Legislature(2021 - 2022)SENATE FINANCE 532
02/18/2021 09:00 AM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| Presentation: Executive Order 119 - Department of Health and Social Services Reorganization | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
SENATE FINANCE COMMITTEE
February 18, 2021
9:01 a.m.
9:01:29 AM
CALL TO ORDER
Co-Chair Bishop called the Senate Finance Committee meeting
to order at 9:01 a.m.
MEMBERS PRESENT
Senator Click Bishop, Co-Chair
Senator Bert Stedman, Co-Chair
Senator Lyman Hoffman
Senator Bill Wielechowski
Senator Donny Olson
Senator Natasha von Imhof
Senator David Wilson
MEMBERS ABSENT
None
ALSO PRESENT
Adam Crum, Commissioner, Department of Health and Social
Services; Sylvan Robb, Assistant Commissioner, Department
of Health and Social Services.
PRESENT VIA TELECONFERENCE
Clinton Lasley, Deputy Commissioner, Department of Health
and Social Services, Anchorage.
SUMMARY
^PRESENTATION: EXECUTIVE ORDER 119 - DEPARTMENT OF HEALTH
AND SOCIAL SERVICES REORGANIZATION
9:02:39 AM
Co-Chair Bishop outlined the process for hearing an
executive order.
9:04:22 AM
ADAM CRUM, COMMISSIONER, DEPARTMENT OF HEALTH AND SOCIAL
SERVICES, discussed the presentation, "Alaska Department of
Health and Social Services (DHSS), Executive Order 119,
DHSS Reorganization" (copy on file). He highlighted slide
2, "Alaska Department of Health and Social Services." He
noted that there were four divisions that were proposed to
be moved to a new commissioner's office and new department.
Commissioner Crum looked at slide 3, "How DHSS Exists
Today":
FY2021 Budget (Including Supplementals): $3,483,908.6
Positions: 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 pointed to slide 4:
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
9:12:49 AM
Co-Chair Bishop noted the issue of retention of the case
workers in the Office of Children's Service (OCS). He
wondered whether the 51 percent turnover was indicative of
other states and their child service divisions.
Commissioner Crum replied that there were many child
welfare departments in the country that had about 20
percent turnovers. He stated that a 20 percent turnover
rate in a child welfare department would be considered
"stable."
Co-Chair Bishop queried the lessons from the exit
interviews.
Commissioner Crum replied that there needed to be a higher
level of support. He remarked that it seemed like there was
a never ending process, due to the weight of the cases. He
deferred to Mr. Lasley about any specific poignant items.
9:14:37 AM
CLINTON LASLEY, DEPUTY COMMISSIONER, DEPARTMENT OF HEALTH
AND SOCIAL SERVICES, ANCHORAGE (via teleconference),
explained that the primary concern for leaving was the
amount of cases that the staff were required to carry.
Co-Chair Stedman remarked that 65 percent of the young
people with cases through OCS were Alaska Native. He
requested a breakdown of Alaska Natives as a percentage,
and by geographic region. He felt that it was substantially
disproportionate to the population of Alaska Natives in the
state.
Commissioner Crum agreed to provide that information. He
further explained that examining the Division of Public
Assistance and putting forth more support provided a
greater level of retention.
Co-Chair Bishop stressed that the Division of Public
Assistance needed continued support.
Commissioner Crum addressed slide 5, "For Comparison." He
noted the comparisons of the Department of Health and
Social Services (DHSS) to the other departments in the
state.
Commissioner Crum looked at slide 6, "Executive Order 119
Vision":
The Reorganization of DHSS
Goal: Provide proactive, efficient leadership and
management of programs to achieve better outcomes for
Alaskans
Align Current Functions and Programs
1. Direct Care and Services to Alaskans in State
Administered Programs
2. Eligibility for Alaskans and Payment to Providers
Focus Management to Improve Outcomes
1. Innovation
2. Work Processes
9:20:56 AM
SYLVAN ROBB, ASSISTANT COMMISSIONER, DEPARTMENT OF HEALTH
AND SOCIAL SERVICES, discussed slide 7:
Dept. of Health and Social Services
FY2021 Management Plan + Supplementals
UGF $1,124,967.4
Total $3,483,908.6
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 $898,948.7
Total $3,038,018.6
Full Time Positions 1439
Senator Wielechowski remarked that the executive order was
106 pages, and changed dozens of statutes. He wondered
whether the statutory changes would go into effect if the
legislature did not take any action.
Commissioner Crum replied in the affirmative.
Senator Wielechowski did not understand how the executive
order was considered legal, when it changed many statutes.
Commissioner Crum deferred to someone with a legal opinion.
Co-Chair Stedman felt that there could be a request for a
legal opinion.
Ms. Robb continued to discuss slide 7:
Difference FY2021
Management Plan + Supplementals to FY2022 Governor's
Amended
UGF ($12,571.6)
Total ($32,470.4)
Full Time Positions (139)
9:25:33 AM
Commissioner Crum looked at slide 8, "Department of Family
and Community Services." He stated that the slide showed an
organizational chart of a proposed new department.
Senator Wielechowski wondered whether any services would be
privatized with the proposed change.
Commissioner Crum replied that there were no privatized
services proposed in the executive order.
Senator Hoffman referenced the Tribal Child Welfare Act and
other tribal partnerships. He wondered if any tribal
entities had expressed concern about the proposed
restructuring.
Commissioner Crum replied that there was a conversation
working with the Tribal State Collaborate Group on Child
Welfare. He stated that there were some proposed ideas
about OCS realignment, which were changes to the division
on some of the operational items.
9:30:08 AM
Senator von Imhof wondered what ways the department had
engaged meaningfully with the community and different
stakeholders to decide the parameters of the bifurcation
and the transition.
Commissioner Crum replied that there were conversations
with the divisions and other stakeholders.
Senator von Imhof felt that it was important to continue
with the engagement with stakeholders in order to get the
community on board with the transition.
Commissioner Crum replied that there was work with the
Alaska Children's Trust to get meetings set for public
townhalls.
Co-Chair Stedman requested background on the concept of the
bifurcation came to fruition. He also noted that COVID had
changed the time allotment of the commissioner.
Commissioner Crum replied that conversations began summer
2019.
Co-Chair Stedman felt that there needed to be some numbers
put on the broad concept of the bifurcation.
Co-Chair Bishop assumed that delivery of services was
important in the decision, and assumed that there were some
numbers for a cost-benefit analysis.
Senator Wielechowski looked at page 34 of the executive
order, which included a page of legislative findings
related to persons with disabilities. He remarked that it
was a whole new section that was not in statute. He
wondered why they were included in the executive order,
when they were not findings by the legislature.
Commissioner Crum agreed to provide further information
from the Department of Law (LAW).
Senator Wielechowski noted that there were five pages with
the use of Alaska Mental Health Trust Authority (AMHTA)
Settlement Income Account money, and wondered whether it
was in regulation or statute.
Commissioner Crum replied that the legislative writing team
at LAW helped to write the executive order, so he would
provide more information about those specifics.
9:40:16 AM
Senator Wielechowski wondered whether there would be a
change to where the AMHTA could spend money, or whether it
was codifying the current practice.
Commissioner Crum replied that it would not change the way
AMHTA spent money.
Senator Wielechowski stressed that it was five pages
outlining the way AMHTA could spend money. He felt that it
was inappropriate for an executive order. He wondered why
it was not drafted into legislation.
Commissioner Crum replied that it was a constitutional
provision that allowed the executive branch to reorganize
by an executive order.
Senator von Imhof wondered whether AMHTA had expressed
support for the executive order.
Commissioner Crum replied in the affirmative, and stated
that there were multiple conversations with AMHTA.
Co-Chair Bishop requested the AMHTA documentation.
Senator Olson thanked Commissioner Crum for the work on
social service in his district. He wondered whether the
tribal health organizations were in support of the
bifurcation.
Commissioner Crum replied that he could not speak for those
entities, but shared that there had been many conversations
with the entities.
Senator Olson asked whether there was formal support from
those entities.
Commissioner Crum replied in the negative.
Senator Olson commented that he had a discussion with the
former commissioner of DHSS about splitting the department,
but the willpower was not there at the time.
Commissioner Crum pointed to slide 9, "Department of
Health." He stated that the slide showed the proposed
organizational chart for the proposed new Department of
Health.
9:45:52 AM
Co-Chair Bishop wanted more explanation about the "fee for
service" and value.
Commissioner Crum replied that it would be "value-based
care" as opposed to "fee for service."
Co-Chair Bishop asked for further definition.
Commissioner Crum explained that an example of value-based
care would be moving toward bundled payments. He shared
that there was a process in the Office of Rate Review,
which was an ongoing project working with the hospital
association to do diagnosis-related groups. He shared that
that the bills would be for a situation or condition,
rather than a specific appointment. He explained that there
was similar program in other parts of the country.
Senator Hoffman looked at page 27 of the executive order,
which referred to public assistance. He wondered whether
the services listed were being redefined that might
diminish current services.
Commissioner Crum replied that there was no diminishment of
services for any divisions or programs offered to
individuals and Alaskans.
Senator Wielechowski looked at pages 57, 58, and 59 of the
executive order that were new legislative findings related
to children. He wondered whether the administration had
consulted with the legislature prior to enacting the
legislative findings.
Commissioner Crum replied that he would consult with LAW
regarding that question.
9:48:58 AM
AT EASE
9:50:38 AM
RECONVENED
9:50:43 AM
Co-Chair Bishop stressed that the day's meeting was
intended to be an overview, and there would be a sectional
analysis with LAW at a later date.
Senator Wielechowski looked at page 57, and asked for a
definition of "reasonable corporal discipline."
Commissioner Crum replied that all of the definitions were
in existing statutes, and were getting moved to conform to
the new department. He agreed to provide further
information.
Senator Olson asked for a copy of that response.
Co-Chair Stedman asked for a repeat of the line number
referenced.
Senator Wielechowski stated that on page 57 there were
legislative findings related to children. The specific item
was line 17.
Ms. Robb highlighted slide 10, "Increments for
Commissioner's Office and Department Support Services." She
noted the creation and addition of new positions within the
new departments. She stated that the total cost for the
reorganization was approximately $5.7 million.
Co-Chair Stedman wondered whether it would be more economic
to add the people to the existing structure.
Mr. Crum replied that the intent had been to trim down and
allow a deep dive into reducing high turnover numbers.
9:55:01 AM
Co-Chair Stedman thought 13 people working on the issue was
plenty. He struggled to understand the additional people to
the structure.
Mr. Crum said that the total was 25 people who would work
to make the transition successful. He said that there were
many mechanisms in place for maximum efficiency.
Co-Chair Stedman requested that the department set up
benchmarks and tracking to report back to the committee.
Co-Chair Bishop wondered whether there thirteen vacant
positions for the new positions.
Ms. Robb replied that the request for additional 13
positions was within the budget.
Co-Chair Stedman remarked that $5.6 million divided by 13
was $436,000. He queried the cost of the 13 positions.
Commissioner Crum agreed to provide that information.
Co-Chair Bishop asked the number of classified versus
exempt positions in that proposal.
Senator Wilson asked for an overview of how the added
positions would enhance benefits for those already
receiving services.
Commissioner Crum stressed that the main goal was reducing
the backlog to provide better services to Alaskans.
Senator Wielechowski wondered whether there were any
concerns expressed about the executive order by any of the
labor unions.
Commissioner Crum replied that he had met with the labor
groups to address their concerns. He remarked that there
was also some assuaged union concerns.
Co-Chair Bishop asked whether the labor unions were in
support of the executive order.
Commissioner Crum replied that they did not have a
definitive expression of support, but he was working to
follow up with them to ensure that he was addressing their
concerns.
Senator Hoffman requested a detail of the location of the
thirteen positions. He looked at page 7, and remarked that
there were 139 eliminated positions, and queried the
location of those positions.
Commissioner Crum agreed to provide that information.
10:05:56 AM
Co-Chair Stedman clarified the math from earlier.
Senator Wielechowski queried the projections' impact on
homelessness, suicide, and domestic violence in the state.
Commissioner Crum replied that the changes were not
anticipated to affect the issues, because the Division of
Behavioral Health would remain intact.
Senator Wielechowski queried any substantive changes to
foster care or OCS.
Commissioner Crum hoped that the impact would result in a
positive change for foster care.
Ms. Robb looked at slide 11, "FY2021 Management Plan +
FY2021 Supplemental Comparison to FY2022 Gov Amend Two
Department Structure."
Commissioner Crum shared that there would be specifics
requested and other cost savings.
Co-Chair Stedman wondered whether there would be reduced
footnotes and disclaimers as a result of the
reorganization.
Commissioner Crum replied in the affirmative.
Ms. Robb furthered that the goal was to keep a closer eye
and reduce the number of audit findings.
10:10:44 AM
Senator Wielechowski looked at page 1, which removed the
Alaska Pioneers Home and the Alaska Veterans Home from the
definition of "health care facility", and queried that
impact.
Commissioner Crum replied that they would still be defined
as health care facilities, but believed that they were part
of the statutory "clean-up" of moving the departments.
Senator Wielechowski stressed the definition removed those
facilities, and queried the reason.
Commissioner Crum thanked the committee.
Co-Chair Bishop discussed housekeeping.
ADJOURNMENT
10:13:03 AM
The meeting was adjourned at 10:12 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| EO 119 Presentation - Senate Finance Committee - February 18 2021.pdf |
SFIN 2/18/2021 9:00:00 AM |
Executive Order 119 |