Legislature(1999 - 2000)
04/29/1999 03:05 PM House HES
| Audio | Topic |
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL
SERVICES STANDING COMMITTEE
April 29, 1999
3:05 p.m.
MEMBERS PRESENT
Representative Fred Dyson, Co-Chair
Representative John Coghill, Co-Chair
Representative Carl Morgan
Representative Tom Brice
Representative Allen Kemplen
MEMBERS ABSENT
Representative Jim Whitaker
Representative Joe Green
COMMITTEE CALENDAR
* HOUSE CONCURRENT RESOLUTION NO. 11
Relating to substance abuse treatment for offenders in the criminal
justice system.
- MOVED HCR 11 OUT OF COMMITTEE
HOUSE BILL NO. 15
"An Act relating to disclosure of information about certain
children; and amending Rule 22, Alaska Child in Need of Aid Rules."
- MOVED CSHB 15 OUT OF COMMITTEE
* HOUSE BILL NO. 162
"An Act relating to confidential mental health records; relating to
mental health services and programs; relating to liability for
payment for mental health evaluation and treatment services; and
providing for an effective date."
- MOVED CSHB 162 OUT OF COMMITTEE
HOUSE BILL NO. 16
"An Act transferring to the Department of Health and Social
Services the authority to license all assisted living facilities;
eliminating the authority of the Department of Administration to
license assisted living facilities; and providing for an effective
date."
- HEARD AND HELD
(* First public hearing)
PREVIOUS ACTION
BILL: HCR 11
SHORT TITLE: SUBSTANCE ABUSE TREATMENT FOR OFFENDERS
SPONSOR(S): REPRESENTATIVES(S) DYSON
Jrn-Date Jrn-Page Action
4/26/99 1004 (H) READ THE FIRST TIME - REFERRAL(S)
4/26/99 1005 (H) HES, JUD
4/29/99 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 15
SHORT TITLE: FOSTER PARENT RIGHTS TO DISCLOSE INFO
SPONSOR(S): REPRESENTATIVES(S) ROKEBERG, Dyson
Jrn-Date Jrn-Page Action
1/19/99 21 (H) PREFILE RELEASED 1/8/99
1/19/99 21 (H) READ THE FIRST TIME - REFERRAL(S)
1/19/99 21 (H) HES, JUDICIARY
3/16/99 (H) HES AT 3:00 PM CAPITOL 106
3/16/99 (H) HEARD AND HELD
3/16/99 (H) MINUTE(HES)
3/18/99 (H) HES AT 3:00 PM CAPITOL 106
3/18/99 (H) MEETING CANCELED
4/24/99 (H) HES AT 10:00 AM CAPITOL 106
4/24/99 (H) SCHEDULED BUT NOT HEARD
4/29/99 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 162
SHORT TITLE: MENTAL HEALTH; RECORDS; TREATMENT
SPONSOR(S): REPRESENTATIVES(S) KEMPLEN
Jrn-Date Jrn-Page Action
3/26/99 583 (H) READ THE FIRST TIME - REFERRAL(S)
3/26/99 583 (H) HES, JUD, FIN
4/29/99 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 16
SHORT TITLE: LICENSURE OF ASSISTED LIVING FACILITIES
SPONSOR(S): REPRESENTATIVES(S) CROFT, Dyson
Jrn-Date Jrn-Page Action
1/19/99 22 (H) PREFILE RELEASED 1/8/99
1/19/99 22 (H) READ THE FIRST TIME - REFERRAL(S)
1/19/99 22 (H) STATE AFFAIRS, HES
2/24/99 307 (H) COSPONSOR(S): DYSON
4/13/99 (H) STA AT 8:00 AM CAPITOL 102
4/13/99 (H) HEARD AND HELD
4/13/99 (H) MINUTE(STA)
4/15/99 (H) STA AT 8:00 AM CAPITOL 102
4/15/99 (H) SCHEDULED BUT NOT HEARD
4/20/99 (H) STA AT 8:00 AM CAPITOL 102
4/20/99 (H) SCHEDULED BUT NOT HEARD
4/22/99 (H) STA AT 8:00 AM CAPITOL 102
4/22/99 (H) SCHEDULED BUT NOT HEARD
4/27/99 (H) STA AT 8:00 AM CAPITOL 102
4/27/99 (H) WAIVED OUT OF COMMITTEE
4/27/99 1034 (H) STA REFERRAL WAIVED
4/27/99 1034 (H) REFERRED TO HES
4/29/99 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
DONALD DAPCEVICH
Governor's Advisory Board on Alcoholism and Drug Abuse
P.O. Box 021571
Juneau, Alaska 99802
Telephone: (907) 586-2173
POSITION STATEMENT: Presented HCR 11.
ALICE JOHNSTONE, Legislative Chair
Governor's Advisory Board on Alcoholism and Drug Abuse
213 Shotgun Alley
Sitka, Alaska 99835
Telephone: (907) 465-4667
POSITION STATEMENT: Presented HCR 11.
JANET SEITZ, Legislative Assistant
for Representative Norman Rokeberg
Alaska State Legislature
Capitol Building, Room 24
Juneau, Alaska 99801
Telephone: (907) 465-4968
POSITION STATEMENT: Presented HB 15.
RUSSELL WEBB, Deputy Commissioner
Department of Health and Social Services
P.O. Box 110601
Juneau, Alaska 99811
Telephone: (907) 465-3030
POSITION STATEMENT: Testified on HB 15.
MARCI SCHMIDT
2040 Fishhook Road
Wasilla, Alaska 99654
Telephone: (907) 357-3618
POSITION STATEMENT: Testified on HB 15.
JAN RUTHERDALE, Assistant Attorney General
Human Services Section
Civil Division (Juneau)
Department of Law
P.O. Box 10300
Juneau, Alaska 99811
Telephone: (907) 465-3600
POSITION STATEMENT: Provided information on HB 15.
SARAH SHORT, President
Families First Partnership
5535 North Street
Anchorage, Alaska 99518
Telephone: (907) 561-5976
POSITION STATEMENT: Testified on HB 15.
GINA MACDONALD, Special Projects Coordinator
Central Office
Division of Mental Health and Developmental Disabilities
Department of Health and Social Services
P.O. Box 110620
Juneau, Alaska 99811
Telephone: (907) 465-3370
POSITION STATEMENT: Testified on HB 162.
SHANNON O'FALLON, Assistant Attorney General
Human Services Section
Civil Division (Juneau)
Department of Law
P.O. Box 110300
Juneau, Alaska 99811
Telephone: (907) 465-3600
POSITION STATEMENT: Testified on HB 162.
ROBERT B. BRIGGS, Staff Attorney
Disability Law Center of Alaska
230 South Franklin Street
Juneau, Alaska 99801
Telephone: (907) 586-1627
POSITION STATEMENT: Testified in support of HB 162.
WALTER MAJOROS, Executive Director
Alaska Mental Health Board
Office of the Commissioner
Department of Health and Social Services
431 North Franklin Street, Suite 201
Juneau, Alaska 99801
Telephone: (907) 465-3071
POSITION STATEMENT: Testified in support of HB 162.
JEFF JESSEE, Executive Director
Alaska Mental Health Trust Authority
555 West Seventh
Anchorage, Alaska 99501
Telephone: (907) 269-7960
POSITION STATEMENT: Testified in support of HB 162.
JANET CLARK, Director
Division of Administrative Services
Department of Health and Social Services
P.O. Box 110650
Juneau, Alaska 99811
Telephone: (907) 465-3082
POSITION STATEMENT: Provided information on HB 162.
PAT CLASBY
Alaska State Hospital and Nursing Home Association
211 Fourth Avenue, Suite 114
Juneau, Alaska 99801
Telephone: (907) 463-6753
POSITION STATEMENT: Testified in support of HB 162.
ACTION NARRATIVE
TAPE 99-46, SIDE A
Number 0001
CO-CHAIRMAN DYSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:05 p.m. Members
present at the call to order were Representatives Dyson, Coghill,
Morgan, Brice and Kemplen.
HCR 11 - SUBSTANCE ABUSE TREATMENT FOR OFFENDERS
Number 0163
DONALD DAPCEVICH, Governor's Advisory Board on Alcoholism and Drug
Abuse, came forward to present HCR 11 saying they brought this
resolution to the attention of the committee early in the session
when the Division of Alcoholism and Drug Abuse Advisory Board
presented issues around the state.
Number 0226
ALICE JOHNSTONE, Legislative Chair, Governor's Advisory Board on
Alcoholism and Drug Abuse, came forward to present HCR 11 saying
about 80 percent of the prisoners are either under the influence of
addictive drugs or alcohol at the time of their arrest, or they
have that problem, and it related to their offense. Although there
is treatment in the prisons for people now, it is not adequate.
They would encourage the legislature to establish treatment in all
the prisons so that they can address this issue to teach the
prisoners how to live a better lifestyle and get unaddicted, so
they can be productive citizens when they get out of jail and not
have any other violations that would put them back in jail again.
She indicated that this will cut down the costs of prisons and
incarceration.
CO-CHAIRMAN DYSON asked if they have any data from other
jurisdictions showing that alcohol treatment in prison really
works, and recidivism goes down.
Number 0406
MR. DAPCEVICH answered that the most comprehensive study is the
Cal-Data study which studied treatment in general, but some of that
study extended to the prison system. It is true that there is some
reduction in recidivism among inmates who participate in treatment
activities while in prison. This resolution calls for looking at
what they are doing to make sure that it is addressing the problems
and is resulting in lower recidivism. If it doesn't, then they
need to change what they are doing.
MR. DAPCEVICH noted that they also need to look at the possibility
of re-engineering what they do in looking at trading hard beds for
soft beds in the prison system. Those soft beds would have
concurrent treatment going on. There is already a partnership
between the correction system and the advisory board for women's
treatment. All the women in need of treatment at Hiland Mountain
Prison have been provided a full continuum of alcohol treatment,
targeting specifically the issues of fetal alcohol syndrome (FAS),
the issues of child abuse for those women, who when they come out
of prison may or may not have some relationship with their children
again and may or may not be at risk for FAS births.
MR. DAPCEVICH said that they want to provide the women good service
while they are in prison, and they want to link community services
to those women as they come out. The program at Hiland Mountain
Prison links the institutional probation officer, the community
probation officer and the treatment program in the community before
the woman leaves prison so that there is a continuum of service
after she leaves. He hopes this initiative will address those
issues, and they will be able to get hard data for Alaska. The
answer to the question is yes, and the Department of Corrections
could provide the hard data.
Number 0616
CO-CHAIRMAN DYSON asked if most of the prisons already have
Alcoholics Anonymous (AA) chapters.
MR. DAPCEVICH answered yes.
CO-CHAIRMAN DYSON asked what percentage of the prison population
chooses to participate in AA.
Number 0661
MR. DAPCEVICH answered in 1997, the program provided clinical
assessments to 1,577 inmates; 1,681 received education programs and
those led to assessments so there were a few more; 807 received
outpatient services. The new Hiland Mountain project is expected
to provide services to 64 inmates at any given time. There are
waiting lists for those services in the criminal justice system.
They don't know how many people are coming into the system with
problems because no assessments are done on entrance into the
prison system.
CO-CHAIRMAN COGHILL asked if some inmates are mandated to the AA
treatments.
MR. DAPCEVICH answered there are some mandates for treatments but
not within the prison system. There are mandates for treatment for
people who are involved in unlawful activity pre-sentencing, and
there are some contingencies for treatment laid out as a part of
parole, but he doesn't believe there are any mandates while in
prison.
Number 0798
CO-CHAIRMAN COGHILL noted that HCR 11 calls for sanctions for those
who refuse to cooperate. He said that is strong language, yet it
is weak language on getting a standardized screening information
process. He wondered if that was on purpose.
MR. DAPCEVICH answered that it is with purpose. They are not
looking at those who want service, they are looking at providing
service for those who need service as determined by the criminal
justice system first.
Number 0876
REPRESENTATIVE BRICE made a motion to move HCR 11 from the
committee with individual recommendations and zero fiscal note.
There being no objection, HCR 11 moved from the House Health,
Education and Social Services Standing Committee.
HB 15 - FOSTER PARENT RIGHTS TO DISCLOSE INFO
Number 0914
CO-CHAIRMAN DYSON announced the next order of business as House
Bill No. 15, "An Act relating to disclosure of information about
certain children; and amending Rule 22, Alaska Child in Need of Aid
Rules."
Number 0928
JANET SEITZ, Legislative Assistant for Representative Norman
Rokeberg, sponsor of HB 15, came forward to present the blank
committee substitute (CS) 1-LSO131\D for HB 15. The previous bill
would have allowed the foster parents to talk to the legislators.
With the assistance of the Department of Health and Social Services
(DHSS) and their legal counsel, they have come up with this
proposal which says if foster parents feel that a proposed
placement is not in the best interest of the child, they can
approach a judge and ask that judge to look at the matter. Then
the judge can either uphold the department or agree with the foster
parent. It is a safety valve for foster parents.
Number 1039
REPRESENTATIVE BRICE made a motion to adopt the proposed (CS) for
HB 15, version 1-LSO131\D, Chenoweth/Lauterbach, 4/14/99, as a work
draft. There being no objection, Version D was before the
committee.
MS. SEITZ told the committee that the DHSS has requested an
amendment that would remove the term "out-of-home caregiver"
wherever it appears in the legislation. She indicated that
Representative Rokeberg would not oppose that.
Number 1090
RUSSELL WEBB, Deputy Commissioner, DHSS, came forward to testify
saying they have worked with the sponsor to provide a safety valve
for a very limited, and narrow range of cases, recognizing that no
one is perfect, and there may be instances where the DHSS makes a
mistake. They want to provide an opportunity for foster parents
who have information that indicates that a department's decision
about a child's placement will risk the health or safety of the
child, to have a safety valve in a very limited range of cases.
Number 1135
REPRESENTATIVE BRICE asked what the current grievance procedures
are for foster parents to address their concerns.
MR. WEBB answered currently their grievance procedures through
their regulations do not allow a foster parent to grieve a change
in placement.
REPRESENTATIVE BRICE asked if Version D will give the DHSS an
ability to provide that grievance procedure.
Number 1183
MR. WEBB said they are attempting to fix a very small problem.
They are specifically not attempting to provide party status to a
case to foster parents. They clearly do not want to provide foster
parents with the right to intervene in a case; they want to give
them a safety valve.
REPRESENTATIVE BRICE asked is there a step down from court.
Number 1244
MR. WEBB answered there is, and there are several safety valves
discussed previously. There is an opportunity for foster parents
to raise their concerns to parties to the case, including the
child's guardian ad litem (GAL). Other avenues also exist. In
this instance, the foster parent believed that they were not heard
either by the DHSS or the child's GAL.
CO-CHAIRMAN COGHILL asked for the reason for removing out-of-home
caregiver.
Number 1297
MR. WEBB answered that they want to narrow this down because foster
parents have a different relationship to children than a
residential care provider or care provider in an inpatient
psychiatric facility. Those people have a different relationship
to the child, and potentially have a financial interest in the
child remaining in a placement, and they want to narrow it so the
safety valve exists, but it is very limited.
MR. WEBB suggested that the amendment remove the words "out-of-home
caregiver" on page 2, lines 2, 5, and 6, and 8.
REPRESENTATIVE BRICE asked why they want to take out "out-of-home
caregiver."
MR. WEBB answered if a provider had concerns and reported it to the
DHSS, they would be interested in the information, but they
wouldn't necessarily have the information about a change in
placement.
REPRESENTATIVE KEMPLEN asked for some examples of an out-of-home
caregiver.
MR. WEBB replied a residential care provider, Alaska Children's
Services in Anchorage, Charter North, or a relative, but relatives
have different status to bring their concerns up.
REPRESENTATIVE KEMPLEN pointed out that the word "caregiver's" on
page 2, line 3 should also be removed since it refers to the
"out-of-home caregiver."
Number 1604
MR. WEBB agreed. He pointed out another reason for removing those
words because it gives an avenue for a for-profit entity to bring
the matter to the court's attention, when the for-profit entity
might have a financial interest in the issue.
CO-CHAIRMAN DYSON asked Ms. Seitz how the sponsor would feel about
the amendment.
MS. SEITZ responded that the sponsor is interested in narrowing
this to foster parents.
Number 1733
REPRESENTATIVE BRICE made a motion for a conceptual amendment to
strike the words "out-of-home caregiver or caregiver's placement"
on page 2, line 3, 5, 6 and 8. There being no objection, the
amendment was adopted.
CO-CHAIRMAN DYSON asked Mr. Webb if they support this process.
MR. WEBB reiterated that they are not creating party status for
foster parents. They are creating a safety valve that would be
applied in a very limited number of cases. If HB 15 were
interpreted to mean that anytime the foster parent disagreed with
the placement decision made by the DHSS, the foster parent could go
to court, the department would be opposed to it. If it is applied
in those circumstances where foster parents have credible
information that indicates that the DHSS is making a bad decision,
they can bring that information to the court, and the court can
evaluate it. If the court believes that it has credibility, the
court can grant a hearing on it. It would be a very small number
of cases. He indicated that they would need some advice from the
Department of Law to look at this closely, but he indicated that
now they are getting close to their intention.
CO-CHAIRMAN DYSON commented that HB 15 goes to the Judiciary
Committee next and that would be an appropriate place for that
discussion.
Number 1894
MARCI SCHMIDT testified via teleconference from the
Matanuska-Susitna (Mat-Su) Legislative Information Office (LIO)
asking if, under this proposed CS, they are no longer allowing
foster parents to discuss the case with the legislators.
Number 1918
MS. SEITZ agreed this is an entirely new draft because of the
concerns raised about the Title IV-E funding that they would lose
under the first bill.
MS. SCHMIDT said she would rather have the original language of HB
15 put back in; it is vital for the safety of their children. It
seems a shame that they are so concerned about dollars rather than
children. She supports the original language being put back in.
Number 2018
JAN RUTHERDALE, Assistant Attorney General, Human Services Section,
Civil Division (Juneau), Department of Law, came forward to testify
saying that the proposed CS does fix the problem of federal
funding. She is concerned that they are heading down the road
giving foster parents party status; this bill doesn't do it, but
foster parents are hired by the Division of Family and Youth
Services (DFYS) to provide temporary shelter, but they are not
parties themselves. However, last year HB 375 gave several rights
to foster parents, one being the right to get notices and an
opportunity to be heard in hearings and also to get notice in the
change of placement. Now this bill allows them an additional right
to petition the court to object to a placement in certain
circumstances.
MS. RUTHERDALE pointed out that this applies in cases when no one
else agrees with the foster parents. She noted some problems: it
will pull everybody into court when they may not need to; it may be
a frivolous motion to the court. If they are called into defend
it, it could require DFYS to go on record as defending their
position which is defending the parent. It is possible that later
the case could change and they sought to terminate parental rights,
the DFYS is now on record of testimony saying "Look how great this
parent is." It also raises questions if this somehow allows the
foster parents to have court-appointed attorneys if they can't
afford their own attorney. She asked if the foster parents will be
allowed to practice law without a license or do they have a right
of appeal. There might be a fiscal note from the court. Since
this is a work draft, the Department of Law hasn't submitted a
fiscal note, but she estimated conservatively that there could be
40 cases which could cost $18,000.
CO-CHAIRMAN DYSON asked Ms. Rutherdale if a foster parent can now
go to court to protest a placement.
MS. RUTHERDALE answered as a practical matter, yes. They have to
go through parties. This bill doesn't seem to be necessary, but
foster parents are being allowed in court anyway.
TAPE 99-46, SIDE B
Number 2240
SARAH SHORT, President, Families First Partnership, testified via
teleconference from Anchorage saying she agreed with Marci Schmidt
that the original text of the bill was better for the child's best
interest. Any external review of DFYS is an absolute necessity.
Anything to aid the child should be done. She pointed out that the
foster parents spend more time with the children than other people
that are parties to the case. She said she believes that the
process now does not work. There is no external review because
they have taken away the Foster Care Review Board. She pointed out
that sometimes children are at Alaska Children's Services for one
to two months before they are placed in a foster home, and she
wondered why they wouldn't be allowed to have adequate input since
they have daily interaction with these children.
MS. SHORT stated that the foster parents should have access to any
legislator because they set the laws, and they should know every
single thing about these children out there in crises. The DFYS
profits from keeping children in care so she doesn't understand why
they wouldn't allow the other for-profit groups to have a say. She
believes that the foster parents have better insight than most of
the case workers and guardians ad litem. They need to be able to
openly communicate, and she urged them to go back to the original
language.
Number 2034
CO-CHAIRMAN DYSON asked if she did not want the foster parents to
be able to go into court.
Number 2031
MS. SHORT said they should be able to tell not only the court but
also the legislators. She agreed that HB 15 is a good bill, it
just needs to be able to open up a little bit more and also include
the out-of-home caregivers.
REPRESENTATIVE BRICE agreed with Ms. Short that the Foster Care
Review Board is important, and it is needed. But the important
distinction between the two drafts before them are that the
legislators do not make decisions on the disposition of a child in
state custody, the courts do. The foster parents need to be able
to have access to the courts, and the proposed CS does that.
Number 1939
REPRESENTATIVE BRICE made a motion to move the proposed CSHB 15,
version 1-LSO131\D, Chenoweth/Lauterbach, 4/14/99, as amended, out
of the committee with individual recommendations. There being no
objections, CSHB 15(HES) moved from the House Health, Education and
Social Services Committee.
Number 1916
CO-CHAIRMAN DYSON commented that strongly over his objection they
eliminated the Foster Care Review Board, which was a major
protection and safety valve, and it worked well in some cases. He
appreciates the sponsor and the DHSS working together on this. He
agreed the original bill had some merit, but he is not going to go
against the sponsor and amend it.
HB 162 - MENTAL HEALTH; RECORDS; TREATMENT
Number 1817
CO-CHAIRMAN DYSON announced the next order of business as House
Bill No. 162, "An Act relating to confidential mental health
records; relating to mental health services and programs; relating
to liability for payment for mental health evaluation and treatment
services; and providing for an effective date."
Number 1805
REPRESENTATIVE KEMPLEN, sponsor, presented HB 162 saying the
purpose of this legislation is to provide the necessary, statutory
changes on three features concerning mental health services. It
clarifies client eligibility for mental health services, it
establishes procedures for determining eligibility, processing
applications, and paying claims, and it offers a conduit for mental
health services to eligible clients through a community-based
program. It provides adequate funding for evaluation and treatment
services for a community-based program. He noted that the
Department of Health and Social Services (DHSS) can answer any
technical questions. The fiscal note reflects an agreement between
the department and Alaska Mental Health Trust Authority (AMHTA).
Senator Ted Stevens has come through with some of the necessary
funding for this program. He mentioned that there are letters of
support in the committee's packets.
Number 1634
GINA MACDONALD, Special Projects Coordinator, Central Office,
Division of Mental Health and Developmental Disabilities,
Department of Health and Social Services, came forward to testify.
She told the committee that this legislation emphasizes the
inpatient services for people who are at risk of harming themselves
or others, or are severely impaired by their mental health
condition at the time they are hospitalized. The department is
looking to fund the inpatient services for those people in private
hospitals throughout the state. In order to do that in an
organized, clear and consistent way, the DHSS wanted clarity in the
statute about eligibility and payment structure and the service
delivery aspects of this program. The DHSS has been doing this for
years, but this allows them to do it in more organized way. As the
Alaska Psychiatric Institute (API) is downsized, they are going to
need those services in Anchorage and throughout the state, for the
short-term hospitalization for patients in danger of harming
themselves or others.
REPRESENTATIVE BRICE asked what the current standards are for
eligibility for a facility to be reimbursed for designated
evaluation and treatment (DET) services.
Number 1562
MS. MACDONALD answered there are two aspects of the bill in terms
of standards. One is clinical in terms of harm to self or others
and the other is eligibility in terms of income level. Currently
the clinical standards are the same. Historically, they have
provided services for people who are committed under the court
order to be in the hospital. In the past year, they have also been
providing services for people who would be committed if they
decided to leave the hospital, but they choose to stay in the
hospital and receive services voluntarily. They want to support
that because it is clinically more appropriate for the patients to
make that choice, and they know they would be committed otherwise.
Number 1505
REPRESENTATIVE BRICE asked if it is appropriate to categorize the
designated evaluation and treatment services as a mental health
emergency room.
MS. MACDONALD answered that it is more of an inpatient level. The
emergency room level would be more of an assessment prior to
admission into a hospital facility. This is one step beyond the
emergency room level. There would be an inpatient stay, the
patient would remain overnight and during that time, there is an
extended evaluation process that happens. It does serve a
community emergency response function in that it does provide a
local place for someone in crisis to go and be safe and be
evaluated.
Number 1444
SHANNON O'FALLON, Assistant Attorney General, Human Services
Section, Civil Division (Juneau), Department of Law, came forward
to testify saying she does mental commitments in southeast Alaska.
They do commit people for up to 30 days at Bartlett Regional
Hospital, a designated treatment facility. It is the shorter term
treatment, and people who are in crisis there are in imminent
danger of harming themselves or others.
Number 1421
REPRESENTATIVE BRICE asked how HB 162 will establish the clinical
standards by which services will be provided to those people.
Number 1406
MS. MACDONALD answered that under the authority of this statute,
the DHSS will be able to establish standards for those services
provided on an inpatient basis, but that is just part of the
picture. There are services provided on an inpatient basis, and
then there is the outpatient component of the service delivery for
people who are in crisis.
REPRESENTATIVE BRICE asked how HB 162 is going to keep someone in
crisis from going to jail, and how does HB 162 direct that
individual into the appropriate level of care.
Number 1360
MS. MACDONALD answered that it gives hospitals a more steady source
of funding for serving these patients so they are able to
anticipate that capacity more readily. The biggest part of this
bill is that it assures hospitals that they will have funding for
providing services to indigent patients. If they don't have the
capacity to do that, they haven't created a structure to be ready
for them.
REPRESENTATIVE BRICE asked what the financial eligibility standards
are currently for the state to reimburse a designated evaluation
facility. He asked how the department pursues that funding.
Number 1278
MS. O'FALLON replied that once the facility has tried to pursue
payment through a third party payer or go to court to try to
collect money from the patient, and those things haven't worked
out, the hospital will submit their bill to the state. If the
person appears to be indigent, the department will pay for those
services.
MS. MACDONALD said the definition of who is eligible has been in
dispute. The need for clarity is what has brought this bill about.
Number 1112
ROBERT B. BRIGGS, Staff Attorney, Disability Law Center of Alaska,
came forward to testify. He explained that the Disability Law
Center provides legal representation for persons with disabilities
in legal matters relating to their disability. They also work to
effect systems change for persons with disabilities when they can.
His involvement with the issue of the liability for mental health
treatment for someone who has been involuntarily committed began
with a client, who walked through his door, and presented him with
a large amount of bills saying he can't pay these bills. The
Disability Law Center has had a history with past mental health
commitments where the DHSS had paid the bills of people who
couldn't afford to pay them. When he presented a claim to the
DHSS, they declined to provide any assistance.
MR. BRIGGS indicated that the Disability Law Center felt that was
not an implementation of an existing statute so they filed a
lawsuit. As part of that lawsuit, they sought regulations from the
DHSS to implement AS 47.30.910 which, in their view, contains a
provision for requiring the DHSS to determine the ability of
persons to pay for the costs of involuntary commitment, whether
they are committed involuntarily, or whether they are committed
"voluntarily-in-lieu" of an involuntary commitment. He uses
"voluntarily-in-lieu" admission to cover the class of person who is
presented to the hospital, a doctor informs that person that they
do meet the criteria for involuntary commitment, and the doctor is
going to commit them unless they agree to go voluntarily.
Number 0998
CO-CHAIRMAN DYSON asked if there are different benefits for a
voluntary versus involuntary commitment.
MR. BRIGGS answered under the existing statute, in their view,
there is not. The statute applies to both people who are
involuntarily committed, and those who are committed in lieu of an
involuntary commitment.
CO-CHAIRMAN DYSON asked the same question about the proposed bill.
Number 0971
MR. BRIGGS answered that HB 162 would clearly state that the
benefit would be equal. There is a dispute over the interpretation
of the statute he cited. This bill goes a long way to limiting
that dispute and making it clear that both people who are voluntary
committed in lieu of an involuntary admission, as well as those
people involuntarily admitted, are subject to the relief measure.
That is the upside of this bill for people who have mental
disabilities. The downside of the bill is that under existing law
there is no income cap on the eligibility for the benefit. This
addresses a question What is the income criterion under existing
law? It is simply stated in the statute "ability to pay," and
there is no income cap. This bill would clearly state a cap on
this benefit.
MR. BRIGGS explained that in deciding to advocate on behalf of
passage of this bill, one has to take into consideration both
sides. The Disability Law Center speaks in favor of the bill
simply because they believe that it is going to be of more benefit
to more people to be assured that their voluntary admission will
have access to the same level of benefits as somebody who is
involuntarily committed because it will encourage voluntary
treatment.
CO-CHAIRMAN DYSON asked Mr. Briggs why he doesn't like the income
cap.
Number 0857
MR. BRIGGS answered there is a large group of people who may have
some source of income, but they are the working poor. Those people
could benefit also from this program. He said the fiscal climate
may not be correct for establishing a threshold at 200 percent of
poverty, but as the fiscal climate changes, he will be back
advocating that they increase the cap.
CO-CHAIRMAN DYSON asked Mr. Briggs if the cap were five times the
poverty level would that be okay.
MR. BRIGGS answered absolutely, but he is not certain that it would
be acceptable. He suggested a hybrid approach to having an income
cap, and then having an ability-to-pay formula that compares a
variety of factors, including the total amount of unexpended bill,
total income, easily liquidated cash and other assets.
Number 0748
REPRESENTATIVE KEMPLEN made a motion to adopt the proposed
committee substitute (CS) for HB 162, version 1-LSO761\H,
Lauterbach, 4/29/99, as a work draft. There being no objection,
Version H was before the committee.
Number 0715
REPRESENTATIVE BRICE indicated he is supportive of the hybrid
approach for those who don't fit under HB 162.
CO-CHAIRMAN DYSON agreed it would be good, but he advised
Representative Brice to be wise about not slowing down the process.
REPRESENTATIVE BRICE agreed they needed to be wary of expediency,
but they also need to ensure they are doing what they are supposed
to do in addressing the needs of the people. He agrees they have
a readily acceptable solution to the issues.
MR. BRIGGS noted that Version H does resolve the issue of who is
eligible for the benefit as compared to involuntary and
voluntary-in-lieu admissions, but the eligibility threshold is not
clear. Not only does someone have to have an income less than 185
percent of a poverty guideline, there is not a clear definition of
which poverty guideline is being referred to, and there are
potential interpretations of several poverty measures, so some
correspondence from the DHSS on exactly which poverty guideline is
intended would help that ambiguity.
MR. BRIGGS indicated that the existing statute talks about the
ability of a person to pay. This bill instead substitutes the
phrase of "eligibility based on someone lacking the ability to pay
or contribute to the payment of charges," which isn't fundamentally
different from the concept of ability to pay. One of the reasons
they filed the claim against the DHSS was because they felt there
was a need for regulations that interpret the concept of ability to
pay. There is recognition that there still is a need for those
regulations; the bill in its current form does require regulations.
Number 0513
MR. BRIGGS noted that there is not a deadline on when those
regulations must be adopted. He suggests that they ask the DHSS
what may constitute the factors that they will look at in
determining ability to pay. He suggests looking at the magnitude
of the overall liability, the income available to the liable person
as well as their assets.
MR. BRIGGS informed the committee that he will forward his
definition of ability to pay to the committee. The other element
of this bill is to provide a clear and efficient mechanism for
funding the privatization of a state function. There is still one
ambiguity in the bill that should be clarified. He is not sure of
the intention of the paragraph on page 4, lines 22-26. He
indicated it is intended to say that if a liable person does not
provide the necessary information, the DHSS may issue an
administrative order imposing liability on that person. He has
language that might more clearly state that which he will provide
in writing to the committee.
MR. BRIGGS pointed out another aspect of this bill that has not
been talked about is the reality that under existing law there is
a cap on what hospitals may charge for the services rendered under
the range of statutes from AS 47.30.670 through AS 47.30.915. He
highlighted the language on page 4 of his written testimony that
limits what charges may be imposed to "the actual cost of care and
treatment." That term has a specific definition within the
existing statute. That provides some measure of protection to
consumers that this involuntary treatment will not cause charges
that are outrageous and unreasonable. The new language in Version
H is contained on page 2, line "Charges assessed for services
provided under AS 47.30.670 - 47.30. 915 when a patient is
hospitalized at a state-operated facility may not exceed the actual
cost of care and treatment." Version H proposes a change in the
cost cap. He is not prepared today to oppose that change.
MR. BRIGGS is concerned that when there is a cost cap that is
available to someone who is treated at a state-operated facility,
and it is not available to a patient who is hospitalized at another
facility, there is a potential equal protection problem. It is
entirely possible that in practice, the costs incurred by patients
at private facilities under this bill may be less than those
charges incurred at a state-operated facility. They don't know.
MR. BRIGGS is no expert on the ways hospitals are constrained in
their billing practices by Medicare, Medicaid and other fiscal
constraints. He pointed out it is a change in law, and there is a
potential equal protection problem that can only be discerned as
the bill is implemented. He urged the committee to pass this bill
this year, and he remains committed to work to reach a consensus on
this bill.
TAPE 99-47, SIDE A
Number 0008
WALTER MAJOROS, Executive Director, Alaska Mental Health Board,
Office of the Commissioner, Department of Health and Social
Services, came forward to testify in support of HB 162. This bill
is critical and at the center of the effort to downsize API from a
79-bed facility to a 54-bed facility. This can only be done by
transferring some of the functions now being provided at API into
the community. One of the most important of those is acute-care
hospitalization services that now can be provided within community
hospitals that are being provided in API. It is important to
recognize this as a form of privatization.
MR. MAJOROS pointed out that there will be a primary focus on the
implementation of these services in the Anchorage bowl area because
there are no inpatient psychiatric services of this nature to serve
the involuntary patients in the Anchorage area. Approximately 85
percent of the admissions to API are from the Anchorage bowl area;
there is a very strong need to provide this service within the
Anchorage area. The services will also extend to other parts of
the state, including Fairbanks, Juneau and some of the more rural
areas.
MR. MAJOROS noted that there are problems with the current law in
the perceived lack of clarity on eligibility for the current
program and payment practices. The hospitals need to know under
what circumstances they can bill for services and receive payment
for those services.
MR. MAJOROS stated that the board is very supportive of the issue
of voluntary status. Right now the statute encourages people to
convert from involuntary to voluntary status, and it does not make
sense to the board that someone can say to a patient "we want you
to convert over to voluntary status, but in the process of doing
that, you lose the possibility that the state will reimburse for
the service." They are in favor of this service being available to
people who are involuntarily committed, and those who come
voluntarily, but meet those same criteria which is danger to self
or others or gravely disabled besides being mentally ill.
MR. MAJOROS stressed the importance of the partnership that has
gone into the construction of this bill. There have been six or
seven meetings over the past two weeks between representatives of
the DHSS, the mental health board, the mental health trust
authority, the hospital association, consumers, advocates of
disability law, and they have worked hard to bring about a
consensus on the draft bill. The changes could go on indefinitely,
but he encouraged the committee to move the bill forward in its
present form because it will make a significant improvement. It is
an appropriate compromise.
MR. MAJOROS stated that this bill allows services to be given to
consumers closer to home and closer to their natural support
systems. It would allow them to receive these services more
readily in community hospitals throughout the state including rural
areas. This bill is cost effective, and there are leveraged
resources that are being applied to this. There is no state fiscal
impact initially; the services will be provided exclusively through
federal funds. Mr. Majoros also pointed out that community
hospitals are able to bill Medicaid so it will create an additional
revenue source that doesn't presently exist for API.
Number 0487
JEFF JESSEE, Executive Director, Alaska Mental Health Trust
Authority, testified via teleconference from Anchorage saying this
is an important bill to the trustees. They have worked to develop
a community-based system to take the place of some of the API beds,
and this legislation is essential to carry out the goals of that
effort. It will bring clarity to the funding mechanism that they
need in order to assure both the beneficiaries and the agencies and
corporations that they are hoping will take on these
responsibilities, that the money will follow the client from the
state hospital to the community-based designated evaluation and
treatment facility.
MR. JESSEE agrees there could be improvements to HB 162, but time
is short, and by adding amendments at this point the bill would not
be consistent with the one in the Senate, and they are concerned
that that could result in the bill not passing. The trustees have
expressed their willingness to continue to look at how this bill is
implemented. As they get data and information about the impact of
these areas that people have expressed concerns about, then they
will be in a better position to come back and jointly recommend any
necessary changes to the legislation in the future.
MR. JESSEE encouraged them to pass the bill out of the committee,
and he hopes it passes this year. They are planning to begin
spending several million dollars of federal funds, and part of what
they have assured Senator Stevens is that they will have the
infrastructure in place to implement these community services.
This bill is a very essential part of that effort.
Number 0682
REPRESENTATIVE BRICE asked Mr. Jessee what the trust authority is
doing to ensure that hospitals that are currently providing
designated evaluation and treatment programs aren't turning away
people who are in crisis.
MR. JESSEE answered the number one thing that is being done is the
attempt to pass this legislation to bring more clarity to the
funding role for designated evaluation and treatment. Once there
is clarity as to how one component fits into the overall continuum
of care, then they can start to integrate the other services that
have to work together in tandem with that. This bill provides, at
this point, the best delineation of that for designated evaluation
and treatment that they have been able to develop.
Number 0919
JANET CLARK, Director, Division of Administrative Services,
Department of Health and Social Services, came forward to testify.
She reiterated how important designated evaluation and treatment
are to the long-range plan. They have developed a five-year plan
that has three components: It deals with the building part of API
and providing a new facility at API; the second component deals
with the actual downsizing of the API hospital from 79 to 54 beds,
and the third piece is the community piece which designated
evaluation and treatment is just one piece.
MS. CLARK noted that the fiscal note shows that in fiscal year (FY)
2000 and FY 2001 they have secured federal funds to reconfigure the
community mental health system. She referred them to page 2 of the
fiscal note. More than $1 million outlined in the governor's
budget are federal funds that would go toward designated evaluation
and treatment. Those federal funds are available again in FY 2001
to fully implement this reconfiguration. In FY 2002 the federal
funds are not available, so the DHSS will be back in front of the
legislature saying now that they have been able to reconfigure
services, the legislature will need to consider that funding
request at that time.
Number 1071
PAT CLASBY, Alaska State Hospital and Nursing Home Association,
came forward to testify in support of HB 162. They were one of the
groups at the meetings in the past two weeks. The committee
substitute is a compromise of that group who has met in the last
two weeks. They all would probably have liked to have gotten more
in the bill, but they are proud of the fact that they have a bill
that they can all agree on and support and hope that the
legislature moves it forward.
Number 1130
REPRESENTATIVE BRICE asked how will the hospitals collect their
bills on someone who can't pay. He really is asking them to say
they would appreciate some sort of sliding fee scale so the
hospitals don't end up paying the whole bill.
MS. CLASBY said the hospitals do want to be protected financially
as they provide the services. This bill has come a long way to
increase the kind of financial situation those hospitals were in
prior to getting this bill introduced as far as getting reimbursed
from the state. Perhaps the Finance Committee can look at that.
They would have liked a higher income limit.
Number 1309
REPRESENTATIVE BRICE made a motion to move CSHB 162, version
1-LSO761\H, Lauterbach, 4/29/99, from the committee with individual
recommendations and attached fiscal notes.
Number 1320
CO-CHAIRMAN COGHILL commented that they are expanding an
entitlement here. With the questions and expectations that federal
government monies are going to come, and they are obligating a
future legislature. He doesn't object to moving it, but he might
object on the floor.
CO-CHAIRMAN DYSON added that whatever is ongoing is subject to
appropriations by the legislature. There are no commitments beyond
that. There being no objection, CSHB 162(HES) moved from the House
Health, Education and Social Services Standing Committee.
HB 16 - LICENSURE OF ASSISTED LIVING FACILITIES
Number 1368
CO-CHAIRMAN DYSON announced the next order of business as House
Bill No. 16, "An Act transferring to the Department of Health and
Social Services the authority to license all assisted living
facilities; eliminating the authority of the Department of
Administration to license assisted living facilities; and providing
for an effective date." He indicated that HB 16 would be held over
for further hearing.
ADJOURNMENT
Number 1374
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 4:55 p.m.
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