Legislature(2007 - 2008)CAPITOL 106
11/02/2007 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Substance Abuse and Mental Health Strategies | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
November 2, 2007
3:14 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Bob Roses, Vice Chair
Representative Anna Fairclough
Representative Wes Keller
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
Representative Paul Seaton
OTHER LEGISLATORS PRESENT
Representative Andrea Doll
Senator Bettye Davis
Senator Fred Dyson
Senator Joe Thomas
COMMITTEE CALENDAR
SUBSTANCE ABUSE AND MENTAL HEALTH STRATEGIES
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
ANGELA SOLARNO, Advocacy Coordinator
Advisory Board on Alcoholism and Drug Abuse (ABADA)/Alaska
Mental Health Board (AMHB)
Juneau, Alaska
POSITION STATEMENT: Presented a report of behalf of the
Advisory Board on Alcoholism and Drug Abuse/Alaska Mental Health
Board.
LONNIE WALTERS, Member
Advisory Board on Alcoholism and Drug Abuse (ABADA); Co-
Executive Director, Communities Organized for Health Options
(COHO)
Craig, Alaska
POSITION STATEMENT: Answered questions during the ABADA/AMHB
report.
JEFF JESSEE, Chief Executive Officer
Alaska Mental Health Trust Authority (AMHTA)
Department of Revenue
Anchorage, Alaska
POSITION STATEMENT Participated in the roundtable discussion.
KARLEEN JACKSON, Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Provided information on the funding of
behavioral health services.
DWAYNE PEEPLES, Deputy Commissioner
Office of the Commissioner
Department of Corrections (DOC)
Juneau, Alaska
POSITION STATEMENT: Participated in the roundtable discussion.
MELISSA STONE, Director
Division of Behavioral Health
Department of Health & Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Participated in the roundtable discussion.
PATRICK HEFLEY, Director
Behavioral Health Service
SouthEast Alaska Regional Health Consortium (SEARHC)
Sitka, Alaska
POSITION STATEMENT: Participated in the roundtable discussion.
JERRY FULLER, Project Director
Office of Program Review
Office of the Commissioner
Department of Health & Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Participated in the roundtable discussion.
BILL HOGAN, Deputy Commissioner
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Participated in the roundtable discussion.
COLLEEN PATRICK-RILEY, Mental Health Clinician
Department of Corrections (DOC)
Anchorage, Alaska
POSITION STATEMENT: Participated in the roundtable discussion.
SUSAN OHMER, Executive Director
Petersburg Mental Health Services, Inc.
Petersburg, Alaska
POSITION STATEMENT: Participated in the roundtable discussion.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:14:00 PM.
Representatives Fairclough, Keller, Cissna, Gardner, Roses, and
Wilson were present at the call to order. Also present were
Senators Davis, Dyson, and Thomas, and Representative Doll.
3:14:50 PM
^Substance Abuse and Mental Health Strategies
3:16:10 PM
CHAIR WILSON announced that the first order of business would be
a presentation by the Alaska Mental Health Board (AMHB) and the
Governor's Advisory Board on Alcohol and Drug Abuse (ABADA).
3:19:29 PM
ANGELA SOLARNO, Advocacy Coordinator, Advisory Board on
Alcoholism and Drug Abuse (ABADA)/Alaska Mental Health Board
(AMHB), informed the committee that the joint boards of ABADA
and AMHB share the goal of a full continuum of behavioral health
services that will help reduce Alaska's future economic burden,
improve the quality of life for Alaskans, and ensure the health
and productivity of our citizens. Ms. Solarno explained that
funding the public behavioral health system is a mix of Medicaid
and grants; in fact, regulations direct that there are priority
groups including: adults with a serious mental illness;
children and youth who have serious emotional disturbances; and
persons with a maladaptive pattern of substance abuse. Ms.
Solarno stated that the present system provides good service to
the priority population and clients show improvement and
satisfaction with the services they receive. She opined that,
by and large, the system is only serving these priority groups
as neither grants nor Medicaid serves the following: returning
veterans; families, children, and youth who don't qualify;
Alaskans with moderate illness; and those who cycle through the
corrections system.
3:22:46 PM
CHAIR WILSON asked whether veterans are served by the U. S.
Department of Veteran's Affairs (VA).
MS. SOLARNO answered that VA services are not helping returning
veterans with mental problems, such as post-traumatic stress
disorder.
3:23:56 PM
MS. SOLARNO spoke of the obstacles to the access of mental
health services and said that even citizens that have private
insurance are not guaranteed mental health services; there is
insurance discrimination throughout the nation and a lack of
parity. Furthermore, there may not be a provider nearby or
there may be a restriction in coverage by a private insurer.
3:24:53 PM
CHAIR WILSON suggested that Ms. Solarno hold part of her
presentation until the roundtable discussion.
3:25:33 PM
MS. SOLARNO asked the committee to review the handout titled,
"Mandatory diversion of non-violent drug offenders: The
California Experience" published by AMHB/ABADA.
3:25:41 PM
REPRESENTATIVE GARDNER asked for further information on the
Alcohol Treatment and Prevention Fund.
MS. SOLARNO answered that, in 2002, Representative Murkowski's
legislation, known as the "Dime a Drink" bill, created the
Alcohol and Other Drug Treatment and Prevention Fund. She noted
that the fund cannot be dedicated; however, the original intent
was that half of all alcohol taxes were to go into this fund to
be spent to enhance drug and alcohol treatment in the state.
The reality is that the money, which is about $17 million per
year, is used to supplant general funds. Ms. Solarno asked the
committee to consider how this fund could be re-directed to
behavioral health services.
3:28:32 PM
CHAIR WILSON inquired as to how the ABADA and the AMHB are
working together as a joint board.
3:29:03 PM
LONNIE WALTERS, Member, Advisory Board on Alcoholism and Drug
Abuse (ABADA); Co-Executive Director, Communities Organized for
Health Options (COHO), informed the committee that he retired
after 22 years in the U. S. Navy and serves as a beneficiary
member of the ABADA. He is one of four members of the board who
are recovering alcoholics and he credits his recovery from
alcoholism with saving his life and preserving his family. The
military is motivated to support its members through recovery
from addictions because of the expense invested in training its
personnel; in addition, every Fortune 500 company has substance
abuse treatment programs for employees because alcohol and drug
abuse cost them money. Mr. Walters said that alcoholism is
impossible to ignore in a small and rural town. Budget cuts
have cost his small facility $72,000 and on an island with 4,000
residents that meant the loss of many services. He opined that
alcohol and drug abuse is the number one problem in Alaska as
indicated by its impact on the courts, law enforcement,
emergency services, child abuse, spousal abuse, and school
dysfunction. However, it is not the number one priority with
state services. Mr. Walters said that he is unable to continue
his work at the treatment center but will continue to be a
member of the ABADA. The work is too hard considering the
difficulty with recruiting and [in]adequate pay. Pay has
declined, regulations are more complex, and the funding is cut.
He emphasized that the state will not fund programs even though
citizens are dying of alcoholism.
3:33:45 PM
CHAIR WILSON asked whether the center is able to provide the
services that are necessary for his community.
MR. WALTERS said no.
3:34:06 PM
SENATOR DAVIS asked for further information on how AMHB and
ABADA connect together and whether they have joint plans for the
future.
3:34:35 PM
MS. SOLARNO acknowledged that the merger was a painful marriage,
although members now meet together regularly as one board.
There remain differences about the proper treatment for
substance abuse and mental illness, but members are learning
about the integration of treatments for co-occurring disorders.
She opined that more time will go by before clinicians are
trained in both disciplines; however, the two boards are now
working together well. She explained that the two boards will
not be combined into one due to the potential impact to the
Alaska Mental Health Trust settlement.
3:36:04 PM
REPRESENTATIVE KELLER asked for the percentage of funds, for
each board, that comes from the Alaska Mental Health Trust
Authority (AMHTA).
MS. SOLARNO said that the exact percentages will be provided to
the committee. She further explained that the boards were
traditionally funded by the general fund (GF); since 2002, when
budgets were slashed dramatically and the staff was merged, the
boards request GF funds annually, but rely on the AMHTA for
funding.
3:37:10 PM
REPRESENTATIVE CISSNA stated that, from her experience in
behavioral health training, she has seen that alcohol and
substance abuse is funded less and treated like a step-child by
the system. She asked Mr. Walters to comment on the
relationship and what pieces are missing.
3:38:23 PM
MR. WALTERS responded that many small and rural agencies have
been combined because of a lack of space and available dollars.
His facility on Prince of Wales Island is a combination of the
mental health and substance abuse agencies; in fact, the
agencies worked well together even before the mandate to merge.
He opined that the combination has been at the expense of
substance abuse and substance abuse programs receive less and
less. This may happen because most mental health field
counselors have a higher degree of education and thus, wield
more power.
The committee took an at-ease from 3:41 p.m. to 3:42 p.m.
3:42:39 PM
CHAIR WILSON announced that housing, recruiting, and retaining a
workforce will be topics of the roundtable discussion.
3:43:45 PM
REPRESENTATIVE CISSNA asked whether the participants were ready
to speak about the cost of each solution that they are
proposing.
3:44:46 PM
CHAIR WILSON assured the committee that any missing information
will be provided at a later date. She then asked Mr. Jessee to
address the issue of creating the appropriate balance of
Medicaid and grant funding.
3:45:26 PM
JEFF JESSEE, Chief Executive Officer, Alaska Mental Health Trust
Authority (AMHTA), informed the committee that Medicaid has
limitations regarding eligibility and covered services. The
present system, which depends heavily on Medicaid, requires
providers to wait for people to get seriously ill and destitute
before they qualify for treatment; this is not a cost effective
way to provide care. The AMHTA requests the legislature to give
thought to the appropriate balance between grants that fund
early intervention, and Medicaid, in order to prevent costs at
the higher end of system. Notwithstanding the outcome for
individuals, the state must consider the financial cost of not
providing preventive services, and instead seeing the costs of
treatment by the Department of Corrections (DOC) and hospital
emergency rooms. He pointed out that this committee could,
during this legislative session, adjust upward the rates of
reimbursement as a first step toward solving workforce and
capacity issues. Rates have not been adjusted, in some cases,
for a decade and programs cannot continue to provide services.
Mr. Jessee opined that DHSS is doing an excellent job reviewing
the rates for review by the finance committee. The House
Health, Education and Social Services Standing Committee could
pass legislation that would place rate reviews for community
programs on the same footing and in the same timeframe as those
for hospitals and nursing homes. In the long run, rates must be
kept current to prevent degradation of the system and another
crisis.
3:48:46 PM
REPRESENTATIVE KELLER asked for the percentage of AMHTA funds
that are dedicated to prevention and early intervention.
MR. JESSEE estimated about 15 percent would go to areas of
prevention.
3:49:18 PM
SENATOR THOMAS pointed out that the public is not educated about
putting money upfront to forward fund services such as education
and mental health. He asked how to answer those who see funding
programs in advance as a demand for oil industry revenue to
support "more big government." He opined that it is a problem
to convince the general public that forward funding is an
opportunity to save money in the long run.
MR. JESSEE suggested that the public be informed about how many
people in prison have mental health and substance abuse issues,
and the cost to serve them through the DOC, compared to serving
citizens in the community and keeping them out of the prison
system. Discussions of health care cost should include proof
that a portion of emergency room costs are accrued because
patients were not treated for mental health and substance abuse
disorders in the community. He drew an analogy to the cost of
the emergency measures taken by the oil industry when upfront
dollars are not invested to maintain facilities and equipment.
This can be explained as a business decision like any other.
3:52:45 PM
CHAIR WILSON announced that, due to time constraints, the
committee will need to submit written questions to the
roundtable participants for responses at a later date.
3:53:31 PM
MR. WALTERS expressed his belief that, over time, prevention
measures are effective. For example, dental health and heart
health have improved tremendously over the last 30 to 40 years.
He then spoke of the imbalance of Medicaid billing and pointed
out that he was only able to serve two Medicaid patients last
year, while his mental health counterpart saw much a higher
percentage of patients because they qualified for Medicaid.
3:55:24 PM
KARLEEN JACKSON, Commissioner, Department of Health and Social
Services (DHSS), reminded the committee of the other pieces of
the health services funding system including: Indian Health
Service (IHS), Medicare, the state retirement system, and the U.
S. Department of Veterans Affairs (VA). She encouraged the
committee to consider that the departments are funded in stand-
alone chunks. It is important to consider not only where the
costs are, but where funds can be leveraged together.
Commissioner Jackson suggested that the committee see how to
fund differently across functional areas and not just
departments; for example, funding of the prevention and
treatment of mental illness and substance abuse across the
entire state system and not within individual departments.
Similarly, how the legislature can plan, and fund, for more than
one fiscal year at a time.
3:57:30 PM
DWAYNE PEEPLES, Deputy Commissioner, Office of the Commissioner,
Department of Corrections (DOC), informed the committee that the
DOC has a very limited role in direct community services to the
mentally ill. There are about 5,500 individuals in institutions
and another 5,500 in probation, parole, and community service.
The DOC primarily provides case management and planning for the
chronically mentally ill, but is very dependent on community
services to provide substance abuse treatment to stabilize its
outgoing population. He observed that, when there is a
degradation of community services the prison census rises. In
fact, at this time there is a sharp rise in population growth
that is only explained by the increasing failure of former
inmates to stabilize in the community. He stated that basic
case management will strengthen the community and there needs to
be a strong, stable, base for released mental health trust
beneficiaries to prevent recidivism.
3:59:40 PM
MELISSA STONE, Director, Division of Behavioral Health,
Department of Health & Social Services, told the committee that
they must first consider the issues of eligibility to determine
who is served. Currently, the populations served are seriously
emotionally disturbed children, seriously mentally ill adults
and substance abusers. The populations that are missing, and
that the state has to pay for, are at the other end of the
continuum and are early intervention and prevention. She
explained that for funding, there are services that can be
selected relative to the populations chosen, such as outpatient
substance abuse and inpatient residential services. Services
not paid from Medicaid and general funds are: screening, grief
counseling, early intervention, intensive case management,
housing, and transportation. The determination of an
appropriate balance between Medicaid and grant funding goes back
to how much of the population will be served and how to pay for
groups of individuals that are added to the populations served.
The Pacific Health Consulting Group study suggested an expansion
of substance abuse services in the state; in fact, the Division
of Behavioral Health is developing a scope of work in order to
determine how services can include those citizens, aged 22 to
64, who are not eligible for Medicaid.
4:03:21 PM
PATRICK HEFLEY, Director, Behavioral Health Service, SouthEast
Alaska Regional Health Consortium (SEARHC), related his
observation that the legislature speaks about money first; the
focus for the SEARHC is on what needs to be done, and then how
to pay for it. He informed the committee that tribal health
organization facilities are frequently the only medical and
behavioral health resource in rural areas. He further explained
that the SEARHC organizations are a variation on the managed
care concept; they have a budget that is defined for a scope of
service and a mission to improve health care status. He opined
that policy setters are regional consumers who need to redirect
resources to address the issues specific to their region. His
organization also provides rehabilitative services and early
intervention. Mr. Hefley shared that there is a group working
to deliver some recommendations for the tribes as how to work in
partnership with the legislature.
4:06:16 PM
MR. HEFLEY continued to say that his group has determined three
needs: treat people closer to where they live; treat people
lower in acuity; and find a mechanism to have a continuity of
care using various systems. In addition, the group has broken
down three variables: the type of services; the type of
provider; and the location of the provider. He stated that
recommendations from the working group are forthcoming. Mr.
Hefley pointed out that over 90 percent of the money that SEARHC
receives does not come through state as it costs too much to
process state money. He suggested an all-inclusive rate to
bundle the costs of services for behavioral health and simplify
the billing system. He stated that the SEARHC is building its
capacity but needs the states help. As SEARHC has 1,000
employees and must work together, he suggested that state
agencies should work together as a policy. For example, SEARHC
and Juneau Youth Services (JYS) spent almost two years working
on the Bring the Kids Home Initiative, a successful partnership
with the state to reduce costs and allow the state to divert its
resources to other capacities.
4:10:35 PM
JERRY FULLER, Project Director, Office of Program Review, Office
of the Commissioner, Department of Health & Social Services
(DHSS) stated that the DHSS is quite aware of the current
issues; further explanation and development of the new
opportunities is needed. There is some amount of flexibility to
change the system and the process to obtain a waiver from
Medicaid, provide substance abuse services for all Alaskans, and
to devise a best practices treatment delivery system, has just
begun.
4:11:39 PM
BILL HOGAN, Deputy Commissioner, Office of the Commissioner,
Department of Health and Social Services, emphasized the need to
focus on positive outcomes for the people receiving services.
4:12:18 PM
COLLEEN PATRICK-RILEY, Mental Health Clinician, Department of
Corrections (DOC), pointed out that the DOC is working on best
practice initiatives with Social Security. Additionally, the
DOC is partnering with the DHSS to increase applications for
Medicaid eligibility; is participating in the state mental
health court, and is participating in the Assess, Plan,
Identify, Coordinate (APIC) best practices program. She opined
that, while DOC is willing to expand its current services, it
also strongly supports the need for improving the nature of
services in the community that are funded through the DHSS. She
reiterated her impression and belief in the real correlation
between the number of effective services available in the
community and the numbers entering corrections.
4:14:01 PM
CHAIR WILSON inquired as to whether the DOC is informed about
the mental health background of inmates at intake.
MS. PATRICK-RILEY answered that when an individual is booked
there is a medical and mental health screening. However, the
questions and observations are for very overt things and will
not capture everyone with a mental health disability. In
addition, not all facilities have an on-site clinician. She
opined that Fetal Alcohol Spectrum Disorder (FASD) and traumatic
brain injuries (TBI) are vastly under identified.
4:17:19 PM
CHAIR WILSON informed the roundtable participants that the next
question involves Medicaid reimbursement and parity between
mental health and substance abuse.
4:17:42 PM
MR. JESSEE pointed out that the Pacific Health Consulting Group
report recommends obtaining a substance abuse waiver to get
better Medicaid funding and the DHSS is working on a Request for
Proposal (RFP) for this endeavor. He questioned allowing the
private insurance industry to continue to cost-shift behavioral
health services to the state. As long as private insurance does
not cover behavioral health on parity with physical health,
moderate and low income patients are forced to use the publicly
funded system. Mr. Jessee encouraged the committee to write
legislation that will solve this problem.
4:19:13 PM
MS. STONE informed the committee that the DHSS is developing a
project to integrate the current Medicaid regulations.
Currently, there are two different sets of Medicaid regulations
for mental health and substance abuse; integration of these
regulations will create parity and allow an integrated agency to
serve, treat, and bill services for both substance abuse and
mental health disorders.
4:20:35 PM
CHAIR WILSON asked for clarification on the regulations.
MS. STONE explained that state Medicaid regulations are being
developed, by regulation writers, from concepts submitted by the
Division of Behavioral Health.
4:21:06 PM
CHAIR WILSON informed the roundtable participants that the next
question is about building Native behavioral health care
capacity.
4:21:28 PM
MR. HEFLEY reported that his organization will submit
recommendations on this topic within six months.
4:21:44 PM
CHAIR WILSON said that the next question is about increased
capacity of residential substance abuse treatment (RSAT) within
the DOC.
4:21:56 PM
MR. PEEPLES explained that the DOC currently operates three
residential substance abuse treatment (RSAT) programs. The DOC
is trying to strengthen current operations and is also pursuing
intensive outpatient services for those in the general
population. In addition, DOC is considering linking outpatient
services to community services and expanding community
outpatient follow-up.
4:23:37 PM
MR. WALTERS stated that many Prince of Wales Island residents
have come out of prison; furthermore, 100 percent of his
referrals from the probation officer are addicted or alcoholic.
He explained that time in prison does not cure alcoholism. His
experience is that parolees that have been through a RSAT
program are emotionally ready to begin living outside; those
that have not, are not. He said that he has not had an RSAT
parolee violate parole.
4:26:59 PM
MS. PATRICK-RILEY pointed out that RSAT programs are for those
who are sentenced to prison for over one year. Inmates also
must volunteer for the program and there are very few spaces
available. Additional facilities must be built in order to
assist in this treatment effort.
4:28:38 PM
REPRESENTATIVE CISSNA commented that the RSAT programs, which
sound like they are cost effective and successful, should be
vigorously supported by the committee.
4:29:43 PM
CHAIR WILSON stated that the next question is about increased
release and how the community can support released individuals
through reintegration planning.
4:30:09 PM
MR. PEEPLES observed that the DOC is working with the AMHTA to
expand its prerelease and discharge case management capacity.
Additionally, the number of individuals eligible for Medicaid
and social security can be increased; however, the DOC looks to
community providers for services when individuals are returned
to communities. He stressed that the DOC is charged with public
safety and is only responsible to treat those incarcerated, on
parole, or on probation.
4:32:07 PM
MS. PATRICK-RILEY recalled that there are about 200 individuals
in the closely coordinated mental health release program;
consistently there is a lower recidivism rate when community
services are provided, even at a less than ideal level.
4:33:01 PM
SUSAN OHMER, Executive Director, Petersburg Mental Health
Services, Inc., expressed her support of community behavioral
health centers. She noted that, in Petersburg, there is support
for accountability, but there is also concern for the changes
the state is making that have seriously impacted the ability of
a small and rural center to survive. She said that the increase
in administrative requirements have cost her center a clinical
position and have reduced the center's capacity by 100 patients
per year. Furthermore, the addition of substance abuse services
to her center's caseload has tripled the number of cases while
reducing its income by $30,000 per year.
4:35:42 PM
CHAIR WILSON said that the next question is about safe, stable,
and affordable, housing.
4:36:14 PM
MR. JESSEE shared that the AMHTA has learned that without safe,
secure, reliable, housing individuals become homeless and all
the other services are for naught. A study of homelessness
revealed that most of the federal low income housing funds are
provided to those who have 70 percent and above of the median
income. In fact, the homeless earn 30 to 40 percent and below
of the median income. He explained that low income projects are
subsidized but still must make some money. In addition,
individuals with problems such as substance abuse, mental
health, and domestic violence, are not as successful in low
income housing unless they receive support services. AMHTA
further discovered that the Housing First model, supported by a
housing trust, is successful in over 30 states nationwide. A
housing trust adds additional capital to reduce the cost of a
project, thereby reducing the amount of the rent. It can also
provide support service funding for case management, alcohol and
mental health treatment, landlord support, and tenant education.
Finally, it can provide a rental subsidy from the U. S.
Department of Housing and Urban Development (HUD) Housing Choice
Voucher Program, Section 8(housing) vouchers. For example, the
Gates Foundation funded a $40 million homeless families
initiative, that resulted in dramatic results in reducing
homelessness, by supplying capital to projects, five to ten
years of social support funding, and Section 8(housing)
vouchers. Alaska's Council on the Homeless recommended the
creation of a housing trust in Alaska and has the support of the
governor. He suggested that excess revenue from the Alaska
Housing Finance Corporation (AHFC) should be used to build a
housing trust and address the problem of homelessness in the
state.
4:43:04 PM
MR. WALTERS noted that rural areas do not report a lot of
homelessness; however, individuals are returning to
dysfunctional homes and still need a safer and a better place to
live.
4:43:53 PM
COMMISSIONER JACKSON confirmed that safe, stable, and affordable
housing is important in rural and urban areas. There must be
efforts across all departments to address the core and
underlying issues of this problem.
4:44:53 PM
MS. SOLARNO agreed that serving the entire family, and doing so
early, are priorities as important as serving severely acute
people.
4:45:24 PM
CHAIR WILSON announced that the discussion will now focus on
recruiting and workforce development, competitive wages, grant
funding, loan repayment, and housing stipend programs.
4:45:48 PM
MR. HEFLEY informed the committee that one in fourteen Alaskans
works in the health care industry; of this pool, the third
largest group is behavioral health workers. Of all occupational
health areas, 29 percent of the vacancies are of behavioral
health positions; this is a total of 1,033 vacant positions.
The number one reason that positions are unfilled is that there
were no qualified applicants. Moreover, there are the
additional problems of inadequate pay and high turnover.
4:47:35 PM
CHAIR WILSON observed that Alaska no longer offers the
enticement of higher pay when compared to the Lower 48.
4:48:28 PM
MR. WALTERS stated that he has resigned his position; there have
been no qualified applicants to replace him in the last eight
months. He opined that working conditions are important to
retaining employees and the emotional load of putting up with
the present system is too difficult. The working place needs to
be less bureaucratic in order to keep workers on the job.
CHAIR WILSON re-stated that employee working conditions are a
factor.
MR. WALTERS said that constant change keeps morale low.
4:51:35 PM
REPRESENTATIVE CISSNA opined that peer counselors are probably
most effective, yet they do not receive the status that they
deserve.
4:52:23 PM
MR. WALTERS agreed. He added that counselors are judged by
their titles instead of by their competence.
4:53:19 PM
MS. SALERNO pointed out that there is a problem of reciprocity
for professional licensing from state to state. She suggested
that the committee study how Alaska's professional licensing
statutes compare with other states.
4:54:28 PM
MR. HEFLEY recalled that psychiatrists and physicians recognize
the work that counselors do. He pointed out that the last
increase in state grants was in 1990; furthermore, the lower
percentage of Medicare eligible patients requiring behavioral
health services limits what SEARHC can pay staff. Residential
programs must turn away business when shifts cannot be staffed
at a safe level. Potential rate increases may help but the real
help will come with a fair balance of eligibility.
4:58:22 PM
MS. STONE reemphasized the impact of vacancies, particularly in
small agencies in rural areas, where the loss of one position
may shut down a program. Furthermore, Medicaid has changed the
nature of our provider agencies such that clinical agencies are
forced to be business-oriented, thus have added administrative
employees, human resources personnel, quality assurance
personnel, and additional levels of practitioners at the
detriment of services.
5:00:55 PM
MR. JESSEE stated that workforce is one of the five focus areas
of AMHTA. Nevertheless, he encouraged the committee to first
study the rate review issue. As a matter of public policy, the
legislature provides for regular rate reviews for hospitals and
nursing homes. A conscience decision, he said, must be made
whether to continue the state policy of not providing similar
rate reviews for community programs simply because they have not
been provided before.
5:02:47 PM
CHAIR WILSON stated that the roundtable will be continued at a
later date.
5:03:26 PM
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 5:03:29 PM.
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