Legislature(1999 - 2000)
02/02/2000 01:50 PM House FIN
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
GENERAL SUBJECT(S): OVERVIEW: MENTAL HEALTH TRUST
The following overview was taken in log note format. Tapes and
handouts will be on file with the House Finance Committee through the
21st Legislative Session, contact 465-2156. After the 21st Legislative
Session they will be available through the Legislative Library at 465-
3808.
Time Meeting Convened: 1:50 P.M.
Tape(s): HFC 00 - 23, Side 1
HFC 00 - 23, Side 2
PRESENT:
X
Representative G. Davis
X
Co-Chair Therriault
X
Representative Foster
X
Co-Chair Mulder
X
Representative Grussendorf
X
Vice Chair Bunde
X
Representative Moses
X
Representative Austerman
Absent
Representative Phillips
X
Representative J. Davies
Absent
Representative Williams
ALSO PRESENT: REPRESENTATIVE TOM BRICE; JEFF JESSEE, EXECUTIVE
DIRECTOR, ALASKA MENTAL HEALTH TRUST AUTHORITY, DEPARTMENT OF
REVENUE; CAREN ROBINSON, CHAIR, MENTAL HEALTH TRUST AUTHORITY,
DEPARTMENT OF REVENUE; NELSON PAGE, BUDGET CHAIR, MENTAL HEALTH
TRUST AUTORITY, DEPARTMENT OF REVENUE.
LOG
SPEAKER
DISCUSSION
TAPE HFC 00 - 23
SIDE 1
000
CO-CHAIR MULDER
Co-Chair Mulder convened the House
Finance Committee meeting at 1:50 P.M.
ALASKA MENTAL HEALTH TRUST AUTHORITY
173
CAREN ROBINSON,
CHAIR, MENTAL HEALTH
TRUST AUTHORITY
Ms. Robinson distributed handouts from
the Alaska Mental Health Trust Authority
(AMHTA). [Copies on File]. She noted
that the mission and vision of the Alaska
Mental Health Trust Authority (AMHTA) was
to administer the Mental Health Trust
established in perpetuity. AMHTA has a
fiduciary responsibility to its
beneficiaries to enhance and protect the
Trust and to provide leadership in
advocacy, planning, implementation, and
funding of a comprehensive integrated
mental health program to improve the
lives and circumstances of its
beneficiaries.
210
MS. ROBINSON
Listed the members of the Trustees
Council: John Pugh, Phil Younker, Tom
Hawkins, Nelson Page, John Malone, and
Susan LaBelle and herself.
344
MS. ROBINSON
Noted the customers of the Trust's
Beneficiaries:
? People with mental illness;
? People with mental retardation &
similar disabilities;
? Chronic alcoholics with psychosis;
? People with Alzheimer's disease &
other dementia.
427
MS. ROBINSON
Listed the boards that advise the Trust:
? Alaska Mental Health Board;
? Governor's Council on Disabilities and
Special Education;
? Advisory Board on Alcoholism and Drug
Abuse
? Alaska Commission on Aging.
454
NELSON PAGE, BUDGET
CHAIR, MENTAL HEALTH
TRUST AUTHORITY,
DEPARTMENT OF
REVENUE
Addressed the programs and the
responsibilities of the AMHTA.
? Manage the land and cash assets of the
Trust in perpetuity;
? Provide leadership & advocacy for
beneficiaries;
? Recommend the State's budget for the
Comprehensive Integrated Mental Health
Program;
? Spend Trust income to improve lives
and conditions of beneficiaries.
Mr. Nelson spoke to the Trust Fund
Assumptions and the Trust Fund Actual
received.
667
VICE CHAIR BUNDE
Pointed out that the "pay out" was less
than intended.
746
MR. PAGE
Replied that amount indicates the success
of the program. He acknowledged that the
Trust was ahead of the number indicated.
791
CO-CHAIR MULDER
Asked if the $40 million was real estate
assets.
808
MR. PAGE
Replied that they are all liquid assets.
820
MR. PAGE
Spoke to the liabilities. He noted that
in FY01, there is money that can not be
considered as an asset.
850
JEFF JESSEE,
EXECUTIVE DIRECTOR,
MENTAL HEALTH TRUST
AUTHORITY,
DEPARTMENT OF
REVENUE
Explained that when funds are obligated
through the mental health bill, that
portfolio then will be separated into a
separate account.
885
REPRESENTATIVE J.
DAVIES
Noted that these funds were set aside to
cover the liabilities.
903
MR. PAGE
Explained that there are funds which are
generated as the land assets. The total
this year of that amount is about $17.5
million dollars.
941
MR. PAGE
Spoke to the increase of revenues that
have been generated by timber sales and
land that has been sold. Additionally,
AMHTA has tried to be a good partner in
land swapping.
1033
REPRESENTATIVE J.
DAVIES
Questioned the land sales philosophy.
1045
MR. PAGE
Explained that the Trust is not trying to
dispose of land assets. At this point
they are trying to maximize the revenues
into perpetuity.
1078
MS. ROBINSON
Added, the staff has developed agreements
with the various communities so as to
work in agreement rather than conflict
with one another.
1138
MR. JESSEE
Reminded members that the Trust was in
the mental health business. He
emphasized that there is a difference
between the cost of doing business and
creating mental health communities. He
noted that AMHTA is trying to be
sensitive to generating revenue and still
sensitive to community needs.
1222
REPRESENTATIVE
GRUSSENDORF
Inquired if a situation has arisen where
the Trust had advocated for a land
exchange.
1241
MR. JESSEE
Acknowledged the situation in Juneau with
the sub-port facility. The Trust
approached CBJ with the proposed land
exchange so as to be able to develop the
property. The intent is to always create
a win/win situation.
1325
MS. ROBINSON
Added, if the initial proposal does not
work, then other alternatives are
explored.
1385
MR. PAGE
Expanded on that concern. He spoke to a
"memorandum of understanding" with each
community before development takes place.
1439
MS. ROBINSON
Addressed the results that the Board is
looking for:
? Are Trust beneficiaries healthy?
? Are they safe?
? Are they economically secure?
? Are they productively engaged or in
school? and
? Are they living with dignity, as
valued members of their communities?
1504
MS. ROBINSON
Addressed the comprehensive plan and how
that was determined. She indicated that
there had been a statewide survey to
identify the various beneficiary groups.
1561
MS. ROBINSON
Noted that the next volume would be
available in January 2002.
1589
MS. ROBINSON
Provided the evaluation criteria:
? Did they do what they agreed to do?
? Did they do it when they said it would
get done?
? What was the effect on the people they
served?
? Did the program/service cost less than
"doing nothing"? and
? If the product isn't what we hoped
for, what can we learn?
1650
MS. ROBINSON
Noted that each agency is required to
provide a status report twice a year or
more. It is obvious that there are
housing needs for people coming out of
this program.
1700
REPRESENTATIVE
GRUSSENDORF
Asked what would happen if no result
happen.
1712
MR. JESSEE
Replied that none of these situations are
free. Rather than spending all the
resources of the Trust, they are done
only after undertaking a cost benefit
analysis.
1753
REPRESENTATIVE J.
DAVIES
Inquired if it would cost more to do
nothing.
1763
MR. JESSEE
Replied that in many cases it does and
particularly in the criminalization of
those people who are mentally ill.
1788
REPRESENTATIVE J.
DAVIES
agreed that this would be a financial and
efficiency measure.
1809
REPRESENTATIVE
GRUSSENDORF
Pointed out that this is costing less to
both the Trust and the State.
1821
MS. ROBINSON
Commented on some of the programs that
have been funded.
1837
MS. ROBINSON
Fairbanks Chronic Inebriate Program - She
listed what they did:
? Expanded Community Service Patrol;
? New transfer station; and
? Domiciliary treatment for public
inebriates.
They did that in the first year which
resulted in about 984 fewer calls to
Police Department about public
inebriates.
1923
VICE CHAIR BUNDE
Asked the investment in the program.
1931
MS. ROBINSON
Provided those figures which would be
transferred to Mental Health in 2002. To
date, the cost has been $200 thousand
dollars.
1959
MR. JESSEE
In response to Vice Chair Bunde, Mr.
Jessee noted that the number of fewer
calls could be provided but not the
number of total calls.
2000
MS. ROBINSON
Emphasized that the number of calls was
substantially lower. The vast majority
of the fewer calls were directly related
to that program.
2055
MR. PAGE
Addressed the next project which was the
Provider Capacity Building - 1998/1999
* Funded by Trust, UAA & federal
government;
? UAA taught classes, developed on-line
& video training;
? Trust paid $100 thousand dollars for
scholarships for grantsmanship
classes;
? 73 received scholarships.
2157
MR. JESSEE
Stated that the type of projects that
were awarded were mental health related.
The intent was to help develop a skill.
2180
REPRESENTATIVE J.
DAVIES
Asked if any of the grants displaced
money from existing programs.
2193
MR. JESSEE
Replied that he did not know.
2203
MR. PAGE
Added that within each program, the Trust
has built in some criteria to determine
the success of the program. He noted
that each program funded would have good
accomplished by it.
2231
MS. ROBINSON
Continued listing the projects: Trauma
Victim Study: Providence Hospital
? In 9 months of 1999, 156 people
admitted to the emergency room,
injured while under the influence;
? 5 died and 1 remained in a coma;
? 120 received substance abuse
consultations;
? 106 received motivational
interventions;
? 70 complied with treatment
recommendations within 1 month.
2298
MR. JESSEE
Noted that the hospital created the
criteria regarding the influence and the
injury.
TAPE HFC 00 - 23
SIDE 2
000
MR. JESSEE
Stated that it is important to establish
what the costs actually are mental health
issues impact that.
039
MR. PAGE
Spoke to the Jail Alternative Services
(JAS):
? In 1998, Mental Health Court saw 138
people with mental illness,
developmental disabilities or brain
injury;
? 111 also had substance abuse problems;
? 36 volunteered for intensive case
management through JAS;
? 59% decrease in API admissions for JAS
participants compared to;
? 60% increase in API admissions for
non-JAS participants.
213
CO-CHAIR MULDER
Asked the cost differential for the type
of treatment for the JAS versus non-JAS.
242
MR. JESSEE
Stated that he could not give those
numbers but he knew it was significantly
less than API charges.
275
MS. ROBINSON
Offered to provide that information.
290
MR. PAGE
Noted that AMHT had provided money FY00
and FY01.
340
MR. JESSEE
Explained the eligibility criteria for
those selected. He added that part of
the financial balancing is the per year
costs and spoke to breaking the cycles to
place these folks in a more stable
situation.
414
MR. JESSEE
Added that the Court System and Justice
System costs must be considered.
441
VICE CHAIR BUNDE
Questioned the numbers being used to
compare.
488
REPRESENTATIVE J.
DAVIES
Asked who the mental health board was.
503
MR. JESSEE
Replied that it consisted of district
court judges, defensive attorneys, and
lawyers who identify these people and try
to meet their needs before they become
serious. The JAS alternative services
have added the benefit of Mental Health
liaison to help with these problems.
614
REPRESENTATIVE J.
DAVIES
Asked what happened to the 102 persons
listed previously.
648
MR. JESSEE
They were given incentive to follow
through on some type of treatment.
692
CO-CHAIR MULDER
Stated that this an outgrowth of the
Criminal Justice System. He pointed out
that 37% of those in the current jail
system have some sort of mental illness.
He pointed out that 102 preferred to go
to jail than go into the treatment
system.
760
MS. ROBINSON
Noted that the Trust is trying to
determine other alternatives to going to
jail.
784
VICE CHAIR BUNDE
Stated that perhaps they prefer jail
because of a warm place to live.
804
CO-CHAIR THERRIAULT
Referenced Page 5, the modest increase
over the previous year.
824
MR. JESSEE
Replied that in FY99, there was a
lucrative timber sale; and over + million
of that was from that sale.
858
MS. ROBINSON
Spoke to the Women's Residential
Substance Abuse Treatment in Corrections.
She added that now there is no waiting
list to receive treatment. The Trust's
money has leveraged 80% federal funded
dollars through the Department of
Corrections.
940
MS. ROBINSON
Spoke briefly to the Healthy Families
component. She indicated that program is
very successful.
970
CO-CHAIR THERRIAULT
Asked if John Hopkins had developed the
criteria for that program.
995
MS. ROBINSON
Did not know, but she did know that it
was being set. She offered to provide
that info to the Committee.
1019
MR. PAGE
Spoke to the Alaska Psychiatric Institute
(API). He commented on what happened in
with that hospital:
? What the Trust and DHSS said we would
do was to address the API replacement
problem.
? What we did: Community implementation
plan; due diligence review of
property; established removal costs
for the old building; confirmed need
for hospitals 54-72 beds.
? What we are doing now: Completing a
coordinated package, buy a new
building, remove old building, pay for
community services before federal rate
changes cost the State millions more.
1210
MR. JESSEE
Noted that the Department of Health and
Social Services has been very helpful in
improving the quality of care in that
facility.
1240
MR. PAGE
Commented that the main concern now is
the aging old building.
1255
MS. ROBINSON
Spoke to System Improvements
? Trust paid for several system reviews
such as HCB Waiver study, guardianship
review, managed care study and
economic development review; and
? Results with no general fund costs
such as waiver system changes, OPA and
DSS re-structuring, Mental Health
Medicaid regulation changes, $2.1
million federal employment
demonstration project.
1381
MR. PAGE
Spoke to the best use of resources.
1427
MR. PAGE
Addressed the responsible oversight of
the Trust.
? The Young Adult Transition Program
FY98-99; and
? The Children's care coordination pilot
project for FY97-99
These programs were not functioning to
the expected level. The funding was cut
for both those programs. He urged
Committee members to understand that the
Trust is concerned about State funds.
1575
MS. ROBINSON
Spoke to the Trust Priorities:
? Assisted living;
? API;
? Decriminalizing the mentally ill;
? Emergency behavioral health care;
? Medicaid and basic support.
1666
MS. ROBINSON
Commented on the "Future" The Trust is:
? Two-year comprehensive integrated
mental health plan;
? Two-year budget cycle;
? Fewer projects with longer terms.
1717
REPRESENTATIVE J.
DAVIES
Asked how the community-based programs
were doing.
1728
MR. JESSEE
Replied that generally the progress is
good, however, there are difficulties.
The projects need to be co-located in a
facility. The likely vendor should be
Providence Hospital but they have no
room. Another issue is that one of the
main components of the system is having a
24-hour service center. There is not the
interest in Anchorage because there is
competition in the health care industry
in that city. He suggested that the
State could undertake that through the
procurement process. There are other
facilities that could be built for the
contract. The Department is sorting that
out at this time.
1835
MS. ROBINSON
Added that there has been good work done.
The Commissioner has hired Lloyd Jones to
help with this work. It is not there
yet, but it is in motion.
1865
REPRESENTATIVE
GRUSSENDORF
Asked a question providing a hypothetical
situation in a potentially dangerous
situation.
1912
MR. JESSEE
explained that there are people who
develop mental disabilities and operate
from a more childish peer group. There
currently is a residential program in
Anchorage for that group living situation
and that model does have a 24-hour staff.
It is expensive to serve those people.
Along with that is an educational
treatment providing structure for
appropriate feelings.
1989
MS. ROBINSON
Added that the Trust has made funding
available to assess brain injury studies.
The Trust is working on that
consideration at this time.
2024
MS. ROBINSON
Applauded all the various Boards that
contribute to the work of the Trust and
the Department of Corrections and the
Department of Health and Social Services.
2057
MS. ROBINSON
Reiterated that there are amazing
consumer groups throughout the State that
are watching the Trust and working with
it.
2075
CO-CHAIR MULDER
Thanked the Trust for determining the
missions and measures and then providing
that information to the Committee. He
stated that AMTA has a well-defined
program.
2117
VICE CHAIR BUNDE
ADJOURNMENT
The meeting adjourned at 3:20 P.M.
HOUSE FINANCE COMMITTEE
LOG NOTES
February 2, 2000
H.F.C. 9 2/02/00
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