Legislature(1999 - 2000)
01/27/2000 09:07 AM Senate FIN
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SENATE FINANCE COMMITTEE LOG NOTES 01/27/00 General Subject(s): Review of Department's Accomplishments For FY'99 and FY'00 Department of Health and Social Services The following overview was taken in log note format. Tapes and handouts will be on file with the Senate Finance Committee through the 21st Legislative Session, contact 465-4935. After the 21st Legislative session they will be available through the Legislative Library at 465-3808. Time Meeting Convened: 9:07 a.m. Tape(s): SFC-00 # 14, Side A & B PRESENT: Senator Parnell Senator Adams Senator Torgerson Senator P. Kelly Senator Donley Senator Green Senator Leman Senator Phillips NOT PRESENT: Senator Wilken ALSO PRESENT: KAREN PERDUE, COMMISSIONER, DEPARTMENT OF HEALTH & SOCIAL SERVICES LOREN JONES, DIRECTOR, DIVISION OF ALCOHOLISM & DRUG ABUSE, DEPARTMENT OF HEALTH & SOCIAL SERVICES LOG SPEAKER DISCUSSION 43 KAREN PERDUE, COMMISSIONER, HEALTH & SOCIAL SERVICES Referred to a handout entitled, "Department of Health & Social Services, Highlights." She stated that the Department has historically followed population-based outcomes. She gave a quick overview of these. Infant mortality in Alaska is down, both post-neonatal and neonatal. At one time Alaska had the highest rate of post- neonatal deaths in the nation. Alaska's teen pregnancy deaths are down by about 25 percent. 74 SENATOR DONLEY Asked how the state was doing with pre- natal as versus post-natal for all cases of death. Alaska now has state-of-the-art technology to combat these two, but he was concerned about post-natal issues. 86 COMMISSIONER PERDUE Noted that these infant mortality rates account for those after a baby is born. She added that these numbers are related to public health care, community health care, and etceteras. These numbers are not related to government programs. She explained how the department collects this data. Continued to note that juvenile crime, related to police referrals, is down significantly. Welfare dependency is down. Per capita consumption of alcohol is down, to almost a gallon per person in 20 years. The number of people being hospitalized for mental retardation is down to zero. Alaska has closed all of their institutions. Hospitalization for mental illness has diminished significantly. Listed the following numbers related to children in the State of Alaska, as up or even. Immunization rates for two-year- olds, number of children who have health insurance, health of babies being born (higher birth rate) and number of child abuse reports have leveled off within the last calendar year. 118 Senator P. Kelly Asked about the number of people being hospitalized for mental illness, whether or not this was different from the Designated Evaluation and Treatment (DET.) The need for more beds was quite evident and he thought this was due to closing Alaska Psychiatric Institute (API.) He asked if the long-term difference was due to this situation. 128 COMMISSIONER PERDUE Responded affirmatively and noted that people used to live at API indefinitely or sometimes for ten years at a stretch. This was very expensive to the state. Now, clients live in the community and use the hospital as backup for acute care. 145 SENATOR P. KELLY [Indiscernible.] 147 COMMISSIONER PERDUE Noted that the state still had a high child death rate, for those children one-year old and older. Many children die from unintentional injuries, such as drowning, firearms, fires, dog bites, etceteras. Alaska's obesity levels are growing. About 58 percent of Alaskans are overweight or obese. Added that tobacco has received quite a lot of focus as well. 173 COMMISSIONER PERDUE Remarked that the Department's mission was to promote and protect the health and well being of Alaskans. This mission is mandated by constitutional provisions, as well as statutory ones. She then outlined some of the Department's key performance measures. One of these was the amount of restitution being paid within the Division of Juvenile Justice. The Department also looked at the amount of community work service hours which, when ordered were, actually fulfilled. A benchmark for restitution was set at 79 percent and community work service at 83 percent. She noted that the actual numbers were a little higher than these benchmarks. With Legislative support, the Department is relieving facility overcrowding as well. Originally the state was at 50 percent overcrowding in juvenile facilities three years ago; presently the state is at 30 percent overcrowding. The Department has added several beds and several more are due to come on line in the near future. Noted that Alaska is one of six states in the nation with a fully accredited juvenile system, which is mandated by the American Correctional Association. Alaska received this distinction in November. 210 SENATOR DONLEY Responded that the Legislature had tried to deal with the Department's juvenile overcrowding situation, but he felt that the Department used this as a reason and platform for vastly expanding the number of other juvenile services presently offered at these facilities. Instead of maximizing the utilization of these dollars, the Department used this money as leverage to vastly expand their number of employees, rather than maximizing the number of additional beds instituted. He felt as though the Legislature had not intended on creating a state-of-the-art juvenile system, they wanted to buy as many beds possible to deal with the problem of housing juveniles. 229 COMMISSIONER PERDUE Responded that the State has six facilities and was not sure where the concern lies. She disagreed with this assessment. None of the additional staff relates to a new mission. The Department opened a cottage and they hope to expand their detention units. In the smaller communities, such as Ketchikan, because the beds are so expensive due to the limited number, the Department has tried to find other ways to bring additional community resources to help spread the cost. The Matsu community group has also worked on this issue. The money spent so far has been on facility construction and youth [indiscernible] staff. 247 SENATOR GREEN Recalled that there was a lot of discussion about changing part of the facility as an intake and evaluation, while moving cooperative agencies into this agency as well. 259 COMMISSIONER PERDUE Responded that the Department intended to move probation staff into the Matsu facility for a 24-hour intake service. This was a cost-effective measure. The accreditation process lowers the Department's liability. The Department met over 400 mandatory standards by 100 percent and in the voluntary standards by 94 percent. These relate to such dynamics as fiscal restraint, policies for training staff, etceteras. The Community Youth Court has been very valuable in lowering the number of juveniles coming into the system or those re-offenders. The "warning letter" is rapidly disappearing as a way of handling a juvenile. She knew this was a big concern for some individuals. About ten percent of their referrals are handled by "youth courts." She listed all the communities around the State where these courts exist. Moved onto discussing the Division of Family and Youth Services (DYFS.) The mission for this Division is to "protect children who are abused and neglected or at risk of abuse and neglect." She stated that the Division set a goal of 90 percent response rate for legitimate calls. Some months they meet this goal. In some areas, the Division was doing much worse, especially in the Matsu. There the Division responded to about half the calls. Since then, the Division has contracted with a local community group, which has enabled them to respond to almost all the calls there. This community group responds to the lower level reports. 303 SENATOR PHILLIPS Asked what the Division's heaviest month was for the year. 305 COMMISSIONER PERDUE Responded October and November. 306 SENATOR PHILLIPS Noted that this was "dividend time." After discussing this issue with DYFS, it was determined that during the month of August the Division responded to ten cases, as versus the month of October when this number rose to 71 for child abuse. 313 COMMISSIONER PERDUE Responded that this is also when school starts, children who are in dangerous situations, come to the attention of many adults. Most of these cases are due alcohol and drug use. 326 SENATOR P. KELLY Referred to the Department's detail books regarding a million-dollar figure to reduce their social worker vacancy factor to two. 336 COMMISSIONER PERDUE Stated that this figure was related to about 20 people. She then discussed workforce issues, such as a problem with turnover, training and morale. The Department now trains their employees before they take on a caseload. The training academy in Anchorage has been very successful. The Department is down to their budgeted vacancy. If a direct line social worker quit, the Department could not hire another person because they are at their budgeted vacancy, which is seven percent. Noted that safety is still an issue with the Department's workers. They have been required to install a metal detector in the office due to several death threats. These issues are escalating and the Commissioner gave examples as such. Noted those safety measures, which she would like to put in place. 358 SENATOR P. KELLY Noted that one of the problems the Department had last year was not providing adequate training. He asked if she had seen an impact in the Department's turn over rate. 362 COMMISSIONER PERDUE Responded that this turnover has dramatically lowered. One of other points that the new law covered, specifically in regards to audits, children in custody for the longest period of time needed to be moved into permanent homes. The Department put a lot of effort into their adoption services. The Department found that six hundred Alaskan children had been in custody for long periods of time, on average, over three years. Two-thirds of this population have either been adopted or placed in guardianships, as well as back into their homes. The Department's partnership with Catholic Social Services to do home studies and for recruiting Foster parents and adoptive parents has been very successful. Adoptions are increasing. The Department launched a "future campaign" to recruit Foster parents and has signed up about 200 families. Safety is still an issue in Foster care. More than one thousand Alaskan children are in Foster care. The Department is supposed to check on these children once a month. Ninety-five to ninety-nine percent of the Foster parents are wonderful, but there is a small percentage that is not. There was another death in Foster care this year. Outlined an example of a Foster parent who is ready to adopt, but then they are arrested for a felony, not related to a child safety issue. Alaskan law does not allow a felon to become a Foster parent. 407 SENATOR P. KELLY Asked how many Foster parents there were in Alaska. 412 COMMISSIONER PERDUE Responded 1,200. 416 SENATOR P. KELLY Asked if the incident of domestic violence and felony indictments was higher in this population than the general population. 418 COMMISSIONER PERDUE Stated that she doubted this was the case. 425 SENATOR P. KELLY Asked if it cost $31 a day for Foster care. 427 COMMISSIONER PERDUE Responded that $34 a day was the average. 439 COMMISSIONER PERDUE Noted that the state's subsidized adoption program has been very effective in recruiting adoptive parents and that it was a much cheaper program to support. The Department has been working to improve residential care, both the quality and availability. This system is essential to support those Foster children that are unruly for a period of time. In response to a question posed by Senator P. Kelly regarding whether the Department had taken a $2.36 rollback for Foster parents, Commissioner Perdue stated that the Department had not, but that a supplemental was in place. The Department meets with the public defender and OPA to help streamline adoption cases. She then referred to an audit suggestion regarding a risk assessment tool, which the Department was asked to fix. Stated that the Department's public health mission was to "preserve and promote the state's public health." She noted that the Division has been working very hard on immunization rates for two-year-olds since in the past their related performance was very poor. Alaska is now twenty-second in the nation from forty-eight. Their full goal for this project is ninety percent. Noted that the Department's goal regarding smokeless tobacco was to decrease youth smoking by ten percent. The Department is having a hard time compiling this data to see how well their efforts are being received. Their data shows a decline in middle school use, which probably means that these children have never smoked before. Outlined highlights in public health. Child deaths are a very large concern for the Department. The medical examiner now autopsies every suspicious child death in the state. The Department wants to verify the causes of a child's death, whether by SIDS or otherwise. The Department's "Back to Sleep," campaign (promoting that infants sleep on their backs) for the prevention of SIDS is a direct outgrowth of this work. 477 CO-CHAIR PARNELL Asked how many children comprised the five hundred numbers of deaths investigated by the Crime each year. 481 COMMISSIONER PERDUE Estimated 80 to 90 of these are children. These numbers have held steady over the years. What the Department has learned through their work with the Troopers, the District Attorney and the medical professionals, is that their analyzation of children's death are improving. The Department has determined that fewer, younger children are dying of natural causes and more are dying of suspicious causes. 488 CO-CHAIR PARNELL Asked what percent of the 80 child deaths are suspicious. 489 COMMISSIONER PERDUE Estimated that probably 20 to 30 of these children die of suspicious causes. Child death's are very labor intensive for criminal prosecution since there are no witnesses and a special sensitivity must be fostered with parents. This is a very rough time. She also noted that suicide was a very serious issue for the Department. She noted one young man that died by unknown causes and as a result of toxicology testing, it was determined that he overdosed on a prescribed medication for seasickness. Through research it was discovered that there had been a "run" on this drug in the state and hence, pharmacists were able to control the amount of its circulation. 502 CO-CHAIR PARNELL Asked how many of the 80 children that die, do so as a result of suicide. 503 COMMISSIONER PERDUE Responded that she did not presently have these figures, but would provide them to the Committee. Continued that Denali Kid Care was doing well. The parents are happy with the streamlining of the Department's application process. The Department is finding that as claims come in, the per unit state cost of yearly coverage is somewhere between $500 to $700. 510 CO-CHAIR PARNELL Inquired as to whether any studies have been conducted to see if individuals have dropped their private sector insurance [indiscernible] that time period when they could come on with Denali Kid Care. 512 COMMISSIONER PERDUE Responded affirmatively and added that the Department was still analyzing the results. The Commissioner's preliminary impression of these results is that 1.5 percent of the individuals who had coverage within the last year, prior to signing up for Denali Kid Care, (something which their regulations prohibit) were either engaged in fraud or that there was some errors in their sampling. 518 CO-CHAIR PARNELL Asked if they checked the labor rolls to see if any individual had been paid any wages within the last year. 519 COMMISSIONER PERDUE Noted that the Department did have some processes in place within eligibility. 521 SENATOR GREEN Asked about the role that the federal government played in this program during the first, second and third year. She wondered if their participation would eventually decline. 524 COMMISSIONER PERDUE Responded that the program was authorized for five years at the same participation level. It is due to be re-authorized in Congress. This program was a joint bipartisan arrangement initiated by Senators Kennedy and Hatch. The Commissioner assessed that the states would not be able to pick up the 75 percent, which the federal government presently pays. 532 SENATOR GREEN Asked if someone in the Department developed the language included in their brochure, or was it language that the federal government created. More specifically, she asked if the Department had changed its view regarding the definition of life. In regards to a family head count, according to this brochure, the unborn child of a pregnant mother is included. 538 COMMISSIONER PERDUE Responded that this was federal language and reminded the Committee that the Denali Kid Care expands to cover pregnant mothers as well. 540 SENATOR GREEN Stated that she wished to know why an unborn child would be included in a family head count, when this same unborn child is not recognized as "a life" for other purposes. 543 SENATOR P. KELLY Asked that if someone is on Medicaid, whether or not this person's child would simultaneously be on Denali Kid Care. 548 COMMISSIONER PERDUE Answered that Denali Kid Care is a subgroup of Medicaid kids. The reason why it is called something different is because the application process is streamlined. The Department assumes that these individuals are not getting public assistance, but just taking part in health insurance for their children. 552 SENATOR P. KELLY Asked if the population of children signed up for Kid Care does not necessarily represent an increase of persons receiving funds for medical care. He wondered if these numbers of children could be considered new clients instead. 557 COMMISSIONER PERDUE Responded affirmatively. She stated that there are roughly 12,000 new children, some of them are above the eligibility that the state signed them up for and some of them simply are outreach children who have been signed up as new clients. This program is dependent on the income level of the family. 560 SENATOR P. KELLY Asked how the Department was designating these children before if their parent was on Medicaid and the family was receiving services under this latter program. These children would have essentially moved off of Medicaid to Kid Care. 565 COMMISSIONER PERDUE Noted that the Department has signed up an additional 12,000 children in excess of those numbers previously outlined by Senator P. Kelly. She added that if the state was to change the Denali Kid Care Program, they would lose about half of these children, because of the eligibility numbers. As more people get off of welfare, the state has lost 4,000 families. The state is not paying medical coverage for the adults anymore, but only for the children. Right now there are about six or seven thousand children that are above the new income levels, along with 800 pregnant women, with an additional 6,000 children in the zero to 125% range of eligibility. 577 COMMISSIONER PERDUE Continued that Alaska has one of the best Emergency Medical Services (EMS) in the nation. There are about 4,000 both Emergency Medical Technicians (EMT) and EMS workers around the state, 75 percent of them who are volunteers. The National Highway Traffic Safety conducted a review of Alaska's EMS system. Feedback was excellent, but Ms. Perdue stated that the system is a little frayed around the edges with making sure volunteers and equipment is supported. The Department is trying to mitigate a high rate of turnover for volunteers. She then outlined the ways in which the state is segregated in regions for administrative purposes related to the EMS system. 590 SENATOR P. KELLY Asked if the Department researched other ways in which volunteers could be compensated instead of money, such as issuing hunting licenses for free. 595 COMMISSIONER PERDUE Responded that they had not researched this, but thought it would be a welcome recognition. 598 SENATOR LEMAN Asked about the Traffic Safety Review, and wondered if it made any mention of changes in statutes that they originally thought were archaic. 603 COMMISSIONER PERDUE Responded that she did not have this in her notes, but would provide the report to Senator Leman. She then shared numbers and anecdotes about run-down ambulances and equipment that exists statewide. 621 COMMISSIONER PERDUE Outlined that the new public health lab in Anchorage will be opening next December. The Kenai Health Center is in design as a partnership between the local community and the Department. She then offered some information about cervical and breast cancer screenings. 625 SIDE B, 9:55 AM 620 COMMISSIONER PERDUE Added that the Department has made sure to procure federal money to ensure that women over fifty, without access to insurance, can get mammograms. She then made mention of "Healthy Alaskans." The Surgeon General establishes specific outcomes and targets regarding health issues. She referred to a map in a handout entitled, "Prevalence of Obesity among U.S. Adults," and gave a synopsis of how Alaska rates nationwide for obesity. Stated that one of the measures of the Division of Mental Health and Developmental Disabilities was to look at the number of publicly funded psychiatric days. The Department set a benchmark of 13 days, use per person, which are publicly funded. The Department has seen a decline in the first half of 1999 by one full day. This relates to the amount of time people spend in a hospital, such as API. For this particular hospital, there are 28 percent more admissions for this facility, but the length of stay is much lower. She then gave a run down of more specific departmental mental health issues for consideration, including a comprehensive integrated mental health plan. About developmental disabilities, the Department was able to serve everyone on the waiting list, those, which had some need to attend to. The Department was able to take 400 people off this list. Noted that although Alaska still has a very serious alcohol problem, the state is making progress in consumption patterns. The Department has spent quite a lot of time on federally funded research designed to determine the prevalence, severity and need for alcohol treatment, including the state's effectiveness of treatment. 560 LOREN JONES, COMMUNITY MENTAL HEALTH SERVICES API 2000 PROJECT DIRECTOR, DEPARTMENT OF HEALTH & SOCIAL SERVICES Stated that the Department has conducted a lot of research regarding prevalence and outcomes. The Department conducted a survey of thirteen of their programs and followed up on about 1500 clients who had been in treatment. The clients were interviewed after six and 12 months of finishing treatment. About 56 percent of these clients in outpatient care, abstained for a full year after treatment. For residential programs, this was true for about 42 percent. He noted that there was some improvement with hospitalization. 36 percent of residential clients were hospitalized one year prior to treatment and only 15 percent were hospitalized a year after treatment. The same type of decrease for outpatient clients took place as well. The Department saw general improvement with employment, legal, health, and social issues that substance abuse can raise in a year prior to and after treatment. These research results were in line with national, state and private sector programs. Reviewed the Alaska Safety Action Program (ASAP), which serves misdemeanant DWI offenders and misdemeanant alcohol offenders. 66 percent of the misdemeanants that entered ASAP, did not commit a re- offense three years subsequent to this program. Gave an overview of how the Department conducted their research. About 35 percent of clients do re-offend and the Department was given good recommendations on how to improve their services. Other research was conducted on prevalence and need, but noted that the Committee could review this information in the report entitled, "A Summary of Recent Findings Regarding Substance Abuse in Alaska." 547 CO-CHAIR PARNELL Asked about minimum outcomes from the grantees as being part of the Department's contract. 545 MR. JONES Responded that an audit was completed in December of last year. The Department included in their RFP minimum outcomes as the required reporting for all the providers. He then went into greater detail about how they conducted the procedures for making the recommended audit suggestions. 512 CO-CHAIR PARNELL Asked how many internal employees helped to oversee the necessary changes to Department procedure. 511 MR. JONES Responded that a staff of four in Anchorage dealt primarily with the treatment programs. There is one staff in Juneau who deals primarily with the prevention programs. He noted that they have over 120 grantees. Responded to a question posed by Senator Green about tracking the number of clients, which the Department serves, what the funding was during a period of time, and how this has changed to help account for how money is ultimately spent. Senator Green referred to a particular letter drafted by a grantee in regards to funding cuts for alcohol programs. Mr. Jones responded that the client caseload from 1992 to 1998 had grown by 90 percent. But, in these same years, the cost per client decreased by 46 percent, from a high of $4300 per client to a low in 1998, at $2300 per client. He then went into specific detail of how these dollars were spent. 500 CO-CHAIR PARNELL Noted that he would like to follow up on the grantees to make sure that there are consequences for not meeting minimum outcomes. 454 COMMISSIONER PERDUE Referred to two other documents provided to the Committee. The first is entitled, "Results Within Our Reach, Alaska State Plan for Alcohol and Drug Abuse Services, 1999-2003" and the second, "Fetal Alcohol Syndrome, Alaska's #1 Preventable Birth Defect." The Department intends to begin work in the classroom for the teachers regarding Fetal Alcohol Syndrome as a preventative measure. She noted that there is a lot of debate about prognosis of Fetal Alcohol Syndrome. She went into detail about why this is so. The Department intends to work with high-risk women more readily, as part of their full-scale effort to work on this issue. Noted medical assistance and the outcome measure agreed upon, which is the percent of providers enrolled and participating in the Department's program. Over time the Department will look for a possible trend of providers leaving the program and what that would mean in terms of [indiscernible.] She noted that dental was a big issue. The state has many providers who refuse to take Medicaid patients. She then explained why this was so. 414 CO-CHAIR PARNELL Adjourned the meeting at 10:30 am. SENATE FINANCE COMMITTEE LOG NOTES01/27/00 Page 1
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