Legislature(2021 - 2022)BY TELECONFERENCE
02/25/2021 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Executive Order 119 - Dhss Reorganization | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
HOUSE HEALTH 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
Reorganization.
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
provided]:
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,
2003).
? 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
program.
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
provided]:
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
provided]:
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
Revenue.
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
department.
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
Programs/Services
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
programs.
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
provided]:
Challenges
?Division of Public Assistance Backlog
?Alaska Psychiatric Institute
?Office of Children's Services
?COVID-19 Public Health Emergency
?IT/Network Systems
Opportunities
?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
Judiciary
Legislature
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
Alaskans
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
1.Innovation
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
department.
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
Difference
FY2021 Management Plan +
Supplementals to
FY2022 Governor's
Amended
UGF ($12,606.0)
Total ($32,504.8)
Full Time Positions
(139)
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
checks.
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
budget.
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
it.
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
workload.
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
department.
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
Alaskans.
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
committee.
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
reductions.
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
committee.
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
ADJOURNMENT
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 |