Legislature(2011 - 2012)CAPITOL 106
01/27/2011 03:00 PM House HEALTH & SOCIAL SERVICES
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| Overview: Department of Health and Social Services | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
January 27, 2011
3:03 p.m.
MEMBERS PRESENT
Representative Wes Keller, Chair
Representative Alan Dick, Vice Chair
Representative Bob Herron
Representative Paul Seaton
Representative Sharon Cissna
Representative Bob Miller
Representative Charisse Millett
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
OVERVIEW: DEPARTMENT OF HEALTH AND SOCIAL SERVICES
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to report
WITNESS REGISTER
BILL STREUR, Acting Commissioner
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented a power point overview of the
Department of Health and Social Services.
ALISON ELGEE, Assistant Commissioner
Central Office
Finance and Management Services
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Presented a power point overview of the
Department of Health and Social Services.
DAVE COTE, Director
Central Office
Division of Alaska Pioneer Homes
Juneau, Alaska
POSITION STATEMENT: Answered questions during the overview of
Department of Health and Social Services.
MELISSA WITZLER-STONE, Director
Central Office
Division of Behavioral Health
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the overview of
Department of Health and Social Services.
CHRISTY LAWTON, Acting Director
Central Office
Office of Children's Services
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during the overview of
Department of Health and Social Services.
DR. WARD HURLBURT, Director and Chief Medical Officer
Central Office
Division of Public Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the overview of
Department of Health and Social Services.
ACTION NARRATIVE
3:03:02 PM
CHAIR WES KELLER called the House Health and Social Services
Standing Committee meeting to order at 3:03 p.m.
Representatives Keller, Dick, Herron, Seaton, Cissna, Miller,
and Millett were present at the call to order.
^OVERVIEW: DEPARTMENT OF HEALTH AND SOCIAL SERVICES
OVERVIEW: DEPARTMENT OF HEALTH AND SOCIAL SERVICES
3:03:24 PM
CHAIR KELLER announced that the only order of business would be
an overview by the Department of Health and Social Services
(DHSS).
3:04:46 PM
BILL STREUR, Acting Commissioner, Office of the Commissioner,
Department of Health and Social Services (DHSS), explained that
this overview would not delve into budget detail. He referenced
the handout entitled, "2011 Priorities' [Included in members'
packets.] and relayed that the DHSS mission was to promote and
protect the health and well being of Alaskans, and its vision
was for all individuals and families to be healthy, safe, and
productive. He listed the first DHSS major priority, substance
abuse and mental health, and declared that each were significant
issues in Alaska. He summarized the major strategies to deal
with this: prevention and health promotion, early intervention,
treatment services, and recovery. He noted that this was a
lifelong process. He directed attention to the second priority,
health and wellness, and ascertained its major strategies to
include: prevention and health promotion, disease control,
access, emergency response and preparedness, and environmental
health impacts. He elaborated on the next priority, health care
access and delivery, and listed these major strategies to
include: technology for sustainable and effective health care
delivery, workforce development, and enhanced management of high
health needs. He emphasized the need for an electronic health
records system.
3:10:56 PM
REPRESENTATIVE SEATON observed that providers had concerns for
connectivity with the DHSS system.
3:11:31 PM
ACTING COMMISSIONER STREUR acknowledged that older systems may
need to be updated; however, he pointed out that the Health
Information Exchange worked with a variety of systems. He
offered his belief that there would be many fewer problems than
feared initially.
3:12:13 PM
CHAIR KELLER opined that there was still a long way to go, as
only 18 percent of providers had signed on.
3:12:47 PM
ACTING COMMISSIONER STREUR agreed. He suggested that the first
step was to entice providers to convert to electronic health
records, and then for the providers to recognize the value of
participation with the Health Information Exchange. He directed
attention to federal financial support for the state and the
providers for conversion. He elaborated on the workforce
development advancements around Alaska.
3:14:31 PM
REPRESENTATIVE CISSNA asked about the current billing problems
with telemedicine.
3:16:19 PM
ACTING COMMISSIONER STREUR, in response to Representative
Cissna, shared that a change in regulations would resolve this
problem. He observed that telemedicine programs lowered
transportation costs by 40 percent.
3:17:47 PM
ACTING COMMISSIONER STREUR, in response to Chair Keller, said
that very little would change for the provider with the Medicaid
Management Information System (MMIS) system. He confirmed that
more than 78 percent of claims were submitted electronically.
3:18:18 PM
CHAIR KELLER asked what steps DHSS was taking to make the work
force more attractive.
ACTING COMMISSIONER STREUR replied that DHSS was working with
the University of Alaska on strategies to entice and retain a
skilled workforce. He confirmed that the State of Alaska
offered few incentives, such as loan repayment or forgiveness
programs. He offered his belief that there was an effort from
the Alaska State Legislature to bring an incentive program
forward. He stated the importance of a work environment in
which the providers wanted to stay.
3:19:34 PM
ACTING COMMISSIONER STREUR summarized that "15 percent of the
population consumes 75 percent or 85 percent of the health care
dollar." He pointed to the necessity for enhanced management of
high health needs. He assessed the next major priority to be a
sustainable long term care delivery system, and identified its
strategies: identify and coordinate health and welfare need,
promote a service array that meets the needs of underserved who
require long term care services, and develop an integrated and
comprehensive model of care.
3:21:29 PM
ACTING COMMISSIONER STREUR presented the final priority,
vulnerable Alaskans, and the need to provide protective
services, which included the promotion of domestic violence and
sexual assault programs, and suicide prevention programs. He
updated the Bring the Kids Home initiative, sharing that
although 90 kids were still out of state, this was down from
more than 400 kids.
3:23:20 PM
REPRESENTATIVE CISSNA asked if there was a means for the public
to track the Bring the Kids Home program.
3:24:34 PM
ACTING COMMISSIONER STREUR replied that he would research this,
but he did not know of any website to track this.
3:24:49 PM
CHAIR KELLER clarified that the goal for the Bring the Kids Home
program was not to bring all the kids home, as there were some
needs that could not be addressed in Alaska.
3:25:27 PM
REPRESENTATIVE HERRON asked if the bed capacity had been
increased at the Fairbanks Boys and Girls Home of Alaska.
ACTING COMMISSIONER STREUR replied that he would forward that
information.
3:26:12 PM
ACTING COMMISSIONER STREUR concluded his discussion of major
strategies for Vulnerable Alaskans. He reported that expansion
of the Family First Initiative would help families leave the
public assistance rolls.
3:26:55 PM
CHAIR KELLER expressed his appreciation for the emphasis on
"individual and family responsibility and engagement, and
community engagement."
3:27:47 PM
ACTING COMMISSIONER STREUR, referring to the PowerPoint entitled
"2011 Alaska Department of Health and Social Services Overview,"
[Included in members' packets] explained the Alaska Department
of Health and Social Services Organization Chart (slide 1). He
shared that DHSS was a "super agency at the national level" as
it included full health and social services within eight
divisions. He reported that DHSS employed 3690 people, and had
a budget of $2.445 billion. He continued with slide 2, "Budget
Highlights," explained the distribution of the money, and
directed attention to Medicaid as the largest recipient, $1.513
billion.
3:29:41 PM
REPRESENTATIVE HERRON praised the federal performance bonus that
DHSS had received.
ACTING COMMISSIONER STREUR confirmed that a $4.4 million
performance bonus had been received for the Denali Kid Care
program.
3:30:38 PM
CHAIR KELLER communicated his appreciation for DHSS.
3:31:10 PM
ALISON ELGEE, Assistant Commissioner, Central Office, Finance
and Management Services, Department of Health and Social
Services, referring to the FY 2012 budget overview documents and
the FY 2011 operating grants book, [distributed earlier to the
HHSS members] shared that each of these documents contained "a
wealth of information."
3:32:41 PM
CHAIR KELLER directed attention to the details in the operating
grants book which were reflected in just a few lines of the
budget.
MS. ELGEE relayed that grants accounted for more than $160
million to the division programs.
3:33:16 PM
REPRESENTATIVE CISSNA asked if there were any reference to
former grant levels, in order to compare to current
distributions.
MS. ELGEE, in response, said that although that information was
not included in this publication, it was possible for a year to
year comparison of program areas. She noted that the
availability of grant funding had remained "relatively steady."
REPRESENTATIVE CISSNA asked for a nationwide comparison.
3:34:59 PM
MS. ELGEE, pointing to slide 3, "Alaska Pioneer Homes,"
recounted that there were 5 Pioneer Homes, with 508 licensed
assisted living beds, located in Anchorage, Fairbanks, Juneau,
Ketchikan, and Sitka. In addition, there was the Palmer State
Veterans and Pioneer Home. She explained the eligibility for
admission: 65 years of age and an Alaska resident for the year
prior. She recounted that there were both active and inactive
wait lists, depending on your immediate need. She confirmed
that 500 people were currently on the active wait list for the
508 beds. She listed the range of fees, $2135/month to
$6170/month, depending on the level of service. She identified
that the Palmer Home had a federal obligation for veteran
preference. She disclosed that financial information was not a
criterion for admission, and there was aid to look at payment
assistance which could include Medicaid waivers, state payment
assistance programs, and veterans' assistance.
3:40:19 PM
MS. ELGEE shared that in 1995, 63 percent of residents needed
the highest level of care, whereas today 88 percent required
this same level of care. She explained that a result of
progressive dementia could include a period of assaultive
behavior. She reported on the financial difficulty for
maintaining higher levels of staffing.
3:42:00 PM
REPRESENTATIVE HERRON asked if the staffing ratio was one
employee per resident.
MS. ELGEE agreed that this ratio reflected total staffing, but
she clarified that this was not possible for a 24 hour day/ 7
day week (24/7) coverage.
REPRESENTATIVE HERRON asked about the schedule for patient
transfers between facilities in order to maintain their level of
care.
3:43:06 PM
CHAIR KELLER asked about the availability of nursing beds
throughout Alaska.
MS. ELGEE, in response, said that 700 nursing home beds were
available in assisted living homes. She confirmed that 3500
patients had long term care waivers, though some of these
patients were still in their homes.
CHAIR KELLER asked about the coordination of care between
nursing homes and the Pioneer Homes.
3:44:26 PM
DAVE COTE, Director, Central Office, Division of Alaska Pioneer
Homes, in response to a question by Representative Herron, said
that should Pioneer Home patients need nursing home care, it
became necessary for them to move to a nursing home. He
acknowledged that the Pioneer Home level of care only went to
Level 3.
CHAIR KELLER asked to define the levels of care.
MR. COTE explained that level 3 patients needed 24 hour care,
and that the Pioneer Homes were not licensed as a nursing home.
REPRESENTATIVE HERRON asked if the medication error rate in
Pioneer Homes had decreased, and if the Medicaid administered
rate had increased over the prior year.
MR. COTE replied that the medication error rate was stable, and
that the volume of medication was about 550,000 doses quarterly.
3:46:39 PM
REPRESENTATIVE SEATON asked if the issue surrounding veterans'
medication packaging had been resolved.
MR. COTE replied that the Veterans Administration (VA)
medications were being directly administered by nurses.
3:47:38 PM
MS. ELGEE addressed slide 4, "Behavioral Health," and reported
that the Division of Behavioral Health had 334 full time
employees. She noted that 240 of the staff worked at Alaska
Psychiatric Institute (API) in a 24/7 operating environment.
She relayed that the majority of its work was done in
partnership with communities and non-profit agencies throughout
Alaska, and it had served almost 19,000 people in 2010. She
established that program performance standards were built into
the grant review process. She reported that the Alaska Mental
Health Board, the Alcohol and Substance Abuse Advisory Board,
and the Suicide Prevention Council were all administered by the
Division of Behavioral Health. She pointed out that patients
were often referred to API, where alternative treatments at the
community level would be more appropriate.
3:51:27 PM
REPRESENTATIVE SEATON asked if the earlier problems with
mandatory overtime and staffing at API had been resolved.
MS. ELGEE replied that reports regarding the use of mandatory
overtime were being prepared, and would include both API and the
Pioneer Homes. She stressed that the department worked hard to
avoid mandatory overtime, or unplanned overtime. She pointed
out the difference with scheduled overtime, noting that the
employees participated in the scheduling.
REPRESENTATIVE SEATON expressed his concern for patient safety,
regardless of the type of overtime.
MS. ELGEE agreed that nurses should not work more than 14 hours
each day.
3:54:32 PM
REPRESENTATIVE CISSNA expressed appreciation for the ongoing
efforts from the Division of Behavioral Health. She asked about
the availability of community health care jobs for recent
graduates.
MELISSA WITZLER-STONE, Director, Central Office, Division of
Behavioral Health, in response to an earlier question by
Representative Herron, said that the Fairbanks Boys and Girls
Home had 60 beds, of which 56 were currently occupied. She
added that 44 of the patients were Level 5 and 16 were Level 3.
3:57:38 PM
CHAIR KELLER asked if API care was both in-patient and out-
patient.
MS. STONE replied that there was only in-patient care, and there
were 80 beds.
3:58:09 PM
REPRESENTATIVE DICK questioned whether expansion to 120 beds
would also result in full occupancy.
MS. STONE replied that it was most important to maintain
appropriate admission decisions, and that before expansion, it
was necessary to ensure that the system was working as
efficiently and effectively as possible.
REPRESENTATIVE DICK reflected that ten years ago, people needed
service that was not available.
3:59:42 PM
REPRESENTATIVE SEATON asked about a program for intermediate
stays.
MS. STONE clarified that Representative Seaton had referred to
the designated emergency stabilization and treatment option.
She pointed out that there was a recent focus to keep people at
the local community care level, and there was now a statewide
effort to make it work effectively.
4:01:23 PM
MS. ELGEE referred to slide 5, "Office of Children's Services,"
and introduced its Acting Director, Christy Lawton. She stated
that Office of Children's Services (OCS) had 499 full time
staff, organized in 5 regions with 26 field offices. She
announced that the primary purpose of OCS was to provide
protective services to children at risk of harm. She pointed
out that OCS also managed the grants for the Infant Learning
Program. These grants provide early childhood special education
services to children with developmental delays. She observed
that OCS provided grant funding to 9 child advocacy centers.
She said that "the division provides a multitude of family
support and family preservation services to improve the success
of families in caring for children who otherwise might be at
risk of removal." Its first effort was to maintain intact
families, where at all possible, and provide direct family
services to enable this. She affirmed that OCS was subject to
periodic review by its federal partners, as measured against
federal statistics for performance and improvement standards.
She shared that the biggest challenge was to maintain an
experienced staff, as this was a high stress environment. She
pointed to an earlier survey of OCS staff which indicated that
60 percent of frontline social workers were in position for less
than 2 years. She reported on the realignment of OCS resources
to create the Western Region, a result of suggestions from the
Citizens Advisory Review Panel, the court system, and the
legislative delegation. She acknowledged that the Wasilla
office for the Southcentral region had experienced an increased
caseload, so this separate region allowed for a more direct
management. She noted that the rural offices still experienced
difficulty in hiring experienced staff.
4:05:54 PM
REPRESENTATIVE HERRON asked if the Citizens Advisory Review
Panel would be making a presentation to the House Health and
Social Services Standing Committee.
CHAIR KELLER, referring to the DHSS organization chart, declared
that it would allow for the committee to better understand the
relationship of each division and committee. In response to
Representative Herron, he said that the panel would make a
presentation on a still to be determined date.
REPRESENTATIVE CISSNA reflected on the need for foster care, as
it was an "ongoing chronic problem." She observed that the
safest place for a child was in their own home. She requested
regular updates on the foster care program to help ensure "that
these kids are getting the kind of care that gives them a better
future."
4:12:30 PM
CHRISTY LAWTON, Acting Director, Central Office, Office of
Children's Services, Department of Health and Social Services,
in response to Representative Cissna, offered to provide data on
a regular basis. She agreed that kids should be in their own
home, and that the OCS emphasis was to do so, whenever it was
safe.
4:13:37 PM
MS. ELGEE, directing attention to slide 6, "Public Health,"
declared that there were 507 full time staff. She listed the
various operations to include public health nursing, vital
statistics, public health labs, infectious disease information,
licensing for health facilities, and the State Medical
Examiner's office. She added that the division administered the
statewide emergency services programs.
4:15:55 PM
REPRESENTATIVE HERRON summarized an incident in Bethel with the
office of the State Medical Examiner, and he asked to discuss
the possibility of a policy change for rural Alaska.
DR. WARD HURLBURT, Director and Chief Medical Officer, Central
Office, Division of Public Health, Department of Health and
Social Services, agreed to work on that. He discussed the
reasons for the policy, and he opined that during these times of
grief there could be miscommunications.
REPRESENTATIVE HERRON emphasized that this was an important
issue for his constituency.
4:19:50 PM
REPRESENTATIVE SEATON asked if the state's decision to no longer
offer flu shots for adults indicated a shift away from
preventative health.
DR. HURLBURT explained that efforts by the late Senator Ted
Stevens had resulted in Alaska consistently receiving extra
federal funding for immunizations. He pointed out that Alaska
now received less funding, but still maintained vaccinations for
children. He indicated that there was still an effort to
maintain vaccinations for people over 65 years of age.
4:22:26 PM
REPRESENTATIVE SEATON reported on his research about Vitamin D,
and stated his desire to work with DHSS on the use of Vitamin D
for preventative health.
CHAIR KELLER pointed out that Dr. Hurlburt was also Chair of the
Alaska Health Commission, which would present an annual report
to HHSS. He stated his respect and appreciation for the
expertise and leadership skills of Dr. Hurlburt.
4:25:01 PM
REPRESENTATIVE CISSNA, referencing the Alaska State
Constitution, said that "the legislature shall provide promotion
and protection of public health." She pointed out that the
Division of Public Health was responsible for fulfilling this
constitutional mandate. She asked Dr. Hurlburt to elaborate on
the preventative aspect.
4:26:19 PM
DR. HURLBURT agreed that public health and prevention efforts
were important. He affirmed that all Alaskans were patients of
the Division of Public Health, and although it did not receive
the glamour "of the high tech stuff," prevention was important.
He detailed that although some infectious diseases were still a
problem, the chronic diseases, especially tobacco, were the
problem now. He pointed to the progress being made for all age
groups toward cessation of tobacco use. He credited Governor
Parnell, who as a legislator had been instrumental in using the
tobacco settlement money for tobacco education. He referenced
the Center for Disease Control and Prevention (CDC) report which
stated that Alaska was the number one state in funding for anti
tobacco efforts. He offered his belief that now the biggest
public health challenge was the complications from obesity and
overweight, as this was approaching the same number of premature
deaths as tobacco. He referred to a CDC study which estimated
that 33 percent of the kids born in the last decade were at high
risk of developing diabetes, compared to a current rate of 6 - 8
percent of adults. He stressed that the economic impact would
be "unfathomable" and he emphasized the importance for a change
to the culture.
4:30:08 PM
The committee took a brief at-ease.
4:31:30 PM
CHAIR KELLER reported that the overview would continue at the
next HHSS meeting.
4:32:24 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:32 p.m.
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