Legislature(2019 - 2020)SENATE FINANCE 532
03/16/2020 09:00 AM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB134 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 134 | TELECONFERENCED | |
SENATE FINANCE COMMITTEE
March 16, 2020
9:05 a.m.
9:05:14 AM
CALL TO ORDER
Co-Chair von Imhof called the Senate Finance Committee
meeting to order at 9:05 a.m.
MEMBERS PRESENT
Senator Natasha von Imhof, Co-Chair
Senator Bert Stedman, Co-Chair
Senator Click Bishop
Senator Lyman Hoffman
Senator Donny Olson
Senator Bill Wielechowski
Senator David Wilson
MEMBERS ABSENT
None
ALSO PRESENT
Senator David Wilson, Sponsor; Gary Zepp, Staff, Senator
David Wilson.
PRESENT VIA TELECONFERENCE
Albert Wall, Deputy Commissioner, Department of Health and
Social Services; Jared Kosin, President and CEO, Alaska
State Hospital and Nursing Home Association, Anchorage; Jon
Zasada, Policy Director, Alaska Primary Care Association,
Hope; Jocelyn Pemberton, CEO, Alaska Hospitalist Group,
Anchorage; Prentiss Pemberton, Counseling Solutions of
Alaska, Anchorage; Jennifer Morton, Licensed Professional
Counselor, Nome; Vikki Jo Kennedy, Self, Juneau; Laura
Porter, Self, Palmer.
SUMMARY
SB 134 MEDICAID COVERAGE OF LIC. COUNSELORS
SB 134 was HEARD and HELD in committee for
further consideration.
SENATE BILL NO. 134
"An Act relating to medical assistance reimbursement
for the services of licensed professional counselors;
and providing for an effective date."
9:05:44 AM
Co-Chair von Imhof discussed housekeeping and read the
title of the bill.
9:06:12 AM
SENATOR DAVID WILSON, SPONSOR, read from the sponsor
statement (copy on file):
"An Act relating to medical assistance reimbursement
for the services of licensed professional counselors;
and providing for an effective date."
If enacted, SB 134 would add licensed professional
counselors to the list of independent licensed
practitioners to address the shortage of Medicaid-
eligible behavioral health providers in the state,
afford more options for beneficiaries, and increase
access to behavioral health care.
Currently, licensed professional counselors (LPCs) are
only allowed to provide services in community health
clinics or physician mental health clinics, which
limits the number of willing providers. SB 134 expands
medical assistance reimbursement services to cover
those services provided directly/independently by
LPCs.
Specifically, SB 134:
? Adds Professional Counseling services to the list of
Medicaid optional services under AS
47.07.030(b);
? Defines Professional Counseling services and
licensing under AS 08.29;
? Authorizes Professional Counselor services as
eligible to render and bill for Medicaid funded
services as independent practitioners under Alaska
Statute 47.07.030 (b).
? Requests the Department of Health & Social Services
to amend the state plan for medical assistance
coverage under Title XIX of the Social Security Act;
We respectfully encourage your support of Senate Bill
134.
9:08:03 AM
AT EASE
9:11:45 AM
RECONVENED
GARY ZEPP, STAFF, SENATOR DAVID WILSON, discussed the
presentation "SB 134" (copy on file). He commented that the
bill concept was to add additional capacity and utilization
of behavioral healthcare in a clinical setting versus a
state of crisis in emergency rooms throughout the state.
The expansion of healthcare was projected to reduce wait
times and improve quality of care by providing the
appropriate care by the appropriate healthcare
professional. He related that the cost would be less than
the behavioral healthcare in emergency rooms across the
state. He said that conversations with stakeholders had
revealed problems with wait times for services like alcohol
and drug abuse, suicide and depression, trauma from
violence and serious mental illness; wait times for these
issues averaged 3 to 6 months for Medicaid clients. The
wait times were due to a workforce shortage of behavioral
health professionals available to receive Medicaid clients.
He thought that examples of the behavioral healthcare
shortage could be witnessed in the daily lives of
communities throughout the state.
9:13:18 AM
Mr. Zepp looked at Slide 2, "SB 134":
"An Act relating to medical assistance reimbursement
for the services of licensed professional counselors;
and providing for an effective date."
SB 134 would add 717 Licensed Professional Counselors
to the Medicaid Optional Services. The concept of the
bill is to expand behavioral health capacity and
utilization for Alaska's most vulnerable population,
our Medicaid population. If behavioral health issues
can be treated in a preventative manner within a
clinical setting, rather than a crisis stage at a
platinum level, the costs lesson and the quality of
the healthcare services improves. This proposed
legislation is a piece of the puzzle for providing
behavioral health services to Alaskans.
his would provide the "appropriate care with the
appropriate provider."
Mr. Zepp said that licensed, professional counselors were a
valuable, cost effective, part of treatment for behavioral
healthcare. He stated that the legislation was a piece of
the behavioral healthcare puzzle that already included
licensed social workers, PHD psychologists, prescribing
nurse practitioners, marital and family therapists, and
medical doctors like psychiatrists and primary care
physicians. He relayed that there were approximately 717,
licensed, professional counselors currently in the state.
9:13:55 AM
Mr. Zepp spoke to Slide 3, " Behavioral Health":
Behavioral health is the scientific study of the
emotions, behaviors, and biology relating to a
person's mental well-being, their ability to function
in everyday life, and their concept of self.
"Behavioral health" is the preferred term to "mental
health." A person struggling with his or her
behavioral health may face stress, depression,
anxiety, relationship problems, grief, addiction,
attention deficit/hyperactivity disorder or learning
disabilities, mood disorders, or other psychological
concerns.
Counselors, therapists, life coaches, psychologists,
nurse practitioners, or physicians can help manage
behavioral health concerns with treatments such as
therapy counseling or medication.
Mr. Zepp related that the term mental health covered many
of the same issues as behavioral health but only covered
the biological component of the aspect of wellness.
9:14:47 AM
Mr. Zepp referenced Slide 4, " Why Medicaid clients and who
are they?":
Medicaid provides health coverage and long-term care
services for Alaska's most vulnerable: children,
seniors, people with disabilities, pregnant women, and
very low income or working poor.
Medicaid clients have difficulties finding access to
behavioral healthcare and often have to wait three to
six months for appointments. So you can imagine a
person in crisis who cannot find behavioral healthcare
access or are told it's available in three to four
months, what are their options?
Alaska's emergency room facilities are in a crisis
mode treating behavioral health issues.
Mr. Zepp stressed that the legislation would directly
impact the lives of the states most vulnerable population
of citizens: the poor, the young, and seniors. He lamented
that Alaskas emergency rooms had been overwhelmed with
volumes of Medicaid clients in emergency situations and in
need of behavioral health. He shared that leading cause of
emergency room visits were related to alcohol related
disorders and the associated ailments of alcohol abuse. He
furthered that often Medicaid clients had nowhere else to
go because of the lack of access and the lack of capacity,
which caused two problems; patients stay longer in hospital
than they should and if a Medicaid client is in a stage of
crisis without access to the appropriate care they leave
the facility and the cycle repeats itself.
9:16:24 AM
Co-Chair von Imhof noted that Mr. Zepp had brought up
Medicaid because of the recent 115 waiver and the need to
expand access to health insurance for that particular
population. She asked if Mr. Zepp could comment on private
insurers and whether the population had access to a wider
pool of providers.
Mr. Zepp did not know specifics of coverage by private
insurance for behavioral health. He said he could provide
the information to the committee.
Mr. Zepp thought the General Government Bargaining Unit had
an employee assistance program that covered counselling and
other various services.
9:17:29 AM
Senator Wilson thought one of the invited testifiers could
answer the question. He thought generally private insurers
covered 10 weeks of behavioral health therapy but the it
had to be pre-approved, depending on the provider. He said
that health insurance for state employees covered
behavioral health services.
9:18:07 AM
Mr. Zepp turned to Slide 5, "Adult Untreated Behavior
Health Statistics," which showed a flow chart of statistics
related to adult behavioral health:
• In 2017, of the 56.8 million adults ages 18 or older
with a behavioral health condition about 39.7
million (70 percent) did not receive treatment in
the past year.
• 18.7 million with substance use conditions, 17.2
million of those are untreated
• 11.2 million with serious mental illness, 3.7
million of those are untreated
• 35.4 million with other mental illness, 22.9 million
of those are untreated
Mr. Zepp said that approximately 70 percent of Americans
that needed behavioral health services did not receive
treatment. For substance abuse disorders the statistic was
92 percent; 66 percent of adults with serious behavioral
health issues did not receive treatment. He lamented that
lack of treatment in a timely manner often lead to
interactions with law enforcement, and the court and prison
systems. He relayed at according to Bureau of Justice
Statistics approximately 51.4 percent of prisoners have a
seriously psychological distress or a history of mental
health problems, 20 percent of which were considered
severely and persistently mentally ill.
9:19:03 AM
Mr. Zepp considered Slide 6, "Children's Untreated
Behavioral Health Statistics," which showed a bar graph
entitled 'Depression, Anxiety, Behavior Disorders, by Age."
He pointed out that children were very susceptible to
behavior health issues. Common issues included depression,
anxiety, behavioral disorders, and most commonly Attention
Deficit Hyperactivity Disorder (ADHD). He said that a child
diagnosed with depression had a 74 percent chance of having
a co-disorder like anxiety. He warned that if not treated
the condition increased and worsened over time. He pointed
out that boys were more likely than girls to have a mental
disorder and children living below the poverty line had a
22 percent more likelihood of a mental, behavioral, or
developmental disorder. He stressed that the legislation
could expand the capacity of behavioral healthcare in
schools, communities, and healthcare facilitates.
9:20:04 AM
Mr. Zepp lamented that mental disorders among children
could cause serious changes in ways that children learn,
behave, and express their emotions, which can cause stress
throughout their day.
Mr. Zepp displayed Slide 7, "Alaska assessment of
behavioral health care needs":
Mental Health Care Needs Alaska's suicide rate is
among the highest in the nation, with the prevalence
among the Alaska Native population, particularly in
the most remote areas of the state, surpassing that of
the general Alaskan population1 (Figure 1). The 2016
Alaska Behavioral Health Systems Assessment Report
estimated that 145,790 adult Alaskansroughly 20% of
the state's populationneed mental and behavioral
health services. One component necessary to address
mental health issues is a well-trained cadre of mental
health care providers to provide preventative support
and treatment.
There are several reasons why individuals needing
mental health services do not receive them. In some
cases, the perceived stigma associated with the
problem or illness prevents individuals from seeking
help. In other cases, individuals may be more
comfortable seeking help from alternative providers
such as faith-based, tradition/culture based or peer-
support resources within their community. Finally,
particularly in remote areas, availability and access
to mental health care providers are often limited.
Mr. Zepp relayed that Alaska has the highest rate of
suicide, per capita, of any state in the country and that
suicide was the number one cause of death for Alaskans ages
10 to 64. He said that the states suicide rate was 21.8
suicides per 100,000 people; for rural Alaska it was 35.1.
He relayed that there was a 13 percent increase in suicides
from 2013 to 2017, as compared to the previous 5-year
period of 2007 to 2011. He related that toxicology results
following suicides since 2015 showed 70 percent involved
one or more substances, most frequently alcohol. He shared
that more than 90 percent of people who die by suicide have
depression or diagnosable, treatable, mental or substance
abuse disorders.
9:21:27 AM
Mr. Zepp highlighted Slide 8, " Alaska assessment of
behavioral health care needs":
How Many Behavioral Health Care Providers Are Needed?
Despite the number of individuals in need of
behavioral health care services, the ratio of
behavioral health care providers to population is
lower in Alaska than nationally. Furthermore, most
providers work in urban areas, such that the state's
remote areas have even lower provider/population
ratios. There are many types of behavioral health
providers in Alaska (e.g., psychiatrists,
neurologists, psychologists, counselors, clinicians,
technicians, behavioral nurse practitioners, and
behavioral health aides), though as an example, here
we consider only the shortage of psychiatrists. Two
studies estimated a need for 25.96 and 15.37
psychiatrists per 100,000 adults nationally, with the
authors of the second study noting that the behavioral
health care needs of rural populations may not have
been adequately captured. National estimates do not
account for Alaska's unique population, geography, and
need but can serve as a benchmark for estimating the
number of psychiatrists needed in Alaska. Based on
2010 Census data, Alaska needs 184 or 106
psychiatrists, respectively.
9:22:15 AM
Mr. Zepp looked at Slide 9, "Alaska Emergency Room
Department; Super-Utilizer Facts - Total Medicaid Billed
Charges," which showed a bar graph that reflected the total
cost that the state had paid to emergency rooms for
Medicaid clients throughout the state over the previous 4
years.
Mr. Zepp continued to address Slide 9. He noted that in
2016, the state paid over $233 million, which had risen by
$47.1 million, or 20.1 percent. He said that in 2019, the
top 2.9 percent of super utilizers (more than 5 ER visits
per calendar year) consumed 16.3 percent of the charges at
$46 million. He furthered that that was 1301 clients at an
average cost of $35,357 per person. He furthered that in
2019, 10.03 percent, or 6,250 Medicaid clients, cost the
state $114 million 40.67 percent of the overall annual
charges. He lamented that costs were rising at an
unsustainable rate. Programs needed to be improved and made
more cost efficient. He believed that outcomes would be
improved by adding more licensed professional counselors.
9:23:59 AM
Senator Wielechowski asked whether the graph on Slide 9
showed all Medicaid clients or only behavioral health.
Mr. Zepp replied that the chart included all Medicaid
clients.
Senator Wielechowski asked whether there was a way to
separate the behavioral health clients from the non-
behavioral health clients.
Mr. Zepp stated he had a "super-utilizer" report (copy on
file) that might prove illuminating.
9:24:56 AM
Senator Bishop understood that a super utilizer had 5 or
more visits to the ER per calendar year.
Mr. Zepp replied in the affirmative.
9:25:11 AM
Co-Chair von Imhof asked whether Mr. Zepp had a slide
showing super-utilizers.
Mr. Zepp replied that he did not have a slide that
specifically showed the Alaska Medicaid facts and figures
from DHSS, but he had several graphs that summarized the
issues.
9:25:53 AM
Senator Wielechowski pointed out to everyone that the fifth
page of the report listed that the health issues for the
top 2.7 percent of patients, with more than 10 visits were:
1. Alcohol abuse with intoxication
2. Alcohol dependents with withdrawal
3. Chest pain
Co-Chair von Imhof relayed that the Department of
Corrections subcommittee had discussed inebriates being
picked up and held until they were sobered up. She wondered
whether the state needed more sleep it off centers. She
wondered whether the sponsor could comment on the
prevalence of alcohol as an outstanding issue.
Senator Wilson stated that the bill was trying to address
some of the larger issues, but not all super-utilizers
would be addressed. He cited that a large hospital I
Anchorage had over 220 assessments at their ER that had to
be billed at a high rate. He discussed the provider
shortage and mentioned un-used beds in the Mat-Su hospital
due to lack of the ability to bill Medicaid for them due to
the provider shortage. He wanted to allow entities to
recoup costs related to the high need of behavioral health
services in the state.
9:28:29 AM
Mr. Zepp continued to address Slide 9. He considered that
by adding more LPC counseling services the state could
improve outcomes. He said that the federal approval of the
state's 1115 waiver for behavioral healthcare services, and
by adding LPCs to the mix of behavioral healthcare
professionals, would provide the opportunity to expand
capacity, increase quality of care, and lower the cost that
the state was already paying.
9:29:14 AM
Senator Wielechowski understood that there was a difference
between behavioral health and mental health. He wondered
whether the LPCs that would be hired would be dealing with
alcohol related issues.
Mr. Zepp answered in the affirmative. He noted that SB 105,
passed in 2018, included licensed marital and family
therapists who could treat substance abuse.
Senator Wielechowski spoke of the 2,531 patient visits
related to alcohol abuse with intoxication in 2018. He
thought that the 2019 numbers showed alcohol abuse with
intoxication as the leading cause of patient visits.
9:30:26 AM
Mr. Zepp addressed Slide 10, "Alaska Emergency Room
Department Super-Utilizer Facts Number of Medicaid
Clients," which showed a line graph that depicted that the
medical costs, and not the number of Medicaid clients in
ERs, had increased. He stated that invited testimony from
DHSS would comment on the statistics. He reiterated that
the most common diagnosis for super utilizers were form
alcohol related disorders and associated ailments. The top
2.7 percent were likely to be between 20 and 59 years of
age; 61 percent were female, and 39 percent were male.
9:31:10 AM
Mr. Zepp turned to slide 11, "Preventative behavioral
health care can reduce costs":
Cost of Emergency Room visit for Medicaid client for a
behavioral health assessment = $4,360 versus $200
average per clinical visit to a behavioral healthcare
professional like a Licensed Professional Counselor
(LPC).
The fiscal note from the Department of Health & Social
Services reflects that 20% of the Medicaid clients
would receive behavioral health services from LPCs, if
this bill were passed. Keep in mind, these are not new
Medicaid clients, they are current clients. In FY2019,
the total cost of emergency room care in Alaska for
Medicaid clients totaled $280.0 million. If we use 20%
of the Medicaid client population for comparison
purposes as stated in the fiscal note, we believe
there is an opportunity for significant cost savings.
Consider:
? In 2019: 62,284 Medicaid clients visited the
emergency rooms in Alaska:
? 20% X 62,284 clients= 12,457 clients
? Current costs of emergency room visits = 12,457
clients X $4,360 = $54,312,250
? Current average costs of LPC clinical visit =
12,457 clients X $200 = $2,491,520
The difference equals = $51,821,120. We are not saying
this is what you'll save but you can clearly the
potential savings of diverting Medicaid clients from
the emergency room in a crisis stage and at a platinum
cost to a preventative clinical setting with a
Licensed Professional Counselor.
Mr. Zepp commented that the fiscal note from DHSS.
Senator Wilson commented that some hospitals in the state
would like to hire an LPC to help divert those
overutilizing the ER. He elaborated on the various ways
that this would benefit hospitals.
9:34:58 AM
Senator Bishop asked the sponsor about the 12,457 clients
listed on Slide 11, and how many of the visits were alcohol
related.
Senator Wilson stated that the departmental invited
testimony would address the numbers further.
9:35:48 AM
Mr. Zepp looked at Slide 12, "SB 134":
"An Act relating to medical assistance reimbursement
for the services of licensed professional counselors;
and providing for an effective date."
Acknowledgement of support & our sincere thanks to the
following:
? Alaska State Hospital and Nursing Home Association
? Providence Health and Services Alaska
? Southeast Alaska Regional Health Consortium
? Alaska Regional Hospital
? Mat-Su Health Foundation
? Alaska Primary Care Association
? Mat-Su Health Services
? Alaska Mental Health Trust Authority
? Alaska Department of Health & Social Services
? Alaska Department of Commerce, Community & Economic
Development
? Discovery Cove Recovery & Wellness Center
? Recover Alaska
9:36:34 AM
Mr. Zepp addressed a Sectional Analysis (copy on file)"
SB 134 impacts AS 47.07.030(b) "Medical Services to be
Provided" and AS 47.09.900 "Definitions," under title
47, chapter 5, "Administration of Welfare, Social
Services, and Institutions."
Section 1: "Medical Services to be Provided" - AS
47.07.030(b) PAGE 1, LINES 4-14 & PAGE 2, LINES 1-9:
expands the Medicaid optional services by including
professional counseling services to the list of
optional services available through the Department of
Health & Social Services under this subsection.
Section 2: "Definitions" AS 47.07.900(20) PAGE 2,
LINES 10-14: amends chapter 07, "Medical Assistance
for Needy Persons" by adding the definition of
professional counseling services.
Section 3: "Medical Services to be Provided" AS
47.07.030(b) PAGE 2, LINES 15-20: adds professional
counseling services to the list of optional services
available through the Department of Health & Social
Services under this subsection.
Section 4: "Medicaid State Plan and Federal Approval"
PAGE 2, LINES 21-29: amends the uncodified law to
instruct the Department of Health and Social Services
to submit an amendment to the state plan for medical
assistance coverage and seek approval from the U.S.
Department of Health and Human Services.
Section 5: PAGE 2, LINES 30-31 & PAGE 3, LINE 1:
provides for a contingent effective date.
9:38:58 AM
Co-Chair von Imhof asked invited testimony to speak to the
issues related to the legislation.
ALBERT WALL, DEPUTY COMMISSIONER, DEPARTMENT OF HEALTH AND
SOCIAL SERVICES (via teleconference), stated that the
department was pleased to work with the sponsor on the
bill. He reiterated that it was possible to bill Medicaid
currently, but only under the auspices of working in a
clinic, with supervision from a medical provider that could
sign off on their work. This limited the number of LPCs
that were available to do work with Medicaid patients
across the state. He stated in the department's view, the
bill would provide more accessibility for behavioral
healthcare for Alaskans and provide some relief for the
stress currently placed on the behavioral health system. He
noted that currently a patient had to be in crisis and go
to the ER in order to get help. The provision of adding
LPCs as independent practitioners would divert patients
from ERs by providing more mid-level and preventative care.
He shared that private insurance covered LPCs, to a point.
He explained that LPC coverage was available depending on
the individual care plan, such as covering several
appointments with prior authorization; counselors had to be
referred and Medicaid did not cover those appointments.
9:42:20 AM
Mr. Wall commented on the super-utilizer program, which the
department called the Care Management Plan. He explained
that the individuals in the plan had co-occurring
conditions and the highest number of visits to ERs. He
mentioned the 1115 Waiver, and thought the legislation was
an importance piece of rolling out coverage for the waiver.
He commented that there were a few pieces of legislation
related to the waiver. He discussed substance abuse
providers, many of whom were LPCs.
Mr. Wall explained that the 1115 Waiver was an effort to
drive the level of acuity down in order to drive costs down
and allow people to be treated in their communities.
9:44:02 AM
Senator Hoffman referenced Slide 11, which was an analysis
of potential savings. He asked Mr. Wall to comment on the
slide.
Mr. Wall could not see the slide but recalled he had seen
it previously. He spoke generally to the savings proposed
by the bill. He explained if more providers were present,
there was better accessibility, which would prevent crisis
situations.
9:45:43 AM
Senator Wielechowski asked how patients suffering from
alcohol abuse related issues were cared for in emergency
room situations.
Mr. Wall stated that many hospitals had an adjacent sleep-
off centers. He stated that generally hospitals would give
care to individuals experiencing a dangerous level of
intoxication that required medical observation. He said
that if a detox bed was available, the patient would be
sent there, but that the beds were limited.
Mr. Wall noted that there was a significant difference
between detoxification and ongoing therapy. He explained
that the detoxification process was done by medical
professionals that could administer drugs if needed. An LPC
would see a patient on an ongoing basis in order to keep
the patient sober. The LPC did the work to keep people out
of the ER in the first place.
9:48:00 AM
Senator Wielechowski asked whether the bill would provide
hospitals with the tools needed to break the cycle of drug
and alcohol abuse.
Mr. Wall thought the bill was not a panacea but would help.
He thought the problem should be addressed culturally and
noted that alcohol killed people at high rates all over the
country.
9:49:17 AM
Senator Hoffman asked how many LPCs would be needed and if
there were enough counsellors available to fill the
positions should the funding become available.
Mr. Wall thought there was 700 LPCs licensed across the
state and that some were currently working in health
centers. He thought one barrier that would happen to reduce
the effectiveness of LPCs was the administrative work of
billing Medicaid. He did believe that the bill would
address the issue of accessibility. He thought that once
the 1115 waiver made different types of services available,
the level of acuity in the state would decrease.
9:52:18 AM
Senator Wielechowski pointed out that the number one reason
people visited the ER was for acute upper respiratory
issues such as influenza. He asked what the department was
doing to educate the public, and the Medicaid population in
particular, about handwashing and social distancing.
Mr. Wall explained that the public health did a tremendous
job through signage and advertisement; including messaging
through radio and print. He noted that providers were
trained to interact in a preventative way with patients. He
stressed that there was a multi-level effort to address
preventative care.
9:54:16 AM
Co-Chair von Imhof thought that cultural shifts needed a
catalyst and that Covid-19 could be that catalyst. She
considered other countries behavior in relation to the
virus and noted that some had bent the curve more
successfully than others due to a more robust national
response based on historical knowledge. She suspected that
rather than just signs in the doctor office there would be
signs everywhere in the ensuing years.
9:56:05 AM
JARED KOSIN, PRESIDENT AND CEO, ALASKA STATE HOSPITAL AND
NURSING HOME ASSOCIATION, ANCHORAGE (via teleconference),
introduced himself. He explained that he had been in
meetings all morning regarding the COVID-19 response. He
thought the bill should be a priority. He expressed that if
more counselors were willing and able to see Medicaid
patients, Alaskas behavioral health care will be in a
better place. He emphasized that hospitals were the most
expensive point of care in the healthcare continuum. He
stated it was better for the patients and caregivers that
people received care at the correct and preventative level.
Mr. Kosin pondered whether the bill would allow hospitals
the tools to address the problem. He strongly believed that
if there was a sustainable place in the community for
individuals to receive long-term recovery care it would
allow patients to receive needed services at a much lower
cost to all involved parties. He thought the bill was very
smart public policy and very good fiscal policy. He had
spoken with a CEO of a rural hospital, who had expressed
that if the bill did not get passed all hope was lost. He
reiterated his strong support for the legislation.
10:00:43 AM
Co-Chair von Imhof OPENED public testimony.
JON ZASADA, POLICY DIRECTOR, ALASKA PRIMARY CARE
ASSOCIATION, HOPE (via teleconference), spoke in support of
the bill. He stated that adding Medicaid reimbursement for
LPCs was a top priority for his organization, and had been
for many years, to expand access to behavioral health
services. He noted that community healthcare centers were
already using LPCs in their practices to provide school-
based services, individual counselling services, substance
abuse disorder treatment, and in supporting care
coordination and coaching for basic health and hygiene
issues such as handwashing. He explained that the services
were not reimbursable and were paid for with private
grants, which was not sustainable. He furthered that
federally qualified health centers had received
considerable federal investment to expand behavioral health
services and substance abuse treatment in the primary care
setting. Those centers are required to provide behavioral
healthcare integrated with medical, dental, pharmacy, and
other services. Adding LPCs to the roster of available
providers enables health centers to make their service
expansion sustainable and was a national best practice. He
stressed that LPCs were a valuable component to team based,
whole person, primary care. He explained that whole person
primary care consisted of medical, dental, behavioral,
pharmacy, and support providers.
10:04:20 AM
JOCELYN PEMBERTON, CEO, ALASKA HOSPITALIST GROUP, ANCHORAGE
(via teleconference), testified regarding her concerns with
the bill. She expressed concern that the provision to
require a medical provider to oversee an LPN in order to
provide therapy would restrict access. She said that no
other insurance companies had the same requirement. She
believed that many Medicaid recipients could be referred to
either psychiatrists or nurse practitioners for behavioral
health medication prescriptions. She stressed that talk
therapy could prove more beneficial to a persons
behavioral health than medication.
10:06:21 AM
PRENTISS PEMBERTON, COUNSELING SOLUTIONS OF ALASKA,
ANCHORAGE (via teleconference), voiced his concerns with
the legislation. He noted that his company employed
therapist in Anchorage and eagle River who could not
provide services to Medicaid recipients because they did
not employ a psychiatrist. He reiterated the previous
testifiers concerns about accessibility.
10:09:09 AM
JENNIFER MORTON, LICENSED PROFESSIONAL COUNSELOR, NOME (via
teleconference), spoke in support of the bill. For the
previous eight years she had worked in rural parts of the
state including Dillingham and surrounding villages. She
thought the primary issue in rural Alaska is that there was
only one option for care: the community mental health
center. She lamented that many of the public did not trust
the care provided by the centers because it was short-
lived. This caused abandonment issues. She said that the
community would not seek services if they felt providers
were not invested in the community. She had specialized in
art therapy, which she thought was culturally relevant. She
stated that she could not bill Medicaid. She stressed that
low-income, unemployed people needed the most help. She
stressed the additional counselling services would help
keep people out of the emergency room.
10:13:02 AM
VIKKI JO KENNEDY, SELF, JUNEAU (via teleconference),
testified in support of the bill. She discussed the
importance of mental health. She had spoken with DHSS about
the matter. She thought there was a problem with people
receiving services and then leaving the state. She thought
mental health services and substance abuse services were
important.
10:14:51 AM
LAURA PORTER, SELF, PALMER (via teleconference), spoke in
support of the bill. She was an LPC and worked as a
subcontractor with a children's advocacy center. She said
that she received weekly calls from people in need and she
had to turn them away. She shared that she was in private
practice and was willing to take on the administrative side
to billing Medicaid.
Senator Wilson asked Ms. Porter to explain a child's
advocacy center.
Ms. Porter explained that a childrens advocacy center
investigated Office of Childrens Services (OCS) cases
involving abuse, neglect, or sexual assault.
10:16:59 AM
Co-Chair von Imhof CLOSED public testimony.
Co-Chair von Imhof noted there were invited testifiers
available to answer questions.
10:17:34 AM
Senator Olson wondered why the fiscal note was so
significant for a bill that was expected to save Medicaid
dollars.
Co-Chair von Imhof said that the fiscal note would be
discussed.
10:18:00 AM
Senator Wielechowski discussed FN 1 from the Department of
Health and Social Services, OMB Component 3234. He read
from the analysis on page 2 of the fiscal note:
The bill allows licensed professional counselors
(LPCs) to enroll and participate in the Medicaid
program as individual billing providers and receive
Medicaid reimbursement for medically necessary
services provided to eligible Medicaid beneficiaries
outside of a clinic setting.
Total number of registered LPCs in Alaska: 717
Percentage estimated to accept Medicaid patients: 20%
Estimated LPCs accepting Medicaid patients: 143
Estimated number of patients seen per week by one
counselor (one hour each): 20
Percentage of patients estimated to be Medicaid
eligible: 20%
Estimated Medicaid patients seen per week by one
counselor (one hour each): 4
Current individual psychotherapy hourly reimbursement
for LPC: $118.60
143 LPCs x 4 Medicaid patients/week x $118.60/hr cost
= $67.8 estimated weekly incremental cost
Estimated annual incremental cost of LPCs (48 working
weeks): $3,254.4
To implement this bill a modification of Medicaid
Management Information System to add a new provider
type and associated business rules would be required.
The work would take an estimated 600 modification
hours at a total cost of $55.9 and would be completed
by the system contractor. Adding this provider type
would not require additional staff to maintain the
system changes.
Co-Chair von Imhof asked Senator Wielechowski to review the
fund sources.
Senator Wielechowski read from Page 1:
Fund Source (Operating Only)
1002 Fed Rcpts (Fed) $2,385.1
1003 GF/Match (UGF) $14.0
1037 GF/MH (UGF) $911.2
Total: $3,310.3
1002 Fed Rcpts (Fed) through FY 26: $2,343.2
1037 GF/MH (UGF) through FY 26: $911.2
Co-Chair von Imhof referenced Senator Olsons question.
10:20:46 AM
Senator Wilson stated that he had been working with the
department on the fiscal note. He thought it was difficult
to disperse the cost savings. He discussed the complexity
of the medical billing.
10:21:52 AM
Senator Olson wondered whether the sponsor expected the
fiscal impact to change.
Senator Wilson answered in the affirmative. He said that
the goal was to increase the access at the lower level and
cost of care.
Senator Olson thought the plan was optimistic.
Co-Chair von Imhof thought the intent of the bill was to
shift care when appropriate from other medical care
providers to LPCs. She thought the issue was any savings
should be examined and considered. She thought it could
take several years for the system to come up to speed.
Co-Chair von Imhof addressed Senator Olson's point and
thought the department was hesitant to identify savings
until they materialized.
10:23:31 AM
Senator Wielechowski was curious about Mr. Walls opinion
on the matter.
Senator Wilson thought that Gennifer Moreau-Johnson, Acting
Director, Division of Behavioral Health, Department of
Health and Social Services could speak to the question.
10:24:01 AM
Ms. Moreau stated that Senator Wilson described the matter
accurately, and the fiscal note reflected an abundance of
caution. There were multiple initiatives that were
anticipated to result in a cost savings by reduced use of
the emergency room. She detailed the complexity of the
note.
Senator Wielechowski queried the savings using the average
cost of each ER visit.
Ms. Moreau believed there had been a report submitted to
the sponsor that cited the LPCER savings estimate, which
was determined through the department's actuary.
10:26:21 AM
SB 134 was HEARD and HELD in committee for further
consideration.
Co-Chair von Imhof discussed housekeeping.
ADJOURNMENT
10:26:58 AM
The meeting was adjourned at 10:26 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 134 - Sectional Analysis.pdf |
SFIN 3/16/2020 9:00:00 AM SHSS 2/21/2020 1:30:00 PM |
SB 134 |
| SB 134 - Sponsor Statement.pdf |
SFIN 3/16/2020 9:00:00 AM SHSS 2/21/2020 1:30:00 PM |
SB 134 |
| SB134 Letters of Support.pdf |
SFIN 3/16/2020 9:00:00 AM |
SB 134 |
| SB 134 Public Testimony MSHF.pdf |
SFIN 3/16/2020 9:00:00 AM |
SB 134 |
| SB 134 - LPCs to Medicaid Optional Services - Senate Finance Committee - 3.14.20.pdf |
SFIN 3/16/2020 9:00:00 AM |
SB 134 |
| SB 134 Mat-Su HUMS 2018 Q4 Report - Executive Summary.pdf |
SFIN 3/16/2020 9:00:00 AM |
SB 134 |
| SB 134 Providence Alaska Coordinated Care Project Overview.pdf |
SFIN 3/16/2020 9:00:00 AM |
SB 134 |
| SB 134 Public Testimony Pemberton.pdf |
SFIN 3/16/2020 9:00:00 AM |
SB 134 |
| SB 134 Public Testimony Bomalaski.pdf |
SFIN 3/16/2020 9:00:00 AM |
SB 134 |