Legislature(2021 - 2022)BY TELECONFERENCE

02/25/2021 03:00 PM House HEALTH & SOCIAL SERVICES

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03:03:21 PM Start
03:04:20 PM Executive Order 119 - Dhss Reorganization
04:46:25 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Executive Order 119 - DHSS Reorganization TELECONFERENCED
-- Testimony <Invitation Only> --
**Streamed live on AKL.tv**
                    ALASKA STATE LEGISLATURE                                                                                  
       HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                        February 25, 2021                                                                                       
                            3:03 p.m.                                                                                           
MEMBERS PRESENT                                                                                                               
Representative Liz Snyder, Co-Chair (via teleconference)                                                                        
Representative Tiffany Zulkosky, Co-Chair (via teleconference)                                                                  
Representative Ivy Spohnholz (via teleconference)                                                                               
Representative Zack Fields (via teleconference)                                                                                 
Representative Christopher Kurka (via teleconference)                                                                           
Representative Mike Prax (via teleconference)                                                                                   
MEMBERS ABSENT                                                                                                                
Representative Ken McCarty                                                                                                      
COMMITTEE CALENDAR                                                                                                            
EXECUTIVE ORDER 119 - DHSS REORGANIZATION                                                                                       
     HEARD AND HELD                                                                                                             
PREVIOUS COMMITTEE ACTION                                                                                                     
No previous action to record                                                                                                    
WITNESS REGISTER                                                                                                              
STACIE KRALY, Chief Assistant Attorney General                                                                                  
Statewide Section Supervisor                                                                                                    
Human Services Section                                                                                                          
Civil Division (Juneau)                                                                                                         
Department of Law                                                                                                               
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented a sectional analysis for                                                                       
Executive Order 119.                                                                                                            
ADAM CRUM, Commissioner                                                                                                         
Office of the Commissioner                                                                                                      
Department of Health and Social Services (DHSS)                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Co-presented a presentation entitled                                                                     
"Alaska Department of Health and Social Services; Executive                                                                     
Order 119 DHSS Reorganization."                                                                                                 
SYLVAN ROBB, Assistant Commissioner                                                                                             
Office of the Commissioner                                                                                                      
Department of Health and Social Services (DHSS)                                                                                 
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:     Co-presented   a  presentation   entitled                                                            
"Alaska  Department  of  Health  and  Social  Services;  Executive                                                              
Order 119 DHSS Reorganization."                                                                                                 
CLINTON LASLEY, Deputy Commissioner                                                                                             
Office of the Commissioner                                                                                                      
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Answered  questions  about Executive  Order                                                            
119 and  the proposed reorganization  of the Department  of Health                                                              
and Social Services.                                                                                                            
ACTION NARRATIVE                                                                                                              
3:03:21 PM                                                                                                                    
CO-CHAIR  TIFFANY  ZULKOSKY called  the  House Health  and  Social                                                            
Services  Standing  Committee  meeting   to  order  at  3:03  p.m.                                                              
Representatives Fields,  Kurka, Snyder, and Zulkosky  were present                                                              
(via  teleconference)  at  the  call  to  order.    Representative                                                              
Spohnholz  and Prax arrived  (via teleconference)  as the  meeting                                                              
was in progress.                                                                                                                
^EXECUTIVE ORDER 119 - DHSS REORGANIZATION                                                                                      
            EXECUTIVE ORDER 119 - DHSS REORGANIZATION                                                                       
3:04:20 PM                                                                                                                    
CO-CHAIR  ZULKOSKY  announced  that  the only  order  of  business                                                              
would  be   discussion  of  Executive   Order  (EO)  119      DHSS                                                              
CO-CHAIR  ZULKOSKY  gave  a  brief  overview  of  the  process  of                                                              
hearing an  executive order, which  differs from a  standard piece                                                              
of legislation.   She shared that  the legislature has 60  days to                                                              
take  action on  an  executive  order when  it  is  issued; if  no                                                              
action  is  taken, then  the  executive  order becomes  law  after                                                              
those 60 days have  elapsed.  Any action taken  by the legislature                                                              
to reject the EO 119 must occur by March 21, 2021.                                                                              
3:07:38 PM                                                                                                                    
STACIE  KRALY,   Chief  Assistant   Attorney  General,   Statewide                                                              
Section  Supervisor,   Human  Services  Section,   Civil  Division                                                              
(Juneau),  Department   of  Law,   gave  a  presentation   on  the                                                              
sectional  analysis of  Executive Order  119.   She stated  that a                                                              
memorandum  ("memo")  was  provided to  committee  members,  which                                                              
outlines  the  changes   the  department  made  in   the  proposed                                                              
reorganization of DHSS  and why it made those changes.   Ms. Kraly                                                              
turned to the  memo and paraphrased the provision  that allows the                                                              
governor  to take the  action of  the executive  order, listed  in                                                              
the memorandum  under "Authority  for Executive  Orders" and  also                                                              
found  in   Article  III,   Section  23,   of  the  Alaska   State                                                              
Constitution.     The   provision   read  as   follows   [original                                                              
punctuation provided]:                                                                                                          
     "The  governor  may make  changes  in the  organization                                                                    
     of  the  executive  branch   or in  the  assignment   of                                                                   
     functions   among   its   units   which  he   considers                                                                    
     necessary    for   efficient   administration.    Where                                                                    
     these  changes  require  the force  of law,  they shall                                                                    
     be  set forth  in  executive  orders.  The  legislature                                                                    
     shall  have  sixty  days  of a  regular  session,  or  a                                                                   
     full  session  if of shorter  duration,  to  disapprove                                                                    
     these   executive   orders.   Unless   disapproved    by                                                                   
     resolution   concurred   in   by  a  majority   of   the                                                                   
     members   in  joint   session,   these   orders  become                                                                    
     effective  at  a date  thereafter  to be  designated  by                                                                   
     the governor."                                                                                                             
MS.   KRALY  continued   paraphrasing   from  the   text  of   the                                                              
memorandum,   which   read  as   follows   [original   punctuation                                                              
      Under   this    constitutional   authority,    previous                                                                   
     governors  have  proposed  approximately  118  Executive                                                                   
     Orders  to  reorganize  units  of  state  government  or                                                                   
     change the  assignment of functions  among its  units. A                                                                   
     number   of   Executive   Orders   have   impacted   the                                                                   
     Department of Health and Social Services:                                                                                  
     ? Executive Order  54: Attempted to create  the Dept. of                                                                   
     Corrections  from a division  that was  in DHSS, but  it                                                                   
     was  disapproved by  the legislature,  which  introduced                                                                   
     HB 103  (1983) as a bill  to create the new  department.                                                                   
     Before  the  House  held  its   concurrent  vote  on  SC                                                                   
     CSHB103  (FIN)  am S,  the  governor introduced  EO  55,                                                                   
     which was  not disapproved  and which incorporated  many                                                                   
     of the  sections from  the bill that  were missed  in EO                                                                   
     54. (Sheffield, 1983 and 1984).                                                                                            
     ?  Executive Order  108: Reorganized  the Department  of                                                                   
     Health and  Social Services,  which entailed moving  the                                                                   
     Division  of  Senior  Services and  the  Alaska  Pioneer                                                                   
     Homes  from  the Department  of  Administration  to  the                                                                   
     Department  of Health and  Social Services.  (Murkowski,                                                                   
     ?  Executive Order  116: Assigned  the  function of  the                                                                   
     DHSS  departmental  administrative  hearing  process  to                                                                   
     the  Department  of  Administration,  in the  Office  of                                                                   
     Administrative Hearings. (Parnell, 2012).                                                                                  
3:12:09 PM                                                                                                                    
MS.  KRALY  read from  the  next  section  of the  memo,  entitled                                                              
"Scope  of Executive  Orders,"  which  read as  follows  [original                                                              
punctuation provided]:                                                                                                          
     An Executive  Order is a restructuring of  statutes that                                                                   
     have  already been enacted  into law,  resulting in  the                                                                   
     reorganization  or  reassignment  of  functions  of  the                                                                   
     executive branch.  An Executive Order relocates  current                                                                   
     statutes  or  reframes  references  for  administrative,                                                                   
     organization, and efficiency purposes.                                                                                     
     An  Executive  Order  may  not  be  used  to  enact  new                                                                   
     substantive  law; as  such,  it is  not  treated like  a                                                                   
     bill  and does not  require three  readings and  passage                                                                   
     by the legislature prior to going into effect.                                                                             
MS. KRALY  stated that  once the  decision was  made to  bifurcate                                                              
the  Department of  Health  and Social  Services  (DHSS) into  two                                                              
departments,  the Department  of Law  (DOL) prepared  to draft  EO                                                              
119.   She  continued  by paraphrasing  the  next  section of  the                                                              
memo, entitled  "Executive Order  119 Development Process,"  which                                                              
read as follows [original punctuation provided]:                                                                                
     Currently,   the  Department   of   Health  and   Social                                                                   
     Services  is established  primarily in  three titles  of                                                                   
     the  Alaska statutes:  AS  18,  AS 44,  and  AS 47.  But                                                                   
     references  to  the  Department  of  Health  and  Social                                                                   
     Services  are  found  in  many   titles,  chapters,  and                                                                   
     sections of state law.                                                                                                     
     The  Department  of  Law  identified  all  instances  in                                                                   
     statute  where  the  Department  of  Health  and  Social                                                                   
     Services, the  Commissioner of the Department  of Health                                                                   
     and   Social   Services,  or   relevant   statutes   are                                                                   
     referenced  and amended  each reference  to reflect  the                                                                   
     move  to  either   the  Department  of  Health   or  the                                                                   
     Department  of  Family  and   Community  Services.  Each                                                                   
     reference  was assigned  to  the appropriate  department                                                                   
     based   on  the   authorities   or  programs   of   each                                                                   
     department.  There   were  approximately   300  discrete                                                                   
     references  that required  a conforming  edit to  change                                                                   
     the name  of the department  to reflect the  appropriate                                                                   
     department with the assigned function.                                                                                     
3:14:36 PM                                                                                                                    
MS. KRALY continued by paraphrasing the next section, entitled                                                                  
"The Structure of the Order," which read as follows [original                                                                   
punctuation provided]:                                                                                                          
     All  of the  statutes affected  by  Executive Order  119                                                                   
     have  been properly  passed by the  legislature and  the                                                                   
     duties,  functions, and  programs  assigned under  those                                                                   
     statutes  currently   reside  with  the   Department  of                                                                   
     Health   and  Social  Services.   Executive  Order   119                                                                   
     reallocates  these duties,  functions,  and programs  to                                                                   
     the Department  of Health and  the Department  of Family                                                                   
     and  Community Services.  In  some instances,  discussed                                                                   
     below, there  are functions  that are allocated  to both                                                                   
     departments,  in  order to  fulfil  a requirement  of  a                                                                   
     Basic  structure.  Title  44   of  the  Alaska  Statutes                                                                 
     establishes  the departments  of  the Executive  Branch.                                                                   
     In Section  27 of the  Executive Order, AS  44.17.005 is                                                                   
     amended  to  list  the  Department  of  Health  and  the                                                                   
     Department   of  Family   and   Community  Services   as                                                                   
     principal offices and departments  of state government.                                                                    
     Department  of  Health.  Currently, the  duties  of  the                                                                 
     Department   of   Health   and   Social   Services   are                                                                   
     established  under   AS  44.29.  The  Executive   Order,                                                                   
     beginning  in   section  29,  amends  this   chapter  to                                                                   
     reflect   that  the   Department  of   Health  will   be                                                                   
     established  under AS  44.29. The  Department of  Health                                                                   
     will  implement  duties to  oversee  specific  statutory                                                                   
     programs   and  services  outlined   in  AS   47.05.010.                                                                   
     Section 39.                                                                                                                
     The  Executive  Order  likewise  amends  AS  18,  Public                                                                   
     Health,  and  the  authorities  and programs  of  AS  18                                                                   
     Public  Health,   to  reflect  that  these   will  be  a                                                                   
     function of the Department of Health.                                                                                      
     Department  of   Family  and  Community   Services.  The                                                                 
     Department   of  Family   and   Community  Services   is                                                                   
     established under  a new chapter, AS 44.30.  Section 36.                                                                   
     The  Department of  Family and  Community Services  will                                                                   
     implement  specific  statutory   programs  and  services                                                                   
     outlined in AS 47.06.010. Section 62.                                                                                      
     For each  Department, the  Executive Order then  assigns                                                                   
     each  chapter of  Title 47  to  the correct  Department.                                                                   
     For  example:  AS  47.07  (Medical  Assistance)  and  AS                                                                   
     47.24 (Adult  Protective Services)  are assigned  to the                                                                   
     Department of  Health, whereas AS 47.10  (Child Welfare)                                                                   
     and  AS 47.14  (Juvenile Justice)  are  assigned to  the                                                                   
     Department of Family and Community Services.                                                                               
3:17:45 PM                                                                                                                    
MS. KRALY talked about the shared responsibilities of the new                                                                   
departments, shown in the memo, as follows [original punctuation                                                                
     Shared  responsibilities. There  are  statutes that  are                                                                 
     allocated  to  both  departments   because  the  statute                                                                   
     contains  a  function  that each  department  will  have                                                                   
     responsibility to provide. For example:                                                                                    
     1.  AS  47.05  pertaining  to  background  checks:  Each                                                                   
     respective department  will have the responsibility  for                                                                   
     conducting background checks.                                                                                              
     2.  AS   47.32  pertaining   to  licensing  of   certain                                                                   
     facilities:  Each respective  department  will have  the                                                                   
     responsibility  for  licensing   of  certain  facilities                                                                   
     (health  care facilities  in  Department  of Health  and                                                                   
     foster  care  homes  in the  Department  of  Family  and                                                                   
     Community Services).                                                                                                       
     3.   AS  47.30   pertaining  to   mental  health:   Each                                                                   
     respective  department  will  have a  responsibility  in                                                                   
     the    planning,   support,    and   provision   of    a                                                                   
     comprehensive mental health program.                                                                                       
3:20:40 PM                                                                                                                    
MS. KRALY  then addressed  the boards  and commissions  that would                                                              
be changed under  the executive order, paraphrasing  from the next                                                              
section  of the  memo, entitled  "Specific changes  to Boards  and                                                              
Commissions,"   which  read  as   follows  [original   punctuation                                                              
     1. The Alaska Mental Health Trust Authority:                                                                             
     The   Alaska   Mental   Health    Trust   Authority   is                                                                   
     established   in  state  law   at  AS  47.30.011      AS                                                                   
     47.30.061.  The  Alaska  Mental Health  Trust  does  not                                                                   
     operate  as  a  board,  commission,  or  entity  of  the                                                                   
     Department   of   Health  and   Social   Services.   For                                                                   
     organization and  budgetary purposes, the  Alaska Mental                                                                   
     Health  Trust   is  housed  within  the   Department  of                                                                   
     The  Executive  Order  moves the  Alaska  Mental  Health                                                                   
     Trust  Authority  to  AS 44.25,  which  establishes  the                                                                   
     Department   of   Revenue   as   an   executive   branch                                                                   
     department.  This is accomplished  in Section 28  of the                                                                   
     Executive   Order,    pages   12   through    21.   Hon.                                                                   
     Representatives.  Zulkosky and Snyder February  25, 2021                                                                   
     Re: Overview of Executive Order no. 119 Page 5 of 6                                                                        
     2. The Office of the Long-Term Care Ombudsman:                                                                             
     The   Office  of   the  Long-Term   Care  Ombudsman   is                                                                   
     established  in AS 47.62.010    through AS 47.62.090  as                                                                   
     an  entity   under  the   Alaska  Mental  Health   Trust                                                                   
     Authority. The  Executive Order moves the Office  of the                                                                   
     Long  Term Care  Ombudsman to  AS 44.25  along with  the                                                                   
     Alaska   Mental   Health  Trust   Authority.   This   is                                                                   
     accomplished  in  Section  28 of  the  Executive  Order,                                                                   
     pages 23  through 27. The Office  of the Long  Term Care                                                                   
     Ombudsman  is  retained  as  an  entity  of  the  Alaska                                                                   
     Mental Health Trust.                                                                                                       
     3. Other boards  and commissions. There are  a number of                                                                   
     boards  and  commissions  that are  established  in  the                                                                   
     Department  of Health and  Social Services that  utilize                                                                   
     resources  of   the  department.  The   Executive  Order                                                                   
     aligns  the   boards  and   the  commissions  with   the                                                                   
     appropriate department.                                                                                                    
     The  Executive Order  moves  the Governor's  Council  on                                                                   
     Disabilities and  Special Education currently  set forth                                                                   
     in 47.80.030-095  as a council  under the Department  of                                                                   
     Health (Section 35, page 31).                                                                                              
     The  Executive  Order  moves in  statute  the  Statewide                                                                   
     Independent  Living Council  currently set  forth in  AS                                                                   
     47.80.300-330  as  a  council under  the  Department  of                                                                   
     Health (Section 35, page 35).                                                                                              
     The Executive  Order moves in statute the  Alaska Mental                                                                   
     Health  Board  as a  board  currently  set forth  in  AS                                                                   
     47.30.661-669  under the Department  of Health  (Section                                                                   
     35, page 37).                                                                                                              
     The  Executive   Order  moves  in  statute   the  Alaska                                                                   
     Pioneer   Home  Advisory  Board,   currently  under   AS                                                                   
     44.29.500      AS  44.29.530,  as  a  board   under  the                                                                   
     Department  of Family  and Community  Services  (Section                                                                   
     36, page 42).                                                                                                              
     The  Executive   Order  moves  in  statute   the  Alaska                                                                   
     Commission  on Aging, currently  under AS 47.45.200,  to                                                                   
     a  commission under  the Department  of Health  (Section                                                                   
     125 page 92).                                                                                                              
     The  Advisory  Board  on  Alcoholism   and  Drug  Abuse,                                                                   
     currently under  AS 44.29.100, will be aligned  with the                                                                   
     Department of Health.                                                                                                      
     The  Statewide  Suicide  Prevention  Council,  currently                                                                   
     under   AS  44.29.300,   will   be  aligned   with   the                                                                   
     Department of Health.                                                                                                      
3:22:57 PM                                                                                                                    
MS. KRALY  stated that  the executive order  outlines a  number of                                                              
transitional provisions  to ensure that  once it is  approved, the                                                              
business  of the department  can  continue to  operate.  She  said                                                              
that these  provisions include,  for example, pending  litigation,                                                              
grants  and   contracts,  payments,   continued  eligibility   for                                                              
programs,  the  child welfare  compact,  instructions  related  to                                                              
boards  and commissions,  memberships on  boards and  commissions,                                                              
and regulations.   The complete  list of  provisions is on  page 4                                                              
of the  memo.  She  said these provisions  ensure that if  or when                                                              
the executive  order is enacted,  applications submitted  will get                                                              
referred to the correct department.                                                                                             
MS. KRALY related  that questions were asked of DOL  in a previous                                                              
committee  hearing.   One was  concerning  child welfare  statute.                                                              
She directed  attention  to the part  of the  memo that  describes                                                              
the shift of the statute from one department to the other, as                                                                   
follows [original punctuation provided]:                                                                                        
     Currently,   AS   47.05.065    establishes   legislative                                                                   
     findings  related to  Alaska's  Child Welfare  Statutes.                                                                   
     With the  reorganization and  the realignment of  duties                                                                   
     and responsibilities  of the child welfare  programs and                                                                   
     family services  established in  AS 44.30 and  AS 47.06,                                                                   
     this  statute was  moved to  AS  47.06.020 (Section  62,                                                                   
     page  57). It is  properly aligned  with the  Department                                                                   
     of  Family  and Community  Services.  This  statute  was                                                                   
     originally  adopted in  1998  and amended  in 2018.  The                                                                   
     Executive  Order makes  no change  to  this language  or                                                                   
     legislative  findings,  it  merely aligns  it  with  the                                                                   
     proper  statutory   construct  for  the   Department  of                                                                   
     Family and Community Services.                                                                                             
MS. KRALY referred to language of the memo addressing the                                                                       
removal of the Pioneers' Home, which read as follows [original                                                                  
punctuation provided]:                                                                                                          
     Next,  as to  the amendments  related  to the  Pioneers'                                                                   
     Home and Veterans Home in AS 08.68.700(g). Section 2                                                                       
     The change  in subsection (f)  was made to  clarify that                                                                   
     the  regulatory authority  under  this  section will  be                                                                   
     with the Department of Health.                                                                                             
     The  change under subsection  (g) to  the definition  of                                                                   
     "health   care  facility"   was  to   ensure  that   the                                                                   
     Department  of Health and Social  Services did  not have                                                                   
     regulatory    authority   over   another    department's                                                                   
     division.  However, nothing  in  this section  precludes                                                                   
     the Pioneer Homes  and Veterans Homes from  working with                                                                   
     the   primary  care   physicians   of  their   residents                                                                   
     relating  to issuing  death  certificates for  residents                                                                   
     in the future.                                                                                                             
     In  summary,  this  Executive   Order  does  not  remove                                                                   
     Pioneer Homes  or Veterans Homes  from the "health  care                                                                   
     facility"  definition in  other  definition sections  of                                                                   
     state  law. The definition  of health  care facility  in                                                                   
     AS 18.35.399  (prohibiting smoking in certain  locations                                                                   
     and  circumstances)   and  AS  13.52.390   (Health  Care                                                                   
     Decisions  Act) will  still  include  Pioneer Homes  and                                                                   
     Veterans Homes.                                                                                                            
3:28:12 PM                                                                                                                    
ADAM CRUM,  Commissioner, Office  of the Commissioner,  Department                                                              
of  Health   and  Social   Services  (DHSS),   gave  the   "Alaska                                                              
Department  of Health  and Social  Services;  Executive Order  119                                                              
DHSS Reorganization"  presentation by way of PowerPoint.   He said                                                              
he  would   discuss  the  current   DHSS  setup,   challenges  and                                                              
opportunities, and  how EO 119 can  benefit Alaskans now  and into                                                              
the future.   He directed attention  to slide 2,  entitled "Alaska                                                              
Department   of   Health   and   Social   Services;   Adam   Crum,                                                              
Commissioner,"  which  depicted  an organizational  chart  of  the                                                              
current DHSS  organizational setup.   He  stated that it  consists                                                              
of  nine  service   divisions  and  a  Division   of  Finance  and                                                              
Management Services.   On the right side of the  chart, he pointed                                                              
out the Alaska  Pioneers' Home, the Alaska  Psychiatric Institute,                                                              
the  Office of  Children's Services,  and the  Office of  Juvenile                                                              
Justice,  which  he  said  are  the  four  divisions  that  he  is                                                              
proposing to be  broken out under a new commissioner's  office and                                                              
COMISSIONER  CRUM directed  attention  to slide  3, entitled  "How                                                              
DHSS Exists  Today," and  explained that including  supplementals,                                                              
DHSS  has the  largest budget  of any  department at  $3,483,874.2                                                              
billion.   He continued to paraphrase  from the slide,  which read                                                              
as follows [original punctuation provided]:                                                                                     
     FY2021 Budget (Including Supplementals): $3,483,874.2                                                                      
     PCN: 3401                                                                                                                  
     Over 100 programs that serve Alaskans directly                                                                             
     How  Alaskan  are  served:   birth  certificates,  death                                                                   
     certificates,  licensed  medical   facilities,  licensed                                                                   
     assisted     living/skilled      nursing     facilities,                                                                   
     eligibility   for  assistance   programs,  foster   care                                                                   
     services,  family  preservation  services,  preventative                                                                   
     health,  adult protective  services, tobacco  prevention                                                                   
     programs, marijuana  education and prevention  programs,                                                                   
     comprehensive  community  and  mental  health  services,                                                                   
     payments  to support Alaskans,  payments for  providers,                                                                   
     complex   case   management   services,   transportation                                                                   
     services,  home  and community-based  waivers,  juvenile                                                                   
     detention   services,   chronic   disease   and   health                                                                   
     promotion,   preventative  health,  childcare   facility                                                                   
     licensing  and safety, early  intervention and  learning                                                                   
     programs,  public health  nurses,  substance misuse  and                                                                   
     addiction  prevention,  newborn  hearing  and  screening                                                                   
     Major Categories of Services                                                                                               
     Regulatory/Claims Processing/Eligibility for Services                                                                      
     Public Health Services                                                                                                     
       Protecting Vulnerable Alaskans, Children, Families                                                                       
     (Service/Provider/Provider Based)                                                                                          
COMMISSIONER  CRUM   moved  to  slide  4,   entitled  "Challenges;                                                              
Opportunities,"  which  read  as   follows  [original  punctuation                                                              
     ?Division of Public Assistance Backlog                                                                                     
     ?Alaska Psychiatric Institute                                                                                              
     ?Office of Children's Services                                                                                             
     ?COVID-19 Public Health Emergency                                                                                          
     ?IT/Network Systems                                                                                                        
     ?Tribal Child Welfare Compact                                                                                              
     ?1115 Waiver                                                                                                               
     ?Tribal Claiming                                                                                                           
     ?Care Management Programs                                                                                                  
COMMISSIONER  CRUM  explained the  challenge  of  the Division  of                                                              
Public  Assistance's significant  backlog which  had a  processing                                                              
time for applications  of 100 days on average.   He explained that                                                              
DHSS  inserted  new  leadership and  supported  changes,  such  as                                                              
restructuring  of management  within  the division,  alignment  of                                                              
programs    and   support   functions    within   the    division,                                                              
implementation  of   a  new  training  structure   and  electronic                                                              
document management,  and more.  He shared that  now, the division                                                              
has  only a  couple hundred  applications  that are  over 45  days                                                              
old, and the average processing time is 3-5 days.                                                                               
3:32:08 PM                                                                                                                    
COMMISSIONER  CRUM  added that  another  item  from slide  4  that                                                              
required   immediate   attention   was  the   Alaska   Psychiatric                                                              
Institute  (API), which  was in danger  of losing  its license  to                                                              
operate  as  a hospital.    He  shared  that  API is  the  primary                                                              
psychiatric  hospital for  the state.   The commissioner's  office                                                              
made  the decision  to provide  management  consulting and  direct                                                              
oversight  and attention  to API.   Through  these efforts,  which                                                              
also  included  a  newly  formed  governance  board,  API  has  an                                                              
available  census  of up  to  60  patients up  from  a  low of  20                                                              
patients,  and  the  Center for  Medicare  and  Medicaid  Services                                                              
(CMS) has rescinded  its termination of the facility  as it is now                                                              
considered compliant with state and federal rules.                                                                              
COMMISSIONER  CRUM   addressed  the   next  item  from   slide  4,                                                              
"Challenges,"  and stated  that COVID-19  has  been a  significant                                                              
challenge  as  it  has  taken  up time  from  the  Office  of  the                                                              
Commissioner  in order  to help lead  the response  and deal  with                                                              
the challenges.   He  stated that  this shows  the need  for focus                                                              
and oversight because  a lot of key changes needed  to occur, such                                                              
as   federal  waivers   and  flexibility,   and   it  requires   a                                                              
"tremendous  lift"   by  everyone  in  the  office   in  order  to                                                              
accomplish that.                                                                                                                
COMMISSIONER CRUM  shared the next challenge listed  on the slide,                                                              
the Office of Children's  Services (OCS).  He pointed  to the high                                                              
turnover of case  workers as a significant stress  for all parties                                                              
involved.   He said  that national data  shows that high  turnover                                                              
rates   and  staffing   shortages  leave   remaining  staff   with                                                              
insufficient  time to  conduct the  kind of home  visits that  are                                                              
necessary  to  assess children's  safety  to  make  well-supported                                                              
decisions.   He  shared that  consistency and  continuity of  case                                                              
managers  is  a  key  factor in  helping  children  succeed.    He                                                              
explained that  this information  had been  shared and  debated in                                                              
prior legislatures,  and pointed to House Bill  151 [passed during                                                              
the Thirtieth Alaska  State Legislature], in 2018,  which provided                                                              
funding and  support to  OCS, but he  stated that the  anticipated                                                              
level of success has  not been achieved.  He added  that OCS has a                                                              
current turnover  rate of  51.9 percent  for case-carrying  staff.                                                              
If  the  national data  is  to  be  believed,  he said  that  this                                                              
turnover causes a  financial burden of $13 million.   He concluded                                                              
that   the  challenge   of   turnover  needs   direct   attention,                                                              
management, and support from the Office of the Commissioner.                                                                    
3:35:14 PM                                                                                                                    
COMMISSIONER  CRUM,  highlighting "Challenges;  Opportunities"  on                                                              
slide 4,  stated that the  conversation about challenges  leads to                                                              
a conversation  about opportunities.   He expanded upon  the slide                                                              
and stated his office  has not been able to dedicate  as much time                                                              
as it  would've liked  to the  Alaska Child  Welfare Compact.   He                                                              
shared a statistic  that 65 percent of children in  OCS are Alaska                                                              
Native, and  for that reason he said  that the compact  must be as                                                              
successful   as  possible.     He  explained   that  an   expanded                                                              
commissioner's office  would be able  to address  these challenges                                                              
more completely.   He continued  paraphrasing from the  next items                                                              
on the slide,  and added that the  1115 waiver is also  a critical                                                              
component in  building up  behavioral health care  as it  can help                                                              
keep  expensive  emergency  room   appointments  down.    He  also                                                              
mentioned the Tribal  Claiming Program, which brings  general fund                                                              
dollars back to Alaska.                                                                                                         
COMMISSIONER   CRUM   proceeded   to  slide   5,   entitled   "For                                                              
Comparison," and stated  the content on the slide  shows that DHSS                                                              
is unlike  any other department  in the state.   He said  that the                                                              
intent of sharing  this slide is so show the breadth  and depth of                                                              
the department.   The slide shows the difference  between the DHSS                                                              
budget and  15 other  departments, and  read as follows  [original                                                              
punctuation provided]:                                                                                                          
     Dept. of Health & Social Services                                                                                          
     $3,407,847,800 FY2022 Governor                                                                                             
     3263 Total PCNs                                                                                                            
     Dept. of Transportation & Public Facilities                                                                                
     Dept. of Corrections                                                                                                       
     Dept. of Revenue                                                                                                           
     Dept. of Administration                                                                                                    
     Dept. of Public Safety                                                                                                     
     Dept. of Fish & Game                                                                                                       
     Dept. of Labor & Workforce Development                                                                                     
     Dept. of Natural Resources                                                                                                 
     Dept. of Law                                                                                                               
     Dept. of Commerce, Community & Economic Develop.                                                                           
     Dept. of Environmental Conservation                                                                                        
     Dept. of Military and Veterans Affairs                                                                                     
     Office of the Governor                                                                                                     
COMMISSIONER  CRUM   paraphrased  the  information   on  slide  6,                                                              
entitled  "Executive  Order  119  Vision;  The  Reorganization  of                                                              
DHSS," which read as follows [original punctuation provided]:                                                                   
        Goal: Provide proactive, efficient leadership and                                                                       
      management of programs to achieve better outcomes for                                                                     
     Align Current Functions & Programs                                                                                         
         1.Direct Care and Services to Alaskans in State                                                                        
     Administered Programs                                                                                                      
     2.Eligibility for Alaskans & Payment to Providers                                                                          
     Focus Management to Improve Outcomes                                                                                       
     2.Work Processes                                                                                                           
COMMISSIONER CRUM  concluded that with the current  structuring of                                                              
the department, there  is only time to go from "fire  to fire" and                                                              
there  is  not enough  time  and  attention  to focus  on  broadly                                                              
implementing  strategic   plans  and  improving  aspects   of  the                                                              
3:38:52 PM                                                                                                                    
SYLVAN ROBB, Assistant  Commissioner, Office of  the Commissioner,                                                              
Department  of  Health  and  Social  Services  (DHSS),  introduced                                                              
slide  7, which  listed  the  current  DHSS budget,  the  proposed                                                              
budgets of the  two new departments - Department  of Community and                                                              
Family  Services   and  the  Department   of  Health  -   and  the                                                              
differences  between them.    Slide 7  read  as follows  [original                                                              
punctuation provided]:                                                                                                          
     Dept. of Health and Social Services                                                                                        
     FY2021 Management Plan + Supplementals                                                                                     
     UGF $1,124,933.0                                                                                                           
     Total $3,483,874.2                                                                                                         
     Full Time Positions 3401                                                                                                   
     Dept. of Family and Community Services                                                                                     
     FY2022 Governor's Amended                                                                                                  
     UGF $213,447.1                                                                                                             
     Total $413,419.6                                                                                                           
     Full Time Positions 1823                                                                                                   
     Dept. of Health                                                                                                            
     FY2022 Governor's Amended                                                                                                  
     UGF $898,914.3                                                                                                             
     Total $3,037,956.3                                                                                                         
     Full Time Positions 1439                                                                                                   
     FY2021 Management Plan +                                                                                                   
     Supplementals to                                                                                                           
     FY2022 Governor's                                                                                                          
     UGF ($12,606.0)                                                                                                            
     Total ($32,504.8)                                                                                                          
     Full Time Positions                                                                                                        
     All dollars in thousands                                                                                                   
MS. ROBB  concluded  that even with  the budget  for the  proposed                                                              
EO, the  budgets for  the two  new proposed  departments would  be                                                              
less than the  budget for DHSS this  year in fiscal year  2021 (FY                                                              
21).   She  acknowledged  that  there  are costs  associated  with                                                              
making these changes which are detailed on a subsequent slide.                                                                  
3:41:29 PM                                                                                                                    
CO-CHAIR ZULKOSKY  asked for  confirmation that  the top  blue box                                                              
on  the slide  ["Dept.  of Health  and  Social  Services"] is  the                                                              
existing  department's  budget, and  the  pink  box on  the  slide                                                              
["Difference"]  is what the  budget would  look like following  EO                                                              
119 and the reorganization of the department.                                                                                   
MS. ROBB answered that is correct.                                                                                              
3:42:10 PM                                                                                                                    
COMMISSIONER  CRUM continued  with  the presentation  on slide  8,                                                              
entitled  "Department of  Family & Community  Services," and  said                                                              
that  it  showed   the  proposed  organizational   chart  for  the                                                              
Department of  Family and Community  Services.  He stated  that by                                                              
being  removed from  the  Medicaid conversation,  this  department                                                              
would  be able  to focus  on  key items  of  improvement, such  as                                                              
finding  the cause  of the  high turnover  at OCS.   He said  that                                                              
this  will   help  the  department   help  families  in   need  by                                                              
connecting them  with community  resources before intervention  is                                                              
needed.   He  added  that a  discussion  with  the Tribal  Compact                                                              
cosigners is  occurring to see if  they would be willing  to allow                                                              
the Tribal  Compact to  move to  the   Office of the  Commissioner                                                              
under this  new organization.   He stated  that this is  to ensure                                                              
that the  compact is maximized  for the  benefit of Alaskans.   He                                                              
also  touched on  the  Alaska Pioneers'  Home  and  said that  the                                                              
intention is  to continue to  ensure that  the best level  of care                                                              
is provided  to Alaska's  elders.   He added  that new  facilities                                                              
such   as  skilled   nursing   facilities   and  assisted   living                                                              
facilities  are being  built, and  it  is important  to make  sure                                                              
that  there is  a proper  place for  the services  needed for  the                                                              
Alaska Pioneers' Home.                                                                                                          
COMMISSIONER CRUM  turned to slide 9, entitled  "The Department of                                                              
Health," which  showed the proposed  organizational chart  for the                                                              
proposed  Department of Health.   He  shared that  the goal  is to                                                              
align  health  improvements,  chronic   health  prevention,  data,                                                              
payment, and healthcare  delivery groups.  He  said that increased                                                              
stakeholder   and   constituent    engagement,   federal   partner                                                              
engagement,  and  implementing further  flexibilities  granted  by                                                              
the legislature  in 2016  with Senate Bill  74 [passed  during the                                                              
Twenty-Ninth  Alaska  State  Legislature]  can all  help  increase                                                              
focus and improve  management regarding the Medicaid  program.  He                                                              
shared that  the office does $34-$45  million a week  for Medicaid                                                              
COMMISSIONER CRUM  stated that another benefit with  this proposed                                                              
reorganization is that  it would allow the focus to  shift more to                                                              
value-based  care; currently  Alaska  is one  of  the only  states                                                              
that does  not have a fee-for-service  option.  He  also mentioned                                                              
that  a focus  shift to  primary care  is important  to make  sure                                                              
that  there  is no  delayed  access  to healthcare  for  Alaskans,                                                              
because the cost  of chronic care is what is driving  the Medicaid                                                              
3:46:45 PM                                                                                                                    
MS.   ROBB  began   presenting  again   on   slide  10,   entitled                                                              
"Increments  for  Commissioner's  Office  and  Department  Support                                                              
Services,"  and stated  that the  spreadsheet on  the slide  shows                                                              
the increments  required to  make the split  of DHSS.   She shared                                                              
that,  as the  committee  can see  from  the slide,  the  proposed                                                              
Department  of  Family  and  Community   Services  has  seven  new                                                              
positions,  and the  proposed  Department of  Health  has six  new                                                              
positions.   She said that the  total cost of these  new positions                                                              
is $1.8  million, and  that the total  cost of the  reorganization                                                              
is $5.7  million, of which  $5.2 million  are ongoing costs.   She                                                              
also pointed  to the  general fund  impact of the  reorganization,                                                              
which is $3.1 million, of which $2.8 million are ongoing costs.                                                                 
MS.  ROBB  stated  that  the Office  of  the  Commissioner  did  a                                                              
thorough job  of examining every  potential cost, for  example, by                                                              
asking staff do  a census at every facility in  order to ascertain                                                              
how much signage  would need to be replaced.  She  added that both                                                              
departments are designed  to be fully functional  and that neither                                                              
of the  two new proposed  departments was  the "little  sister" to                                                              
the other.                                                                                                                      
MS. ROBB proceeded to slide  11, entitled " FY2021 Management Plan                                                              
+  FY2021  Supplemental  Comparison  to  FY2022 Gov  Amend     Two                                                              
Department  Structure," which compared  the FY  21 budget  and the                                                              
proposed FY  22 budget with  the reorganization, which  is similar                                                              
to the information  on slide 7, but she added that  slide 11 shows                                                              
all  fund  sources.    She  stated  that  the  conclusion  of  the                                                              
comparison  shows that operating  DHSS in  2021 is more  expensive                                                              
than the  proposed operation of the  two new departments  in 2022,                                                              
even with the costs mentioned earlier in the presentation.                                                                      
3:49:54 PM                                                                                                                    
COMMISSIONER  CRUM took  another  turn with  the presentation  and                                                              
shared  that  after  EO  119 was  announced,  the  Office  of  the                                                              
Commissioner did  extensive outreach  with constituent  groups and                                                              
stakeholders  to ensure  that  they understood  that  the goal  is                                                              
minimal impact  of services.  To  do this, he shared,  the office:                                                              
met with  leadership of  the labor  unions for  the state  and has                                                              
continuing meetings  set up; held  13 town hall meetings  for DHSS                                                              
employees to  ask any questions they  had to the  commissioner and                                                              
his team;  and has made use  of Internet sites and  staff feedback                                                              
emails.  He said  the groups include the Alaska  Children's Trust,                                                              
Rasmussen Foundation,  the Alaska Mental Health Trust,  the Alaska                                                              
Behavioral  Health  Association,  the  Mental  Health  Board,  the                                                              
Alaska  Native   Tribal  Health   Consortium,  the  Alaska   State                                                              
Hospital and  Nursing Home Association,  the Alaska  State Medical                                                              
Association, the  Alaska Primary Care Association,  the governor's                                                              
Council  on  Disabilities   and  Special  Education,   the  Alaska                                                              
Commission on Aging,  the Key Coalition, developmental  disability                                                              
groups,  and  more.    He  stated  that  these  groups  have  been                                                              
educated  on  the goal  of  this  reorganization, which  is  added                                                              
interaction  with the  commissioner's staff  and the  commissioner                                                              
to ensure that they  are getting the time and attention  they need                                                              
on key items.   He added that conversations with  federal partners                                                              
have  also occurred,  as well  as the  Tribal State  Collaboration                                                              
Groups and  Tribal Compact  partners to  ensure that these  groups                                                              
understood the  reorganization.  Commissioner Crum  concluded that                                                              
the  reorganization allows  for intensive  management of  programs                                                              
and  reduced scope,  alignment of  function  for each  department,                                                              
more  focus  on   constituents  and  services,  and   more  nimble                                                              
responses to constituents.                                                                                                      
3:53:09 PM                                                                                                                    
REPRESENTATIVE   SPOHNHOLZ   shared   that   she  is   glad   that                                                              
conversations  with impacted  stakeholders are  taking place,  but                                                              
said that  she thinks  these conversations  might  be a bit  late.                                                              
The  best-case   scenario   for  a  reorganization   of  a   "mega                                                              
department"  takes a long  time.   She brought  up the example  of                                                              
the State  of Washington,  which did  the same  thing a  few years                                                              
back.      She    shared   that   Washington    accomplished   its                                                              
reorganization  by creating  a commission  that spent nine  months                                                              
studying the logistics,  and it ended up taking them  two years to                                                              
facilitate  the reorganization.   She  added that  she thinks  the                                                              
reason that stakeholder  engagement is so important  is because it                                                              
is vital  to understand the  impact of the  proposal on  those who                                                              
are  providing the  services being  affected and  those that  need                                                              
these services.   She asked about the projected  cost savings, and                                                              
asked where  the savings  are coming  from and  whether there  are                                                              
other positions that are being eliminated.                                                                                      
3:55:56 PM                                                                                                                    
COMMISSIONER   CRUM   replied   that    this   reorganization   is                                                              
"dramatically different"  from what  the State of  Washington did.                                                              
He  said   that  the   conversations  about   the  split   started                                                              
internally  in  about   Summer  2019.    He  stated   that  unlike                                                              
Washington,  Alaska is  keeping positions  and leadership  exactly                                                              
the   same,  which   he  said   will  cause   minimal  impact   to                                                              
constituents and service provider groups.                                                                                       
3:56:59 PM                                                                                                                    
MS.  ROBB walked  the committee  through some  of the  reductions,                                                              
addressing   Representative  Spohnholz's   question.     The   139                                                              
positions  that   are  being  reduced   are  mostly  due   to  the                                                              
efficiencies  that have  been  gained in  the  Division of  Public                                                              
Assistance.   She  stated that  unrelated  to the  reorganization,                                                              
there are  a number of positions  that are being reduced,  such as                                                              
the eight  positions  at the Division  of Juvenile  Justice.   She                                                              
concluded  that  for the  most  part,  the  rest of  the  position                                                              
reductions  are  related to  the  administrative  orders from  the                                                              
governor  that consolidate  Human Resources  and Procurement  into                                                              
the  Department of  Administration  and represent  positions  that                                                              
were transferred over to the Department of Administration.                                                                      
3:58:23 PM                                                                                                                    
REPRESENTATIVE  SPOHNHOLZ   shared  her  understanding   that  the                                                              
majority   of  the   savings  do   not   have  to   do  with   the                                                              
reorganization.   She  mentioned the  commissioner's comment  that                                                              
what Alaska  is proposing is different  from what happened  in the                                                              
State  of  Washington  because  Washington's  transition  included                                                              
title  changes,   and  she   said  that   what  she  knows   about                                                              
transitions  is that they  are incredibly  difficult.   She shared                                                              
that  she studied  transitions  in graduate  school,  and a  great                                                              
deal of  research has  been done  on the topic.   She spoke  about                                                              
transitions  as  being incredibly  stressful  for  staff, and  she                                                              
pointed to  the ongoing  stress of  the COVID-19 pandemic,  during                                                              
which DHSS  has been on the  frontline.  Representative  Spohnholz                                                              
expressed that adding  another layer of stress  seems problematic,                                                              
especially   if   the   savings    are   not   coming   from   the                                                              
reorganization, and  she suggested that this may not  be the right                                                              
time for this reorganization.                                                                                                   
4:00:36 PM                                                                                                                    
COMMISSIONER  CRUM  responded that  this  plan  has not  been  put                                                              
forward as  a cost-saving measure;  the juxtaposition  between the                                                              
FY  21   and  proposed   FY  22  budgets   was  included   in  the                                                              
presentation  to  show  that  it's not  necessarily  a  growth  in                                                              
government.   He said that the goal  is to make the  system better                                                              
for Alaskans,  and this is  a way to  accomplish that and  make it                                                              
cheaper and  more effective to provide  services to Alaskans.   He                                                              
shared  that the status  quo at  OCS is  increasing turnover,  and                                                              
that when House  Bill 151 was put into place, the  turnover was in                                                              
the fortieth  percentile.  He stated  that turnover is now  in the                                                              
fifty-second  percentile.    He   concluded  that  the  system  is                                                              
getting worse and that the time is now for the reorganization.                                                                  
4:02:33 PM                                                                                                                    
CO-CHAIR SNYDER echoed  the concerns and questions  put forward by                                                              
Representative  Spohnholz.   She asked  if there  is a  transition                                                              
plan in  place and whether  it is under  development, and,  if so,                                                              
she questioned  where  that can be  found and  who contributed  to                                                              
COMMISSIONER  CRUM  said that  the  transition plan  is  primarily                                                              
involved   with  Finance   and  Management   Services,   including                                                              
information  technology  (IT),  while  the  Office  of  Children's                                                              
Services,  the  Division  of  Alaska  Psychiatric  Institute,  the                                                              
Division of Health  Care Services, and the Division  of Senior and                                                              
Disability Services  require no transition  because there  will be                                                              
no change to staff.                                                                                                             
CO-CHAIR  SNYDER   asked  about   the  transition  evaluation   to                                                              
determine  whether  the  stated goals  and  objectives  have  been                                                              
achieved,  and  she   asked  whether  there  are   metrics  for  a                                                              
successful bifurcation in the short and long-term.                                                                              
4:04:36 PM                                                                                                                    
COMMISSIONER CRUM responded  that one of the easy  metrics to look                                                              
to  is  the turnover  for  OCS  staff.   As  to  the rest  of  the                                                              
transitions, he indicated  that no firm numbers are  in place, but                                                              
they are  being determined so that  the staff understand  what the                                                              
goals  and changes  are.   He shared  that  during a  conversation                                                              
with a  constituent  group, the group  asked if  someone could  be                                                              
appointed  to a role  similar to  a transitional  liaison so  that                                                              
people  would  have   a  specific  person  to  go   to  for  their                                                              
questions.   He added that they  are looking to implement  this to                                                              
ensure that the transition provides  services better to Alaskans.                                                               
4:05:44 PM                                                                                                                    
CO-CHAIR   ZULKOSKY  asked   where   the  legislature   sees   the                                                              
transition  planning information  that the commissioner  mentioned                                                              
earlier  in  his response  to  Representative  Snyder's  question.                                                              
She asked  if the  over 800  employees that  would be impacted  by                                                              
this transition are  aware of the plan and how will  they go about                                                              
finding out more information about it.                                                                                          
COMMISSIONER CRUM deferred the question to Ms. Robb.                                                                            
4:07:22 PM                                                                                                                    
MS.  ROBB responded  that  a transition  plan  is in  development.                                                              
She  shared that  the  announcement regarding  the  reorganization                                                              
was made  on December  22, 2020,  and staff got  to work  the next                                                              
day  to move  forward in  the process.   The  transition plan  has                                                              
been  to work  through  all the  necessary  items  to ensure  that                                                              
Alaskans  receive a  smooth continuity  of services.   She  shared                                                              
that  the list  of these  almost  100 items  has  been divided  by                                                              
month  to  ensure  that  staff  is   not  falling  behind  on  the                                                              
4:08:51 PM                                                                                                                    
CO-CHAIR  ZULKOSKY  commented  that  this proposal  is  being  put                                                              
forward for  the legislature's  consideration  and it sounds  like                                                              
there's  some  substantive  information that  the  department  has                                                              
prepared that  the committee would  be interested in seeing.   She                                                              
echoed  Representative  Spohnholz's  earlier question  and  agreed                                                              
that  such a  significant  change amidst  a  pandemic with  little                                                              
information  given to  the  public elicits  some  questions.   She                                                              
asked  Commissioner Crum  whether  written  analyses and  research                                                              
had  been done  to  examine  the impact  of  the proposal  on  the                                                              
department's  work, particularly  the public-facing  work that  it                                                              
does, which has a direct impact on Alaskans.                                                                                    
4:10:49 PM                                                                                                                    
COMMISSIONER CRUM  reiterated that all of the  existing divisions,                                                              
contacts, phone  numbers, et cetera  will remain the same  on June                                                              
30,  2021,  as they  will  on July  1,  2021,  which is  when  the                                                              
proposal would be in  effect.  Part of the plan is  to look at the                                                              
programs that  Alaskans utilize and  how they interact  within the                                                              
4:11:49 PM                                                                                                                    
CO-CHAIR SNYDER  asked about the  positions that are being  cut as                                                              
a result  of electronic renewals,  and whether those  renewals are                                                              
happening yet.                                                                                                                  
MS. ROBB  responded that  yes, the  Division of Public  Assistance                                                              
has had online  applications for some  time now.  The  division is                                                              
moving  toward online  processing  of changes  that  beneficiaries                                                              
need to send in  to receive public assistance and  is moving to an                                                              
online system.   In  the past  when these  changes have  been made                                                              
via hardcopy,  it creates  a large  volume of  mail and  paperwork                                                              
processing which  comes at  an expense.   As they move  towards an                                                              
online system, it allows for increased efficiency.                                                                              
CO-CHAIR SNYDER agreed that that sounded like an improvement.                                                                   
4:14:02 PM                                                                                                                    
REPRESENTATIVE   KURKA    stated   his   understanding    of   the                                                              
presentation,  which is that  this is merely  a transition  in the                                                              
management and  oversight of DHSS,  and that everything  else will                                                              
remain  the  same.    He shared  that  he  is  alarmed  about  the                                                              
"extreme  dysfunction" in  OCS.   From  what he  is hearing,  case                                                              
workers  at  OCS are  being  turned  over  before they  get  fully                                                              
trained.  He asked whether part of the plan is reforming OCS.                                                                   
COMMISSIONER  CRUM agreed  that OCS has  issues, particularly  the                                                              
turnover  rate  and the  time  required  to  get new  hires  fully                                                              
trained,  which  includes understanding  the  unique  requirements                                                              
and circumstances of  each region of Alaska.   In the construction                                                              
of the  plan, the  department pondered  what it  can do  to remove                                                              
administrative burdens  on OCS employees  to help make  their jobs                                                              
easier  and what  the items  of pressing  concern  to families  of                                                              
Alaska are.  He  shared his belief that this will  result in cost-                                                              
savings as  well as  improve outcomes  for children.   One  of the                                                              
main goals of  the department is to ensure that  family resilience                                                              
is prioritized.   He stated that  it requires a lot of  effort for                                                              
organizations  to  bring  employees  on who  are  responsible  for                                                              
learning  best practices  and taking  advantage of  opportunities,                                                              
and  shared that  the  department  does not  have  enough time  or                                                              
resources to  explore every opportunity  that it should.   He said                                                              
that  an   added  benefit  would   be  the  extra   attention  the                                                              
department could give to the Alaska Tribal Compact.                                                                             
4:18:28 PM                                                                                                                    
REPRESENTATIVE  SPOHNHOLZ  stated  that  she  is  "thrilled"  that                                                              
there is an interest  not just in saving money but  also in trying                                                              
to deliver  a better service.  She  agreed that there needs  to be                                                              
more focus  and investment  in OCS  to reduce  turnover, and  that                                                              
other  departments such  as API  need leadership  attention.   She                                                              
commented  that she  is also  thrilled that  the commissioner  and                                                              
the  administration  has  come  around  on  things  like  Medicare                                                              
reform.   She stated  that her  question regarding  the timing  of                                                              
this reorganization  remains;  she is concerned  about the  timing                                                              
still, as well as  the amount of stakeholder engagement.   She has                                                              
heard   concerns    from   Direct   Service    Providers,   tribal                                                              
organizations, and  other DHSS partners about this.   She recalled                                                              
that  Casey Family  Programs  testified  and also  questioned  the                                                              
timing  and the  transition.   She  asked  if  the department  has                                                              
brought in  and questioned  any other experts  to help  assess the                                                              
various options and considerations around timing.                                                                               
4:21:03 PM                                                                                                                    
COMMISSIONER CRUM  said that he had  a meeting with  the Rasmussen                                                              
Foundation  and the  Casey Foundation  last week  and believes  he                                                              
will with  them every two  weeks to discuss  concerns.   He shared                                                              
his  understand  that these  organizations  are getting  more  and                                                              
more  comfortable  with  the  proposal.   He  reiterated  that  he                                                              
believes that this  is the best way to provide  better services to                                                              
REPRESENTATIVE   SPOHNHOLZ   asked   again   if   any   additional                                                              
consultants or experts were engaged.                                                                                            
COMMISSIONER CRUM responded no.                                                                                                 
4:23:35 PM                                                                                                                    
CO-CHAIR  SNYDER  stated that  she  is  hearing  two "sides  of  a                                                              
coin," one being  that the reorganization is not a  big change and                                                              
the other  being that the  change is significant.   She  asked for                                                              
details  on the  salary range  for the  13 new  positions and  how                                                              
that compares to the positions that will be removed.                                                                            
MS. ROBB responded  that she doesn't have the details  in front of                                                              
her, but that  she would be happy  to get that information  to the                                                              
4:25:05 PM                                                                                                                    
CO-CHAIR ZULKOSKY asked  Ms. Robb if she could  speak generally to                                                              
the types of positions  and the support that would  be provided to                                                              
either of the two new proposed departments.                                                                                     
MS. ROBB  shared that six  new positions  were being added  in the                                                              
Department of  Health and  seven in the  Department of  Family and                                                              
Community  Services.     Three  of   the  new  positions   in  the                                                              
Department  of  Family  and  Community  Services  are  within  the                                                              
Office of  the Commissioner.   She said  that the other  positions                                                              
that are  being added are meant  to provide strong  leadership and                                                              
oversight  within   finance  and  management  services   for  both                                                              
departments after  the split.   She expanded that  these positions                                                              
will include some IT staff and administrative staff.                                                                            
4:26:40 PM                                                                                                                    
CO-CHAIR   ZULKOSKY  highlighted   a  hearing   on  the   proposed                                                              
reorganization  that was held  on January 13,  2021, and  that she                                                              
was  grateful to  have  Casey Family  Programs  and child  welfare                                                              
advocates speak  to the proposal.   The presentation given  by Ms.                                                              
Biggs  that the  committee heard,  which  she stated  is on  BASIS                                                              
under  House  Health   and  Social  Services   Standing  Committee                                                              
meetings, indicated  that research is lacking and  that there's no                                                              
ideal structure  for the  split, and every  approach has  pros and                                                              
cons.   In particular,  she highlighted  that positive  family and                                                              
child  outcomes  cannot be  attributed  to any  particular  model.                                                              
She added  that there  is no research  that indicates  an improved                                                              
accountability  or service  quality  with any  particular type  of                                                              
organization.    She  questioned  the  cutting  of  the  positions                                                              
within  the Division  of Public  Assistance  (DPA), and  mentioned                                                              
the cost savings  the commissioner spoke about  that he attributed                                                              
to a  decrease in  backlog.   She asked  how the commissioner  can                                                              
assure that the  backlog will not increase with  so many positions                                                              
in that  department  being cut, and  asked about  the strategy  of                                                              
leaving the  DPA in the  Department of Health  and not  putting it                                                              
into the Department of Family and Community Services.                                                                           
COMMISSIONER  CRUM agreed  that there  is  no preferred  structure                                                              
and that  it varies state  by state.   He imparted that  the broad                                                              
consensus among  staff is that  OCS and  API are not  working, and                                                              
that change  is absolutely necessary.   Regarding the  decision to                                                              
organize DPA  under the Department  of Health, he stated  that the                                                              
intent  was  to ensure  that  Alaskans  continue to  receive  high                                                              
levels of service.   He echoed Ms. Robb and shared  that there are                                                              
other items  being worked  on to  continue the efficiency  process                                                              
to  make  it  easier  for  staff  to  continue  to  respond.    He                                                              
concluded that  the goal  for the new  departments is  to continue                                                              
to  meet the  needs  of Alaskans  while maintaining  the  position                                                              
4:30:50 PM                                                                                                                    
CO-CHAIR  ZULKOSKY   restated  the  last  part  of   her  question                                                              
regarding the  strategy behind maintaining  DPA in  the Department                                                              
of Health and not  putting it within the Department  of Family and                                                              
Community Services.                                                                                                             
COMMISSIONER  CRUM responded  that  DPA  does a  lot  of work  and                                                              
interacts a  lot with CMS and for  that reason the strategy  is to                                                              
ensure  that  the  CMS authorities  are  aligned  under  a  single                                                              
department.    He  said  that the  job  of  CMS  includes  working                                                              
between  agencies,   and  that  the   Department  of   Family  and                                                              
Community Services  is intended to be a provider-based  group that                                                              
provides direct care services to Alaskans.                                                                                      
CO-CHAIR  ZULKOSKY   asked  about   similar  issues   relating  to                                                              
Medicaid  and related  oversight at  API.   She said  that she  is                                                              
trying to understand the organization choices.                                                                                  
4:32:53 PM                                                                                                                    
CLINTON LASLEY,  Deputy Commissioner, Office of  the Commissioner,                                                              
Department  of  Health  and  Social  Services,  answered  Co-Chair                                                              
Zulkosky's  question  and explained  that  API  is a  provider  of                                                              
service delivery,  and that  there are  few individuals  who enter                                                              
API who  are actually  eligible for  Medicaid.   He said  that the                                                              
key takeaway  is that the way that  API works now is  the way that                                                              
it  will continue  to work  within the  new structure.   He  added                                                              
that divisions  work together  within DHSS  and also within  other                                                              
departments,  such as  the Department  of Corrections,  Department                                                              
of Law, Department  of Public Safety, and so on,  and that this is                                                              
a normal process within state government.                                                                                       
4:34:24 PM                                                                                                                    
CO-CHAIR SNYDER  spoke about  the benefit  of townhalls  that have                                                              
been  held and  other focused  conversations that  have been  held                                                              
with  stakeholders.   She  asked  if  the townhall  meetings  were                                                              
documented and,  if so, she said  she would like  that information                                                              
shared  with the  committee.   She also  asked whether  department                                                              
employees are working remotely in response to the pandemic.                                                                     
COMMISSIONER  CRUM   responded  that  yes,  there   are  employees                                                              
working remotely.                                                                                                               
CO-CHAIR  SNYDER  asked  what portion  of  employees  are  working                                                              
remotely   and  whether   they  have  concerns   about  how   this                                                              
transition  might be  impacted if  there are  still a  significant                                                              
portion of employees working remotely.                                                                                          
COMMISSIONER  CRUM shared that  teleworking has  become a  norm in                                                              
Health and  Social Services  for those  not working in  facilities                                                              
or  in direct  public  interaction.   The  department doesn't  see                                                              
telework as a barrier to the transition.                                                                                        
4:36:33 PM                                                                                                                    
CO-CHAIR  ZULKOSKY  echoed Representative  Snyder's  request  that                                                              
information   about  townhall   meetings   be   shared  with   the                                                              
COMMISSIONER CRUM  responded that  the employee townhall  meetings                                                              
are  internal  but  there  are other  groups  that  meet  in  that                                                              
fashion who  may be  okay with their  conversations being  shared.                                                              
He added  that not all  conversations have  been recorded,  but he                                                              
can provide dates and inquire if that would help.                                                                               
CO-CHAIR  ZULKOSKY shared  that the Children's  Trust submitted  a                                                              
letter to  the committee  prior to the  January 13 meeting,  which                                                              
is  located on  the  legislature's  web page  in  addition to  the                                                              
presentation  given  by  Casey  Family  Programs.    She  recalled                                                              
hearing  in the  presentation from  child  welfare advocates  that                                                              
around  40 percent  of licensed  foster  care homes  opted out  of                                                              
continuing  their status  as  foster care  homes  due to  concerns                                                              
brought on  by the pandemic.   She asked whether concerns  such as                                                              
this have been taken  into account in terms of the  amount of time                                                              
and resources  it will  take within  these respective  departments                                                              
to  take  the  appropriate  steps   to  prepare  for  the  July  1                                                              
effective date of EO 119.                                                                                                       
COMMISSIONER CRUM  responded that yes, the service  providers will                                                              
continue to provide  through the transition and  that there should                                                              
be no disruption.                                                                                                               
4:39:43 PM                                                                                                                    
REPRESENTATIVE   SPOHNHOLZ  shared   that   she  appreciates   the                                                              
interest  in  wanting  to  deliver   the  services  that  DHSS  is                                                              
dedicated  to in a  more effective  way; however  she thinks  that                                                              
there is a  simpler way to accomplish  this.  She noted  that what                                                              
she sees in the  reorganization is a "bunch of  new administrative                                                              
positions" just  to add  a couple of  new leadership  positions in                                                              
the  commissioner's   office,  adding  more  bureaucracy   in  the                                                              
process.  She added  that the savings that were  identified in the                                                              
presentation were not  really savings.  She said that  what she is                                                              
hearing  is that there  is a  lack of  leadership capacity  within                                                              
the office  to be able to  oversee the important work  done within                                                              
DHSS, and  that the  simpler way  to address  this problem  as she                                                              
sees  it  would  be to  add  a  couple  of new  positions  to  the                                                              
commissioner's  office.    She mentioned  the  $2  billion  dollar                                                              
fiscal  gap  in  the  state, and  she  stated  that  although  the                                                              
transition  is not  that expensive,  it gives  her "heartache"  to                                                              
allocate money  to more administrative  positions.   She concluded                                                              
that  she  is  hearing  more  concerns  than  enthusiasm  for  the                                                              
reorganization,  and she  opined that  it is  not the  time to  go                                                              
forward with it.                                                                                                                
4:42:24 PM                                                                                                                    
CO-CHAIR  ZULKOSKY asked  the commissioner  about the decision  to                                                              
put forward the  reorganization through an executive  order rather                                                              
than legislation.                                                                                                               
COMMISSIONER CRUM  responded that  the reasoning for  an executive                                                              
order was  specifically contemplated by  the framers of  the state                                                              
constitution and has  been done numerous times before.   He stated                                                              
that the  goal of executive  orders according to  the constitution                                                              
is to  delineate them  from the political  process to  ensure that                                                              
it is the best choice for Alaskans as well as department staff.                                                                 
4:43:52 PM                                                                                                                    
CO-CHAIR  ZULKOSKY  commented that  the  choice  to put  forth  an                                                              
executive  order  to  split  the  state's  largest  department  is                                                              
"interesting" when  the purpose of  the legislative process  is to                                                              
embed public  engagement  in the  process.  She  opined that  it's                                                              
great  that the  department has  enacted focused  dialogue on  the                                                              
issue, but she is  concerned about the position that  was taken in                                                              
order  to effect  this  change  in terms  of  public  trust.   She                                                              
concluded  that  she looks  forward  to  additional  conversations                                                              
with  the department  about  EO  119, particularly  regarding  the                                                              
expenses of it.                                                                                                                 
4:46:25 PM                                                                                                                    
There being no further business before the committee, the House                                                                 
Health and Social Services Standing Committee meeting was                                                                       
adjourned at 4:46 p.m.                                                                                                          

Document Name Date/Time Subjects
EO 119 Presentation_House HSS_02252021.pdf HHSS 2/25/2021 3:00:00 PM
Executive Order 119 Presentation
EO 119 Sectional Analysis.pdf HHSS 2/25/2021 3:00:00 PM
Executive Order 119 Sectional Analysis
HOUSE HSS memo.final 2.25.21.pdf HHSS 2/25/2021 3:00:00 PM
E0 119 - DOL Memo
exor0119.pdf HHSS 2/25/2021 3:00:00 PM
EO 119 - Full Text