03/21/2018 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB151 | |
| HB215 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 215 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 151 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 21, 2018
1:30 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Natasha von Imhof, Vice Chair
Senator Cathy Giessel
Senator Peter Micciche
Senator Tom Begich
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 151(FIN)
"An Act relating to the duties of the Department of Health and
Social Services; relating to training and workload standards for
employees of the Department of Health and Social Services and
providing immunity from damages related to those standards;
relating to foster care home licensing; relating to civil and
criminal history background checks for foster care licensing and
payments; relating to placement of a child in need of aid;
relating to the rights and responsibilities of foster parents;
requiring the Department of Health and Social Services to
provide information to a child or person released from the
department's custody; and providing for an effective date."
- HEARD & HELD
COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 215(FIN)
"An Act relating to program receipts; and relating to fees for
services provided by the Department of Health and Social
Services."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 151
SHORT TITLE: DHSS;CINA; FOSTER CARE; CHILD PROTECTION
SPONSOR(s): REPRESENTATIVE(s) GARA
03/01/17 (H) READ THE FIRST TIME - REFERRALS
03/01/17 (H) HSS, FIN
03/16/17 (H) HSS AT 3:00 PM CAPITOL 106
03/16/17 (H) Heard & Held
03/16/17 (H) MINUTE(HSS)
03/21/17 (H) HSS AT 3:00 PM CAPITOL 106
03/21/17 (H) Heard & Held
03/21/17 (H) MINUTE(HSS)
03/23/17 (H) HSS AT 3:00 PM CAPITOL 106
03/23/17 (H) Moved CSHB 151(HSS) Out of Committee
03/23/17 (H) MINUTE(HSS)
03/24/17 (H) HSS RPT CS(HSS) NT 3DP 1DNP 1NR 2AM
03/24/17 (H) DP: TARR, EDGMON, SPOHNHOLZ
03/24/17 (H) DNP: EASTMAN
03/24/17 (H) NR: KITO
03/24/17 (H) AM: JOHNSTON, SULLIVAN-LEONARD
03/28/17 (H) HSS AT 3:00 PM CAPITOL 106
03/28/17 (H) <Bill Hearing Canceled>
04/12/17 (H) FIN AT 1:30 PM HOUSE FINANCE 519
04/12/17 (H) Heard & Held
04/12/17 (H) MINUTE(FIN)
04/13/17 (H) FIN AT 1:30 PM HOUSE FINANCE 519
04/13/17 (H) Heard & Held
04/13/17 (H) MINUTE(FIN)
05/15/17 (H) FIN AT 1:30 PM HOUSE FINANCE 519
05/15/17 (H) Moved CSHB 151(FIN) Out of Committee
05/15/17 (H) MINUTE(FIN)
05/16/17 (H) FIN RPT CS(FIN) NT 4DP 1NR 4AM
05/16/17 (H) DP: ORTIZ, GARA, SEATON, FOSTER
05/16/17 (H) NR: GUTTENBERG
05/16/17 (H) AM: TILTON, THOMPSON, KAWASAKI, WILSON
05/17/17 (H) TRANSMITTED TO (S)
05/17/17 (H) VERSION: CSHB 151(FIN)
01/18/18 (S) READ THE FIRST TIME - REFERRALS
01/18/18 (S) HSS, FIN
03/19/18 (S) HSS AT 1:30 PM BUTROVICH 205
03/19/18 (S) Heard & Held
03/19/18 (S) MINUTE(HSS)
03/21/18 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: HB 215
SHORT TITLE: DHSS: PUBLIC HEALTH FEES
SPONSOR(s): FINANCE
04/07/17 (H) READ THE FIRST TIME - REFERRALS
04/07/17 (H) HSS, FIN
04/18/17 (H) HSS AT 3:00 PM CAPITOL 106
04/18/17 (H) Heard & Held
04/18/17 (H) MINUTE(HSS)
04/20/17 (H) HSS AT 3:00 PM CAPITOL 106
04/20/17 (H) -- MEETING CANCELED --
04/25/17 (H) HSS AT 3:00 PM CAPITOL 106
04/25/17 (H) -- MEETING CANCELED --
05/09/17 (H) HSS AT 3:00 PM CAPITOL 106
05/09/17 (H) Moved CSHB 215(HSS) Out of Committee
05/09/17 (H) MINUTE(HSS)
05/10/17 (H) HSS RPT CS(HSS) 3DP 2NR 1AM
05/10/17 (H) DP: JOHNSTON, EDGMON, SPOHNHOLZ
05/10/17 (H) NR: SULLIVAN-LEONARD, KITO
05/10/17 (H) AM: EASTMAN
02/02/18 (H) FIN AT 1:30 PM HOUSE FINANCE 519
02/02/18 (H) Heard & Held
02/02/18 (H) MINUTE(FIN)
02/07/18 (H) FIN RPT CS(FIN) 6DP 4NR
02/07/18 (H) DP: GRENN, THOMPSON, ORTIZ, GARA,
SEATON, FOSTER
02/07/18 (H) NR: TILTON, GUTTENBERG, WILSON,
KAWASAKI
02/07/18 (H) FIN AT 1:30 PM HOUSE FINANCE 519
02/07/18 (H) Moved CSHB 215(FIN) Out of Committee
02/07/18 (H) MINUTE(FIN)
02/16/18 (H) TRANSMITTED TO (S)
02/16/18 (H) VERSION: CSHB 215(FIN)
02/19/18 (S) READ THE FIRST TIME - REFERRALS
02/19/18 (S) HSS, FIN
03/21/18 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
JANINE REEP, Board Member
Facing Foster Care in Alaska
Juneau, Alaska
POSITION STATEMENT: Supported HB 151.
MICHAEL JEFFERY, Representing Self
Utqiagvik, Alaska
POSITION STATEMENT: Supported HB 151.
ANDREW CUTTING, Program Fellow
Alaska Children's Trust
Anchorage, Alaska
POSITION STATEMENT: Supported HB 151.
TAMAR BEN-YOSEF, Executive Director
All Alaska Pediatric Partnership
Anchorage, Alaska
POSITION STATEMENT: Supported HB 151.
MARK LACKEY, Member
R.O.C.K Mat-Su
Executive Director
CCS Early Learning
Wasilla, Alaska
POSITION STATEMENT: Supported HB 151.
ROSALIE REIN, Representing Self
Fairbanks, Alaska
POSITION STATEMENT: Supported HB 151.
RACHEL BEDSWORTH, Statewide Representative
Facing Foster Care in Alaska
Anchorage, Alaska
POSITION STATEMENT: Supported HB 151.
SARAH REDMON, Administrative Director
Facing Foster Care in Alaska
Anchorage, Alaska
POSITION STATEMENT: Supported HB 151.
NATALIA EDWARDS, Member
Facing Foster Care in Alaska
Anchorage, Alaska
POSITION STATEMENT: Supported HB 151.
ALISON KULAS, Executive Director
Alaska Mental Health Board
Advisory Board on Alcoholism and Drug Abuse
Juneau, Alaska
POSITION STATEMENT: Supported HB 151.
CHRISTY LAWTON, Director
Office of Children's Services
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Offered supporting testimony on HB 151.
REPRESENTATIVE LES GARA
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of HB 151.
ELIZABETH DIAMENT, Staff
Representative Paul Seaton
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 215.
JILL LEWIS, Deputy Director
Division of Public Health
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified on HB 215.
ALISON KULAS, Executive Director
Alaska Mental Health Board
Advisory Board on Alcoholism and Drug Abuse
Juneau, Alaska
POSITION STATEMENT: Supported HB 215.
ACTION NARRATIVE
1:30:47 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 1:30 p.m. Present at the
call to order were Senators Giessel, Micciche, and Chair Wilson.
Senator von Imhof joined shortly thereafter.
HB 151-DHSS;CINA; FOSTER CARE; CHILD PROTECTION
1:31:13 PM
CHAIR WILSON announced the consideration of HB 151. [SCS CSHB
151(FIN) was before the committee.]
1:31:51 PM
CHAIR WILSON opened public testimony.
1:32:07 PM
JANINE REEP, Board Member, Facing Foster Care in Alaska,
supported HB 151. She said she is an attorney who has worked in
the field of child protection for over 30 years. Currently she
is a mediator in child protection cases. She knows the child
protection system very well. She knows how it is supposed to
work and she knows it is not working well. Things are worse now
than when she began 30 years ago. She's been around long enough
to see youth coming back into the system as parents themselves
or more often, incarcerated. The system needs to be fixed.
She opined that the bill might look like it is full of lots of
little things, but the reality is that each of these sections,
if passed into law, can profoundly change a person's life. For
example, filling out a foster care application is a daunting
task. Under the bill, OCS [Office of Children's Services] would
be required to help prospective foster care parents complete
application, and there is a deadline for making a decision on an
application. She also highlighted the provision for prudent care
allowing foster parents to fill out permission forms for field
trips or participation on a sports team. It is awkward for youth
to go a state agency to have a pink slip signed so they can go
on a band trip. It can mean a youth misses out on a network of
peers.
She said the crux of the bill is caseload limits. She has been
saying for decades that nothing will change unless caseloads are
statutorily capped. Caseworkers cannot make good decisions for a
family when overloaded with cases. A relative search is
difficult to do. Families will not share information about
relatives if they don't trust someone. Many times healthy
relatives are estranged from the family. Unless a caseworker has
an ongoing relationship with a family, family placements are
difficult to find. She noted that the graph on slide 16 of
Representative Gara's presentation reflects the relationship
between changes in caseworkers and chances of permanency. She
said she has seen that again and again. Progress cannot be made
when a social worker is in place for five months and then gone.
The case lingers and children languish in the system, often
until they're adults. She urged the committee to pass the bill
because it is an opportunity to make a real change. She
concluded reiterating that until there are lower caseloads,
nothing will work.
1:37:54 PM
SENATOR MICCICHE noted her 30 years of experience. He asked why
none of these issues are getting better. He asked if there is
something systemic that is not in the bill.
MS. REEP said the turnover is insane and the caseloads have
increased. The numbers are outrageous. Social workers are
dissatisfied and feel they are doing a terrible job. It is high
responsibility and they are not going to stay. A cap on numbers
will attract more qualified people. Many social workers are not
interested in working for OCS because of the horror stories and
the caseloads. If they knew there was a limit and they could
actually make a difference in helping families, they'd be
applying.
MICHAEL JEFFERY, Representing Self, supported HB 151. He has
spent 40 years in Barrow, first working with Alaska Legal
Services and then as a superior court judge for 32 years. He
said part of the work of a superior court judge is Child in Need
of Aid cases. He likes many things about HB 151. One of them is
training. He hopes that would include fetal alcohol spectrum
disorder issues. He said social workers want to do right by
these families, but if they are swamped with cases, they can't
do it. He realizes that some funding issues go with that, but
it's important to have these standards. He loves the parts of
the bill about timeliness in foster care license decisions. A
family is offering itself. If the application is dropped into
the void. That denies the availability of that home and it is
also stress for the family. The provisions to have youth
participate in their own case planning and the ability of youth
and families to do things without checking with a social worker
will reduce trauma and long-term damage that can happen from
multiple placements and the feeling of being shut out from
making any decisions about their situation.
1:43:05 PM
ANDREW CUTTING, Program Fellow, Alaska Children's Trust,
supported HB 151. He said his agency looks at children across
the state and worries about kids who are falling through the
cracks. This is a way to move forward with those being left
behind. With the high case numbers and maxed out staff, this
bill supports front line staff. A lot of research shows the cost
of kids revolving through different families. It increases their
ACEs [Adverse Childhood Experiences] scores. The cost across the
state associated with ACEs scores is more than $450,000,000.
Decreasing caseworker loads, providing additional training and
support, decreasing the number of kids who cross their desk
every day and putting kids in supportive families using the
tools in this bill will reduce costs in the long term, even if a
few more staff have to be added in the front end. The Children's
Trust is a big, big supporter of this bill.
1:44:55 PM
TAMAR BEN-YOSEF, Executive Director, All Alaska Pediatric
Partnership, supported HB 151. She said the mission of the All
Alaska Pediatric Partnership is to improve the health and
wellness of all Alaskan children. They consider OCS caseworkers'
high caseloads and resulting inability to adequately serve
families a significant barrier to children's optimal health.
Nearly 3,000 Alaskan children are in out-of-home placement. In
some places of the state, workers are managing more than 30
caseloads, which is more than double the national
recommendations. About ten percent of children entering the
foster care system are under the age of six. The first three to
four years of life are when the brain structures that govern
personality traits, learning processes and self-regulation
skills to deal with stress and emotion are established,
strengthened, and made permanent and the nerve connections and
nerve transmitter networks form during these critical years.
These transmitter networks are influenced by negative
environmental conditions, such as child abuse and neglect,
violence within the family, and exacerbated by multiple
placements. Most children entering the foster care system,
especially those entering early on, have not experienced a
nurturing, stable environment. The positive experiences created
by permanency and a solid relationship with a supportive
caregiver are critical in both the short- and long-term
development of the child and their ability to participate fully
in society. The premature return of a child to the biological
parent and the inability of a caseworker to provide families
with the attention they need to remain stable, compliant, and
safe often result in a return to foster care or ongoing
emotional trauma to the child. No less important is that working
in such stressful environments creates toxic stress for the
caseworker and results in high turnover rates and further
negative outcomes for children. Reduced caseloads and additional
training will result in a healthier and more supported
workforce, leading to more permanency and better outcomes for
children.
1:47:50 PM
MARK LACKEY, Member, R.O.C.K Mat-Su, Executive Director, CCS
Early Learning, supported HB 151. He said he has been a foster
parent in the past. He is familiar with the issues that HB 151
addresses. He adopted a child and would estimate that he was in
care for 6-8 months longer than needed because of staff
turnover. Professionally, CCS Early Learning has seen a steady
increase in the percentage of their slots provided for children
in foster care. The last school year, 17 percent of total slots
were for children in foster care. In 2009, it was six percent.
1:50:05 PM
SENATOR BEGICH arrived.
MR. LACKEY said they have seen a steady increase in children
needing care but until very recently, they have not seen a
corresponding increase in staffing at OCS. Wasilla has seen
recent staffing increases, which has drastically helped their
caseloads. R.O.C.K. Mat-SU has been working closely with OCS on
multiple issues. He can already see changes in morale and how
responsive staff are and in the level of community engagement.
Getting children in and out of the system as quickly as possible
requires sufficient staff.
1:51:42 PM
ROSALIE REIN, Representing Self, supported HB 151. She said she
worked at OCS for seven-and-a-half years and is now developing a
social services program for the Fairbanks School District. The
high rate of front line turnover leaves OCS with less
experienced workers and growing caseloads. The pressure
threatens the longevity of the remaining caseworkers. The
provision in HB 151 capping caseloads for new caseworkers during
the first six months is going to support workers through the
steep learning curve. Staff retention is a positive effect of
allowing workers to develop a solid skill set early in their OCS
careers. Research shows that caseworkers who have social work
education, appropriate training, specialized competencies, and
greater experience are better able to facilitate permanency. New
workers with a full caseload and older workers with a caseload
more than twice the national recommendation cannot keep up with
adequate support for foster parents, let alone the children and
their families. Her testimony is not to convince them to make
sad caseworkers happy. It is about ensuring that children and
families have access to services in a timely manner, have
communication with their worker, and for relatives to be
identified so they can provide care for their own family. These
services require adequate staffing.
1:54:07 PM
RACHEL BEDSWORTH, Statewide Representative, Facing Foster Care
in Alaska, supported HB 151. She said she is a student at the
University of Alaska Anchorage and aged out of the foster care
system when she turned 21 in October. She was in care 12 years
and moved through 47 placements. She had nine social workers.
There was a time in eighth grade when she did not know who her
social worker was. She lived in a foster home for three months
where the only food was rice, broccoli, and cheese. Her social
workers didn't listen to her because they didn't know her. They
need more social workers, so they can give the individual
attention that a child needs and deserves.
1:55:29 PM
SARAH REDMON, Administrative Director, Facing Foster Care in
Alaska, supported HB 151. She said she was in foster care three
different times over seven years. She was in 16 different
placements in those seven years. She is one of 12 siblings who
went into foster care at the same time. During her placement she
had no contact with her siblings. She was like a mother for her
eight younger siblings. She made sure they went to school, went
to bed, and were fed. Not knowing where they were gave her
social anxiety and stress. If she had been able to have contact
with them, that would have provided some relief. Making sure
siblings have contact is her big focus.
1:58:20 PM
NATALIA EDWARDS, Member, Facing Foster Care in Alaska, supported
HB 151. She said she has been in foster care since February 2012
with 11 placements and somewhere between 6 and 15 social
workers. She was separated from four sisters, which caused
constant anxiety. She will face repercussions for that the rest
of her life. In the past two years she has been in and out of
homelessness and has had little to no contact with her social
workers. She was homeless because so many social workers changed
with no notice; it was hard to track down who would have helped
with friends who could have become licensed. It was only when
Amanda Metivier [founder of Facing Foster Care in Alaska] became
her foster mother that they tracked down her social worker to
figure what needed to be done so she could be in a continual
safe home with a steady foster parent. If HB 151 had been in
effect in the past, it would have helped with the repercussions
with her siblings. She would have had more attention in the past
six years.
2:00:30 PM
ALISON KULAS, Executive Director, Alaska Mental Health Board,
Advisory Board on Alcoholism and Drug Abuse, supported HB 151.
She said the joint mission of her boards is to advocate for
programs and services for people with behavioral health
disorders, their families, care providers, and communities. They
look comprehensively to build healthy and safe environments for
Alaskans to reach their individual potential. HB 151 supports
the safety and well-being of Alaska's children in state custody.
This bill addresses the concern that OCS workers are overworked
and their ability to serve families adequately is compromised.
Representative Gara's bill will help mitigate the trauma and
long-term damage of children who experience multiple placements
or who languish in foster care. Instability and neglect cause an
increased likelihood of mental health challenges, substance
abuse, homelessness, incarceration, public assistance, and
unemployment. Decreasing caseloads can help to intervene in this
expensive and damaging cycle. Her boards want to make sure that
OCS workers are fully trained and equipped to handle the
challenges of working with families on their caseloads so that
families really get the attention they need to remain stable,
compliant, and safe. They need to stabilize the workforce to
better serve the needs of families involved in the state's child
welfare system.
2:03:01 PM
CHAIR WILSON closed public testimony on HB 151.
CHAIR WILSON asked what the ratio is of OCS supervisors to
caseworkers.
2:03:27 PM
CHRISTY LAWTON, Director, Office of Children's Services,
Department of Health and Social Services (DHSS), testified on HB
151. She said generally in the larger offices, such as
Anchorage, Mat-Su, and Fairbanks, supervisors have six to eight
employees per unit. The Child Welfare League of America
recommends five per supervisor.
SENATOR VON IMHOF observed that the tribal compact agreements
are just getting off the ground, and asked what impact that will
have in taking the burden off employees by lowering caseloads.
MS. LAWTON said in the very long run, it will help with caseload
size, but in the short-term, there will be lessening of some of
the caseload. There are pieces of case management they will be
slowly taking on. Initially the focus is helping with relative
searches and family contact visitation and doing safety walks
through homes in communities where they do not have staff. They
are being strategic about what they are taking on and starting
to build their infrastructure and capacity. It will be a number
of years before they are taking over large numbers of cases.
CHAIR WILSON asked the sponsor if he had any closing remarks.
2:05:37 PM
REPRESENTATIVE LES GARA, Alaska State Legislature, sponsor of HB
151, said there has been talk about how much this is evidence-
based--less turnover, fewer placement changes, less trauma to
children, higher success rates of children, fewer children on
public assistance, more children in the workforce, more children
graduating high school, going to college. What he wants to leave
the committee with is the notion that we are closer than ever to
fixing the system, but the first step is to have all the members
on the team with a good manager and good systems. Drawing a
parallel to a baseball team, he said you need a good manager and
nine players on the field. Without that, you'll always lose.
"We're closer than ever to fixing many, many, many of the
problems at OCS." In terms of cost, the transfer of adult public
assistance money to OCS last year made it possible to hire 31
additional staff. That is within striking distance of reaching
caseload limits that will work, that will reduce turnover rates
like they did in New Jersey.
REPRESENTATIVE GARA said he wanted to be clear about the fiscal
note because there are different ways of writing fiscal notes.
Early fiscal notes were $4, $5, and $7 million. The really
expensive things were removed from the current fiscal note, but
it does assume that the 31 new case workers remain. The cost for
that is $1.4 million. The fiscal note last year provided 75
percent of the funding for those workers. He noted that the
tradition in this building often has been to fund 75 percent of
the cost the first year and 100 percent the next year. The
fiscal note is written as a comparison to what is needed in
addition to the 31 staff that were hired last year. It is not a
comparison to what was in the budget last year. The funds for
those 31 workers is in the governor's budget and the House
budget. He hopes they remain in the Senate budget. With that,
you are within $1.4 million of reach of actually making a huge
difference with mentors and the supervisors to get the
supervisory caseloads to what Director Lawton and the case
workers talked about to reduce the work and reduce the turnover
and reduce the waste of money that we have in the system for
paying for empty positions. The empty positions I've talked
about are hiring somebody who leaves within a year when they
have finally learned their job. That's not a wise use of money."
2:09:19 PM
CHAIR WILSON said he would hold HB 151 awaiting the answers from
DHSS to some outstanding questions.
2:09:37 PM
At ease.
HB 215-DHSS: PUBLIC HEALTH FEES
2:10:05 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of HB 215. [CSHB 215(FIN) was before the
committee.]
2:11:11 PM
ELIZABETH DIAMENT, Staff, Representative Paul Seaton, Alaska
State Legislature, presented HB 215. She said HB 215 is a House
Finance Committee-sponsored bill. During the DHSS subcommittee
process last year, Public Health was identified as a division
that could be charging additional fees to sustain its
constitutional mission, which is protecting and promoting the
health of all Alaskans. DHSS does charge for some Public Health
services but can only charge for what is listed in statute, AS
44.29.022. The duties that are currently fee-eligible are mostly
clinical in nature, and they include maternal and child health
services, nutrition services, preventive medical services,
public health nursing services, health education, and
laboratories. The Division of Public Health lacks fee authority
for other services and functions, such as professional services
and administrative functions. HB 215 would amend AS 44.29.022 to
grant DHSS the authority to establish and collect reasonable
fees to support the administration of public health programs. HB
215 allows DHSS to decide what fees it will establish through
regulation and a public process.
She explained that fees are limited to the actual cost of
services and that regulation would be required for each new fee.
In the current fiscal environment, it is important that every
agency looks for efficiencies and ways to decrease dependence on
unrestricted general funds.
2:13:38 PM
JILL LEWIS, Deputy Director, Division of Public Health,
Department of Health and Social Services (DHSS), testified on HB
215. She said the Division of Public Health focuses on services
that protect and improve the public's health status. Public
health services control infectious diseases, prevent chronic
diseases and injuries, promote healthy lifestyles, protect
maternal and child health, as well as respond to disasters. HB
215 is needed to allow the division to increase and diversify
its revenue opportunities, so it has the means to support health
operations and reduce reliance on general funds. The widening
gap between public health costs and general funds jeopardizes
their ability to provide services that keep Alaskans safe and
healthy. One of the obstacles is they cannot charge fees for all
services they provide.
She said the DPS budget includes nearly $7 million in general
fund program receipts or about six percent of their total
revenue. These receipts come from clinical services such as
laboratory tests and well-child exams. The new fees will not be
substantial enough to fund all operations, but they will reduce
dependence on other funds. DPS lacks fee authority for things
such as data extraction and analysis, training and expert
consultation, inspections and certifications, and program
administration. This is where their opportunities lie. Budget
cuts have forced some cuts to services that industry and the
public are asking for. The bill makes it possible, when it makes
sense, to recoup costs and do these services. Generally the fees
are optional. If services are not used, then there is no fee.
2:16:55 PM
MS. LEWIS explained that to implement the fees, DPS would reach
out to stakeholders in a series of public meetings leading to
separate regulations for each fee. Collaborating with the public
and stakeholders will help determine what is a reasonable fee
and how to balance the burden on the stakeholders with the
reality that public health doesn't mean free health. Rates are
limited to actual costs of providing the services, not making a
profit. Fees will only be implemented when they are in the
public interest, it is economical to do so, and, most
importantly, doesn't undermine the public health mission. They
don't deny services because of an inability to pay and they
employ a system of sliding fee schedules and waivers to ensure
the fee is applied fairly.
She said DPS understands no one wants to pay fees, but in the
current fiscal environment, the widening gap between public
health costs and state general funds jeopardizes their ability
to provide services that protect Alaskans from preventable
causes of illness, injury, and death.
SENATOR VON IMHOF observed that the slides are high-level
example of what type of data is collected. She asked for an
example of an actual entity, a hospital, a clinic, an
organization that would ask for data.
MS. LEWIS said an example of data analysis is a survey done
every other year with school districts of risk factors for
adolescents. They do a statewide report and school districts ask
for a special analysis to target their students, but DPS does
not have the capacity for that analysis. They might be able to
build that capacity if they could charge a fee for it.
SENATOR VON IMHOF noted that the committee heard that DHSS was
contracting services with Evergreen for certain reports. She
asked if they would provide the underlying data from an existing
report if an entity asked for it, and if there would be a charge
for the information.
2:21:01 PM
MS. LEWIS said there is no straight yes or no answer because
each individual data set has individual concerns about privacy,
who is asking for the data, and why. The department has standard
agreements with entities that are interested in the underlying
data. Much of what they produce in data and reports are
published on the Internet or available in aggregate form. DHSS
collects a lot of data from entities that are required to report
and those entities should be able to get something in return for
providing the information. But if someone wants to look deeper
or have a special analysis that takes extra time, collecting a
fee would be appropriate.
SENATOR VON IMHOF said she understands that is true for
specialized data. Her concern is that if there is data already
collected, she hopes they make it available to people asking for
it. DHSS is a data trove and she would hope that it makes the
data it is already collecting readily available to other
entities.
SENATOR GIESSEL said she commends the department for coming
forward with this bill, in collaboration with the House Finance
Committee. It is long overdue. This not unlike what the Park
Division in the Department of Natural Resources is doing. They
are raising fees and selling logo gear to make their division
more self-sustaining. The Public Health Division provides such
great services to Alaska and should charge for them. She asked
if there was any opposition to this bill in the other body.
MS. LEWIS said in the initial hearing in the House Health and
Social Services Committee, they did hear some concern about
whether the regulatory process allowed for sufficient public
input. Rather than just commit to doing preliminary meetings
with stakeholders, it was put into the bill. That's a good
practice and essential. They need to understand what fee
structure will work for the people who will be paying the fees.
2:25:47 PM
SENATOR GIESSEL said that when a regulation packet goes out,
there is always a public comment period. Ms. Lewis is saying
that they are putting in statute a pre-public comment period
where stakeholders would give feedback before DHSS writes
regulations. She said it is similar to what the Department of
Revenue often does with oil and gas tax regulations. She asked
if her interpretation was correct.
MS. LEWIS said yes and it is helpful to work with partners ahead
of time to scope out what a program or rule might look like. The
Department of Law has guidelines on how to have these
preliminary meetings without getting crossways with the official
regulatory process. She agreed that many departments already use
that process.
2:27:15 PM
CHAIR WILSON asked for a list of the current fees
MS. LEWIS said the list of fees is in regulation 7 AAC 80. A
more comprehensive detailed list is in a fee schedule published
by the Office of Management and Budget every year, where every
fee in the state is listed individually. She agreed to send the
extract of their fees.
CHAIR WILSON said she could provide the links and page numbers
to his office. He asked if the fees collected would go into the
general fund or be designated.
2:29:27 PM
MS. LEWIS said these would be designated general fund program
receipts. In Section 1 of the bill, they are added to the list
of fees already in statute. It helps make it clear that the
intent of fees is to be used for those programs. The legislature
always has the power to appropriate funds, but that makes the
intent clear.
CHAIR WILSON asked what the guesstimate is for revenue.
MS. LEWIS said the fiscal note is for $600,000 in new fees,
which is a comparatively small amount. The division budget is
roughly $117 million from all fund sources, but now there are no
funds for those particular services. This is the way forward to
provide those services.
2:31:37 PM
CHAIR WILSON said he is a huge supporter of public health. He
has been disappointed that a lot of the education services and
other items key for communities have been cut. He agrees with
Senator Giessel that the administration is trying to solve the
problem in providing services.
SENATOR MICCICHE said he is excited to see this bill. There is
already a section in the Fiscal Procedures Act that covers
monetary recoveries by DHSS and Medicaid expenditures and from
recipients and third-party providers under AS 47. He asked if
there are any further discussions on offsetting costs from those
who can afford something.
MS. LEWIS said the department is always looking at its fee
structure. [AS 44.29.022] has a list of what kind of fees the
department may charge for, and specific fee authority is in
other statutes. That particular list includes a fairly broad
authority for things such as child welfare, public assistance,
and juvenile justice, but the public health pieces of that are
very specific. Instead of saying the department has authority
for public health services, it says maternal child health,
health education, public health nursing. Essentially nothing
else is allowed. Public Health is different in the way it is
listed and that is why the bill focuses on that division and
doesn't go broader than that.
2:34:37 PM
CHAIR WILSON opened public testimony.
2:35:09 PM
ALISON KULAS, Executive Director, Alaska Mental Health Board,
Advisory Board on Alcoholism and Drug Abuse, supported HB 215.
She said during this budget crisis it is necessary to look at
other income sources. This won't be a huge revenue gain, but it
is a piece of what they are allowed to do. Reasonable fees and
requiring public input to determine those fees are the key to
the bill. Her board will be one of the voices at the table as
they go through this process. These boards take into
consideration what their community needs and what their
providers need to promote the health and well-being of all
Alaskans. They believe in the mission of public health. All
Alaskans are consumers of what the Division of Public Health
provide.
2:36:52 PM
SENATOR BEGICH asked if both of her boards have analyzed the
impact of this bill and are confident that it will not have an
adverse impact on their beneficiaries, many of whom do not have
the ability to represent themselves.
MS. KULAS responded that that is why they are impressed by the
intent for the public process to establish fees. They look
comprehensively at how to promote the health and well-being of
all Alaskans. They will always keep an eye to ensure that
beneficiaries are protected and that they are not overburdened
by any sort of legislation.
SENATOR MICCICHE opined that the state should be prioritizing
need. Those who can afford to pay allows additional services for
people who can't. The state has not had to worry about that and
has grown its ability to spend money faster than its ability to
manage money. That puts services to everyone at absolute risk.
He said if we get to the point where a broad-based tax is
necessary to pay the bills, there will be a revolution of
opposition to the services the state provides. He suggested
bringing it down to the beneficiary level for those who can
afford to pay, so the state can guarantee services to those who
can't pay. He asked Ms. Kulas for her thoughts.
2:39:35 PM
MS. KULAS said that when she says beneficiaries, she's looking
at the Mental Health Trust beneficiaries, those consumers of
behavioral health services. When looking at models, if people or
agencies can pay, the Trust do want to ensure they are
contributing. But they want to look full picture, so those who
aren't able to pay but really need the services to better
contribute back to society are also afforded those
opportunities. That's why it's great that reasonable fees are
based on the actual service rather than flat fees.
SENATOR MICCICHE said his theory is that every dollar the state
collects from someone who can contribute is a service provided
to someone who can't. The last 15 years the state hasn't had to
consider that, but now it is either cutting out key or in some
cases borderline constitutionally required services because it
can't afford them. He is very supportive of the bill and
appreciates the department bringing it forward. Hopefully the
concept becomes contagious.
CHAIR WILSON said he is supportive but also worried about
potential harm by setting fee schedules. He oversaw a domestic
violence sexual assault shelter and the Mat-Su public health
office would come once a month to provide services. They were
actively involved in their community domestic violence task
force. He doesn't want those services to stop because of fee
schedules, but he is supportive of the legislation overall.
2:42:27 PM
SENATOR MICCICHE asked by what percentage public health nursing
has been reduced over the past four years.
2:42:39 PM
MS. LEWIS said she didn't have numbers in front of her. Public
health nursing is about half of their general fund and the
largest section within the Division of Public Health. They are
mostly general fund supported. Because of that, public health
nursing has absorbed a disproportionate share in their division
because they had nowhere else to take cuts. They have been
reduced 20 percent since 2015. They lost 40 positions. More than
20 were filled at the time and resulted in layoffs.
SENATOR MICCICHE said he just wanted to point that out. That is
why this bill is so important. It's a concept to evaluate. Along
with those positions and that funding, some services went away
that Alaskans count on. He said he's not a bad guy who wants to
rub his hands and see services go away. The more they put their
heads together on similar solutions, the less services will be
cut in the future.
CHAIR WILSON thanked Ms. Lewis for the presentation. He held HB
215 in committee.
2:44:18 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee at 2:44 p.m.