Legislature(2011 - 2012)HOUSE FINANCE 519
01/25/2011 01:30 PM House FINANCE
| Audio | Topic |
|---|---|
| Start | |
| Budget Overview: Department of Health and Social Services | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE FINANCE COMMITTEE
January 25, 2011
1:33 p.m.
1:33:10 PM
CALL TO ORDER
Co-Chair Stoltze called the House Finance Committee meeting
to order at 1:33 p.m.
MEMBERS PRESENT
Representative Bill Stoltze, Co-Chair
Representative Bill Thomas Jr., Co-Chair
Representative Anna Fairclough, Vice-Chair
Representative Mia Costello
Representative Mike Doogan
Representative Bryce Edgmon
Representative David Guttenberg
Representative Mark Neuman
Representative Tammie Wilson
Representative Reggie Joule
MEMBERS ABSENT
Representative Les Gara
ALSO PRESENT
Alison Elgee, Assistant Commissioner, Finance and
Management Services, Department of Health and Social
Services; William J. Streur, Acting Commissioner,
Department of Health and Social Services; Representative
Wes Keller.
PRESENT VIA TELECONFERENCE
None
SUMMARY
^BUDGET OVERVIEW: DEPARTMENT OF HEALTH AND SOCIAL SERVICES
1:34:34 PM
WILLIAM J. STREUR, ACTING COMMISSIONER, DEPARTMENT OF
HEALTH AND SOCIAL SERVICES, provided the "Alaska Department
of Health and Social Services 2011 Priorities" (copy on
file). He began by addressing substance abuse and mental
health, the first of five categories outlined in the
handout. Substance abuse and mental health affected nearly
every individual in the State of Alaska. They were a
contributing factor in suicides, crime, unemployment,
domestic violence, and others. Department of Health and
Social Services (DHSS) strategies would continue to focus
on prevention and health promotion. Without continuing
efforts to combat domestic violence, substance abuse, and
mental health issues no improvement would be made. He
discussed the importance of working with children; early
intervention; and the integration of primary care,
substance abuse, and mental health screening into a single
effort. He detailed that the continuation of treatment
services was imperative to afflicted individuals and would
help them to participate as meaningful members of the
community and ultimately to recover. He shared a personal
story about working in the substance abuse and mental
health field. He delineated that recovery was a lifelong
process that required constant attention.
Mr. Streur addressed the second category regarding health
and wellness. He communicated that many Alaskans led less
happy and productive lives and many died prematurely each
year due to disability and death caused by obesity,
tobacco, alcohol abuse, injuries, diabetes, cancer, heart
disease, and vaccine-preventable diseases. The annual
economic impact of chronic disease in Alaska was
approximately $600 million in addition to $1.9 billion in
lost productivity. He pointed out that the two figures
combined were almost equal to the total DHSS budget. He
relayed that most was preventable and could be attributed
to personal choices involving diet, physical activity and
tobacco use. The department was dedicated to better
screening, diagnosing, and treatment of the conditions. He
focused on major strategies including prevention and health
promotion; disease control; access; emergency response and
preparedness related to trauma and Emergency Medical
Services capabilities; and environmental health impacts
involving increased availability of medical, toxicological,
and public health expertise for individuals and
communities.
Mr. Streur moved on to discuss the third category related
to health care access and delivery (Page 2). He identified
Medicaid as a central issue for the department and
emphasized its importance. Medicaid health insurance
coverage was provided to 130,000 people, approximately 18
percent of Alaska's population, at a total cost of $1.5
billion.
Co-Chair Stoltze asked the commissioner to repeat the
Medicaid number for emphasis.
Mr. Streur repeated that the annual Medicaid cost was $1.5
billion. He began to outline major strategies the
department planned to implement related to health care
access and delivery. He discussed the value of working
towards the realization of a new Medicaid Management
Information System (MMIS) that was scheduled to be
available in the spring of 2012. The MMIS would be
responsible for the handling, monitoring, and payment of
claims for enhanced services. He emphasized that after
three years of development the project was beginning to
take form. The new system would allow close to
instantaneous access to a full range of services. He
emphasized that the department's error rate was under one
percent and Alaska was ranked number one in the federal
Payment Error Rate Measurement (PERM) audit. The department
was also focused on the creation of a statewide Health
Information Exchange (HIE) that would facilitate the
communication of health information sharing. He explained
that although the price was significant, funding for the
information exchange was currently 90 percent federal. He
indicated that one of the biggest challenges would be the
conversion of providers to electronic health records. The
department was hopeful that offering incentives to
providers would encourage the implementation of electronic
health records beginning in April 2011.
Vice-Chair Fairclough asked whether state technology
formats had been aligned to enhance and allow communication
between different sectors. Mr. Streur asked Vice-Chair
Fairclough to repeat the question.
Vice-Chair Fairclough wondered whether formatting of the
information exchanged between providers had been
standardized to assist in the movement towards electronic
records. She inquired about the alignment of software and
hardware in the Division of Public Health that would allow
communication between municipalities.
1:46:45 PM
Mr. Streur replied that the key resided with the HIE and
its ability to convert data from one electronic claim
system to another. The department was working with state
labs and provider groups and the federal government was
currently compiling a list to specify which packages were
reimbursable based on their ability to communicate with
each other.
Vice-Chair Fairclough said she would look forward to
receiving the work. She asked whether terminology
definitions used throughout Alaska had been standardized.
She referred to her previous work as executive director of
STAR [Standing Together Against Rape] and reflected on
challenges they faced with the alignment of terminology.
Mr. Streur answered that an alignment of terminology had
been implemented. He pointed out that the federal
government developed a list of terms, descriptions of data,
information, and procedures in order to expedite alignment
in communication.
Representative Doogan asked about the implementation of
security measures to ensure the safety of patients'
electronic health records. Mr. Streur responded that there
were multiple levels of security built into the electronic
system. He detailed that electronic health record security
was much better protected than paper record security. The
HIE would not retain the data shared between sending and
receiving organizations.
1:50:39 PM
Mr. Streur went on to discuss that one of the biggest
challenges facing Alaska was related to the workforce (Page
2). He contended that the state needed to continue to
develop its workforce and to utilize its professionals
appropriately. He discussed the importance of working with
Alaskan universities, creating professional residency
programs for health care fields such as psychiatry, and
developing alternative approaches to health care delivery
in rural Alaska.
Co-Chair Stoltze asked whether the presentation would
include information on the transition from public
assistance to work. He opined that the transition should be
a goal for the broad majority of public assistance
participants. Mr. Streur responded that the presentation
did not address the subject of transitioning from public
assistance to work, but that it would be covered throughout
the ongoing process.
Co-Chair Stoltze relayed that he would be happy to know
that the administration had a strategy and meaningful
commitment towards the transition from public assistance to
work. Mr. Streur reported that the administration had a
meaningful commitment to the issue.
1:53:46 PM
Representative Edgmon discussed a conference he attended
that outlined the number of new jobs in a variety of
fields. He referenced a statement that cited health care
was the largest growing sector with approximately 1,200 new
jobs. He wondered about the distribution of new jobs across
all sectors and inquired specifically about the tribal
workforce field.
Mr. Streur explained that workforce growth, specifically in
the health care field was almost ubiquitous. He specified
that the Indian Health Service (IHS) was experiencing
continuous growth and that every dollar spent in the IHS
system equated to Medicaid savings. He emphasized that the
more the department could develop IHS resources and
capabilities the better off the state would be.
Representative Edgmon asked what portion of growth was tied
to federal dollars compared to state dollars. He believed
the economic significance of tribes was largely tied to
health care and surmised that a portion of the 1,200 new
jobs were tied to tribal programs. Mr. Streur reported that
Representative Edgmon was correct.
Mr. Streur discussed the enhanced management of high health
needs. He delineated that a small proportion of the
population consumed a large percentage of the Medicaid
budget. The general rule regarding Medicaid services was
that 15 percent of the population consumed 85 percent of
health care and in Alaska approximately 15 percent of the
population consumed 75 percent. He discussed the importance
of the coordination of care for individuals with chronic
health care needs such as diabetes. Without adequate health
care a person's life could be placed in jeopardy and they
could also be very costly to the system. He addressed the
need to analyze care management options, implement the
Health Care Commission's recommendations for managing care,
contain costs, and improve health outcomes and quality. He
shared that on an annual budget of $1.5 billion, it was
scary to be uncertain that recipients were provided proper
care, at the right time and place. The MMIS and data
information systems that were currently underway would help
ensure adequate care for those with chronic health needs.
Mr. Streur pointed to the delivery of sustainable long-term
care (Page 2). He communicated that long-term care would be
a very challenging component within the Medicaid budget due
to an aging and complex senior population. Major strategies
included the identification and coordination of health and
welfare needs and the implementation of quality assurance
strategies that would set forth standards of performance
for home and community-based care providers. He discussed
the need for good long-term care providers and noted that
the state had room for improvement in the area.
1:58:29 PM
Representative Neuman asked whether the state was focused
on improving long-term health care management for veterans.
Mr. Streur replied that long-term health care for veterans
was his greatest challenge. He relayed that he had worked
with Co-Chair Thomas and veterans in the Cordova area to
ensure them greater access to care. He shared that 112
people came to participate at a hosted dinner and that the
most prevalent issue was the continuation and access to
care for veterans. He addressed the need to work with the
federal delegation to provide less complicated funding
through the Veterans Administration (VA) that would allow
veterans greater access to health care through community
health centers and local clinics.
Representative Neuman wondered whether it was possible to
reduce the cumbersome paperwork that veterans were faced
with. Mr. Streur responded in the affirmative and explained
that HIE efforts by the department included working with
the VA to ensure that records could be transferred to VA
recipients and local resources to provide the needed care.
Representative Guttenberg pointed out that the absence of
VA designated hospitals and clinics in Interior Alaska
frequently required veterans to travel for health care
services. He elaborated that the travel presented an
abominable cost to veterans and families. He wondered
whether it was possible to align medical facilities with VA
record sharing programs in order increase efficiency and
enable families to stay together during illness. Mr. Streur
detailed that alignment would require the VA to acknowledge
and to become a part of the health care system in Alaskan
communities. He expounded that the VA held their veteran
care very closely and that agency would need to come to
terms with the idea of paying outside entities to deliver
care.
2:03:46 PM
Representative Guttenberg remarked that efficiencies were
increased in Fairbanks hospitals and clinics as a result of
electronic medical records. He asserted that the VA should
recognize the high travel expense and should focus on
directing their money towards the delivery of medical
services. He believed the state should illustrate the
importance of the issue to the VA. He explained that the
VA's reliable payment history would benefit Alaska's
hospitals.
Co-Chair Thomas noted that the new veterans' clinics in
Anchorage and Juneau were very well received. He reflected
on attending The Moving Wall memorial in Cordova and
recalled that there had been 2000 people in attendance. He
emphasized the importance of recognizing and caring for
Alaska's veterans.
Mr. Streur discussed the need to develop integrated,
proactive, and reactive safety programs related to
complaints and reports of harm that were received by Adult
Protective Services. He emphasized that the state needed to
work closely with the long-term care ombudsman, and to
increase the utilization of aging and disability resource
centers as referral sources to meet the needs of
individuals receiving home care. He discussed the need to
promote services for underserved individuals who required
long-term coordinated care services and to develop
integrated comprehensive models of care. He believed that
the department had a newfound leadership that would strive
to bring ideas to fruition.
Mr. Streur addressed care for vulnerable Alaskans (Page 3).
He illuminated that the department was committed to
ensuring safety of both children and communities; to
guaranteeing quality services and support to
developmentally disabled individuals; and to providing
financial vocational support to enable individuals and
families to be contributing members of society. He
explained that through a focus on family-centered services
and the use of performance-based standards and funding, the
state could better meet the needs of its most vulnerable
citizens and their families.
2:07:20 PM
Mr. Streur talked about major strategies related to the
care of Alaska's vulnerable citizens. He highlighted the
Family First Initiative and the Bring the Kids Home
Initiative, and noted the importance of the continuation of
local resource development.
Co-Chair Stoltze asked about the status of the Bring the
Kids Home Initiatives. He wondered about goals the
department hoped to accomplish and how the initiative
currently compared with its benchmark. Mr. Streur opined
that the department had done a good job on the Bring the
Kids Home Initiative. He noted that at one time there were
500 children in out-of-state psychiatric treatment
facilities and currently there were 128. The department's
goal was to reduce the number to 60. There were a number of
kids that the state did not have the resources to serve. He
gave an example regarding a developmentally disabled child
with hearing difficulties that the state could not provide
adequate support. He explained that in such cases it was
necessary to provide out-of-state care.
Vice-Chair Fairclough asked whether the department would
provide an update on the Medicaid Task Force. Mr. Streur
responded that he hoped to have time to discuss it at the
end of the presentation. He also indicated that it would be
addressed in the Medicaid presentation.
Vice-Chair Fairclough asked if the task force had been able
to meet. Mr. Streur responded that the task force had met
once and had cancelled three meetings due to its inability
to reach a quorum.
2:11:04 PM
Vice-Chair Fairclough wondered whether a meeting with the
speaker of the house and senate president was necessary to
help facilitate bringing the committee together.
Mr. Streur continued to outline strategies related to care
for vulnerable Alaskans. He discussed that domestic
violence and sexual assault would be a significant focus
for the department in the upcoming year. He emphasized that
DHSS would work with other state departments including,
Corrections, Public Safety, and Law. He discussed that DHSS
would work to provide effective and timely protective
services to vulnerable children and adults who experienced
or were at risk for neglect, abuse, and exploitation.
2:12:49 PM
Mr. Streur provided an overview for the vision of the
Department of Health and Social Services with a PowerPoint
presentation titled "2011 Alaska Department of Health and
Social Services Overview." He informed the committee that
the proposed budget was $2.445 billion. He outlined staff
within the department and discussed the size of each of the
departmental divisions (Slide 2). He highlighted several
budget expenditures including $59.7 million for Alaska
Pioneer Homes, $136.7 million for behavioral health, and
$1.5 billion for Medicaid Services.
ALISON ELGEE, ASSISTANT COMMISSIONER, FINANCE AND
MANAGEMENT SERVICES, discussed that the DHSS Budget
Overview Book and Operating Grants Book for the current
fiscal year had been disseminated to committee member
offices. She informed the committee that DHSS provided $160
million in grant funds to over 240 entities.
Representative Joule asked if there was a way to measure
the effectiveness of grant money that had been awarded. Ms.
Elgee disclosed that the department's ability to
demonstrate program performance varied throughout the
divisions. She noted that DHSS had made a concerted effort
to implement a logic-model-approach for grantee program
performance reporting. She explained that grantees were
trained and that the department was developing outcomes to
measure against program performance. She believed the
Division of Behavioral Health (DBH) was furthest along,
where Director Melissa Stone had spent a tremendous effort
educating grantees on program performance expectations. The
department was beginning to see grant distribution dollars
reflect program performance and was providing additional
dollars to those programs that were proving they could
achieve and deliver the desired outcomes.
Vice-Chair Fairclough shared that she had worked with Ms.
Stone on the Alaska Suicide Prevention Counsel. She
remarked that it had been a privilege to work with the
director and praised her efforts to unite communities and
to encourage the compilation of resources.
2:18:02 PM
Representative Guttenberg wondered how childcare assistance
grant activity and effectiveness was measured between
Alaskan communities and how DHSS handled potential
administrative inconsistencies between the communities.
Ms. Elgee noted that she was unfamiliar with any
discrepancies and would discuss the question with program
managers. She relayed that the expectations in some DBH
areas were uniformly established and that the division
taught grantees how to report information of interest.
Representative Guttenberg heard the program in Fairbanks
was not administered the same as the program in Anchorage.
He pointed to differences related to the administering of
child care assistance grants by a borough and said they
could follow through with the question at a later time. Ms.
Elgee confirmed that there were some specific issues with
Fairbanks and that the department would be happy to follow
up on the question later.
Ms. Elgee discussed that DHSS was comprised of nine
divisions and was the largest department based on required
funding and the number of employees. She directed attention
to the Division of Alaska Pioneer Homes (Slide 3). The
division was directed by Dave Cote and operated six homes
throughout the state. There were homes in Sitka, Ketchikan,
Juneau, Anchorage and Fairbanks and a Veterans and Pioneers
Home in Palmer. The division employed over 550 full-time
staff to operate the homes. She noted that it was important
to keep in mind that the institutions required staff seven
days a week, 24 hours a day, which equated to three full-
time shifts per day. The homes were available for residents
that had been in Alaska for a minimum of one year and were
at least 65 years of age. Each of the homes had an active
and an inactive waitlist. She explained that the inactive
waitlist preserved an individual's place in line and once
the person decided they were interested in pioneer home
admission they asked for their application to be
transferred to the active list. Admittance depended on the
location the individual was interested in and on the level
of care needed. There were currently over 500 individuals
on the state's active waitlist. She emphasized that there
were only 500 beds in the state-wide system and that it
could take up to two years for an individual to be placed
in a home.
2:23:59 PM
Ms. Elgee provided detail on fees charged for pioneer home
services (Slide 3). She stressed that admission to one of
the homes was not contingent upon the ability to pay. Fees
were based on the required level of care and currently
ranged from $2,135 per month for the lowest level of care
to $6,170 per month for the highest level of care.
Individuals who were unable to private-pay the fees were
provided assistance with the qualification for Medicaid
waivers and for Veterans Assistance in the Palmer home. The
division also provided a subsidy for individuals when all
other avenues of financing were exhausted.
Co-Chair Thomas asked whether the division had considered
opening a veteran's home in Southeast Alaska. He remarked
that many veterans in Southeast Alaska were not interested
in living their last years in Palmer. He believed there
were a significant number of veterans in the Southeast area
and that there were a limited number of beds designated for
veterans in each pioneer home.
Ms. Elgee divulged that the only home with a quota for
veterans was the Palmer Veterans and Pioneers Home, where
preference was given to veterans. The federal government
expected that a certified veterans home would have a 75
percent veteran occupancy rate. She clarified that the
Palmer home would achieve the expectation over a period of
time.
Co-Chair Thomas asked how many beds the Palmer facility
currently had. Ms. Elgee responded that there were
approximately 80 beds in the Palmer home.
Ms. Elgee communicated that the increased acuity of the
residents was the biggest challenge facing the pioneer
homes. A higher level of staffing was required due to an
increased number of applicants seeking admission at the
highest level of care. In 1995 residents requiring the
highest level of care totaled 63 percent and currently the
number was 88 percent. The pioneer homes also struggled to
meet the needs of admitted individuals who began exhibiting
difficult behaviors as a result of dementia. She delineated
that when a resident became assaultive that one-on-one care
was required to ensure the safety of the individual and of
other residents. She furthered that the division was not
funded to provide one-on-one staffing and that it was a
struggle to locate alternative placements within the state.
Representative Joule referenced the 500 existing pioneer
home beds and the 500 individuals currently on the waiting
list. He surmised that there were probably other
institutions and countless numbers of private homes that
also served the population. He wondered about the total
number of individuals that Alaska was serving.
Ms. Elgee responded that in addition to the pioneer home
long-term care beds the state had just over 700 nursing
home beds located throughout Alaska. There were also a
number of people served through home and community based
waivered services, Medicaid's alternative to
institutionalized long-term care. She expounded that there
were about 3,500 people on waivered services.
2:28:30 PM
Ms. Elgee moved on to discuss the Division of Behavioral
Health (Slide 4). The division headed by Director Melissa
Stone was primarily responsible for the oversight of
numerous grant programs and for the operation of the Alaska
Psychiatric Institute (API). She reported that 240 of the
division's 334 full-time employees worked at API. Most of
the DBH work was conducted through grant program
distribution in conjunction with community partners,
including non-profits and local governments. In FY 10 there
were almost 19,000 people seeking DBH services directly
provided by the state or one of the grantee partnerships.
She detailed that the division was currently developing an
information collection system called AKAIMS [Alaska
Automated Information Management System]. The division
believed that great progress had been made regarding their
ability to document grantee performance outcomes due to the
implementation of performance standards over the past three
years. She explained that division staff provided technical
assistance to grantees for program delivery and Medicaid
billing. Medicaid provided significant help to DBH
recipients.
Ms. Elgee identified several entities within the division,
including the Alaska Mental Health Board, the Alaska
Alcohol and Substance Abuse Advisory Board, and the Alaska
Suicide Prevention Council. She conveyed that the division
continued to struggle with delivery of behavioral health
services due to Alaska's large size, small dispersed
population, and the need for trained personnel. The
division provided telemedicine services using API as a
resource for local communities in order to address the
problem. The division worked to ensure that appropriate
services were provided at the community level first as API
was intended to address high psychiatric care needs and was
currently running at capacity. She briefly highlighted that
funding had been received by the division for three
programs under the governor's Domestic Violence and Sexual
Assault Initiative. The division also provided grants to
the Family Wellness Warriors Initiative that operated
through the Southcentral Foundation and was currently
working to bring the program to Bristol Bay and the Yukon
Kuskokwim service areas.
2:32:45 PM
Ms. Elgee continued to discuss funding received by the DBH
(Slide 4). She delineated that the division was in the
process of awarding rural pilot program grants with an
effective date of February 1, 2011. Funding was also
delegated for the trauma training of DBH providers through
a grantee.
Vice-Chair Fairclough referred to legislation passed during
the previous legislative session that limited nurses'
overtime. She wondered how the workload of pioneer home
staff compared to the heavy workload experienced by API
staff. She asked about costs associated with the
implementation of the legislation.
Ms. Elgee noted the department had spent the past six
months trying to determine their reporting requirements
under the law. She explained that requirements would
commence in February 2011 and that the department was
working to manage overtime within parameters of the
legislation. She discussed that DHSS had struggled to
define the difference between scheduled and mandatory
overtime. Mandatory overtime was required on some occasions
to ensure the safety of the residents. She detailed that
the primary focus was on providing surety to employees
regarding work schedules and staying underneath overtime
limits.
Vice-Chair Fairclough wondered whether the overtime limits
in the legislation would apply to the state. Ms. Elgee
answered that the department intended overtime limits would
apply to the state.
Representative Edgmon asked about costs related to state-
wide behavioral health services excluding API. Ms. Elgee
did not have the figure but agreed to provide it at a later
time. She explained that the majority of the money
contained in DBH was contained in grant funds.
Ms. Elgee continued to discuss increments received by DBH
in FY 11 (Slide 4). The legislature provided funding to
expand Fetal Alcohol Spectrum Disorder treatment services
through four providers in Bethel, Kenai, Sitka, and Juneau.
Funding was also received for the substance abuse treatment
of pregnant women, a designated grant for Soteria House,
the clearing of waitlists for methadone clinics in
Anchorage and Fairbanks, and for suicide postvention
resource development for interventions and actions to be
taken after a suicide. She reported that the division was
working to develop a resource guide that would identify
guidelines, protocols, and resources for communities
working with survivors of suicide attempts. The division
was also working with the Alaska Native Tribal Health
Consortium (ANTHC) to implement Doorway to a Sacred Heart,
the culturally responsive program for suicide survivors
that incorporated traditional healing with Western
counseling.
2:37:41 PM
Ms. Elgee moved on to discuss the Office of Children's
Services (OCS), headed by Acting Director Christy Lawton
(Slide 5). The office had over 499 employees and was
comprised of 26 field offices located in five regions
throughout the state. The office provided child protection
services, including the response to reports of harm and
family preservation support for families at risk of having
a child removed from the home. The office managed the
Infant Learning Program, an early childhood special
education grant program that provided interventions early
in a child's life when developmental delays are identified.
Grant funding was provided for nine child advocacy centers
that were designed to provide a safe place for mistreated
or sexually abused children. Advocacy centers worked to
provide a place for social workers, police, and community
members to meet with a child and to prevent the child from
the burden of repeating a traumatic story. She elaborated
that the approach had been effective and that OCS was
currently working with Kodiak to open a child advocacy
center in FY 12.
Ms. Elgee relayed that OCS was subject to a defined set of
program measurements developed by the federal government.
She explained that OCS was constantly working to achieve
program improvements against federal benchmarks. The office
struggled to maintain experienced social workers due to the
high stress work environment. Statistics from 2009
indicated that 60 percent of social workers had been in
their current position under two years. She communicated
that OCS had encountered particular difficulty locating
experienced workers for rural field offices.
Representative Wilson asked if OCS worked with the
Department of Education (DEED) on the early learning
programs to prevent the duplication of services. Ms. Elgee
responded that OCS worked very closely with DEED on early
childhood programs.
Representative Wilson asked for a brief description of the
program differences between DHSS and DEED. Ms. Elgee
responded that DHSS targeted children beginning at an
earlier age and worked with children at the first signs of
developmental delay. The department provided parenting
skills to help bring delayed children up age appropriate
levels. In some cases the results were very successful, and
enabled a child beginning school to keep up with peers in
their age group.
Representative Guttenberg shared that a constituent
recently had a very positive experience working with OCS,
Ms. Lawton, and program caseworkers. He expressed
appreciation for the professionalism, care, and efficiency
the staff provided. He acknowledged the high stress level
imposed on employees in the child services field.
Ms. Elgee illuminated that the establishment of the Western
Region/Yukon Kuskokwim area had occurred during the current
fiscal year. Before the region's establishment the
Southcentral region in Wasilla managed the areas. She
explained that the change occurred in order to align upper
level management with field service operations in response
to complaints received by the Citizens Review Panel, the
court system in the Bethel area, and the legislative
delegation. Existing funding resources were realigned to
implement the change but OCS continued to struggle with the
recruitment of experienced staff for rural regions of the
state. The change allowed the Southcentral region to focus
on the problems associated directly within its locality,
including Matsu, Kenai, Kodiak, and Dillingham.
2:45:53 PM
Representative Joule commented on positive experiences he
had with OCS related to his district. He asked about the
working relationship between OCS field workers and ICWA
[Indian Child Welfare Act] regarding children services. He
wondered whether progress had been made within OCS in
regards to dealing with ICWA. He understood that when OCS
staff lacked a background or knowledge related to ICWA
there was potential for strained relationships to develop
between the two entities. He wondered if progress had been
made to ensure that people were familiar with ICWA. He also
wondered whether families who experienced difficulty with
high school age children considered regional boarding
schools as an alternative to other options that might
separate their families. He asked whether regional boarding
schools could be utilized in a positive way in order to
preserve the family unit and to provide space and time for
family counseling.
Ms. Elgee replied that OCS was currently conducting
research to identify the numbers of children in boarding
schools that might otherwise be subject to OCS
intervention. In response to the first question she agreed
that the relationship between ICWA and OCS had often been
strained. She explained that several years prior the state
entered into a settlement called Curyung that provided
grant funding to tribal partners specifically to work
towards improving the relationship between OCS operations
and ICWA. She expounded that the current legislature would
be asked to approve the third and final year of the
settlement funding in the FY 12 budget.
Representative Joule asked whether the funding request was
for $1.2 million. Ms. Elgee replied in the affirmative.
Co-Chair Stoltze asked about federal law related to tribal
entities. He wondered if the law presented more challenges
or opportunities for the department regarding the best
interest of a child.
2:50:37 PM
Mr. Streur responded that he would get back to the
committee with an answer. He acknowledged that there were
challenges and opportunities alike.
Co-Chair Stoltze looked forward to the response.
Ms. Elgee continued on the subject of children's services
(Slide 5). She detailed that through the efforts of
Representative Gara and others increased funding had been
included in the FY 11 budget to enhance independent living
transition services. The services provided assistance for
the future success of children that were aging out of the
foster care system. She pointed out that two staff had been
added to OCS as a result of funding that was designated to
increase the number of independent living specialists.
Representative Neuman pointed to the increasing caseload in
Southcentral Alaska. He discussed that previous
administrations had worked against removing children from
abusive homes. He referred to circumstances in which a
child's parents prevented foster parents from adopting the
child. He wondered if the department would work to
permanently place children with better families.
Mr. Streur specified that the department worked to keep
children with their families. He questioned whether it was
the state's place to change that. He elaborated that the
state may need to act sooner in abusive situations but that
the focus had to be on maintaining the family unit. He
informed the committee that Ms. Lawton would be presenting
an overview of the division at a later time and that she
would expound on the issue.
Representative Doogan discussed that there were a couple of
cases of child-on-child sexual assault on an annual basis
in his district. He relayed that he had tried to talk with
OCS and the Department of Juvenile Justice about the issue
for four years without much success. He notified the
commissioner that he would be on his doorstep to discuss
the issue. He stressed that the legislature should do
something about the problem if possible.
2:57:11 PM
Ms Elgee directed attention to the Division of Health Care
Services (HCS), comprised of 134 staff (Slide 6). The
division was responsible for the management of the Medicaid
services payment system and worked to meet all of the
associated federal requirements. The division worked on
provider oversight, rate review and development for
Medicaid services, and management of efforts in health
facility survey licensing and health planning and
infrastructure work. Outside of providing Medicaid
services, the biggest challenge was to stay ahead of
federal managing requirements. She explained that federal
compliance required the department to operate a tribal
consultation process; work with Centers for Medicare and
Medicaid Services (CMS) whenever state plan service
delivery amendments were made; and have a state training
coordinator; an OASIS [Outcomes and Assessment Information
Set] coordinator for Home Health Care; an MDS [Minimum Data
Set] coordinator for skilled nursing facilities; a
complaint coordinator; and an ASPEN [Automated Survey
Processing Environment] coordinator for data entry and
tracking enforcement. She emphasized that the list
reflected a small portion of the requirements needed to
operate Medicaid.
Mr. Streur notified the committee that the division was the
primary interface with CMS and that Medicaid and HCS would
be reoccurring topics. The interface would most likely
become more acute as the Affordable Care Act and health
reform moved forward. Employees at HCS were responsible for
relaying changes in federal interface requirements. He
provided an example about recent changes to pharmacy
regulations. He detailed that the division provided
oversight of acute medicine, general medicine, hospital
based care, physician care, outpatient hospital care, and
nursing home claims and payment.
3:01:06 PM
Ms. Elgee added that Kimberly Poppe-Smart Director of
Health Care Services had temporarily left to manage the
Division of Senior and Developmental Disability Services
and that she had returned to Health Care Services in
December 2010.
Co-Chair Thomas wondered about budget savings related to
the department's shift to generic prescription drugs. He
had been told that shifting to generic drugs from name
brand drugs would save up to 60 percent. Additionally, he
did not plan to fund the FMAP [Federal Medical Assistance
Percentage] for Medicaid and he hoped that the governor
would request future funding that would prevent a large
supplemental budget the following year. He clarified that
any budget increases would need to come at the governor's
request.
Vice-Chair Fairclough wondered if the department provided
recommendations to the administration regarding state
health care plans. She commented that diabetes was a
contributor to the state's health costs. She asked whether
the state worked to incorporate prevention programs into
labor negotiations and contracts that would impact
participant contributions based on healthy versus unhealthy
lifestyles.
Ms. Elgee responded that the state health insurance
programs were managed through the Department of
Administration's Division of Retirement and Benefits. There
was a labor management committee responsible for overseeing
benefits that were provided under the Select Benefits
program. She explained that the majority of state employees
were participants in the General Government Bargaining Unit
that ran and designed its own health trust.
Vice-Chair Fairclough asked about the turning tide on
Medicaid and whether DHSS had made recommendations to
provide incentive for improvement of unhealthy behavior
that negatively impacted costs for other groups.
Ms. Elgee responded that she was not aware of any organized
effort related to rewarding beneficiaries for healthy
lifestyle decisions and that the department would look into
the question further.
Vice-Chair Fairclough ascertained that the department was
in the appropriate position to provide guidance or
recommendations on the general population's health choices
in order to facilitate a corrective course through benefit
package options.
Co-Chair Stoltze requested an update on HB 50, the nurses'
overtime bill that passed during the previous legislative
session. He wondered about the implementation status of the
legislation's regulations and requirements.
Ms. Elgee responded that the regulation responsibility for
the legislation resided with the Department of Labor and
Workforce Development (DOLWD). She explained that DOLWD was
currently implementing an aligned reporting approach for
all impacted departments. DHSS would make its first report
in February 2011 on impacts to the Alaska Pioneer Homes,
API, and Public Health Nursing stations.
Co-Chair Stoltze replied that he looked forward to the
update in February.
3:07:12 PM
Ms. Elgee discussed the Division of Juvenile Justice (DJJ)
that was headed by Director Barbara Henjum and employed 479
staff (Slide 7). She communicated that the division
operated eight 24-hour youth detention facilities in
Anchorage, Matsu, Kenai, Fairbanks, Bethel, Nome, Juneau
and Ketchikan and 16 juvenile probation offices throughout
the state. The McLaughlin Youth Center in Anchorage was the
largest detention facility with 60 detention beds and 96
longer-term treatment beds. Due to the size of the
detention facility, services that were unavailable at other
juvenile facilities were provided at the McLaughlin center.
She elaborated the the McLaughlin facility had treatment
services for youths with a history of sex offence
therefore, juveniles were transferred to the facility for
treatment when appropriate. The division worked to provide
retention and recruitment strategies but continued to
struggle with an aging workforce. She expressed concern
that most of the senior management positions were
approaching retirement.
Ms. Elgee delineated that the Division of Public Assistance
(DPA), headed by Acting Director Ron Kreher, was
responsible for all eligibility determination for Medicaid
programs, state-run financial assistance programs, and
temporary assistance programs that helped families to get
back on their feet. The division employed 535 staff, served
174,000 Alaskans, and operated 15 full-service field
offices throughout the state that were generally co-located
with Alaska Job Services offices. The division also managed
the distribution of federal Food Stamp benefits, the
Heating Assistance Program, Senior Benefits Program, Adult
Public Assistance Program, the Women Infants and Children
(WIC) program, and Child Care Assistance funding. She
illuminated that most of the benefits were distributed
through an electronic environment. The Division of Public
Assistance implemented lean processes in response to
significantly increased caseloads and was managing with
existing resources. She reported that the Affordable Care
Act would change the way eligibility determinations were
conducted and would increase the number of eligible
Medicaid subscribers. The division was currently in the
process of planning for a new eligibility information
system as the old system was built in the early 1980s and
was no longer adequate to address changing program
environments. She detailed that the department received
capital funding to begin the planning process and was very
fortunate to hire a project manager who had recently
implemented the eligibility system for the State of Idaho.
3:12:07 PM
Vice-Chair Fairclough queried whether service fees
associated with electronic pay cards or transfers were
charged to participants. Ms. Elgee replied that she did not
know and would follow up with an answer.
Representative Wilson requested Denali Kid Care statistics
related to the number of children in the Fairbanks area who
required air travel in order to receive special medical
services. Mr. Streur responded that he did not have the
information with him and would provide it to the committee
at a later time.
Representative Edgmon wondered where Alaska ranked on a per
capita basis in comparison to other states based on the
174,000 people served by the division. Ms. Elgee answered
that there was no direct comparison as the division
operated a number of programs that were unique to Alaska. A
comparison could be made between federally driven programs
and the number of people the division provided eligibility
work for. Medicaid, WIC, and the Food Stamp benefits could
all be included in the comparison.
3:14:10 PM
Co-Chair Stoltze interjected that the committee deserved a
more direct answer. Ms. Elgee reported that the department
would get back to the committee with more detail.
Representative Edgmon wondered why the DPA caseload had
been increasing given his understanding that Alaska's
economy had been relatively stable during the recent
nation-wide recession. He communicated that he would like
detail on the issue at a later time.
Representative Costello asked how often the Behavioral Risk
Factor Survey was conducted and whether it contained
information related to gang activity and efforts to reduce
it. Ms. Elgee responded that she did not have statistics
related to gang activity and she would put the
Representative in touch with DJJ Director Barbara Henjum.
She clarified that the Behavioral Risk Factor Survey was
conducted annually through DBH.
3:17:04 PM
Ms. Elgee directed attention to the Division of Public
Health (DPH) headed by Director and Chief Medical Officer
Dr. Ward Hurlburt (Slide 9). The division employed over 500
people and provided a variety of services including,
statewide public health nursing services; the management of
vital statistics records; the operation of two public
health labs; the prevention and control of infectious
disease and epidemics; the certification and licensing for
numerous statewide health facilities, including operator
background checks; and the operation of the State Medical
Examiner's office. The division received $475,000 in FY 11
to educate the public about the dangers of obesity. To
combat obesity the division was currently working with
DEED, the Anchorage School District, ANTHC, and the
Association of Alaska School Boards. The division also
received funding to support the Public Health Nursing
grantees that provided services to all but four regions
throughout the state including the Municipality of
Anchorage, the North Slope Borough, the Maniilaq
Association, and Norton Sound. Public Health Nursing
services would be provided to Norton Sound beginning on
July 1, 2011 as Norton Sound provided notice that it would
discontinue services in the region effective July 1, 2011.
She specified that the department also hoped to obtain
sufficient funding to maintain services provided by other
grantees.
Vice-Chair Fairclough wondered whether Anchorage would hand
over its public Health Nursing Services to the state and in
turn how the state would handle escalating costs for people
who had previously assumed management responsibilities. Ms.
Elgee replied that she would refer the question to Dr.
Hurlburt given the numerous conversations he had conducted
with the Municipality of Anchorage. She relayed that the
municipality's ability to financially provide for the
continuation of the services was currently undetermined.
Ms. Elgee moved on to discuss the Division of Senior and
Disability Services (Slide 10), which was directed by Duane
Mayes and employed 148 staff. The division managed the
delivery of services to senior and developmentally disabled
communities through grant programs and through direct
oversight of the four Medicaid waiver programs that
provided long-term care, including the Children with
Complex Medical Conditions Program, the Adults with
Physical Disabilities Program, the Older Alaskans Program,
and the Developmental Disabilities Program. The division
also managed Adult Protective Services and the Medicaid
Personal Care Attendant Program that provided services to
eligible individuals. She relayed that Senior and
Disability Services continued to work with CMS on meeting
the Corrective Action Plan in order to have waivers
reauthorized in July 2011. She discussed that the home and
community based service providers wanted the state to
convert to a cost-based-rate environment and that the
division was close to implementing the new process.
3:22:51 PM
Ms. Elgee spoke briefly about the Division of Finance and
Management Services (Slide 11). She outlined that the
division included all of DHSS support services,
administrative support functions, information technology,
the commissioner's office, the Human Services Community
Matching Grant Program, and the Community Initiative
Matching Grant Program.
Representative Guttenberg wondered whether there was
overlap with the Health Care Services community health aide
training and supervisor grants, and the Senior Disability
Services provider certification and training. Mr. Streur
clarified that they were two different provider groups and
functions.
Co-Chair Thomas asked for a sheet that detailed increments
received by the department the prior year.
Representative Wilson asked for a copy of the notes that
Mr. Streur and Ms. Elgee read from during the presentation.
ADJOURNMENT
The meeting was adjourned at 3:26 PM.
| Document Name | Date/Time | Subjects |
|---|---|---|
| DHSS Budget Overview 2011.pdf |
HFIN 1/25/2011 1:30:00 PM |
|
| DHSS Priorities 2011.pdf |
HFIN 1/25/2011 1:30:00 PM |