Legislature(2015 - 2016)CAPITOL 106

02/19/2015 03:00 PM HEALTH & SOCIAL SERVICES

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Audio Topic
03:02:18 PM Start
03:02:45 PM Presentation: Division of Behavioral Health
03:45:02 PM Presentation: Recidivism Reduction Plan
04:38:38 PM Presentation: Key Coalition
05:00:14 PM Presentation: Uaf Bachelor of Social Work Students
05:05:39 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Presentations: TELECONFERENCED
- The Key Coalition
- Director Al Wall, Division of Behavioral Health
- Bachelor of Social Work Students
-- Testimony <Invitation Only> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                       February 19, 2015                                                                                        
                           3:02 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Paul Seaton, Chair                                                                                               
Representative Liz Vazquez, Vice Chair                                                                                          
Representative Neal Foster                                                                                                      
Representative Louise Stutes                                                                                                    
Representative David Talerico                                                                                                   
Representative Geran Tarr                                                                                                       
Representative Adam Wool                                                                                                        
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
PRESENTATION: DIVISION OF BEHAVIORAL HEALTH                                                                                     
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PRESENTATION: RECIDIVISM REDUCTION PLAN                                                                                         
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PRESENTATION: KEY COALITION                                                                                                     
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PRESENTATION: UAF BACHELOR OF SOCIAL WORK STUDENTS                                                                              
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
No previous action to record                                                                                                    
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
ALBERT WALL, Director                                                                                                           
Central Office                                                                                                                  
Division of Behavioral Health                                                                                                   
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Presented  a  PowerPoint titled  "Division                                                             
Overview."                                                                                                                      
                                                                                                                                
JEFF JESSEE, Chief Executive Officer                                                                                            
Alaska Mental Health Trust Authority                                                                                            
Department of Revenue                                                                                                           
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:    Presented a  PowerPoint  entitled,  "2015                                                             
Recidivism Reduction Plan."                                                                                                     
                                                                                                                                
CARMEN GUTIEREZ                                                                                                                 
Justice Improvement Solutions                                                                                                   
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:    Presented a  PowerPoint  entitled,  "2015                                                             
Recidivism Reduction Plan."                                                                                                     
                                                                                                                                
EMILY ENNIS, Executive Director                                                                                                 
Fairbanks Resource Agency                                                                                                       
Key Coalition of Alaska                                                                                                         
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:   Spoke  during the  presentation by  the Key                                                             
Coalition.                                                                                                                      
                                                                                                                                
JIM BECK                                                                                                                        
Key Coalition of Alaska                                                                                                         
Access Alaska                                                                                                                   
Palmer, Alaska                                                                                                                  
POSITION STATEMENT:   Spoke  during the  presentation by  the Key                                                             
Coalition.                                                                                                                      
                                                                                                                                
MILLIE RYAN, Executive Director                                                                                                 
REACH, Inc.                                                                                                                     
Key Coalition of Alaska                                                                                                         
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Spoke  during the  presentation by  the Key                                                             
Coalition.                                                                                                                      
                                                                                                                                
RICK FASSEL                                                                                                                     
Key Coalition of Alaska                                                                                                         
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Spoke  during the  presentation by  the Key                                                             
Coalition.                                                                                                                      
                                                                                                                                
DENNIS HAAS                                                                                                                     
Key Coalition of Alaska                                                                                                         
Soldotna, Alaska                                                                                                                
POSITION STATEMENT:   Spoke  during the  presentation by  the Key                                                             
Coalition.                                                                                                                      
                                                                                                                                
NED MAGEN                                                                                                                       
Key Coalition of Alaska                                                                                                         
Soldotna, Alaska                                                                                                                
POSITION STATEMENT:   Spoke  during the  presentation by  the Key                                                             
Coalition.                                                                                                                      
                                                                                                                                
CHARLISSA MAGEN                                                                                                                 
Key Coalition of Alaska                                                                                                         
Soldotna, Alaska                                                                                                                
POSITION STATEMENT:   Spoke  during the  presentation by  the Key                                                             
Coalition.                                                                                                                      
                                                                                                                                
MIKE BAILEY                                                                                                                     
Key Coalition of Alaska                                                                                                         
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:   Spoke  during the  presentation by  the Key                                                             
Coalition.                                                                                                                      
                                                                                                                                
GLENN SHEEHAN                                                                                                                   
Key Coalition of Alaska                                                                                                         
Barrow, Alaska                                                                                                                  
POSITION STATEMENT:   Spoke  during the  presentation by  the Key                                                             
Coalition.                                                                                                                      
                                                                                                                                
DIANE CASTO, Prevention & Early Intervention Manager                                                                            
Prevention & Early Intervention Section                                                                                         
Division of Behavioral Health                                                                                                   
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Testified during  the presentation about the                                                             
UAF Bachelor of Social Work program.                                                                                            
                                                                                                                                
HEIDI BROCIOUS, Clinical Associate Professor                                                                                    
Department of Social Work                                                                                                       
University of Alaska Fairbanks                                                                                                  
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT:  Testified during  the presentation about the                                                             
UAF Bachelor of Social Work program.                                                                                            
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:02:18 PM                                                                                                                    
                                                                                                                                
CHAIR PAUL  SEATON called  the House  Health and  Social Services                                                             
Standing   Committee    meeting   to    order   at    3:02   p.m.                                                               
Representatives Seaton,  Wool, Talerico, and Stutes  were present                                                               
at the call to order.   Representatives Tarr, Vazquez, and Foster                                                               
arrived as the meeting was in progress.                                                                                         
                                                                                                                                
^PRESENTATION: Division of Behavioral Health                                                                                  
          PRESENTATION: Division of Behavioral Health                                                                       
                                                                                                                              
3:02:45 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced that the  first order of business would be                                                               
a presentation by the Division of Behavioral Health.                                                                            
                                                                                                                                
3:05:11 PM                                                                                                                    
                                                                                                                                
ALBERT  WALL, Director,  Central Office,  Division of  Behavioral                                                               
Health,  Department of  Health  and  Social Services,  introduced                                                               
slide  2,  "Behavioral  Health Overview,"  and  stated  that  the                                                               
mission  of  the  division  was  to  "manage  an  integrated  and                                                               
comprehensive  behavioral health  system based  on sound  policy,                                                               
effective  practices  and  partnerships."   He  stated  that  the                                                               
division was  responsible for the behavioral  health continuum of                                                               
care  in   Alaska,  which   included  prevention   through  acute                                                               
treatment.  He noted that  the division had partnerships with the                                                               
agencies  which were  grantees that  provided services,  and with                                                               
tribal entities  and the business  community which  also provided                                                               
services.   He  reported  that  the division  had  348 full  time                                                               
positions and 26 part time positions,  and had a budget of $141.9                                                               
million  in Fiscal  Year (FY)  2015.   He pointed  out that  this                                                               
budget did  not include treatment through  Medicaid expenditures.                                                               
This  budget was  about 5.2  percent of  the total  Department of                                                               
Health  and Social  Services management  plan,  and the  division                                                               
served 32,854 people.                                                                                                           
                                                                                                                                
3:07:21 PM                                                                                                                    
                                                                                                                                
MR. WALL  moved on to  slide 3, "Organization Chart,"  which tied                                                               
everything to the  central purpose of the  division, and included                                                               
the  Statewide  Suicide  Prevention Council,  the  Alaska  Mental                                                               
Health Board and the Advisory Board  on Alcohol & Drug Abuse.  He                                                               
shared that, although he was  responsible for tracking the budget                                                               
for these  three bodies,  they were each  independent.   He spoke                                                               
about the Alaska  Psychiatric Institute (API), which  was "a 24/7                                                               
80  bed  facility,   that  is  for  acute   in-patient  care  for                                                               
psychiatric needs  in the  state."   He stated  that API  was the                                                               
only  in-patient   psychiatric  facility  for  acute   care  that                                                               
accepted  all ages.    He noted  that the  bulk  of the  division                                                               
personnel  were located  at API,  and  included medical  doctors,                                                               
psychiatrists, licensed  nurses, and  psychologists.   He pointed                                                               
out  that,  as  API  was  also  a  certified  teaching  hospital,                                                               
University of  Alaska Anchorage (UAA) nursing  students were able                                                               
to rotate through  API and receive training.  He  moved on to the                                                               
Prevention  and Early  Intervention  Section, which  had 35  full                                                               
time staff, and  included program and grant managers,  as well as                                                               
the  therapeutic courts  program.   He discussed  the Policy  and                                                               
Planning Section, which handled the  database system that all the                                                               
providers used to  enter information to measure  and evaluate the                                                               
effectiveness  of  the  grant  recipients.    He  jumped  to  the                                                               
Administrative    Support   Team,    declaring    them   to    be                                                               
"indispensable" and  he declared his  pride for the  amazing work                                                               
from  this  team.    He  addressed  the  Treatment  and  Recovery                                                               
Section, which was  the primary section for handling  grants.  He                                                               
relayed that  there were only 18  full time staff to  handle more                                                               
than 100  grants.  He  described the Medicaid &  Quality Section,                                                               
which   handled  the   Medicaid   claims,   approvals  and   pre-                                                               
authorizations.                                                                                                                 
                                                                                                                                
3:12:33 PM                                                                                                                    
                                                                                                                                
MR. WALL  turned to slide  4, "Division Core  Service Alignment,"                                                               
and  shared that  the  division had  identified  those five  core                                                               
services which were different than  those of the divisions in the                                                               
department and  how those fed  into the  department's priorities.                                                               
He shared  that some were  specific, citing the core  service for                                                               
API,   "to  provide   accessible,   quality,  active   in-patient                                                               
treatment in  a safe  and comfortable  setting;"   whereas others                                                               
were very broad, "identifying population  and geography needs and                                                               
developing a statewide plan."                                                                                                   
                                                                                                                                
3:13:41 PM                                                                                                                    
                                                                                                                                
MR.  WALL directed  attention to  slide 5,  "Continuum of  Care,"                                                               
which ranged from left to right  on the chart based on the acuity                                                               
or intensity of  need.  He stated  that on the far  left were the                                                               
prevention  services,  generally  lower cost  with  a  tremendous                                                               
statewide  impact.   He referenced  an  earlier presentation  for                                                               
surveys  on risk  behaviors among  youth  associated with  future                                                               
problems, and  noted that all  the risk numbers had  fallen since                                                               
2007.    He suggested  that  this  decrease correlated  with  the                                                               
prevention  efforts  by  the  division.   He  reported  that  the                                                               
numbers associated  with prevention were number  of contacts with                                                               
prevention  messages,  and  not   for  individuals  served.    He                                                               
explained  that the  domestic violence  prevention services  were                                                               
community  based in  grant based  services.   He spoke  about the                                                               
alcohol  safety action  program,  which was  associated with  the                                                               
therapeutic courts.  He described  the actions of the division to                                                               
"either provide for or we  perform behavioral health on behalf of                                                               
Alaskans."   He  stated that  some services  simply provided  the                                                               
means  through a  grant to  a provider,  and other  services were                                                               
provided by  the division.  Referencing  the organizational chart                                                               
on  slide   3,  he   pointed  out   that  prevention   and  early                                                               
intervention had 35  staff, with the bulk of them  in the alcohol                                                               
safety  action program,  in direct  association with  the courts.                                                               
He stated that this program  held people accountable in treatment                                                               
while going through the program.   He pointed to the far right of                                                               
the continuum,  and shared  that API was  also a  direct service.                                                               
He declared  that the division  provided the funding for  most of                                                               
its programs to  other agencies to be performed on  behalf of the                                                               
division.  He moved on  to the community behavioral health center                                                               
clinics, psychologists,  and the  Behavioral Rehab  Services with                                                               
residential  care for  children and  youth.   He said  that these                                                               
were primarily paid  for by a combination of  Medicaid claims and                                                               
grants, although  some had  private and third  party payees.   He                                                               
stated that the bulk of work by  the division was in this area of                                                               
the community behavioral health center, with counseling and day-                                                                
to-day interaction  with clients.   He  said that  these services                                                               
ranged   from  immediate   crisis  intervention   to  long   term                                                               
treatment.   He said  that some of  these services  were provided                                                               
specifically  to  children in  a  clinic.    He spoke  about  the                                                               
behavioral  rehab services,  residential  care  for children  in-                                                               
need, which offered ongoing care  in facilities with a wide range                                                               
to  the level  of  care  needed by  each  individual  child.   He                                                               
reported  that  needs being  met  in  the community,  around  the                                                               
family,  had a  lower cost  and were  statistically proven  to be                                                               
more effective.   He moved to  the right on the  continuum to the                                                               
inpatient  and hospital  based care,  and spoke  about designated                                                               
evaluation, treatment,  and stabilization.   He stated  that this                                                               
was a  grant service,  where a person  with a  psychiatric crisis                                                               
with  an immediate  need  was taken  to  a designated  evaluation                                                               
treatment center,  for determination whether they  needed to stay                                                               
in  the hospital  or could  be treated  at a  different level  of                                                               
care.  He noted  that this was a high cost area.   He moved on to                                                               
the acute  psychiatric care  at API, and  stated that  lengths of                                                               
stay and  levels of acuity varied  greatly.  He pointed  out that                                                               
10 of the  80 beds were specifically designated  for children, 10                                                               
beds were designated  for criminal patients, and  another 10 beds                                                               
were designated  for elderly  or dementia  patients.   He pointed                                                               
out that the state only  had one acute care psychiatric facility,                                                               
API, which accepted  all ages, and he described it  as the anchor                                                               
to  the system.    He referenced  North  Star Behavioral  Health,                                                               
which cared for  children with acute needs, and  noted that there                                                               
were also occasional instances where the  needs had to be met out                                                               
of state.  At  the far right of the continuum  were the long term                                                               
residential  psychiatric  treatment  centers  for  children  with                                                               
tremendous needs, usually very complex.                                                                                         
                                                                                                                                
3:23:06 PM                                                                                                                    
                                                                                                                                
MR.  WALL  addressed  slide  6,  "DBH  Service  Population,"  and                                                               
directed focus to the age  groups primarily served, mainly adults                                                               
aged 18 - 64.                                                                                                                   
                                                                                                                                
MR. WALL  presented slide 7,  "Collaboration," declaring  that it                                                               
was a huge  collaborative effort in behavioral  health for groups                                                               
to triangulate  on individuals and  bring the  necessary services                                                               
to effect  change.  He  declared that  he was impressed  with the                                                               
relationships built with  the care providers.  He  listed many of                                                               
the organizations,  including the  boards and  associations which                                                               
assisted  their partner  agencies.   He offered  his belief  that                                                               
collaboration   was  growing.     He   referenced  the   upcoming                                                               
presentation  on  recidivism  as a  collaborative  effort  across                                                               
departments, agencies, and non-state agencies.                                                                                  
                                                                                                                                
MR. WALL referenced slide 8,  "Recent Successes," which reflected                                                               
collaborative efforts that triaged  immediate need for people who                                                               
could be  stabilized today.   He mentioned Parenting with  Love &                                                               
Limits  (PLL)  and  Opioid  Treatment  (OTP).    He  stated  that                                                               
behavioral  health paid  attention  to outcome  measures and  the                                                               
data driven  specifics of what  treatment did for the  person and                                                               
for society, as well  as for the cost, as it  was important to be                                                               
good  stewards  of the  money.    He  called this  outcome  based                                                               
treatment.  He  explained the Change Agent  Conference, which was                                                               
the  opportunity for  all  the providers  to  discuss things  the                                                               
grantees needed  to know.   He shared  an in-depth  discussion at                                                               
the latest conference for outcome  measures at the grantee level.                                                               
He shared the  importance for all the agencies  to understand the                                                               
value and  the impact of outcome  based service.  He  moved on to                                                               
slide 9,  "Recent Successes, and  spoke about the  Alaska Tobacco                                                               
Retailer Violation Rate (RVR) reported  over time.  He noted that                                                               
since 2004 the violations had stayed below the threshold target.                                                                
                                                                                                                                
3:29:28 PM                                                                                                                    
                                                                                                                                
MR.  WALL  referenced slide  10,  "DBH  Current Challenges,"  and                                                               
addressed Designated Evaluation and  Treatment, which was growing                                                               
rapidly and  was paid out  of the general  fund.  He  shared that                                                               
there  were three  designated centers,  including  API, with  the                                                               
other  two in  Fairbanks and  Juneau.   He stated  that Anchorage                                                               
also  had  a  designated  point of  entry  at  Providence  Alaska                                                               
Medical Center  with services somewhat similar  to the designated                                                               
evaluation and  treatment centers.   He reported that  all travel                                                               
and treatment was  paid out of the general fund.   He pointed out                                                               
that API ran at 95 -  100 percent utilization, and that this wear                                                               
and tear  on the staff  needed to be  addressed.  He  spoke about                                                               
individuals with  dual diagnosis,  and that often  these occurred                                                               
at  both ends  of the  age line.   He  stated that  these complex                                                               
problems created gaps in the  state service system that needed to                                                               
be addressed.                                                                                                                   
                                                                                                                                
3:32:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  asked about  the average patient  stay at                                                               
API.                                                                                                                            
                                                                                                                                
MR.  WALL offered  to provide  an overall  breakdown on  paper as                                                               
there were average stays for each of the different units.                                                                       
                                                                                                                                
REPRESENTATIVE  WOOL  asked  for  clarification  that  the  total                                                               
Division  of  Behavioral Health  budget  of  $142 million  was  5                                                               
percent of the department budget.                                                                                               
                                                                                                                                
MR.  WALL explained  that this  was  5 percent  of the  operating                                                               
budget.                                                                                                                         
                                                                                                                                
CHAIR  SEATON  pointed out  that  the  Department of  Health  and                                                               
Social Services had the largest budget in the state.                                                                            
                                                                                                                                
MR.  WALL shared  that the  difference was  whether the  Medicaid                                                               
budget was  included, and that  the 5.2 percent  provided service                                                               
for about 33,000 people.                                                                                                        
                                                                                                                                
3:34:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  asked  if   the  $142  million  included                                                               
Medicaid payments received by Division of Behavioral Health.                                                                    
                                                                                                                                
MR. WALL  directed attention to  slide 5, which charted  the cost                                                               
of  Medicaid versus  the operating  budget.   He shared  that the                                                               
overall direct service cost in  grants was $124.5 million and the                                                               
overall direct  service in Medicaid payments  was $166.6 million.                                                               
He  stated that  Medicaid was  not included  in the  $141 million                                                               
cost  referenced  by  Representative   Vazquez.    He  said  that                                                               
Medicaid  had a  particular structure  in the  accounting system,                                                               
and  was  not  included  in the  Division  of  Behavioral  Health                                                               
budget, although the division did  track it and had oversight for                                                               
its regulatory authority.                                                                                                       
                                                                                                                                
3:35:39 PM                                                                                                                    
                                                                                                                                
MR. WALL,  in response to  Representative Wool, relayed  that the                                                               
24/7  sobriety   program  was  a   monitoring  program   and  not                                                               
treatment,  although  it  was related  to  the  cross  department                                                               
efforts to reduce recidivism.   He stated that accountability was                                                               
key to treatment for substance abuse.                                                                                           
                                                                                                                                
REPRESENTATIVE  WOOL asked  if his  division was  responsible for                                                               
tracking tobacco enforcement.                                                                                                   
                                                                                                                                
MR. WALL  clarified that this  tracking was for the  illegal sale                                                               
of tobacco to minors.                                                                                                           
                                                                                                                                
REPRESENTATIVE WOOL asked  about tobacco use in  the continuum of                                                               
care.                                                                                                                           
                                                                                                                                
CHAIR SEATON asked to defer question this to later.                                                                             
                                                                                                                                
3:38:00 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON  asked if  it was  possible to  expand tele-medicine                                                               
behavioral health care.                                                                                                         
                                                                                                                                
MR. WALL said  that this was an  area of success and  that it was                                                               
used  substantially.   He noted  that API  had a  tele-behavioral                                                               
health  hub,  which  provided consultation  among  many  partners                                                               
statewide.   He  noted that  the evaluation  for commitment  into                                                               
care had  to be  made in-person, although  any follow-up  and on-                                                               
going care could be done through tele-medicine.                                                                                 
                                                                                                                                
3:39:39 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON  relayed that prevention  and intervention  before a                                                               
crisis situation were goals and keys for the committee.                                                                         
                                                                                                                                
3:40:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE STUTES asked what  type of patient assessments the                                                               
division  made, and  whether these  assessments were  shared with                                                               
other agencies in the department.                                                                                               
                                                                                                                                
MR.  WALL replied  that there  were numerous  different types  of                                                               
assessments  in the  field of  psychology, including  assessments                                                               
for substance  abuse or diagnosis  for psychological crisis.   He                                                               
explained  that assessment,  in  this presentation,  was in  "the                                                               
broadest  sense  possible."    He  pointed  out  that  designated                                                               
evaluation  in  terms of  a  program  was  very specific  for  an                                                               
individual in  crisis, who was  often not functioning  in society                                                               
and was a danger to themselves  or others.  He explained that the                                                               
sharing  of  information  was   covered  under  Health  Insurance                                                               
Portability and Accountability Act (HIPAA) rules.                                                                               
                                                                                                                                
3:43:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR referenced the  challenges to dual diagnosis,                                                               
and asked if  the division was tracking the rates  for issues and                                                               
the  corresponding behavioral  interventions, to  get a  sense of                                                               
the trends in Alaska.                                                                                                           
                                                                                                                                
MR. WALL said that autism  spectrum disorders were very specific,                                                               
and  could fall  between divisions,  as it  was a  disability, as                                                               
well.     He  explained  that   the  complex   behavioral  health                                                               
collaborative  was funded  by the  legislature,  and its  primary                                                               
function was  to track these issues  and outcomes, as well  as to                                                               
assist in  the placement  of individuals at  the proper  level of                                                               
care.  He  shared that placement was more difficult  for the most                                                               
acute levels of need, as there was not enough of this care.                                                                     
                                                                                                                                
^PRESENTATION: Recidivism Reduction Plan                                                                                      
            PRESENTATION: Recidivism Reduction Plan                                                                         
                                                                                                                                
3:45:15 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced  that the next order of  business would be                                                               
a report on recidivism reduction.                                                                                               
                                                                                                                                
3:46:31 PM                                                                                                                    
                                                                                                                                
JEFF JESSEE, Chief Executive Officer,  Alaska Mental Health Trust                                                               
Authority, Department  of Revenue, explained that  there had been                                                               
legislative intent language placed in  the state budget last year                                                               
to  begin a  review  of  the increase  to  prison populations  in                                                               
Alaska, and the  sustainability of this current path  or the need                                                               
for  other alternatives.   He  declared  that this  was an  issue                                                               
where  both sides  of the  political spectrum  had come  together                                                               
with  a  desire  for  the  same outcome,  even  though  they  had                                                               
different perspectives and priorities.   He shared the desire for                                                               
people  to come  out  of  corrections and  be  successful in  the                                                               
community without  a life  of crime.   He  referenced slide  2, a                                                               
quote from Grover Norquist, "We  want to reduce crimes as rapidly                                                               
and  as  seriously  as  possible."   He  pointed  out  that  this                                                               
reduction,  conducted  in the  wrong  way,  would harm  families,                                                               
communities, and neighborhoods and would  spend money that was no                                                               
longer available.                                                                                                               
                                                                                                                                
3:48:04 PM                                                                                                                    
                                                                                                                                
MR.  JESSEE moved  on  to  slide 3,  "HB  266 Legislative  Intent                                                               
Language,"  and stated  that the  intent  was to  collaboratively                                                               
reduce recidivism  by gathering  data on substance  abuse, mental                                                               
health,  employment,   housing,  and  other   services  currently                                                               
provided,  propose some  effectiveness  and efficiency  measures,                                                               
and  then develop  a plan  "to work  our way  out of  this."   He                                                               
offered  his  belief that  the  "big  jump  to light  speed"  was                                                               
recognition  by  the state  legislature  that  the agencies  most                                                               
recognized  and  expected,  the Department  of  Corrections,  the                                                               
Alaska Court System, Department of  Law, and Department of Public                                                               
Safety  were not  going to  get the  job done.   He  acknowledged                                                               
that,  although the  Department of  Corrections had  an important                                                               
role,  after  release  there  were  three  things  necessary  for                                                               
successful  reentry:    housing,   employment,  and  support  for                                                               
recovery.   He  stated that  it was  necessary to  include Alaska                                                               
Housing  Finance Corporation,  Department  of  Labor &  Workforce                                                               
Development,  and  Department  of  Health  and  Social  Services,                                                               
specifically the  Division of Behavioral  Health.  He  noted that                                                               
these agencies  had already been  working with the  Alaska Mental                                                               
Health Trust  Authority with some  good results.  He  stated that                                                               
it was not  yet possible to match the prison  population with the                                                               
need for beds.                                                                                                                  
                                                                                                                                
CARMEN   GUTIEREZ,   Justice  Improvement   Solutions,   directed                                                               
attention  to slide  4, and  questioned why  it was  necessary to                                                               
care  about recidivism  and prison  inmates.   She said  that the                                                               
simple matter  was that "every  offender who comes out  of prison                                                               
and is successful  means one less victim in our  communities.  It                                                               
additionally  means  we have  parents  who  are supporting  their                                                               
children,  it means  we  have  citizens who  are  working in  our                                                               
communities and we have in  total much more healthy communities."                                                               
She  opined that  it was  necessary to  care about  improving the                                                               
state's high  recidivism rate.   She  reported that  the fiscally                                                               
conservative world  also supported  a movement  for ways  to deal                                                               
with criminal  justice.  She  declared that the  criminal justice                                                               
system in Alaska  was not sustainable.  She pointed  out that the                                                               
State of  Alaska had spent $250  million to build a  prison, with                                                               
an additional  $50 million to  house 1500 inmates  added annually                                                               
to the  Department of Corrections  (DOC) budget.   She emphasized                                                               
that there  "is nothing fluffy  about any  of the prisons  in the                                                               
State of Alaska."  She  pointed out that Goose Creek Correctional                                                               
Center  was   geared  toward  providing  individuals   with  some                                                               
rehabilitative needs.   She pointed out that, even  with this new                                                               
prison,  DOC was  now operating  at  101 percent  of its  general                                                               
capacity  with a  projected  annual  growth of  3  percent.   She                                                               
reported  that  Alaska  had  the  third  fastest  growing  prison                                                               
population   in   the  United   States   which   would  lead   to                                                               
overcrowding.   This  brought Alaska  to  a crossroads  decision,                                                               
whether  to build  a new  prison,  incarcerate out  of state,  or                                                               
utilize  evidence   based  strategies   that  other   states  had                                                               
developed  that were  working to  reduce crime,  slow recidivism,                                                               
and level off  the growth rate for prison  populations, which had                                                               
exceeded the growth  rate of the state population.   She reported                                                               
that there were  decreases in both violent  and non-violent crime                                                               
in the  state.   She reiterated  that, as  many other  states had                                                               
experienced  budget   deficits  similar  to  Alaska,   there  was                                                               
recognition  for  the  lack   of  sustainability  to  corrections                                                               
budgets.                                                                                                                        
                                                                                                                                
3:56:19 PM                                                                                                                    
                                                                                                                                
MS. GUTIEREZ directed  attention to slide 5,  "Former Inmates Are                                                               
Our  Neighbors," and  stated that  Alaska currently  incarcerated                                                               
more than 6300  people, which included 1000  people on electronic                                                               
monitoring  and  in halfway  houses.    She  stated that,  as  95                                                               
percent of  the inmate population was  eventually released, there                                                               
were  currently 377  convicted felons  released into  communities                                                               
every month.  She reported  that the recidivism rate was starting                                                               
to  drop, down  to 63  percent in  2011, and  opined that  public                                                               
safety required a continued reduction to this high rate.                                                                        
                                                                                                                                
3:57:55 PM                                                                                                                    
                                                                                                                                
MS.  GUTIEREZ presented  slide 6,  "Have Alaskans  Been Receiving                                                               
Good Value  For The Criminal  Justice Dollars Spent?"   She noted                                                               
that two of three former  offenders returned to prison within the                                                               
first three  years of  release, the  majority within  six months.                                                               
She  declared  that  more  than  1600  statutes  and  regulations                                                               
provided barriers as  a result of criminal  convictions, with 746                                                               
of  these directly  related to  employment.   She shared  that it                                                               
cost $158  per day per inmate  to incarcerate, more than  it cost                                                               
to  go to  Harvard.   She reported  that, in  2009, DOC  began to                                                               
reinstate  some  of  its reformative  programs,  which  had  been                                                               
eliminated  during a  prior administration,  and she  offered her                                                               
belief that this had contributed to the drop in recidivism.                                                                     
                                                                                                                                
4:00:04 PM                                                                                                                    
                                                                                                                                
MS. GUTIEREZ  shared slide  7, "Alaska Is  At A  Crossroads," and                                                               
stated that Alaska  could either build a new  prison, recommit to                                                               
sending inmates  out of  state, or  follow the  lead of  32 other                                                               
states and  invest in cost  effective strategies to  reduce crime                                                               
and reduce  the rate of  prison growth, slide  8, "Do We  Wish To                                                               
Spend $300  Million To Build  A New  Prison?"  She  reported that                                                               
there was technical  assistance to states for  help in addressing                                                               
these  issues.   She addressed  slide 9,  "Invite the  Pew Public                                                               
Safety Performance Project  to Alaska," and said  that they could                                                               
identify and better understand the  factors driving growth in the                                                               
state prison population.   She said that the Pew  approach was to                                                               
identify fiscally sound, public  safety minded policies that held                                                               
offenders accountable and controlled  prison costs, while helping                                                               
states get  a better return  on the expenditure of  public safety                                                               
dollars.  She emphasized that  this technical assistance was free                                                               
to the  state.  She reported  that Pew would work  with DOL, DOC,                                                               
and  DPS  using data  analysis  from  similar programs  in  other                                                               
states to  identify strategies  for each  of the  factors driving                                                               
the prison  population growth  and to  build a  recommended plan,                                                               
slide  10, "Pew  Would  Guide Alaska  In  A Justice  Reinvestment                                                               
Process."                                                                                                                       
                                                                                                                                
4:03:28 PM                                                                                                                    
                                                                                                                                
MS.  GUTIEREZ said  that many  conservative states  had had  very                                                               
positive  experiences with  this Pew  project.   She moved  on to                                                               
slide 13,  "Known Factors Driving  Alaska's Prison Growth."   She                                                               
listed  these  to  include:   "Increased  number  of  pretrial  &                                                               
unsentenced inmates,"  slide 14,  showing that almost  40 percent                                                               
of  the  prison  population  were people  arrested  but  not  yet                                                               
convicted and noting  that there were 18 bail  factors for judges                                                               
to  consider;    "Increased percent  of  non-violent  offenders,"                                                               
slide  15,  which   depicted  that  64  percent   of  the  prison                                                               
population  were  nonviolent  offenders  and  questioned  whether                                                               
there were alternatives to the  incarceration expense of $158 per                                                               
day per  inmate for nonviolent  offenders;  and,  "Public opinion                                                               
on jailing nonviolent offenders  in expensive prison beds," slide                                                               
16, which  shared that  two national public  firms hired  to talk                                                               
with  Americans  about  the  over  incarceration  of  non-violent                                                               
offenders  found  that  the  majority of  the  public  felt  that                                                               
reformation trumped  incarceration for  this group,  that prisons                                                               
should be  used for violent  offenders, and that too  many people                                                               
were being incarcerated today, slides 17, 18, and 19.                                                                           
                                                                                                                                
4:06:59 PM                                                                                                                    
                                                                                                                                
MS.  GUTIEREZ reported  that  10 percent  of  the population  was                                                               
serving  37 months  or more  in 2002,  whereas almost  25 percent                                                               
were  serving  that  same  amount  of time  in  2014,  slide  20,                                                               
"Increased  Average  Length Of  Stay."    She said  that  another                                                               
factor for the increase to  prison population was that the number                                                               
of   petitions  to   revoke  probation,   mainly  for   technical                                                               
violations, had almost  doubled between 2003 and  2013, slide 21,                                                               
"Increased  Probation Violations."    She reported  that only  28                                                               
percent  of   these  petitions  were   because  of   the  alleged                                                               
commission of a new crime.                                                                                                      
                                                                                                                                
4:08:27 PM                                                                                                                    
                                                                                                                                
MS. GUTIEREZ spoke  about slide 22, "What we  know about Alaskans                                                               
who   recidivate,"  and   reported  that   people  convicted   of                                                               
misdemeanors and  Class B felony  offenses, the least  serious of                                                               
the  felony  offenses,  as  well  as  youthful,  male  offenders,                                                               
recidivated  at  a  higher  rate.     She  described  "The  Texas                                                               
Experience," slide 23,  and its decision to find a  better use of                                                               
public dollars than for building  another prison.  She noted that                                                               
Texas, in  2007, was the  first state  to move in  this direction                                                               
because projections  for a  shortfall of  17,000 prison  beds had                                                               
been   accompanied  by   an   estimated   construction  cost   of                                                               
$900,000,000 for  only 4,000  beds.  The  submitted plan  was for                                                               
identification of  the necessary reformative programs  to address                                                               
the  factors leading  to  criminal behavior,  and  then invest  a                                                               
portion of this  projected bed cost in  evidence based strategies                                                               
which had proven to reduce recidivism.                                                                                          
                                                                                                                                
4:10:27 PM                                                                                                                    
                                                                                                                                
MS.  GUTIEREZ reported  that investments  had been  made in  drug                                                               
courts,  intermediate sanction  facilities  for probationers  who                                                               
violate   probation,    residential   treatment    programs   for                                                               
probationers having  difficulty staying clean and  sober, and in-                                                               
prison residential treatment programs,  slide 24, "Evidence based                                                               
investment  strategy."    She stated  that  Texas  increased  the                                                               
community-based  substance  abuse treatment,  passed  legislation                                                               
which provided incentives to  encourage probation compliance, and                                                               
implemented  swift,  certain,  and  proportionate  sanctions  for                                                               
certain   probation  violations,   slide   25,  "Evidence   based                                                               
strategies  for probationers."   She  reported that  these swift,                                                               
certain   sanctions   already    existed   in   the   Probationer                                                               
Accountability  with   Certain  Enforcement  (PACE)   program  in                                                               
Alaska.  If someone violated  a condition of probation, they were                                                               
immediately  arrested,  brought to  court  within  72 hours,  and                                                               
given a  sanction that day in  court.  She declared  that, as the                                                               
sanctions were  proportionate, the  PACE program had  proven very                                                               
effective in Alaska.                                                                                                            
                                                                                                                                
4:12:06 PM                                                                                                                    
                                                                                                                                
MS.  GUTIEREZ reported  that  in Texas,  as  of 2014,  recidivism                                                               
rates had  dropped by 25 percent,  the crime rate had  dropped 18                                                               
percent to its lowest point  since 1968, imprisonment had dropped                                                               
by 10  percent, and  prisons had  been closed  with a  savings of                                                               
nearly $3  billion in  prison costs,  slide 26,  "Texas Results."                                                               
She shared slide 27, "South  Dakota," which depicted a state with                                                               
a smaller  prison population,  primarily composed  of non-violent                                                               
offenders  with  a  high  rate of  probation  revocations.    She                                                               
declared  that this  pattern and  practice were  not sustainable,                                                               
and  that South  Dakota  had  decided to  invest  $53 million  in                                                               
alternative   strategies  to   reduce   recidivism,  instead   of                                                               
investing $207 million on two new  prisons.  She quoted a comment                                                               
by South Dakota Senator Craig Tieszen, slide 30:                                                                                
                                                                                                                                
     We have been putting a lot  of people in prison ... but                                                                    
     we  have   now  recognized  that  we   haven't  changed                                                                    
     behaviors of those prisoners.   Most of them get out of                                                                    
     prison  eventually  and  a very  high  proportion  goes                                                                    
     back,  because  the  main change  that  took  place  in                                                                    
     prison is that they became better criminals.                                                                               
                                                                                                                                
4:14:26 PM                                                                                                                    
                                                                                                                                
MS.  GUTIEREZ  directed  attention   to  slide  32,  "Reformative                                                               
Programs  in  Alaska,"  stating that  the  Alaska  Department  of                                                               
Corrections  had  no  reformative  programs  in  2007,  with  the                                                               
exception  of one  federally funded  alcohol and  substance abuse                                                               
treatment  program.   She reported  that the  legislature offered                                                               
its  support  in 2009  with  the  re-implementation of  substance                                                               
abuse   treatment,  education   and   vocational  programs,   and                                                               
cognitive behavioral treatment.  She  noted that only 2.9 percent                                                               
of  the  DOC budget  goes  to  reformative programing,  with  the                                                               
largest share  of its  budget spent on  personnel services.   She                                                               
presented   slide  33,   "Outcome  from   Investment:  Recidivism                                                               
Reduction,"  which  reflected  the  drop of  recidivism  from  66                                                               
percent in 2007 to 63 percent in  FY 201.  She declared that this                                                               
was finally  a move in the  right direction.  She  referenced the                                                               
recent Legislative Audit  Division audit of the  DOC in December,                                                               
2014,  which found  that DOC  was running  fine quality  programs                                                               
that  were serving  the  inmates, slide  34,  "ADOC Runs  Quality                                                               
Programs."                                                                                                                      
                                                                                                                                
4:16:19 PM                                                                                                                    
                                                                                                                                
MS. GUTIEREZ pointed to slide  35, "Washington State Institute of                                                               
Public  Policy Finds,"  and  shared that  the  institute was  the                                                               
premier  nationwide cost  benefit  analysis entity  and had  done                                                               
extensive research on substance  abuse treatment programs and the                                                               
benefit  of educational  and vocational  programs in  a custodial                                                               
setting.   Their findings  of the cost  benefit analysis  was 100                                                               
percent  that the  benefits would  exceed the  cost.   She stated                                                               
that  the  DOC  was  working  hard  to  ensure  that  any  inmate                                                               
sentenced  to  30  days  or  more  would  be  released  from  the                                                               
institution  with a  re-entry plan,  the Alaska  Prisoner Reentry                                                               
Framework, designed to  help the inmate address  their needs that                                                               
lead  to  criminal  behavior,  slide  36  "Alaska  Department  of                                                               
Corrections."   She stated that  Department of Health  and Social                                                               
Services had been  a "huge collaborator in this  effort to reduce                                                               
recidivism," slide  37, "Division  of Health &  Social Services,"                                                               
and  she mentioned  the  Sobriety 24/7  program  as a  nationally                                                               
recognized  strategy  for  holding offenders  accountable.    She                                                               
declared that this was helpful to  offenders, as it kept "them on                                                               
the straight and  narrow, and in early sobriety that  can be very                                                               
helpful."  She  noted that Alaska had  an outstanding therapeutic                                                               
courts  program,  as  well  as  good  community  based  treatment                                                               
programs.   She explained  that there was  more demand  for these                                                               
treatment programs than there were resources.                                                                                   
                                                                                                                                
4:18:25 PM                                                                                                                    
                                                                                                                                
MS.   GUTIEREZ  declared   that   the   Alaska  Housing   Finance                                                               
Corporation  (AHFC) had  been a  great partner  in the  effort to                                                               
reduce recidivism,  and information  for their work  was included                                                               
in the Recidivism Reduction Plan  [Included in members' packets],                                                               
slide 38, "Alaska  Housing Finance Corp."  She  relayed that AHFC                                                               
had created housing assistance vouchers  which were less than the                                                               
cost of prison housing.  She  stated that the recidivism rate for                                                               
those receiving  this financial support  was 33  percent compared                                                               
to  the overall  63  percent  for the  general  population.   She                                                               
directed attention  to slide 39,  "Labor &  Workforce Development                                                               
Collaborations,"   and   mentioned   that  there   had   been   a                                                               
collaborative  effort  between  DOC  and Department  of  Labor  &                                                               
Workforce Development (DOLWD), and  that DOLWD had instituted the                                                               
WorkKeys  certificate  reflecting  levels  of  capacity  for  the                                                               
basics  of many  jobs, which  many employers  now required.   She                                                               
pointed  out an  interesting collaboration  with fish  processing                                                               
plants  to  hire inmates.    She  reported  that the  Alaska  Job                                                               
Centers now  had individuals specially  trained to work  with the                                                               
prison population.                                                                                                              
                                                                                                                                
4:21:11 PM                                                                                                                    
                                                                                                                                
MR. JESSEE introduced  slide 41, "What we are  doing that works,"                                                               
and referenced  the DOC efforts to  develop reformative programs,                                                               
as well  as work  by the Criminal  Justice Commission  for issues                                                               
around  sentencing  and  barrier  crimes.   He  stated  that  the                                                               
reentry centers  were "incredibly  successful," that  they pulled                                                               
together  the  housing,  employment,  and  support  for  recovery                                                               
services  and then  customized these  for each  individual inmate                                                               
upon release from incarceration.   He pointed out that the agency                                                               
had  been funded  from  capital appropriations  for  the past  18                                                               
months.    He  reported  that Department  of  Health  and  Social                                                               
Services and the Division of  Behavioral Services were working to                                                               
adjust  budgets in  order to  maintain operation  of the  reentry                                                               
center.   He emphasized  that DOC had  already been  working with                                                               
AHFC  and DOLWD  on these  programs.   He moved  on to  slide 42,                                                               
"Next Steps  With Fiscal Component," and  emphasized that funding                                                               
for the current reformative programs  had to be maintained or the                                                               
recidivism rate would  "start to creep back up."   He stated that                                                               
it  was  necessary  to  maintain  support  for  the  DOC  reentry                                                               
program,  and  he  suggested  that a  new  position  for  reentry                                                               
coordinator  be   created.    He  suggested   the  expansion  for                                                               
community  based  substance  abuse  treatment,  and  he  extolled                                                               
Medicaid  expansion  as  being particularly  helpful  for  single                                                               
males between  18 -  64 years  of age  coming out  of corrections                                                               
with  no  income, a  program  being  paid  for primarily  by  the                                                               
federal government.                                                                                                             
                                                                                                                                
4:24:00 PM                                                                                                                    
                                                                                                                                
MR.  JESSEE  addressed  slide  43, "Next  Steps  With  No  Fiscal                                                               
Component," and  shared that the Criminal  Justice Commission was                                                               
still working  on bail  conditions, deferred  sentencing, limited                                                               
licenses, and a  study on barrier crimes.  He  suggested that the                                                               
legislature enact legislation  to provide good time  credits as a                                                               
reward for  good behavior and to  motivate probationers complying                                                               
with their conditions.   He allowed that that  the quick, certain                                                               
consequences  were  now  being addressed,  and  that  a  positive                                                               
reward would  be helpful.   He  noted that this  would also  be a                                                               
positive step for people on electronic monitoring.                                                                              
                                                                                                                                
4:24:48 PM                                                                                                                    
                                                                                                                                
MR. JESSEE pointed to slide  44, "Plan Implementation," reporting                                                               
that the  groups had reviewed  past programs and had  developed a                                                               
future plan.   He  emphasized that  the Alaska  State Legislature                                                               
now had the responsibility to set  a goal for matching the number                                                               
of  people in  prison  to  the number  of  prison beds  currently                                                               
available,  or  to  choose  alternatives.     He  offered  as  an                                                               
alternative, an implementation plan  with a timeline, strategies,                                                               
costs, savings, and  results.  The legislature  could then choose                                                               
whether to place these increments in the budget.                                                                                
                                                                                                                                
4:26:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR asked whether  the public defender agency was                                                               
part of these conversations.                                                                                                    
                                                                                                                                
MS. GUTIEREZ explained  that the public defender  was an involved                                                               
member of  the Alaska  Criminal Justice  Commission.   She stated                                                               
that,  as 40  percent  of the  prison  population were  pre-trial                                                               
inmates  and  the  vast  majority   were  represented  by  public                                                               
defenders, any cuts  to the budget of the  public defender agency                                                               
would have  a ripple  effect across  the entire  criminal justice                                                               
system which would include longer time in prison.                                                                               
                                                                                                                                
4:28:30 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON  asked if  bail conditions had  to come  through the                                                               
public  defender's  office.    He  noted  that  bail  set  on  an                                                               
individual's Own  Recognizance (OR) was working  effectively, and                                                               
asked if the legislature should  become involved with speeding up                                                               
the process,  as many  people were waiting  in jail  because they                                                               
were not financially able to post bail.                                                                                         
                                                                                                                                
MS. GUTIEREZ explained that, as  this issue was a dramatic change                                                               
from 2002, the  Alaska Criminal Justice System  was reviewing it.                                                               
She explained  that, although the  bail statute  says presumption                                                               
for  release, there  were now  18  conditions added  to the  bail                                                               
statute,   which  made   it  more   difficult  to   get  out   of                                                               
incarceration pending  trial.  She  offered her belief  that some                                                               
lawmakers  were   also  reviewing   the  bill  statute   for  the                                                               
conditions of bail, and that "primarily the fix is legislative."                                                                
                                                                                                                                
CHAIR SEATON asked if there  was any model legislation enacted by                                                               
other states that had been effective for reduction.                                                                             
                                                                                                                                
MS.   GUTIEREZ  offered   her  belief   that   there  was   model                                                               
legislation, and she would report back to the committee.                                                                        
                                                                                                                                
4:32:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL  asked whether  mandatory sentencing  was one                                                               
of the aforementioned barriers.                                                                                                 
                                                                                                                                
MS.  GUTIEREZ  explained  that, although  crime  was  decreasing,                                                               
there were  now longer  sentences.   She expressed  her agreement                                                               
with mandatory  sentencing for egregious  crimes in Alaska.   She                                                               
questioned the presumptive sentencing  and offered an example for                                                               
a woman  convicted of  first time cocaine  possession with  a six                                                               
month  sentence.    The  next  time, same  crime,  as  there  was                                                               
presumptive  sentencing, the  minimum mandatory  sentence was  at                                                               
least two  years.  She  questioned whether this was  an effective                                                               
use  of  a  $158  per  day bed.    She  opined  that  presumptive                                                               
sentencing was one  of the reasons for an increase  to the length                                                               
of stay.                                                                                                                        
                                                                                                                                
4:34:03 PM                                                                                                                    
                                                                                                                                
MR.  JESSEE  suggested  that  a comparison  of  days  to  dollars                                                               
offered a  different perspective, pointing  out that a  five year                                                               
minimum sentence cost almost $300,000.   He asked if "we're gonna                                                               
spend $300,000  on this person, are  we so mad at  him that we're                                                               
willin' to spend $300,000  to be mad at him for  five years."  He                                                               
asked what would be different when this person was released.                                                                    
                                                                                                                                
4:35:10 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON  suggested that  Vitamin  D  should be  offered  in                                                               
prisons, as  there was not  any sunshine exposure or  any dietary                                                               
supplement.    He asked  if  there  were any  underlying  medical                                                               
conditions that  the state  could help  alleviate so  "people can                                                               
better control themselves."  He  pointed to the myriad of studies                                                               
which  showed  that  low  levels  of Vitamin  D  were  causal  to                                                               
depression  and   anxiety.    He  stated   that  addressing  this                                                               
underlying  medical deficiency  would move  forward to  lower the                                                               
recidivism rate.                                                                                                                
                                                                                                                                
4:36:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ asked if all  the requests from House Bill                                                               
266 had been addressed.                                                                                                         
                                                                                                                                
MR.  JESSEE  said  absolutely,   that  performance  measures  and                                                               
strategies had been identified.                                                                                                 
                                                                                                                                
REPRESENTATIVE VAZQUEZ asked if  the call to action legislatively                                                               
mandated these.                                                                                                                 
                                                                                                                                
MR. JESSEE  recommended that the  House Finance  Committee should                                                               
have some  ownership of the  next step, and  consider legislative                                                               
intent requesting  a detailed implementation plan  which included                                                               
dollars, timeframes, data, and outcomes.                                                                                        
                                                                                                                                
4:38:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  asked if  legislation  was  going to  be                                                               
submitted to implement this call to action.                                                                                     
                                                                                                                                
MR. JESSEE stated  that his plan was to  meet with Representative                                                               
Neuman to discuss legislative intent language.                                                                                  
                                                                                                                                
^PRESENTATION: Key Coalition                                                                                                  
                  PRESENTATION: Key Coalition                                                                               
                                                                                                                              
4:38:38 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced that the  final order of business would be                                                               
a presentation by the Key Coalition.                                                                                            
                                                                                                                                
4:39:12 PM                                                                                                                    
                                                                                                                                
EMILY ENNIS,  Executive Director, Fairbanks Resource  Agency, Key                                                               
Coalition of Alaska,  shared that this was the  28th Key Campaign                                                               
whereby the Key Coalition came to  the capital to speak about the                                                               
issues   facing    individuals,   and   their    families,   with                                                               
developmental  disabilities.   She  reported that  more than  150                                                               
members  were attending  so they  could share  the importance  of                                                               
services to themselves and their  families.  She noted that there                                                               
was a responsibility to speak  for Alaskans with disabilities who                                                               
were  not  able   to  speak  for  themselves.     She  said  that                                                               
intellectual and developmental disabilities  was a condition that                                                               
occurred  before the  age of  22, had  significant impact  on the                                                               
areas  of major  life  function, and  required lifelong  support.                                                               
She pointed  out that  this did not  mean that  individuals could                                                               
not  have a  full, productive,  quality  life.   She stated  that                                                               
robust  support  systems were  necessary  and  the Key  Coalition                                                               
would  present  its  suggestions   for  major  priorities.    She                                                               
declared that  the first suggestion  was for cost savings  in the                                                               
service  system,  and  she  added  that  all  of  these  services                                                               
provided long term cost savings.                                                                                                
                                                                                                                                
4:42:25 PM                                                                                                                    
                                                                                                                                
JIM BECK,  Key Coalition  of Alaska,  Access Alaska,  offered his                                                               
recommendation to the legislature, the  use of Medicaid funds for                                                               
the  reuse of  durable  medical equipment,  which  he stated  was                                                               
already happening  in other states.   He noted that the  State of                                                               
Alaska  currently  prohibited use  of  Medicaid  dollars for  the                                                               
purchase of  used equipment, much  of which was designed  to last                                                               
for  years.   He stated  that  the federal  government did  allow                                                               
this.   He reported that Kansas  had shown a return  of $3.15 for                                                               
every  $1  invested  in  the  durable  medical  equipment  re-use                                                               
program,  and that  recipient satisfaction  for this  program was                                                               
very high.  In the first  year of service in Oklahoma, 74 devices                                                               
were reassigned,  which represented  a costs savings  of $31,692.                                                               
In Alaska,  Access Alaska loaned  2064 pieces of  durable medical                                                               
equipment in  2014 in Anchorage,  which represented a  savings to                                                               
Medicare, Medicaid and private insurance  of $461,685.  He shared                                                               
that Access  Alaska had sanitization  programs, and, as it  was a                                                               
mature industry,  it would be  "into play in Alaska  very quickly                                                               
and, I think, recognize great savings and high satisfaction."                                                                   
                                                                                                                                
4:45:09 PM                                                                                                                    
                                                                                                                                
MILLIE RYAN,  Executive Director,  REACH, Inc., Key  Coalition of                                                               
Alaska,  referenced House  Bill 211,  the employment  first bill,                                                               
and said that she was  working with the state for implementation.                                                               
This offered  a number of  opportunities to lower  Medicaid costs                                                               
and  replace state  funded services  that people  would otherwise                                                               
need if they were not working.   She said that a number of states                                                               
had   Medicaid   buy-in   programs  for   working   people   with                                                               
disabilities,  and  she  described  the  successes  in  Utah  and                                                               
Kansas.   She  pointed  out that  up  to one  in  five no  longer                                                               
received benefits  as they were  now earning enough to  no longer                                                               
be eligible.   She shared  that the  State of Washington  had its                                                               
costs decrease  in the food  stamp program, and that  the working                                                               
disabled  Medicaid  buy-in in  Alaska  had  resulted in  a  $12.4                                                               
million contribution  to the  state economy.   She  reported that                                                               
there were 350  - 370 persons participating in  the Alaska buy-in                                                               
program  and  that policies  which  increased  this number  would                                                               
recognize  a decrease  in health  costs, food  stamps, and  adult                                                               
public  assistance.    She pointed  to  supported  employment,  a                                                               
program  funded through  the Medicaid  home  and community  based                                                               
waivers.   She referenced  a research study  on the  economics of                                                               
supported   employment  by   Robert   Somora  identifying   three                                                               
recommendations  which  could  reduce Medicaid  funded  supported                                                               
employment  costs by  32 -  60 percent  and allow  service to  an                                                               
additional 126 -  232 people without any  additional state money.                                                               
She pointed out  that these people would also  be contributing to                                                               
the  economy and  paying federal  taxes,  thereby reducing  their                                                               
dependence on other public benefits.                                                                                            
                                                                                                                                
RICK FASSEL, Key Coalition of Alaska,  said that he would like to                                                               
see other people have the opportunity for jobs.                                                                                 
                                                                                                                                
CHAIR SEATON  asked that the  suggestions and  recommendations be                                                               
presented in writing.                                                                                                           
                                                                                                                                
4:49:27 PM                                                                                                                    
                                                                                                                                
DENNIS HAAS, Key  Coalition of Alaska, stated that  the wait list                                                               
had always  been a top  priority.  He  reported that the  list of                                                               
people qualifying for services but  not receiving them because of                                                               
a lack  of funding was  more than 696 people.   He asked  for the                                                               
state to  continue its commitment  to remove 200 people  from the                                                               
list each  year.   He declared that  these programs  saved lives,                                                               
sharing  that, if  not for  the  program, his  daughter would  be                                                               
dead.  He emphasized that parents could not do it without help.                                                                 
                                                                                                                                
4:51:24 PM                                                                                                                    
                                                                                                                                
NED MAGEN, Key  Coalition of Alaska, offered a  success story for                                                               
the wait  list, and shared that  his 28 year old  son, Daryl, had                                                               
developmental  disabilities and  had been  on the  wait list  for                                                               
many years.  He noted that, as  both he and his wife worked, they                                                               
were not  able to spend  every minute  with their son.   However,                                                               
once Daryl was  taken off the wait list, he  had staff support to                                                               
go swimming and  to the gym, he  lost 50 pounds, and  he became a                                                               
Special  Olympics  champion  swimmer.    Currently,  he  had  two                                                               
different jobs with  a job coach, lived in an  apartment, and his                                                               
self-esteem and  his self-confidence  had grown.   He  lauded the                                                               
services that Daryl had received  and directed much of the credit                                                               
toward those services.                                                                                                          
                                                                                                                                
CHARLISSA  MAGEN, Key  Coalition of  Alaska, echoed  her husband,                                                               
Ned,  and  reported that  their  son  had  received 15  years  of                                                               
services, which  had made him  "an active  and vital part  of our                                                               
community in  Soldotna and Kenai."   She shared that she  and her                                                               
husband  were known  as "Daryl's  parents,  not as  individuals."                                                               
She  spoke about  her son's  work and  his volunteering,  and she                                                               
expressed her  hope that the  State of Alaska would  maintain its                                                               
commitment to annually select people still on the wait list.                                                                    
                                                                                                                                
4:53:35 PM                                                                                                                    
                                                                                                                                
MIKE BAILEY, Key Coalition of Alaska,  stated that he was the CEO                                                               
of  a provider  agency, and  he  addressed the  integrity of  the                                                               
Medicaid  system, declaring  his support  for Medicaid  expansion                                                               
and that the  savings this would realize would  allow for funding                                                               
to the  wait list  without any  increase to  budget expectations.                                                               
He  acknowledged the  failure  of the  upgrades  to the  Medicaid                                                               
payment  system and  the eligibility  system.   Although each  of                                                               
these  were  supposed  to  create   efficiencies,  this  had  not                                                               
occurred,  and  the  additional administrative  burden  detracted                                                               
from the  services provided.   He pointed out that  some payments                                                               
were  18 months  past  due, which  put  a lot  of  strain on  the                                                               
providers.   He  stated that  he was  still committed  to working                                                               
toward these efficiencies.  He  expressed his appreciation to the                                                               
minimal  cuts to  the Department  of Health  and Social  Services                                                               
budget, and he recognized the  wisdom to not cutting any Medicaid                                                               
services with  a federal  match component.   He pointed  out that                                                               
the rates for Medicaid payments were  based on four years of rate                                                               
freeze,  with some  minimal inflationary  adjustments.   He  said                                                               
that he was  working with the Office of Rate  Review to arrive at                                                               
a  sustainable rates  rebasement methodology.   He  reported that                                                               
the Key Coalition was advocating  that providers continue to work                                                               
with this,  as the goal  was sustainability.   He asked  that the                                                               
unfunded  mandates   on  providers  also  be   recognized,  which                                                               
included  minimum  wage  increases and  increased  administrative                                                               
overhead.   He stated that the  Key Coalition was asking  for the                                                               
providers to continue  to work with the Office of  Rate Review to                                                               
create a  sustainable system.   He cautioned that there  could be                                                               
some  compromise necessary.   He  asked that  new legislation  be                                                               
better assessed for its impact on Medicaid rates.                                                                               
                                                                                                                                
CHAIR SEATON  asked that the  providers speak to  the legislature                                                               
about these impacts.                                                                                                            
                                                                                                                                
4:58:24 PM                                                                                                                    
                                                                                                                                
GLENN SHEEHAN,  Key Coalition of  Alaska, spoke for  his daughter                                                               
who had  cerebral palsy and  severe anxiety, which  inhibited her                                                               
ability to  speak publicly.   He addressed a potential  change in                                                               
state regulations  that could "save  money and help people."   He                                                               
said  that,  although tele-practice  was  currently  in use,  the                                                               
state did  not encourage  it for  people on  waivers.   He stated                                                               
that  the logistics  for providing  health to  people on  waivers                                                               
could  be  improved  greatly,  as  there was  a  huge  amount  of                                                               
professional time spent in travel.   He offered some examples for                                                               
ways that tele-practice could save money.                                                                                       
                                                                                                                                
CHAIR SEATON  acknowledged that the  committee did have  this "on                                                               
our radar screen."   He asked that Mr. Sheehan  send his comments                                                               
regarding an upcoming proposed bill on this subject.                                                                            
                                                                                                                                
^PRESENTATION: UAF Bachelor of Social Work Students                                                                           
       PRESENTATION: UAF Bachelor of Social Work Students                                                                   
                                                                                                                              
5:00:14 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced that the  final order of business would be                                                               
a  presentation by  the students  in the  UAF Bachelor  of Social                                                               
Work program.                                                                                                                   
                                                                                                                                
DIANE CASTO, Prevention &  Early Intervention Manager, Prevention                                                               
&  Early Intervention  Section,  Division  of Behavioral  Health,                                                               
Department of  Health and Social Services,  thanked the committee                                                               
for  its   push  toward  prevention.     She  shared   that  this                                                               
partnership  between the  Division of  Behavioral Health  and the                                                               
University  of Alaska  had started  10 years  prior for  bringing                                                               
students out into the community  and to learn about "macro social                                                               
work,  which  is everything  you  guys  have been  talking  about                                                               
today,  the policies,  the laws,  how all  of this  works."   She                                                               
noted that  25 students were in  the audience, with half  of them                                                               
campus based in Fairbanks, while  the other half were enrolled in                                                               
distance programs.                                                                                                              
                                                                                                                                
HEIDI  BROCIOUS,  Clinical  Associate  Professor,  Department  of                                                               
Social Work,  University of Alaska  Fairbanks, reported  that the                                                               
distance  programs allowed  students  to  pursue their  education                                                               
while staying in  their home communities.  She  shared details of                                                               
the handout  on the partnership, reporting  that students entered                                                               
certificate or associate Social  Work distance programs [Included                                                               
in  members' packets].    She offered  her  belief that  students                                                               
staying in their  home communities fit the  prevention aspect, as                                                               
educated providers remaining in  their home community allowed for                                                               
less  "shipping out."   She  directed attention  to the  graduate                                                               
data from the  Department of Labor &  Workforce Development which                                                               
listed  the number  of social  worker graduates  employed in  the                                                               
field  of  social  work  [Included in  members'  packets].    She                                                               
emphasized that  these programs were creating  educated employees                                                               
working in the state.                                                                                                           
                                                                                                                                
MS. CASTO said  that they were preparing a full  report with this                                                               
data and that they would forward it to the committee.                                                                           
                                                                                                                                
5:04:58 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  shared that  there was work  currently being                                                               
done on  prevention legislation,  which included Erin's  Law, the                                                               
child sexual abuse prevention legislation.                                                                                      
                                                                                                                                
MS. CASTO said that the students would get copies of the                                                                        
recidivism report and information on Erin's Law.                                                                                
                                                                                                                                
5:05:39 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no further business before the committee, the House                                                                 
Health and Social Services Standing Committee meeting was                                                                       
adjourned at 5:05 p.m.                                                                                                          

Document Name Date/Time Subjects
Behavioral Health HHSS 02 19 2015 overview.pdf HHSS 2/19/2015 3:00:00 PM
Key Coalition 2015 Legislative Priorities.pdf HHSS 2/19/2015 3:00:00 PM
Presentation- Key Coalition
Recidivism RP Presentation.pdf HHSS 2/19/2015 3:00:00 PM
Presentation
UAF Behavioral health education numbers.pdf HHSS 2/19/2015 3:00:00 PM
Presentation