                    
infrastructure   upgrades.  The   $14.5   million  was   the                                                                    
outstanding   balance  needed   to  complete   construction.                                                                    
Representative    Sullivan-Leonard     asked    where    the                                                                    
municipality was  expecting to  obtain the  remaining funds.                                                                    
Ms. Burke  responded that  all avenues  of funding  would be                                                                    
considered to meet the construction expense.                                                                                    
2:16:04 PM                                                                                                                    
Representative   Sullivan-Leonard  was   aware  that   other                                                                    
entities  would  be involved  in  the  funding process.  She                                                                    
requested a list of potential  investors. She pointed to the                                                                    
state's  fiscal  crisis  and advised  that  garnering  state                                                                    
support   would   be   challenging.   She   encouraged   the                                                                    
municipality to take on the brunt of the costs.                                                                                 
Co-Chair Wilson  pointed out that the  cost of incarceration                                                                    
was $178. per day per  prisoner without treatment. She asked                                                                    
for  a breakdown  of the  costs associated  with individuals                                                                    
receiving  treatment depending  on the  level of  treatment.                                                                    
Ms. Pineda was unable to  answer the question. She indicated                                                                    
that the  Salvation Army operated  the current  facility and                                                                    
they  could provide  the costs.  She was  waiting for  final                                                                    
numbers related  to rates  under the  1115 waiver  and would                                                                    
provide  exact  amounts  for the  services  associated  with                                                                    
slide 5.  Co-Chair Wilson  asked about  the success  rate of                                                                    
treatment  and  whether   "further  intense  treatment"  was                                                                    
necessary. Ms. Pineda deferred the  question to a behavioral                                                                    
health  expert.  She  acknowledged  that  some  people  need                                                                    
treatment  multiple  times,  but  most  ultimately  achieved                                                                    
Co-Chair  Wilson   asked  about  the  possibility   for  the                                                                    
facility to provide treatment beds  to individuals under the                                                                    
custody of DOC.  Ms. Burke thought that it  was a beneficial                                                                    
option worth exploring. She expounded  that the facility was                                                                    
designed to fill in the  gaps existing in treatment and stop                                                                    
the cycle of incarceration or homelessness.                                                                                     
Ms.  Burke   transitioned  into  slide  8:   "Aftercare  and                                                                    
Community Supports."                                                                                                            
     ? Many people will stabilize in housing with                                                                               
     supportive services appropriate for their needs                                                                            
     ? Community integration through housing (Pay for                                                                           
     Success) = Reductions in emergency and first responder                                                                     
Ms.  Burke  spoke  of  the importance  of  "syncing  up  the                                                                    
systems" that offered resources  and had proven success with                                                                    
recovery  and  assisting  the   transitions  back  into  the                                                                    
community.  She addressed  the facilities  step  up or  step                                                                    
down  approach of  either intensifying  or reducing  service                                                                    
according to need.                                                                                                              
Co-Chair Wilson  reminded the committee  that 80  percent of                                                                    
incarcerated individuals  had mental health issues.  She did                                                                    
not  know  how the  state  could  not afford  treatment  and                                                                    
expect change.                                                                                                                  
Representative Merrick  asked whether the facility  would be                                                                    
a municipal or  a statewide project. Ms.  Burke replied that                                                                    
the project was statewide.  Representative Merrick asked how                                                                    
residential space  would be  prioritized. Ms.  Burke replied                                                                    
that    space   was    determined    through   a    "funding                                                                    
configuration."  She exemplified  that a  contract with  DOC                                                                    
would provide prioritization.  She suggested that partnering                                                                    
with other  communities that could not  offer the facility's                                                                    
level of care was the best approach for Anchorage.                                                                              
2:22:54 PM                                                                                                                    
Representative Josephson  reiterated that  he had  been told                                                                    
that there  was an "ample supply"  of transitional treatment                                                                    
but  residential treatment  was still  lacking. He  wondered                                                                    
how  the  scenario  impacted treatment  systems.  Ms.  Burke                                                                    
deferred the answer to other professionals.                                                                                     
Representative  Carpenter asked  whether the  facility would                                                                    
include   sex   offenders.   Ms.  Burke   replied   in   the                                                                    
^PRESENTATION: SOUTHCENTRAL FOUNDATION                                                                                        
2:24:53 PM                                                                                                                    
APRIL   KYLE,  VICE   PRESIDENT,   DIVISION  OF   BEHAVIORAL                                                                    
SERVICES,  SOUTHCENTRAL FOUNDATION,  introduced herself  and                                                                    
discussed   the   Southcentral  Foundation   services.   The                                                                    
foundation  was a  regional  native healthcare  organization                                                                    
serving  65  thousand  Alaska  native  and  American  Indian                                                                    
people  in  the region.  The  system  of care  employed  was                                                                    
called the "NUKA  System of Care," which  was a relationship                                                                    
based  primary   care  focused   system  that   included  an                                                                    
extensive   array  of   behavioral   health  services.   She                                                                    
elaborated that the foundation   operated the detox program,                                                                    
which they were expanding to  22 beds through support by the                                                                    
state. The  program served roughly  600 admissions  per year                                                                    
and they  expected to exceed  800 upon expansion.  She asked                                                                    
the  committee to  consider how  the  service would  provide                                                                    
treatment  after detox.  She noted  that the  program served                                                                    
the entire  state and strove  to find treatment  post detox.                                                                    
The gold standard in a detox  program was to offer a "bed to                                                                    
bed  transfer" from  detox  to  treatment. Most  individuals                                                                    
leaving  detox   needed  a   clinical  level   of  treatment                                                                    
appropriate for residential  treatment. The program operated                                                                    
one program in  Anchorage, which was a 16  bed women's detox                                                                    
program that  allowed children  to accompany  their mothers.                                                                    
She  spoke to  the lengthy  waitlist of  up to  2 months  to                                                                    
participate in  the program. She furthered  that residential                                                                    
placement for  elders with medical  needs was  difficult, as                                                                    
well  as   access  to   medically  assisted   treatment  for                                                                    
substance use disorder.                                                                                                         
2:28:52 PM                                                                                                                    
She  addressed the  1115 waiver  that  originally had  three                                                                    
portions:  substance abuse  disorder,  adult, and  children.                                                                    
The  CMS approved  the substance  abuse disorder  portion of                                                                    
the  waiver first  and the  state created  an implementation                                                                    
plan.  The state  planned  for 110  new  treatment beds;  90                                                                    
adult  beds  and  24  youth beds.  In  addition,  the  state                                                                    
planned 24 new beds  specifically for traumatic brain injury                                                                    
and  cognitive  impairment with  a  statewide  focus and  66                                                                    
high-intensity  adult beds  or medium-intensity  youth beds.                                                                    
She  communicated that  the state  received an  exemption to                                                                    
allow  residential  treatment  beyond 16  beds,  which  made                                                                    
treatment  more economical.  The exemption  allowed existing                                                                    
or  new  programs to  grow.  Treatment  centers would  still                                                                    
require start-up  funds and facility  costs. In  addition to                                                                    
one-time money needed to launch  a program, it took multiple                                                                    
years to reach  full capacity, and subsidies  were needed in                                                                    
the ramp  up years. The exemption  provided opportunity, but                                                                    
upfront money was still necessary to launch a program.                                                                          
Ms.  Kyle continued  that  in 2017,  $6  million of  capital                                                                    
funding was awarded to three  providers: The Sober Center in                                                                    
Fairbanks operated  by Tanana Chiefs,  the detox  program at                                                                    
Central   Peninsula   Hospital,   and   Set   Free   women's                                                                    
residential treatment  center in the Mat-Su.  She emphasized                                                                    
that treatment and recovery  changed people into functioning                                                                    
adults. She  observed the reverse  for people  on waitlists.                                                                    
She reported having a difficult  time sleeping knowing there                                                                    
were people  out there waiting  for treatment.  She reported                                                                    
that it was  costlier for the state not to  expend funds for                                                                    
treatment than the cost of treatment itself.                                                                                    
Co-Chair Wilson requested the range  of costs per individual                                                                    
including Medicaid  funding. Ms. Kyle agreed  to provide the                                                                    
2:36:49 PM                                                                                                                    
Representative Knopp  asked why CMS  had a 16-bed  limit. He                                                                    
asked whether the  exemption had a cap or if  the number was                                                                    
unlimited.  Ms.  Kyle answered  that  the  16-bed limit  was                                                                    
established  at  a time  when  mental  health services  were                                                                    
institutionalized  and served  a great  number of  patients.                                                                    
The idea  behind the  limits was to  eliminate the  need for                                                                    
large institutions. She noted that  the state was working to                                                                    
move beyond the limit and was unaware of a new cap.                                                                             
Representative  Carpenter asked  how  many  beds across  the                                                                    
state were  designated for alcohol  treatment. Ms.  Kyle was                                                                    
uncertain  of the  answer and  relayed  that typically  most                                                                    
treatment programs employed a multiple substance approach.                                                                      
Representative   Spohnholz   interjected  that   the   state                                                                    
currently had  325 in-patient beds. The  1115 waiver process                                                                    
estimated that Alaska needed approximately  200 more beds at                                                                    
a more intense level of  treatment than currently offered in                                                                    
the state. Representative Carpenter  was looking at previous                                                                    
slides  that  showed the  number  of  people discharged  for                                                                    
alcohol  related  treatment  was  over  9,000  in  2017.  He                                                                    
thought  that   9,000  occurrences  with  a   total  of  525                                                                    
treatment beds in the state would not solve the problem.                                                                        
Co-Chair Wilson  thought it was  important to know  what the                                                                    
beds were for.                                                                                                                  
Representative  Spohnholz noted  a document  "Number of  New                                                                    
Services  by Region  According  to Appendix  1  of 1115  SUD                                                                    
Waiver Implementation  Plan" (copy  on file)  that described                                                                    
the  range  of services  the  Division  of Behavioral  Heath                                                                    
determined were  needed. She agreed  that an  additional 200                                                                    
beds  were not  enough. However,  additional non-residential                                                                    
treatment programs were included  in the plan. She expounded                                                                    
that   not  everyone   needed  residential   treatment.  The                                                                    
division   estimated  that   an  additional   23  withdrawal                                                                    
management  programs  were  necessary throughout  the  state                                                                    
along  with 28  additional  intensive out-patient  treatment                                                                    
centers.  She surmised  that the  state  needed to  increase                                                                    
access to treatment.                                                                                                            
Co-Chair Wilson  asked Ms. Kyle to  explain her relationship                                                                    
with  the state.  Ms.  Kyle answered  the  foundation had  a                                                                    
variety  of programs  and one  program; the  Family Wellness                                                                    
Warriors Initiative provided  services within the Department                                                                    
of Corrections.                                                                                                                 
2:42:40 PM                                                                                                                    
LANCE JOHNSON,  BEHAVIORAL HEALTH SERVICES  DIRECTOR, NORTON                                                                    
SOUND  HEALTH  CORPORATION  (via  teleconference),  was  the                                                                    
administrative  director of  the corporation  and served  in                                                                    
the  capacity since  2012. He  expounded  that Norton  Sound                                                                    
served approximately  9,800 people.  He had  appreciated the                                                                    
previous comments. He wanted to  emphasize the need for beds                                                                    
and treatment  facilities in  rural areas.  He was  aware of                                                                    
the  large  population  in  Alaska   that  was  addicted  to                                                                    
substances. He  acknowledged that the most  abused substance                                                                    
remained  alcohol. He  had observed  the effects  of limited                                                                    
treatment  resources  for   people  wanting  treatment.  The                                                                    
effects  were  further complicated  by  care  that was  only                                                                    
available  out of  the region;  i.e., residential  treatment                                                                    
centers  and psychiatric  hospitals. He  requested that  the                                                                    
committee  reflect   upon  how  to  build   rural  treatment                                                                    
Mr.  Johnson  provided  information about  what  the  Norton                                                                    
Sound Health  Corporation (NSHC) provided. He  reported that                                                                    
the  corporation provided  out-patient substance  misuse and                                                                    
mental  health  treatment  services.  The  corporation  also                                                                    
provided intensive out-patient  substance misuse services of                                                                    
up to 9 hours a week  per individual. The corporation had an                                                                    
onsite  psychiatry  program  available  7 days  a  week.  In                                                                    
addition, the corporation  provided telehealth and itinerant                                                                    
clinicians for  the 15  surrounding villages.  He elaborated                                                                    
that each  community had a village  based highly experienced                                                                    
counselor and by  October 2019 all would  become a certified                                                                    
behavioral  health  aide. Norton  Sound  decided  to act  on                                                                    
their  own out  of the  need  to change  the narrative  that                                                                    
rural areas were  "stuck", and people had to  leave the area                                                                    
to  get better.  He  believed  that more  could  be done  in                                                                    
partnership with the state to  provide higher levels of care                                                                    
that  was  culturally  reflective  to  keep  people  in  the                                                                    
region.  He   emphasized  that  local  treatment   was  cost                                                                    
effective  and relieved "the burden of a stressed system."                                                                      
2:49:32 PM                                                                                                                    
Vice-Chair Johnston asked whether  NSHC worked with the Nome                                                                    
Youth  Facility and  other  correctional  facilities in  the                                                                    
region.  Mr.   Johnson  answered  in  the   affirmative  but                                                                    
explained  that the  Nome facility  recently  hired its  own                                                                    
clinician and  NSHC currently  participated in  an ancillary                                                                    
role. The corporation had a  contract with DOC for the Anvil                                                                    
Mountain  Correctional Center  and  the Seaside  Residential                                                                    
Community  [half-way house]  in  Nome that  provided a  full                                                                    
time clinician  that offered  individual and  group services                                                                    
for  mental health  and substance  misuse. He  reported that                                                                    
the Correctional Center had a waitlist for services.                                                                            
Vice-Chair Johnston understood that  inmates did not qualify                                                                    
for Medicaid. She wondered whether  DOC and HSHC could build                                                                    
a continuum  of care  to eliminate  the prison  waitlist for                                                                    
services.  She asked  whether Mr.  Johnson thought  that the                                                                    
in-house clinician was providing  and adequate level of care                                                                    
at  the youth  facility. Mr.  Johnson voiced  that NSHC  was                                                                    
already providing a continuum of  care at Anvil Mountain and                                                                    
Seaside facilities  but indicated that the  need was greater                                                                    
than  the number  of  providers  available. He  acknowledged                                                                    
that inmates  had to  wait to apply  for Medicaid  once they                                                                    
were released and he noted  that services would be available                                                                    
to instruct  newly released  prisoners in  how to  apply for                                                                    
Medicaid and  other life  skills. He  relayed that  the NSHC                                                                    
opened a  day center in  Nome for homeless,  substance users                                                                    
from 8:30 AM  until 7:30 PM and hired  recovery coaches that                                                                    
were  peer  support  coaches  to  help  people  recover.  In                                                                    
addition, behavioral  health providers worked in  the center                                                                    
for  4 hour  per day  to engage  in relationships  and build                                                                    
trust. He communicated that the  day center was really a way                                                                    
to  gain  access  to  treatment   other  than  entering  the                                                                    
criminal justice  system. He  stressed that  rural treatment                                                                    
infrastructure  would  mitigate  the demands  for  treatment                                                                    
beds in other parts of the state.                                                                                               
Mr.  Johnson  continued  to  address  Vice-Chair  Johnston's                                                                    
question regarding the Nome  treatment facility. He informed                                                                    
the committee  that by adding  treatment beds,  the facility                                                                    
served  the youth  well. He  was aware  that the  Nome Youth                                                                    
Facility was slated for closure  in the future. He viewed it                                                                    
as  an  opportunity  for transitional  housing  for  inmates                                                                    
released  from  jail. He  used  his  prior scenario  as  "an                                                                    
interesting   example   on   a  way   to   build   treatment                                                                    
Co-Chair Wilson asked  why the youth facility  hired its own                                                                    
clinician. He reported that the  goal of the facility was to                                                                    
develop  treatment beds  and provide  services they  wanted.                                                                    
Co-Chair  Wilson  wondered  whether  the  Seaside  residents                                                                    
qualified  for Medicaid.  She noted  that the  center was  a                                                                    
Community Residential Center (CRC).   Mr. Johnson understood                                                                    
that the  residents' Medicaid was  still suspended in  a CRC                                                                    
because  the  residents  were  still  in  DOC  custody.  The                                                                    
corporation  provided services  to the  residents through  a                                                                    
contract due to the lack  of Medicaid. Co-Chair Wilson asked                                                                    
whether  the residents  could leave  for treatment  or work.                                                                    
Mr.  Johnson  responded  that   Seaside  housed  roughly  50                                                                    
residents,  and some  received furlough  status  to work  or                                                                    
participate  in  treatment.  Co-Chair  Wilson  informed  the                                                                    
committee  that if  the residents  had freedom  of movement,                                                                    
they were  Medicaid eligible  and DOC  was supposed  to help                                                                    
the  residents  fill  out   the  Medicaid  application.  She                                                                    
remarked that  the facility currently housed  23 individuals                                                                    
and was disappointed  that the state did not  utilize all 50                                                                    
Representative Carpenter  asked how many communities  in the                                                                    
Norton Sound area were dry.  He wondered whether Mr. Johnson                                                                    
observed  alcohol  addiction  in the  dry  communities.  Mr.                                                                    
Johnson   responded  that   14  out   of  the   15  outlying                                                                    
communities were  dry. He reported  that there  were alcohol                                                                    
abuse issues in  the communities. He noted that  there was a                                                                    
"significant issue with boot-legging."                                                                                          
Co-Chair  Wilson   asked  what  would  be   accomplished  by                                                                    
offering treatment  versus longer jailtime. Mr.  Johnson did                                                                    
not believe that  longer sentencing was the  answer and that                                                                    
a  certain  level of  substance  abuse  treatment should  be                                                                    
provided  in prisons.  He  related that  90  percent of  the                                                                    
inmates  at Anvil  Mountain were  in jail  due to  substance                                                                    
misuse. He wanted  to mitigate the numbers  by attempting to                                                                    
offer a  full continuum  of care  for treatment  services in                                                                    
Nome. He revealed  that NSHC was working on  such a project,                                                                    
the Wellness Center in Nome,  in partnership with the Alaska                                                                    
Mental  Health  Trust  Authority   (AMHTA)  offered  a  full                                                                    
continuum  of  care  including intensive  out-patient,  out-                                                                    
patient, day treatment, and a  sober center in the facility.                                                                    
He furthered  that the facility  had sober  housing attached                                                                    
as well.  He noted  that the project  was shovel  ready. The                                                                    
corporation  contributed  $8  million  and  was  seeking  $5                                                                    
million more in funding.  Construction would commence in the                                                                    
summer of 2019.  He reminded the committee  that relapse was                                                                    
part  of  treatment  for  some  before  recovery  holds  and                                                                    
offering a regional full continuum  of care offered the wrap                                                                    
around  services,  cultural  relevancy, family  support  and                                                                    
unification,  and  levels  of  services  necessary  for  the                                                                    
individual. He commented that treatment  in prison was still                                                                    
necessary,  but  the  numbers  of  incarcerated  individuals                                                                    
would drop over time.                                                                                                           
Vice-Chair Johnston asked how  many beds the Wellness Center                                                                    
would  provide. Mr.  Johnson characterized  the facility  as                                                                    
"pseudo-residential," which  offered a residential  level of                                                                    
care, but the  patients would live in the  sober housing. He                                                                    
shared  that 52  slots were  available in  total. Vice-Chair                                                                    
Johnston  asked  about  the  number of  beds  in  the  sober                                                                    
housing.  Mr. Johnson  responded  that a  total  of 48  beds                                                                    
would be available.                                                                                                             
Co-Chair Wilson thanked Mr. Johnson for his presentation.                                                                       
^PRESENTATION: MAT-SU HEALTH FOUNDATION                                                                                       
3:07:28 PM                                                                                                                    
ELIZABETH  RIPLEY, CHIEF  EXECUTIVE  OFFICER, MAT-SU  HEALTH                                                                    
FOUNDATION,   introduced   herself    and   the   PowerPoint                                                                    
presentation:  "Mat-Su  Health  Foundation.".  She  reminded                                                                    
committee members that the  Mat-Su Foundation was originally                                                                    
the Valley Hospital Association  that operated the preceding                                                                    
Valley Hospital  in Palmer. The association  wanted to build                                                                    
a new hospital to  accommodate the growing valley population                                                                    
and   entered  into   a  partnership   with  a   "for-profit                                                                    
proprietary company"  to build  the Mat-Su  Regional Medical                                                                    
Center. She reviewed untitled slide 2 titled:                                                                                   
     The Mat-Su  Health Foundation shares ownership  in Mat-                                                                    
     Su  Regional Medical  Center  and  invests its  profits                                                                    
     from  that  partnership  back  into  the  community  to                                                                    
     improve the  health and wellness of  Alaskans living in                                                                    
     the Mat-Su.                                                                                                                
Ms. Ripley turned to slide 3:                                                                                                   
     Theory of Change                                                                                                           
        • Community-driven                                                                                                    
        • Data-driven and strategic                                                                                           
        • Capacity-builder                                                                                                    
Ms. Ripley  emphasized that the foundations  priorities were                                                                    
community   driven.  She   related   that  the   community's                                                                    
priorities were  focused on mental health  substance use and                                                                    
child maltreatment  and were asking  for more  treatment and                                                                    
recovery supports.                                                                                                              
Ms. Ripley advanced to slide 4:                                                                                                 
     Good News!                                                                                                                 
     New Mat-Su BH Services Fill Gaps in the Continuum of                                                                       
          ? Set Free residential SUD Treatment for women*                                                                       
          ? Peer Treatment Services                                                                                             
          ? Outpatient SUD treatment                                                                                            
          ? SUD treatment in a local high school                                                                                
Ms.  Ripley indicated  that all  the services  on the  slide                                                                    
were started with a state appropriation in 2018.                                                                                
Ms. Ripley continued to slide 5:                                                                                                
     Our Role As A Funder                                                                                                       
          ? Support data and research efforts                                                                                   
          ? Convene and advocate to make systems'                                                                               
            improvements and build a complete continuum of                                                                      
          ? Provide local match funding for start-up and                                                                        
            scholarships to develop workforce                                                                                   
Ms. Ripley  related that the foundation  worked closely with                                                                    
DHSS  to continually  improve  its  operating systems.  They                                                                    
used data  to find  problems and  provide match  funding for                                                                    
identified "gaps  in the continuum  of care."  She explained                                                                    
that  the photo  on the  slide  housed the  Set Free  Alaska                                                                    
program  that  received  a  grant from  the  state  and  the                                                                    
foundation to  add residential treatment beds  for women and                                                                    
pregnant  women.  The  funding   was  sustained  by  billing                                                                    
Medicaid or  other insurers. She  thanked the state  for the                                                                    
initial funding and hoped the  state would offer $20 million                                                                    
in additional funding support.                                                                                                  
Ms. Ripley advance to slide 6:                                                                                                  
     More Good News! BH Systems Improvements in Mat-Su                                                                          
       Crisis Intervention/Mental Health First Aid Training                                                                     
       for first responders                                                                                                     
       High Utilizer Mat-Su (HUMS) Program                                                                                      
     Peer support services in the emergency department                                                                          
       Planned psychiatric emergency department and                                                                             
       behavioral health beds                                                                                                   
Ms. Ripley  wanted to  ensure the  committee that  any state                                                                    
funding  was  used  "prudently with  maximum  administrative                                                                    
efficiency"  and  obtained   desired  health  outcomes.  The                                                                    
projects  on  slide  6  were invested  in  to  maximize  the                                                                    
returns  to   the  state  and  improved   behavioral  health                                                                    
services in  the Mat-Su. She  highlighted the  second bullet                                                                    
item:  High  Utilizer Mat-Su  (HUMS).  She  shared that  the                                                                    
foundation invested half of $1  million into the program and                                                                    
reduced emergency room  (ER) use by 61.7  percent within the                                                                    
first year of the pilot  project, which saved the state over                                                                    
$1.1 million.  The programs success  was due to  the ability                                                                    
to fill gaps in the continuum of care.                                                                                          
3:12:41 PM                                                                                                                    
Ms. Ripley turned to slide 7: "The Mat-Su Health Foundation                                                                     
Uses  a Systems  Approach." She  indicated that  the graphic                                                                    
depicted  the Substance  Abuse  and  Mental Health  Services                                                                    
Administration  (SAMHSA)  model  for   a  "good  and  modern                                                                    
addiction mental health service  system." The foundation had                                                                    
been working  on creating  the model  continuum of  care for                                                                    
about  5 years  and was  still in  progress. The  foundation                                                                    
worked at a systems level  to provide its continuum of care.                                                                    
She  reported that  the  1115 waiver  drove  the system  and                                                                    
would pay for  services in the long run.  The slide provided                                                                    
a  wholistic picture  of  how services  should  work in  the                                                                    
Ms. Ripley moved to slide 8:                                                                                                    
     "Prevention is Key."                                                                                                       
     EARLY SIGNS &                                                                                                              
3:14:40 PM                                                                                                                    
Ms. Ripley turned to slide 9:                                                                                                   
   Mat-Su Regional Medical Center Emergency Department.                                                                         
          ? 2013: 2,391 patients w/BH diagnoses = $23M                                                                          
            [increase] in charges                                                                                               
          ? 2016: 3,443 patients w/BH diagnosis = $43.8M                                                                        
            [increase] in charges                                                                                               
          ? Additional costs borne by law enforcement, or                                                                       
            Mat-Su Borough EMS for dispatch and ambulance                                                                       
Ms. Ripley  indicated the slide  showed "where and  how" the                                                                    
foundation  was investing  the  state's dollars  downstream.                                                                    
She noted that  the increase in ER costs was  largely due to                                                                    
the opioid crisis and lack  of out-patient treatment access.                                                                    
She stressed  that if treatment  was available prior  to the                                                                    
point of  crisis the citizens  and the state  would benefit.                                                                    
Additional  funding  was  needed   in  other  areas  of  the                                                                    
continuum  of  care.  She  asserted  that  when  they  first                                                                    
compiled the  data on the  slide it  proved that the  ER was                                                                    
the most utilized  service for those in  a behavioral health                                                                    
crisis and represented a downstream  investment that did not                                                                    
offer a return.                                                                                                                 
Representative   Merrick  asked   about   the  $20   million                                                                    
appropriation  Ms.  Ripley  had  referred  to  earlier.  Ms.                                                                    
Ripley  indicated that  Representative Spohnholz  was hoping                                                                    
for a  $20 million appropriation  in the capital  budget for                                                                    
treatment  services. Representative  Merrick asked  how much                                                                    
of the  amount Ms.  Ripley expected  to receive.  Ms. Ripley                                                                    
replied that the Division of  Behavioral Health (DHSS) would                                                                    
issue  an   RFP  (request  for   proposal)  as  part   of  a                                                                    
competitive  process.  She  expounded  that  the  foundation                                                                    
would  assist   a  local  provider  produce   a  competitive                                                                    
application  and would  not  receive  any funding  directly.                                                                    
Funding  was  not  guaranteed  with  a  competitive  bidding                                                                    
process and needs all over the state.                                                                                           
Co-Chair Wilson asked whether the  foundation was looking at                                                                    
capital  funding  or  funding  for  existing  programs.  Ms.                                                                    
Ripley deferred the answer to a later slide.                                                                                    
Ms. Ripley turned to that the list on untitled slide 10:                                                                        
     Alcohol-related disorders: 438 visits costing on                                                                           
       average $4,246/visit                                                                                                     
     ? Substance Use disorders: 218 visits costing on                                                                           
       average $5,274/visit                                                                                                     
    ? Anxiety-related disorders: 195 visits costing on                                                                          
       average $3,895/visit                                                                                                     
     ? Suicide and self-harm disorders: 315 visits                                                                              
       costing on average $3,161/visit                                                                                          
     ? Mood Disorders: 172 visits costing on average                                                                            
Ms.  Ripley  reported  that the  slide  data  reflected  the                                                                    
number one  visits and average  cost per visit in  2016. The                                                                    
information came from a 2016  McDowell Group study of Mat-Su                                                                    
Regional ER charges. She reminded  the committee that the ER                                                                    
was  not   providing  mental   health  or   substance  abuse                                                                    
treatment and  believed that treatment  offered a  more cost                                                                    
effective way to address the crisis.                                                                                            
3:20:06 PM                                                                                                                    
Ms. Ripley detailed slide 11:                                                                                                   
"Statewide, substance use disorders are costly."                                                                                
     ? 39,000 Alaskans - alcohol dependent or abuse in the                                                                      
       past year                                                                                                                
     ? 13,000 Alaskans were dependent on illicit drugs                                                                          
     ? Cost of alcohol abuse was $1.84 billion (2015)-                                                                          
       42.9% paid by government                                                                                                 
     ? Cost of drug abuse was $1.22 billion (2015)                                                                              
Ms. Ripley  voiced that  the slide  data was  extracted from                                                                    
two  reports (Economic  Cost of  Alcohol Abuse  published in                                                                    
2017  and  the  Economic  Cost   of  Drug  Abuse  in  Alaska                                                                    
published  in 2016)  funded  by the  AMHTA  prepared by  the                                                                    
McDowell  Group.  She  offered  to provide  a  breakdown  of                                                                    
3:21:03 PM                                                                                                                    
Ms. Ripley moved to slide 12:                                                                                                   
     Two areas supported by the Medicaid waiver where                                                                           
     we can save money by having the right services:                                                                            
          ? Substance Use Disorder Treatment                                                                                    
          ? Crisis prevention and care                                                                                          
Ms.  Ripley detailed  that the  foundation would  direct any                                                                    
additional  state  funding to  the  areas  reflected on  the                                                                    
DR. MELISSA  KEMBERLING, VICE PRESIDENT OF  PROGRAMS, MAT-SU                                                                    
HEALTH FOUNDATION,  offered that  she had a  master's degree                                                                    
in  public health  and  a PhD  in  Sociology and  previously                                                                    
worked  for the  Alaska  Native  Tribal Health  Epidemiology                                                                    
3:22:45 PM                                                                                                                    
Dr. Kemberling skipped to slide 14:                                                                                             
     Crisis Prevention and Treatment Gaps                                                                                       
     ? Crisis Call center                                                                                                       
     ? Mobile Crisis Unit*                                                                                                      
     ? Crisis Stabilization and Respite*                                                                                        
     ? Supportive housing                                                                                                       
     * Medicaid 1115 Waiver application includes these                                                                          
Dr.  Kemberling offered  that  Ms.  Riplely illustrated  the                                                                    
huge cost associated with the  lack of crisis prevention and                                                                    
treatment  resulting in  individuals turning  to the  ER for                                                                    
care. She  explained that  a model  called "Crisis  Now" was                                                                    
identified on  the slide. The  model prevented  or shortened                                                                    
the crisis.  The call  center coordinated  the type  of care                                                                    
data and  adhered to the  Suicide Prevention  Lifeline model                                                                    
to  help channel  the caller  to the  appropriate care.  The                                                                    
Mobil Crisis  Unit offered  a "rapid  response to  assess an                                                                    
individual  and  resolve a  crisis"  for  both children  and                                                                    
adults.  The focus  of  the  team was  to  link people  with                                                                    
services  and  coupled  with the  Crisis  Stabilization  and                                                                    
Respite Center, reduce the acute  symptoms and stabilize the                                                                    
individual within 24 hours to avoid hospitalization.                                                                            
Dr. Kemberling advanced to slide 15:                                                                                            
     "The right continuum of crisis services in Phoenix,                                                                        
     ? 37 FTE Police Officers engaged in public safety                                                                          
       instead of mental health transport/security                                                                              
     ? Drastic reduction in psychiatric boarding in                                                                             
       emergency departments ($37 million in cost savings)                                                                      
     ? Reduced potential state acute care inpatient expense                                                                     
       by $260 million (net savings of $100 million)                                                                            
Dr.  Kemberling reported  that the  AMHTA was  examining the                                                                    
approach for  Alaska. The Medicaid waiver  could provide the                                                                    
operating dollars.                                                                                                              
3:27:09 PM                                                                                                                    
Dr. Kemberling reported the list  of capital needs that were                                                                    
reflected on slide 16:                                                                                                          
     "Moving Towards a Complete Behavioral Health Continuum                                                                     
     of Care in Mat-Su."                                                                                                        
          Capital Needs                                                                                                         
          ? Detox: ambulatory and residential                                                                                   
          ? Residential Treatment for Individuals with                                                                          
            Substance Use Disorder                                                                                              
          ? Crisis Call Center                                                                                                  
          ? Mobile Crisis Program                                                                                               
          ? Sub-acute Stabilization (crisis prevention and                                                                      
            Supportive Housing                                                                                                  
Dr. Kemberling pointed  out the list reflected  the needs of                                                                    
the  borough and  the foundation's  approach. She  concluded                                                                    
with untitled slide 17:                                                                                                         
     Investment in capital funding with a "systems                                                                              
     approach" to start these services is crucial for                                                                           
     saving lives, saving dollars and improving the                                                                             
     health of Mat-Su and Alaska.                                                                                               
Co-Chair Wilson asked whether the  foundation had a contract                                                                    
to provide  services for behavioral  health with  the Mat-Su                                                                    
Pretrial  Facility.   Dr.  Kemberling  responded   that  the                                                                    
foundation  did  not   directly  provide  behavioral  health                                                                    
services but  provided grants  to non-profits  and community                                                                    
agencies  and  had not  provided  a  grant to  the  pretrial                                                                    
facility. Co-Chair  Wilson asked if  she was aware  of other                                                                    
organizations  providing  behavioral  health to  the  Mat-Su                                                                    
Pretrial  Facility.  Dr.  Kemberling acknowledged  that  the                                                                    
Prisoner Reentry Coalition and  Mat-Su Pretrial was involved                                                                    
in   community  coalitions   and  the   foundation's  Crisis                                                                    
Intervention Team Coalition as well.                                                                                            
Co-Chair Wilson  commented that  the facility  was different                                                                    
from  a  long-term facility  and  she  wondered whether  any                                                                    
reentry services were available.                                                                                                
Representative  Sullivan-Leonard was  sorry she  was unaware                                                                    
of the  capital grant  by the  Mat-Su Foundation.  She asked                                                                    
for  an  update  on  the foundation's  attempt  to  increase                                                                    
behavioral health  beds and how  the capital grant  may help                                                                    
if  the hospital  was  unable to  move  forward. Ms.  Ripley                                                                    
responded  that  the  hospital  was  in  a  holding  pattern                                                                    
waiting  for  the  legislature  to pass  a  budget  and  the                                                                    
available funding  from Medicaid.  The foundation  created a                                                                    
business  plan.  The  construction   had  proceeded,  and  a                                                                    
director  had been  hired. The  goal was  to have  available                                                                    
beds by the fall of 2019.                                                                                                       
3:31:43 PM                                                                                                                    
Co-Chair Wilson informed everyone  that there were no grants                                                                    
in the  capital budget. She  furthered that the idea  was to                                                                    
look at  how additional capital  budget funds could  be used                                                                    
for treatment and  to fill in the gaps.  She reiterated that                                                                    
currently the $20 million was not available in the budget.                                                                      
Representative Sullivan-Leonard thanked  the chair and noted                                                                    
that it  was "apparent"  organizations were informed  of the                                                                    
possible additional funding and she  wanted to learn how the                                                                    
funds would be utilized.                                                                                                        
Ms.  Ripley was  trying to  demonstrate that,  although they                                                                    
had  worked with  the state  to fill  the gaps  in the  care                                                                    
continuum  still  many  remained.   She  indicated  that  if                                                                    
capital funding  was available the foundation  would be able                                                                    
to assist a non-profit as a local partner.                                                                                      
3:33:55 PM                                                                                                                    
AT EASE                                                                                                                         
3:35:05 PM                                                                                                                    
PHILIP  LICHT,  EXECUTIVE  DIRECTOR, SET  FREE  ALASKA  (via                                                                    
teleconference),  introduced  himself.   He  recounted  that                                                                    
several  years ago  a client  showed up  at Set  Free Alaska                                                                    
after his  fourth DUI  while his children  were in  the car.                                                                    
The offender  faced an additional charge  of endangering the                                                                    
welfare of  a child.  The thought of  losing custody  of two                                                                    
children  sparked  the  motivation  to change.  No  one  had                                                                    
considered the  individual's horrific backstory  of physical                                                                    
and sexual abuse  as a child that set the  path of shame and                                                                    
addiction. He declared that at  Set Free Alaska everyone was                                                                    
valued as a unique  individual. The individual was initially                                                                    
very  guarded, but  overtime  completed treatment,  regained                                                                    
custody of the children, and  gained employment. After a few                                                                    
years of sobriety,  the person applied and was  hired by the                                                                    
program. He  believed the person's life  had changed forever                                                                    
and he no  longer cost the state  money under incarceration.                                                                    
He informed  the committee members that  treatment did work.                                                                    
The  goal  was  to  help  people  stop  offending  and  stop                                                                    
charging people and  start changing them. He  noted the many                                                                    
success  stories under  the program's  partnership with  the                                                                    
criminal  justice system.  He cited  the  lack of  treatment                                                                    
beds and access to treatment.  He relayed that most criminal                                                                    
justice cases  and social ills were  connected to addiction.                                                                    
Often,  court  ordered  treatment helped  people  break  the                                                                    
cycle of addiction and incarceration,  but lack of treatment                                                                    
kept  offenders  in  the  cycle. He  was  pleased  that  the                                                                    
legislature  was considering  capital funding  for addiction                                                                    
treatment. The  cost of launching new  treatment centers was                                                                    
a major  barrier to providing enough  treatment. He remarked                                                                    
that  the   Valley  Oaks  program   was  one  of   the  only                                                                    
residential  treatment facilities  that  was  opened in  the                                                                    
last ten years. He revealed that  Set Free Alaska was in the                                                                    
process of  opening another residential treatment  center in                                                                    
Homer  for men  where children  could accompany  the men  to                                                                    
treatment.  The new  programs would  not have  been possible                                                                    
without substantial capital  and operational funding support                                                                    
during the initial phase of  the projects. The programs were                                                                    
sustained  long-term through  earned  revenue. The  proposed                                                                    
funding could  help start other similar  projects around the                                                                    
state. He  indicated that increased funding  meant increased                                                                    
capacity  which  helped  more  people.  He  emphasized  that                                                                    
criminal  justice   reform  must  go  "hand   in  hand  with                                                                    
treatment and  rehabilitation." He  opined that  people must                                                                    
be treated as  persons rather than just locking  them up. He                                                                    
relayed a  personal story about  his brother's  journey with                                                                    
addiction and incarceration.                                                                                                    
3:42:06 PM                                                                                                                    
Mr.  Licht  spoke  of the  accomplishments  by  his  younger                                                                    
brother  after his  treatment, education,  and job  training                                                                    
while in  prison in  Arizona and  support upon  release. His                                                                    
brother was a success story  with over three years sobriety.                                                                    
He concluded  that treatment  does work,  and people  do get                                                                    
better.  He thought  the collaborative  efforts between  the                                                                    
criminal   justice  system   and  treatment   providers  was                                                                    
powerfully effective.                                                                                                           
Representative Sullivan-Leonard  thanked Mr. Licht.  She was                                                                    
happy to hear  about the program's expansion  in other areas                                                                    
of the state. She asked  if the current Alaska congressional                                                                    
delegation in Washington  had offered to assist  in any way.                                                                    
Mr. Licht  reported that he  had asked Senator  Dan Sullivan                                                                    
about  funding for  addiction treatment.  He confirmed  that                                                                    
funding for  opioid and other  treatment would  continue but                                                                    
he did not mention specific funding for the state.                                                                              
Co-Chair  Wilson  asked  whether   Set  Free  Alaska  had  a                                                                    
relationship with  DOC. Mr. Licht  reported that  the entity                                                                    
was  on the  list of  DHSS approved  providers for  criminal                                                                    
justice system  that included OCS and  DOC. The organization                                                                    
had a contract with DOC  through the Wellness Courts in Mat-                                                                    
Su  to provide  treatment  services for  Wellness Court  and                                                                    
Family Infant/Toddler  Court. In addition,  the organization                                                                    
worked closely  with the probation  officers for  felons and                                                                    
Mat-Su ASAP treatment services for misdemeanants.                                                                               
3:47:15 PM                                                                                                                    
Co-Chair  Wilson  asked  if  it was  accurate  to  say  that                                                                    
without treatment  crime would continue. Mr.  Licht answered                                                                    
in the affirmative.                                                                                                             
Co-Chair  Wilson thanked  the committee.  She believed  that                                                                    
providing more treatment was an urgent need.                                                                                    
HOUSE BILL NO. 1001                                                                                                           
     "An Act making appropriations for public education and                                                                     
     transportation of students; repealing appropriations;                                                                      
     and providing for an effective date."                                                                                      
3:48:12 PM                                                                                                                    
Representative LeBon RECINDED his action on HB 1001. There                                                                      
being NO OBJECTION, it was so ordered.                                                                                          
A roll call vote was taken on the motion to REPORT HB 1001                                                                      
out of committee.                                                                                                               
IN FAVOR:   Merrick, Sullivan-Leonard, Tilton, Carpenter                                                                        
OPPOSED:    LeBon, Ortiz, Josephson, Johnston, Knopp,                                                                           
Foster, Wilson                                                                                                                  
The MOTION FAILED (4/7). HB 1001 did NOT report out of                                                                          
3:49:18 PM                                                                                                                    
The meeting was adjourned at 3:49 p.m.                                                                                          

Document Name Date/Time Subjects
SB 19 MOA Substance Abuse .pdf HFIN 5/21/2019 1:30:00 PM
SB 19
SB 19 New Services for 1115 SUD Waiver Implementation Plan.pdf HFIN 5/21/2019 1:30:00 PM
SB 19
SB 19 MSHF HFIN Capital Budget Pres FINAL.pdf HFIN 5/21/2019 1:30:00 PM
SB 19