Legislature(1999 - 2000)
02/16/2000 01:32 PM Senate HES
| Audio | Topic |
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
February 16, 2000
1:32 p.m.
MEMBERS PRESENT
Senator Mike Miller, Chairman
Senator Pete Kelly, Vice-Chairman
Senator Gary Wilken
Senator Kim Elton
MEMBERS ABSENT
Senator Drue Pearce
COMMITTEE CALENDAR
SENATE BILL NO. 127
"An Act relating to scholarships to attend the University of
Alaska; and providing for an effective date."
-HEARD AND HELD
SENATE BILL NO. 254
"An Act relating to heirloom certificates of marriage."
-MOVED CSSB 254(HES) OUT OF COMMITTEE
SENATE BILL NO. 233
"An Act relating to priorities, claims, and liens for payment for
certain medical services provided to medical assistance recipients;
and providing for an effective date."
-MOVED SB 233 OUT OF COMMITTEE
SENATE BILL NO. 244
"An Act increasing the eligible maximum amount for quality school
grant funding for school districts; and providing for an effective
date."
-MOVED SB 244 OUT OF COMMITTEE
Alaska Mental Health Board Presentation on the December, 1999
Report by the U.S. Surgeon General on Mental Health
PREVIOUS SENATE COMMITTEE ACTION
SB 127 - No previous Senate action.
SB 233 - No previous Senate action.
SB 244 - No previous Senate action.
SB 254 - No previous Senate action.
WITNESS REGISTER
Elmer Lindstrom, Special Assistant
Department of Health and Social Services
PO Box 110601
Juneau, AK 99801-0601
POSITION STATEMENT: Supports SB 254
Carol Brice, President
Alaska Childrens' Trust
c/o Department of Community and Economic Development
PO Box 112100
Juneau, AK 99811
POSITION STATEMENT: Supports SB 254
Jon Sherwood, Program Officer
Division of Medical Assistance
Department of Health and Social Services
PO Box 110660
Juneau, AK 99801-0660
POSITION STATEMENT: Supports SB 233
Rick Cross, Commissioner
Department of Education
801 W 10th St. Ste. 200
Juneau, AK 99801-1894
POSITION STATEMENT: Supports SB 244
Carl Rose, Executive Director
Association of Alaska School Boards
316 W 11th
Juneau, AK 99801
POSITION STATEMENT: Supports SB 244 and SB 127
Vernon Marshall
National Education Association of Alaska
114 2nd
Juneau, AK 99801
POSITION STATEMENT: Supports SB 244
Ann Ringstad
Director of Government Relations
University of Alaska
PO Box 755120
Fairbanks, AK 997775
POSITION STATEMENT: Supports SB 127
Jim Lynch
Vice President of Finance
University of Alaska
PO Box 755120
Fairbanks, AK 997775
POSITION STATEMENT: Supports SB 127
Walter Majoros, Executive Director
Alaska Mental Health Board
431 N.Franklin Street
Suite 200
Juneau, AK 99801-1121
Caren Robinson, Chair
Alaska Mental Health Trust Authority
550 W 7th Ave., Suite 1820
Anchorage, AK 99501
Karl Brimner, Director
Division of Mental Health & Developmental Disabilities
Department of Health and Social Services
PO Box 110620
Juneau, AK 99811-0620
ACTION NARRATIVE
TAPE 00-5, SIDE A
Number 001
CHAIRMAN MILLER called the Senate Health, Education and Social
Services (HESS) Committee to order at 1:32 p.m. Present were
Senators Pete Kelly, Elton and Miller. The first order of business
to come before the committee was SB 254.
SB 254-HEIRLOOM MARRIAGE CERTIFICATES
ELMER LINDSTROM, Special Assistant to Commissioner Karen Perdue of
the Department of Health and Social Services (DHSS), gave the
following testimony on SB 254. Several years ago the Legislature
passed legislation that allowed for the issuance of heirloom birth
certificates. That program has been quite successful and has
generated thousands of dollars for the Alaska Childrens' Trust. SB
254 expands that program to allow the sale of heirloom marriage
certificates. DHSS collects the funds for the Alaska Childrens'
Trust. The DHSS fiscal note estimates additional revenues in the
amount of about $270,000. That amount would be offset by the
operating costs of issuing the certificates.
MR. LINDSTROM noted that Commissioner Perdue suggested, rather than
limiting the fee to $25, leaving the bill open-ended to allow DHSS
to issue limited or special edition certificates to commemorate
particular events. He offered a proposed amendment to allow DHSS
to establish the surcharge in regulation and set the amount at no
more than the estimated actual cost to DHSS not to exceed the
estimated fair market value of comparable artistic rendition. That
language would make the fee market driven. He pointed out that the
fiscal note assumes that the surcharge will be $25 at the outset.
Number 302
SENATOR ELTON said he believes SB 254 is a great idea but he is
chagrin that an Alaska adopted child is not eligible for an
heirloom birth certificate. He asked DHSS staff to respond to his
concern at a later date.
CAROL BRICE, Chair of the Alaska Children's Trust, speaking via
teleconference from Fairbanks, said the Trust needs to address
Senator Elton's concern, as well as a concern expressed about
making heirloom birth certificates available for people born in
territorial days. She then made the following comments. At a cost
of $25 per marriage certificate, the Alaska Children's Trust could
deposit as much as $150,000 to $200,000 per year. On the average,
5300 marriages take place in Alaska each year. She asked for
committee members' support of the legislation.
SENATOR PETE KELLY moved to adopt Amendment 1 proposed by Mr.
Lindstrom of DHSS. Amendment 1 reads as follows.
Page 1, line 6:
Delete "of $25"
Insert "established by regulation"
Page 1, line 8:
Following "registrar."
Insert:
"(b) The department shall adopt regulations that
establish the amount of the fee for each design of an heirloom
certificate of marriage. Notwithstanding AS 37.10.050(a), each fee
shall be set at an amount that is more than the estimated actual
costs to the department not to exceed the estimated fair market
value of a comparable artistic rendition."
Page 1, line 11:
Delete "(b)"
Insert "(c)"
Page 1, line 14:
Delete "(c)"
Insert "(d)"
Page 2, line 1:
Delete "(d)"
Insert "(e)"
Page 2, line 5:
Correct section number.
There being no objection, CHAIRMAN MILLER announced Amendment 1 was
adopted.
There being no further testimony or discussion, SENATOR PETE KELLY
moved SB 254 as amended to its next committee of referral with
individual recommendations and its accompanying fiscal note. There
being no objection, the motion carried.
SB 233-MEDICAL ASSISTANCE:LIENS & CLAIMS
JON SHERWOOD, Division of Medical Assistance, DHSS, gave the
following testimony. SB 233 has two purposes. The first regards
DHSS's third party recovery efforts. A federal Medicaid
requirement mandates applicants for medical assistance to sign
their right to third party recovery to the State of Alaska. The
State of Alaska has a duty to exercise that right to recover. Over
the years, contractors hired by DHSS to pursue third party
recoveries have identified weaknesses in Alaska statutes that
prevent DHSS from assuming its rightful place at the table during
the settlement of lawsuits. SB 233 amends Alaska statutes to
enhance the State's ability to recover money. SB 233 requires
recipients to notify DHSS of recovery action, creates an authority
for DHSS to place a lien upon such recoveries and gives a precedent
to that lien, and gives DHSS the right to take actions in third
party recoveries. DHSS believes these changes will increase
collections from lawsuits and settlements.
MR. SHERWOOD explained that other provisions in the bill pertain to
timely filing of claims for provider payment for medical
assistance. Currently, providers are allowed up to six months to
make claims for payment unless the provider has to bill private
insurance first, in which case the deadline is 12 months. SB 254
changes the limit to 12 months for all claims. Providers are
forced to do a lot of additional processing when submitting claims
if they are unable to get all of the information they need within
the six month window. Often these situations occur when patients
have a serious illness or have been in an accident and are unable
to get Medicaid eligibility information to their provider. SB 254
also allows DHSS, when it finds basis for a good cause exception,
to pay 100 percent of a late claim. Current statute limits that
payment to 50 percent. DHSS sees this provision as a basic
fairness issue - if the provider has a good reason for not filing
in a timely fashion, the provider should be entitled to the full
payment.
Number 920
SENATOR PETE KELLY asked whether Medicaid pays all of the bill.
MR. SHERWOOD explained that DHSS would pay the entire bill but it
would file a lien in a case where a patient was hit by a drunk
driver and received a settlement from a third party - for example,
a bar, insurance company, or other business.
There being no further testimony or discussion, SENATOR ELTON moved
SB 233 from committee with individual recommendations and its
accompanying fiscal note. There being no objection, the motion
carried.
SB 244-QUALITY SCHOOL GRANT FUND INCREASE
COMMISSIONER RICK CROSS, Department of Education and Early
Development, informed committee members that SB 244 increases the
current $16 average daily membership amount paid in quality school
grants to $52. The cost of this proposal will amount to about $7.6
million. The quality school grant is a targeted, value added,
accountability grant, designed to accomplish the State's goal of
bringing accountability and high standards of student achievement
in Alaska's public schools. In 1998, when the Quality School
Initiative and grant program was established, it was specifically
targeted by the Legislature to fund accountability. The
accountability grants will jump start the kind of changes that need
to occur in Alaska's schools to ensure that all students reach high
standards.
COMMISSIONER CROSS said the State will save $19.9 million this year
as the result of three changes: declining school enrollment;
increased local property values which have shifted the
responsibility for school funding from the State to local
communities; and increases in federal Impact to Aid payments that
Alaska receives. School districts anticipated higher revenues this
year and have had to make significant adjustments to their budgets
to accommodate for the loss of revenue. Some districts are facing
as much as $4 million in reductions in expenditures. The $7.6
million of grants will give school districts money to raise
standards and student achievement, and it will allow teachers to
spend more time on task with students.
In 1998, Minnesota allocated $70 million to help school districts
implement new standards. Last year, the Washington State
Legislature passed a $113 million package of initiatives to support
reforms. In 1999, the Connecticut Legislature passed a budget that
added $70 million to help schools get better results. The State of
Louisiana set aside $200 million for reforms which amounts to about
$256 per student. These states, and a number of others, are
recognizing that additional resources are needed to support schools
as they raise standards and hold students and teachers accountable.
He hopes Alaska will do the same.
Number 1239
SENATOR WILKEN pointed out that DOE submitted a zero fiscal note
although the cost of the increase will be $7.6 million.
COMMISSIONER CROSS explained the zero fiscal note reflects the fact
that the Governor's budget for the foundation includes the $7.6
million. If a different budget is used, the fiscal note will need
to be changed. He noted that the fiscal note contains a statement
explaining that the money has been accounted for in the Governor's
budget in the Foundation Program.
SENATOR WILKEN maintained that fiscal notes are to reflect changes
in current spending.
SENATOR PETE KELLY agreed that the fiscal note should reflect the
$7.6 million.
SENATOR WILKEN surmised that the fiscal note reflects a diversion
from the normal process and requires users to "connect the dots."
CHAIRMAN MILLER agreed.
COMMISSIONER CROSS said his understanding is that DOE is to work
off of the Governor's budget and therefore the fiscal note is
correct. He added that the fiscal note is clear about the costs
associated with the bill.
CHAIRMAN MILLER stated that the next committee of referral is where
the fiscal note will be reviewed.
Number 1282
SENATOR PETE KELLY asked if DOE has written its fiscal notes based
on the current year's budget or the projected budget in the past.
COMMISSIONER CROSS acknowledged that he has not been involved for
too many years but he repeated that the rules DOE is to go by
require that the fiscal note reflect the cost if the money is not
accounted for in the Governor's budget.
SENATOR ELTON asked for an explanation of the application process
the districts use and the number of districts that have
participated in the Quality Schools grant program at the $16 level.
COMMISSIONER CROSS replied that all districts have participated in
the grant program and the application process was designed by DOE.
Each district submits an application explaining how the money will
be targeted and on what programs. The districts use the money for
various programs that target poor student performance, i.e. summer
school programs, tutoring, and extended-day programs. DOE reviews
applications and asks for clarification if the use of the money is
unclear. The program is not competitive: each district is allotted
a specific amount.
SENATOR ELTON asked if DOE checks to see whether it is substituting
Quality Schools Initiative grant funding for programs that would
have otherwise been funded from other sources, thereby freeing up
dollars in an existing budget to be spent on functions not related
to quality schools.
COMMISSIONER CROSS indicated that DOE's auditing of school
districts is fairly broad but is getting better as time goes on.
If DOE found a district was substituting quality school money for
a different program funded through a different grant, it would
question that expenditure.
Number 1497
SENATOR ELTON commented that he is not opposed to the concept of SB
244, but he sees several ways to tackle this problem. He noted
that if DOE does not audit to ensure that the additional money will
be spent on academics, then Senator Wilken's approach (SB 198)
might be better.
COMMISSIONER CROSS said he supports Senator Wilken's bill but he is
asking for support of SB 244 because it will ensure that money is
targeted to meet an immediate need that school districts face.
Regarding the auditing, DOE follows up to make sure the districts
are providing the services they were given the grant money for.
CARL ROSE, Executive Director of the Association of Alaska School
Boards (AASB), expressed support for SB 244 for the following
reasons. Many school districts anticipated the $19 million that is
not forthcoming so they are going through severe budget reductions
as a result. Two issues face Alaska school districts: operational
costs and the quality initiatives that have been mandated. The
quality initiatives serve a purpose but will require school
districts to address student achievement on the upcoming exams. He
does not believe Alaska will see wholesale success on those exams
at the start. As younger students go through the bench marking
process at the third, sixth and eighth grades, they will be ready
for the qualifying exam. He is very concerned about remediation
for those students who do not fare well in the new system. The
AASB supports both SB 244 and SB 198. Each bill addresses a
different issue: one is categorical through grants, the other gives
districts latitude for operations. Alaska has the responsibility
of ensuring that its students are as successful as possible in our
global economy.
SENATOR ELTON asked if remediation programs would be eligible for
funding from a quality school grant.
MR. ROSE said the question of why students do not score well on the
upcoming exam and what we can do to help those students will be on
the table. Providing those students with more of the same is
probably not the answer so the AASB is looking at new strategies.
SENATOR ELTON asked if the grant money is used for remediation,
whether the district would receive $52 per student who needed
remediation or whether it would get $52 per ADM in the district
which could be used to remediate fewer students.
MR. ROSE said he believes each school district will come up with
strategies they feel will meet their students' needs and they will
apply to DOE.
Number 1880
VERNON MARSHALL, NEA-Alaska, stated support for SB 244 and
commended the committee for acting on SB 198. The Senate HESS
committee has been the first committee to step to the plate and try
to deal with the school funding issue as it applies to 2001 and
beyond. The school year of 1999-2000 will probably be remembered
as the year of the "test." In March the first exit exam will be
administered and he assumes that before the end of the school term,
the bench mark testing at grades 3,6, and 8 will occur. The next
significant date will be the year 2002 because the exam given in
March will be given to seniors and determine whether they receive
a diploma. During that year every school will be designated. The
next two years are years of opportunity. Test results will be
available in the fall of the year 2000 and at that time educators
will have to review the results and look at the curriculum to
educate better. The issue of remediation will also have to be
addressed. He hopes the remediation programs in place in Fairbanks
are replicated throughout Alaska because that model is held up with
respect. The average teacher salary in Alaska has fallen to
$47,100. The average is decreasing, but the money saved does not
appear to be used for other personnel services by school districts.
He suspects that much of that money is being plowed into
remediation, curriculum realignment, and other things. He asked
for support of SB 244 and said it is a good coupler with SB 198.
There being no further testimony or discussion, SENATOR WILKEN
moved SB 244 with individual recommendations and its accompanying
fiscal note. There being no objection, the motion carried.
SB 127-UNIVERSITY OF ALASKA SCHOLARSHIPS
ANN RINGSTAD, Government Relations Director for the Statewide
Office of University Relations, University of Alaska (UA), stated
support for SB 127 and made the following comments. This
legislation came before the committee in a different form last
year. It allowed the UA to get from high schools the names and
addresses of students who qualify for the Alaska Scholars Program.
SB 127 will put the Alaska Scholars Program into statute and it
repeal statutory language about other scholarship programs that may
or may not be in effect right now.
CHAIRMAN MILLER noted the committee has a work draft before it
labelled "Ford 2/16/00 - GS 1029/D." He asked Ms. Ringstad to
address that version (Version D) of the bill.
MS. RINGSTAD said Version D aligns the legislation with the program
that is in place today.
SENATOR WILKEN asked if Version D funds the Alaska Scholars Program
out of the Alaska Student Loan Corporation (ASLC) profits.
MR. JIM LYNCH, Vice President of Finance for the University of
Alaska, replied he does not think this bill does that.
MS. RINGSTAD clarified that the Governor has submitted legislation
to use proceeds from the ASLC. That legislation does not
necessarily state that those funds will be applied to SB 127 but
the bill's fiscal note could lead one to believe that some of that
money will be used to fund it. The UA plans to fund the program
out of its own pocket in FY00 and FY01 and is not asking for
general funds until next year.
CHAIRMAN MILLER asked if Version D merely sets the scholarship
eligibility criteria in statute.
MS. RINGSTAD said that is correct.
Number 2229
SENATOR WILKEN asked whether there is any connection between
Version D and the ASLC proceeds.
MS. RINGSTAD replied, "There could be, that could be part of the
funds to be used in the future to be paid in the future to pay for
a portion of it."
CHAIRMAN MILLER asked if anything attaches those funds to this
bill.
MS. RINGSTAD said there is not.
Number 2258
CARL ROSE, Association of Alaska School Boards, stated support for
this legislation because it addresses the AASB's concern that
education be viewed as a kindergarten through university level
experience rather than a K-12 experience.
CHAIRMAN MILLER asked Mr. Lynch to come back to the table.
SENATOR WILKEN indicated that the fiscal note for Version D (CSSB
127(HES) clearly states that the fiscal note assumes the return of
capital payments from the ASLC to partially fund the Alaska
Scholars Program. He maintained that language creates a very clear
connection between Version D and the Alaska Scholars Program.
MR. LYNCH said he has not seen that fiscal note.
CHAIRMAN MILLER noted that Mr. Lynch's signature is on the fiscal
note.
SENATOR WILKEN asked Mr. Lynch when he found out about this scheme.
MR. LYNCH replied February 11.
SENATOR WILKEN asked Mr. Lynch if he is aware of the debt that the
ASLC owes the debt to the State of Alaska.
MR. LYNCH replied that he is aware that there is a debt but he does
not know the amount.
SENATOR WILKEN noted that debt is about $42 million. He asked
Chairman Miller if he has received any comments from Diane Barrans
of the ASLP about this legislation.
CHAIRMAN MILLER said he has not.
SENATOR WILKEN made the following comment.
I am not particularly concerned about the bill itself - I have
great concern about the fact that someone, somewhere decided
that they were going to take $6 million that the student loan
corporation has worked hard to become profitable and this
Legislature and Administration's helped them do that - and as
soon as we get $6 million into the plus, we ignore the
promises made in the past and we come trumped up with some
political deal to fund the Scholars Program because some one
person happened to think it's a great idea, and I suggest that
we just take this bill and put it in our pockets and leave
until all the people can be on board."
TAPE 00-05, SIDE B
SENATOR WILKEN pointed out that he sits on the ASLC Board and that
Board members had a cursory discussion at the August and December
meeting about using the $6 million to pay the debt. Suddenly, in
February, this has been rolled out to the public as if the entire
Board believes this is a good idea. He repeated that he is totally
supportive of the Scholars Program but he does not support taking
money that should be paying back the people of Alaska without
taking the proper steps to get the ASLC on board, as well as its
managers and the Legislature. He expressed frustration that
Version D short-circuits the entire process. He repeated that he
supports making changes to fix the Scholars Program in general, but
if legislation is connected to the student loan proceeds, and prior
commitments to that money are ignored, he is opposed to it.
SENATOR ELTON asked Mr. Lynch and Ms. Ringstad whether the UA could
operate the Alaska Scholars Program if it is not enshrined in
statute.
MR. LYNCH said it is his opinion that the UA could continue to run
the program.
SENATOR ELTON asked if Senator Wilken's concerns are extant in the
legislative body, whether the UA could continue the program until
a resolution to the funding source is found.
MR. LYNCH noted the bill also contains a few repealers for other
programs.
SENATOR ELTON asked if those provisions need to be repealed this
session.
MR. LYNCH said there is a cost associated with those provisions.
SENATOR ELTON suggested that Mr. Lynch get back to the committee
with those costs and provide information on why the provisions need
to be repealed. He agreed with Senator Wilken that the committee
should hold on to the bill for awhile.
There being no further testimony on SB 127, CHAIRMAN MILLER asked
Mr. Lynch and Ms. Ringstad to contact the ASLC and Senator Wilken
to discuss the concerns expressed today.
Number 2199
CHAIRMAN MILLER announced the committee would hear a presentation
by Walter Majoros, Caren Robinson, and Karl Brimner on the
December, 1999 report on mental health issues by the Surgeon
General.
WALTER MAJOROS, Executive Director of the Alaska Mental Health
Board (AMHB), introduced Caren Robinson, Chair of the AMHTA, and
Karl Brimner, Director of the Division of Mental Health and
Developmental Disabilities (DMHDD) in the Department of Health and
Social Services. Mr. Majoros distributed copies of the U.S.
Surgeon General's Report on Mental Health, published in December of
1999.
CAREN ROBINSON stated that the AMHTA, the AMHB, the DMHDD, the
Building Bridges Campaign, and the Alaska State Hospital and
Nursing Home Association are sponsoring today's presentation. All
of those organizations have endorsed the Surgeon General's report
and are using it to guide future policies and program development
and advocacy efforts.
MS. ROBINSON referred to page 3 and pointed out the significance of
this report is that very few surgeon generals have published
reports, and this is the only report ever written on mental health
issues. The Surgeon General considers this report to be of the
same level of importance as the Surgeon General's report on
smoking.
MS. ROBINSON explained the partnerships involved in the creation of
the report included SAMHSA, the major federal funding and oversight
agency for mental health and substance abuse, and NIMH, the leading
federal research agency on mental health and mental illnesses. The
planning board included hundreds of consumers, providers and other
stakeholders who collaborated to write the report.
MS. ROBINSON remarked that the importance of the report is that it
helps agencies answer key questions about mental health and mental
illness. The report reviewed four main areas. First, it evaluated
the national response to mental health - how the U.S.fares in
addressing mental illness. Second, it identified barriers to
addressing mental illness - the issues that are preventing a more
positive response to mental illness. Third, it helped guide future
policy and development by reviewing how services are organized and
provided. Fourth, it called for action to reduce mental health
problems in the nation.
MS. ROBINSON said a main point in the report is the importance of
treating mental health as a public health issue. This means
recognizing that mental health is fundamental to overall health and
that mental health disorders are real health conditions. Mental
health disorders have an immense impact on a person's health and
can be extremely disabling. Also, there is a growing recognition
of mental illness as a brain disorder that can be effectively
treated like any other health condition. In addition, mental
health and physical health are inseparable and impact each other.
Number 2060
MR. MAJOROS discussed the continuum of mental health and illness.
The report views mental health and mental illness as points on a
continuum. In this light, the continuum applies to everyone.
First, it is important to look at what is meant by the terms
"mental health, mental health problems, and mental illness."
Mental health is described as positive mental functioning that
results in productivity, positive relationships, and the ability to
adapt. Mental health problems are defined as situational or
developmental conditions that cause short term distress and
impaired functioning a condition that everyone experiences. Mental
illness involves alterations in thinking, mood, or behavior which
lead to more severe, longer-term distress and impaired functioning.
MR. MAJOROS said it is important to note that different points on
the continuum call for different interventions that move from
prevention and informal supports to comprehensive and long term
treatments and supports. In addition, it is important to note that
conditions become more disabling as one moves up the continuum.
Finally, the cost of services increases as one moves up the
continuum.
MR. MAJOROS referred to a corrected chart on page 7 that presents
the percent of disease burden of disabling diseases. Mental
illnesses account for 15.4 percent of the overall years of life
lost to major illnesses in our country. The disease burden of
mental illness is second only to heart disease and is greater than
all forms of cancer added together.
SENATOR ELTON asked for further explanation of the percent of
disease burden.
MR. MAJOROS explained that if all years of lost life from all
diseases for everyone in the country were totalled, 15.4 percent of
those years would be attributable to mental illnesses.
Number 1866
MR. BRIMNER informed committee members of the following facts about
mental illness. Up to half of all visits to primary care
physicians are due to conditions caused or exacerbated by mental
health problems. Approximately 15 percent of all adults with a
mental disorder have a co-occurring substance abuse disorder. As
many as half of people with serious mental illnesses develop
alcohol or drug abuse problems, at some point in their lives. A
third fact is that one in five children has a diagnosable emotional
disorder. Many problems associated with emotional disturbances in
children are best addressed with a systems approach in which
multiple service sectors work together in an organized and
collaborative way. The incidence of suicide among 15 to 24 year
olds has tripled since 1960. This statistic underscores the
importance of positive, comprehensive interventions with troubled
youth. Last, nearly half of those with severe mental illnesses do
not seek treatment.
MR. BRIMNER stated that mental health treatment works. Tremendous
gains have been made in brain research to better understand the
role of the brain regarding health and illness. New medications
are more powerful with fewer side effects. Getting help is the
key. It is tragic that nearly half of the people with severe
mental illnesses do not seek treatment, especially given the fact
that treatment is so effective today.
MS. ROBINSON stated there are three major barriers to mental
health, the first being stigma. A tremendous fear, negative
stereotyping and outright discrimination occurs daily for people
with mental illness. This stigma prevents people with mental
illness from seeking help. The needs of mental health consumers
vary across such factors as age, gender, race and culture. All
factors need to be acknowledged when identifying the specific needs
of each consumer. For example, the elderly population in the
United States and Alaska is increasing dramatically. Alzheimers
Disease and related dementia, depression and high suicide risk are
a few of the important issues to be addressed in regard to the
elderly. Financial challenges are another barrier to mental
health. The organization and financing of mental health services
has been a significant barrier to many consumers. Managed care has
often been used to cut costs and reduce access and services to
people with mental illness. 90 percent of all policies provide
less coverage for mental illness than they do for physical illness.
MS. ROBINSON pointed out the Surgeon General has issued a call to
action to address these challenges. Our nation needs to continue
to build the science base to further advances made in brain
chemistry knowledge. Second, the nation needs to have zero
tolerance for stigma and to dispell the myths that contribute to
that stereotype. It needs to improve public awareness of effective
treatment, to ensure an adequate supply of mental health services
and providers and to reduce financial barriers to treatment.
Services are often unavailable when and where people need them. We
need to ensure state-of-the-art treatments. To be effecive,
diagnosis and treatment must be tailored to the characteristics
that shape a person's identify. People need to know where to turn
for help. Increased parody in private insurance in mental and
physical health is one way to reduce that barrier.
MR. MAJOROS discussed four themes that have been identified that
are driving efforts in Alaska to meet the Surgeon General's call to
action. Those themes include: making services available locally;
providing programs to serve all ages; recognizing that consumers
hold the keys to success; and increasing service accountability.
The Community Mental Health/API 2000 is a project that will
downsize API by moving services into the community for mental
health consumers. Through this project, consumers in the Anchorage
area will have access to an array of emergency mental health
services and for co-occurring disorders. The AMHB, DMHDD and AMHTA
are helping to increase training and support for mental health
services in rural communities. The Trust is redesigning and
enhancing itinerant mental health consultation and support services
for rural mental health providers. The Trust will also be hosting
a conference in April to provide training, support, and networking
for rural mental health providers. The third initiative is
decriminalization of mental illness. The Trust is working to
develop programs to decriminalize the mentally ill to get them out
of the Department of Corrections (DOC) by providing more
appropriate supports in the community. Too many people are ending
up in jail instead of community-based programs. A jail diversion
program has been instituted in Anchorage for mentally ill
misdemeanants, as well as a mental health corps. These programs
are quite successful and are helping to identify the services
needed by mental health consumers to ensure community safety and
adequate support.
MR. MAJOROS said DHSS has initiated several children's programs to
improve mental health care in Alaska. Second, housing with support
services to divert mentally adults from API and DOC is being
developed. Third, integration of mental health and substance abuse
treatment services has begun. Many rural communities are making
changes at the local level to integrate their mental health and
substance abuse services and, at the State level, a steering
committee will soon be formed to support the development of more
integrated services for mental health and substance abuse. Last,
the Long Term Care Task Force has taken a leadership role in
improving the care system for vulnerable adults and the elderly.
MR. BRIMNER said mental health consumers hold the key to success.
Consumer leadership and significant consumer involvement is
becoming a way of life in planning, implementing and monitoring
mental health services throughout Alaska. The Trust has funded a
consumer affairs position which is a senior management position in
DHSS to increase the role of consumers in mental health policy. A
second area of importance is recovery focus. Standards for mental
health services build on the strengths of consumers and assist them
to successfuly live independent and productive lives. Advances
that have occurred through science, combined with a powerful
consumer and advocacy movement have resulted in a major paradigm
shift. Mental health consumers can achieve greater mental health
and have more control over their lives.
MR. BRIMNER discussed increasing service accountability. Quality
assurance monitoring, established by DMHDD in 1996, includes site
reviews by review teams, a Medicaid audit, and record reviews for
the grant program. The Alaska Legislature implemented performance
indicators for measuring outcomes of service delivery. The DMHDD
will continue to work with the Legislature to refine these measures
to provide useful information. The AMHB and DMHDD are leading a
statewide effort to develop common performance measures for public-
funded mental health services.
MS. ROBINSON concluded the presentation by discussing ways the
Legislature can help. Adequate funding for mental health grants
and Medicaid is critical. The assisted living bill (SB 73) is a
serious priority. AMHTA has allocated $1 million to that program.
The mental health parity debate must be cotinued. Many Alaskans
cannot get mental health services and they need that coverage. She
asked that legislators schedule the parity bill for a hearing.
MR. MAJOROS noted that Senator Elton sponsored the parity bill.
MS. ROBINSON continued. Basic support services must be funded.
Individuals with severe mental illnesses struggle daily to function
safely in the community. Support to cover basic needs are
critical to their survival. Last, legislators need to take a
leadership role in addressing mental health issues in their
communities. She thanked committee members for providing the
opportunity for the group to present the findings of the Surgeon
General's Report.
Number 1086
SENATOR WILKEN asked Mr. Majoros what is happening nationwide and
with states in regard to the mental health parity issue.
MR. MAJOROS said the federal Mental Health Parity Act of 1996 was
a major development. That Act requires that annual and lifetime
limits in policies must be the same for physical and mental health,
but it only applies to employers of 50 or more employees who offer
mental health coverage. Several states have built upon that
platform and have added coverage. Parity is not a black and white
issue - it is a continuum from very limited parity to comprehensive
parity. Comprehensive parity means what is provided for physical
health must be provided for mental health. 27 states have passed
some version of mental health parity legislation. AMHTA
understands that progress will be incremental but it must keep the
goal as total parity.
SENATOR WILKEN asked if Mr. Majoros could name one or two states
that have gone far enough down the road to develop dependable data.
MR. MAJOROS replied that Vermont has built into its state law an
analysis of the implementation of parity. The Vermont Division of
Insurance has issued some reports on financial and other impacts of
the parity bill.
SENATOR WILKEN questioned the chart on page 8 of the report. He
noted the percents of disease burden total 63 percent and
questioned what the remaining 37 percent is attributable to.
MR. MAJOROS did not know the other illnesses that compose the
remaining percentage but offered to get that information for
Senator Wilken.
SENATOR WILKEN maintained that the chart makes a bold statement
therefore, if the Legislature is going to use it, it should be
verified.
MR. MAJOROS agreed.
NUMBER 880
SENATOR WILKEN said one concern many people have is that no
programs exist for youth who transition out of prison environments.
He asked how the State can get to decriminalization and still
provide those services that are necessary to that population.
MR. MAJOROS noted that the country underwent a major de-
institutionalization from the 1960's through the 1980's. The
thought was that people with mental health illnesses would be
placed in community based settings but, in fact, those people were
"trans-institutionalized" into state and federal correctional
facilities because there were not enough community services. He
thought the State needs to provide medication management for people
in criminal institutions because they deserve humane care, but he
also believes many people are in prisons because of the lack of
community services.
MS. ROBINSON added that is a problem in Fairbanks where many people
with mental illnesses are waiting to go to API. AMHTA is focussing
on Anchorage so that API can be downsized and other doors can be
opened for people who need an intensive hospital setting. In
addition, AMHTA funded the women's mental health unit in DOC.
AMHTA has learned, however, that once those women are ready to
leave the correctional institution, they have no support services
and end up back in prison. They need to be transitioned to
supportive community settings.
MR. BRIMNER commented that once DMHDD analyzed why some people were
going to jail with regularity was because they were pending
hospitalization or transportation to API. DMHDD instituted some
services in that area that have eliminated the transportation wait.
DMHDD is finding that there are large gaps in services for that
population and is attempting to address those.
MS. ROBINSON informed committee members that AMHTA provides small
community grants for a variety of projects and programs to promote
mental health.
There being no further business to come before the committee,
CHAIRMAN MILLER adjourned the meeting at 3:02 p.m.
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