01/30/2025 03:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation(s): Medicaid 1115 Waiver Update | |
| SB44 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| + | SB 44 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
January 30, 2025
3:31 p.m.
MEMBERS PRESENT
Senator Forrest Dunbar, Chair
Senator Cathy Giessel, Vice Chair
Senator Matt Claman
Senator Löki Tobin
Senator Shelley Hughes
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
PRESENTATION(S): MEDICAID 1115 WAIVER UPDATE
- HEARD
SENATE BILL NO. 44
"An Act relating to the rights of minors undergoing evaluation
or inpatient treatment at psychiatric hospitals; relating to the
use of seclusion or restraint of minors at psychiatric
hospitals; relating to a report published by the Department of
Health; relating to inspections by the Department of Health of
certain psychiatric hospitals; and providing for an effective
date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 44
SHORT TITLE: MINORS & PSYCHIATRIC HOSPITALS
SPONSOR(s): SENATOR(s) CLAMAN
01/17/25 (S) PREFILE RELEASED 1/17/25
01/22/25 (S) READ THE FIRST TIME - REFERRALS
01/22/25 (S) HSS, FIN
01/28/25 (S) HSS AT 3:30 PM BUTROVICH 205
01/28/25 (S) Heard & Held
01/28/25 (S) MINUTE(HSS)
01/30/25 (S) HSS AT 3:30 PM BUTROVICH 205
WITNESS REGISTER
EMILY RICCI, Deputy Commissioner
Department of Health (DOH)
Juneau, Alaska
POSITION STATEMENT: Co-presented The Role of Section 1115
Waivers in Medicaid Opportunities and Updates.
TRACY DOMPELING, Director
Division of Behavioral Health
Department of Health
Juneau, Alaska
POSITION STATEMENT: Co-presented The Role of Section 1115
Waivers in Medicaid Opportunities and Updates.
BETSY WOOD, Associate Director
Office of Health Savings
Department of Health
Juneau, Alaska
POSITION STATEMENT: Co-presented The Role of Section 1115
Waivers in Medicaid Opportunities and Updates.
KATHLEEN WEDEMEYER, Deputy Director
Citizens Commission on Human Rights
Seattle, Washington
POSITION STATEMENT: Testified in support of SB 44 with concerns.
ROBERT NAVE, Division Operations Manager
Division of Health Care Services
Department of Health
Anchorage, Alaska
POSITION STATEMENT: Answered questions on SB 44.
ACTION NARRATIVE
3:31:09 PM
CHAIR DUNBAR called the Senate Health and Social Services
Standing Committee meeting to order at 3:31 p.m. Present at the
call to order were Senators Tobin, Claman, Hughes, Giessel, and
Chair Dunbar.
^PRESENTATION(S): MEDICAID 1115 WAIVER UPDATE
PRESENTATION(S):
MEDICAID 1115 WAIVER UPDATE
3:32:01 PM
CHAIR DUNBAR announced a presentation The Role of Section 1115
Waivers in Medicaid Opportunities and Updates by the Department
of Health.
3:32:52 PM
EMILY RICCI, Deputy Commissioner, Department of Health (DOH),
Juneau, Alaska, co-presented The Role of Section 1115 Waivers in
Medicaid Opportunities and Updates. She expressed appreciation
for the opportunity to explain how 1115 waivers differ from
standard Medicaid coverage.
3:33:15 PM
MS. RICCI moved to slide 2 Medicaid Basics.
[Original punctuation provided.]
Medicaid Basics
• Medicaid is a public health insurance program for
low-income adults, children, pregnant women, elderly
adults, and people with disabilities.
• Administered at the state level, subject to
federal requirements
• Jointly financed by the federal government and
the state
• Alaska adopted Medicaid in 1972.
MS. RICCI stated that Medicaid is a joint state-federal
insurance program for low-income individuals, including
children, pregnant women, the elderly, and people with
disabilities. Alaska joined Medicaid in 1972 and currently
insures nearly 30 percent of its population, making it essential
to both health coverage and healthcare financing in the state.
She explained that although federally funded, Medicaid is state-
administered under federal guidelines, with required and
optional benefits and coverage groups determined at the state
level. The federal government covers at least 50 percent of
costs, with the rate varying by service type and population.
She described the Medicaid state plan as the agreement between
Alaska and the federal government outlining covered services,
eligible populations, payment methods, and administrative
procedures. Changes to the state plan require formal amendments,
including federal review, public comment, tribal consultation,
and financial analysis.
3:36:16 PM
MS. RICCI moved to slide 3, What is an 1115 Waiver:
[Original punctuation provided.]
What Is An 1115 Waiver?
1115 waivers give states the ability to tailor their
Medicaid programs by testing and evaluating state-
specific policy approaches.
Under Section 1115 of the Social Security Act, the
U.S. Health & Human Services Secretary has the
authority to waive compliance with Medicaid law to
approve "any experimental, pilot or demonstration
project" that promotes the objectives of the Act.
Demonstrations may be very broad or very narrow.
Demonstrations can be used to test innovative care
delivery systems, to add or alter benefits, and to
modify eligibility.
Demonstrations must be budget-neutral for the federal
government.
MS. RICCI explained that a Section 1115 waiver allows states to
test Medicaid program changes not typically permitted under
federal rules, using broad statutory authority granted to the
Secretary of Health and Human Services.
MS. RICCI stated that 1115 waivers must align with Medicaid
objectives and are approved as demonstration projects, usually
for five years. These projects start with a clear goal, use
specific metrics to evaluate outcomes, and require extensive
reporting, public comment, tribal consultation, and federal
negotiation throughout their duration.
MS. RICCI emphasized that waivers must be budget neutral from
the federal perspective, meaning total federal costs under the
waiver cannot exceed what they would have been without it.
Measuring budget neutrality is complex and may vary depending on
the federal administration.
MS. RICCI noted that evaluations must be conducted by an
independent contractor to ensure accountability and validity of
outcomes. Waivers can range in scope from narrow service tests
to complete program structures, as seen in Arizona.
3:40:04 PM
TRACY DOMPELING, Director, Division of Behavioral Health,
Department of Health, Juneau, Alaska, Co-presented The Role of
Section 1115 Waivers in Medicaid Opportunities and Updates. She
moved to slide 4 and shared the following points:
[Original punctuation provided.]
Alaska's Current 1115 Waiver
The Behavioral Health Reform 1115 waiver aims to
provide cost-effective, high-quality behavioral health
services at the right time in the right setting.
Increase access to community-based care
Intervene as early as possible to address behavioral
health symptoms
Improve quality and outcomes of the overall behavioral
health system
MS. DOMPELING stated that the 1115 waiver expanded Medicaid
services beyond the standard state plan by incorporating
programs previously funded through grants. She highlighted the
addition of services such as 23-hour crisis care, stabilization
programs, crisis residential, and mobile crisis response, all
aligned with the Crisis Now model. She noted the inclusion of
children, adolescent, and adult mental health residential
programs, partial hospitalization, and substance use disorder
services that meet national standards.
3:41:35 PM
MS. DOMPELING moved to slide 5 Alaska's Current 1115 Waiver
sharing details of the following timeline:
[Original punctuation provided.]
2016 SB 74 passes, directing the Department to pursue
an 1115 waiver for behavioral health system
modernization.
2017 Department drafts 1115 waiver application
(includes behavioral health and substance use
disorder components).
2018 Waiver application submitted for federal
approval. Substance use disorder component of
waiver is approved.
2019 Substance use disorder waiver services available
to Alaskans. Behavioral health component of
waiver is approved.
2020 Behavioral health waiver services available to
Alaskans.
2021 Department develops regulations packages, billing
manuals, other ongoing operational requirements.
2022 Interim evaluation report is submitted.
2023 Department begins process for waiver renewal and
receives federal approval for a temporary
extension.
2024 Waiver is renewed to 12/31/2028 and renamed to
Behavioral Health Reform waiver.
MS. DOMPELING stated that the waiver renewal included a name
change to the Behavioral Health Reform Waiver, replacing the
previous bifurcated title. She explained that the new name
reflects Alaska's commitment to program reform and broader
system transformation in behavioral health.
3:44:33 PM
MS. RICCI added that understanding the waiver timeline is key to
assessing its impact on the behavioral health system,
particularly given the timing of service implementation. She
noted that behavioral health services launched in May 2020
during the onset of the COVID-19 pandemic, which created
challenges for rollout. She indicated that upcoming data slides
will show increased service use and payments under the 1115
waiver, partially due to the delayed uptake caused by the
pandemic.
3:45:15 PM
MS. DOMPELING moved to slide 6, Medicaid Expenditures for
Behavioral Health, a bar graph showing the state and federal
1115 expenditures and state and federal plan expenditures from
FY 2018 to FY 2025. A green line shows the decrease in grants
and a shift to Medicaid services. She emphasized the significant
increase in behavioral health funding over the past seven fiscal
years, combining state plan, 1115 waiver, and grant funding.
MS. DOMPELING noted that Senate Bill 74 aimed to shift from
grant-based support to a more sustainable Medicaid-funded system
to draw down additional federal dollars. From FY 2018 to FY
2024, behavioral health funding increased by $120 milliona 48
percent rise. She explained that the growth in Medicaid
expenditures, particularly under the 1115 waiver, reflects
increased provider participation and service use, while grant
funding has generally declined, aside from a temporary spike in
FY 2022 due to American Rescue Plan Act funds.
MS. DOMPELING reported a 41.6 percent increase in independent
practitioners enrolling in Medicaid between FY 2023 and FY 2024,
along with annual rate increases for 1115 services, including a
4.5 percent bump in both FY 2023. An increase was also seen in
FY 2019 which was based on required rebasing to clinic and
rehabilitation services. In FY 2025 there was another increase
in 1115 services of 4.5 percent increase to the base rate. A 3.8
percent clinic rebasing also took effect in January 2025. She
concluded by highlighting the department's prioritization of
behavioral health and home and community-based service rates in
its ongoing rate methodology review to support provider
sustainability and service expansion.
3:50:07 PM
MS. RICCI emphasized that developing new services under the 1115
waiver takes time due to both policy and operational challenges.
She acknowledged the longstanding focus from the legislature,
the Department of Health, and other stakeholders on
strengthening behavioral health services. She stated that the
1115 waiver is beginning to show clear benefits and funding
maturity, aligning with the policy goals of Senate Bill 74. She
noted a significant shift toward Medicaid funding and increased
use of federal dollars to support Alaska's behavioral health
system and expressed optimism about future data as the waiver
matures.
3:51:13 PM
MS. DOMPELING moved to slide 7, Refining and Sustaining
Services:
[Original punctuation provided.]
Refining and Sustaining Services
Waiver services are evaluated on an ongoing basis as
part of a continuous improvement process.
• Move services into state plan
• Retain services in waiver
• Modify services in waiver
MS. DOMPELING stated that ongoing maintenance of the 1115 waiver
is essential, as it functions as a demonstration to test service
effectiveness and provider uptake. She explained that the
evaluation process helps identify which services may transition
into the state plan and which need adjustments due to
implementation challenges. She noted that amendments offer
opportunities to expand effective services and create
flexibilities to better support provider participation
statewide. She highlighted crisis services as an area for
improvement, referencing provider feedback, a recent statewide
assessment, and new federal guidance from the Substance Abuse
and Mental Health Services Administration (SAMHSA) promoting a
broader crisis continuum. She added that current mobile crisis
response requirements, such as 24/7 availability, are difficult
for smaller communities, and future changes will aim to make
implementation more feasible.
3:54:17 PM
BETSY WOOD, Associate Director, Office of Health Savings,
Department of Health, Juneau, Alaska, co-presented The Role of
Section 1115 Waivers in Medicaid Opportunities and Updates. She
moved to slide 8 and outlined the department's future plans for
the 1115 waiver, focusing on evolving the current waiver through
amendments and exploring new demonstration opportunities that
align with broader Medicaid policy goals.
MS. WOOD stated that the department is evaluating which current
1115 services are working well for providers and beneficiaries,
while also identifying areas where new ideas could be
implemented more efficiently through amendments rather than
starting new waivers from scratch. She highlighted three key
areas of exploration:
• Health-related needs, such as nutrition and transportation
services, supported by recent legislation and modeled after
successful programs in other states.
• Reentry services for incarcerated adults, including
supports available up to 90 days pre-release, in
coordination with the Department of Corrections and
Division of Juvenile Justice through a national Policy
Academy.
• Innovative payment models, including value-based and
population health payment approaches, following a request
for information issued to providers last year.
3:59:41 PM
MS. DOMPELING moved to slide 9, Process and Timeline for 1115
Waivers, and reviewed the overall process for developing and
implementing 1115 waivers, emphasizing that while timelines
vary, the path involves multiple key steps from policy scoping
to the five-year demonstration period. She underscored that
stakeholder engagement is central throughout the processfrom
initial idea to implementationand is critical to the success of
any system change. She expressed appreciation for the work
already done through the Behavioral Health Reform Waiver, noting
the lessons learned and the department's continued effort to
apply best practices from Alaska and other states to streamline
future efforts.
4:01:32 PM
SENATOR HUGHES asked whether the goal of the 1115 waiver pilot
is to identify effective services that can later be incorporated
into the state plan, eliminating the need for ongoing waiver
renewals.
MS. DOMPELING replied yes, that is the ultimate goal.
4:02:38 PM
SENATOR HUGHES asked whether, in meeting the budget neutrality
requirement, the state calculates projected costs without the
waiver and whether the federal government conducts its own
estimates, leading to possible negotiation if there is
disagreement. She referred to slide 6 showing expenditure growth
and asked if the increase to approximately $390 million in FY
2024 was anticipated during the waiver application process. She
inquired what happens if actual spending exceeds projections.
4:03:33 PM
MS. DOMPELING confirmed that budget neutrality is required
during both waiver renewals and amendments and is included in
ongoing reporting throughout the waiver period. She explained
that projections often assume some individuals would otherwise
need more expensive, higher-level care, and that by offering
lower-cost, preventative services, the state maintains
neutrality in federal spending.
4:04:39 PM
MS. RICCI explained that budget neutrality can be measured in
various ways, and negotiations with the federal government often
center on which assumptions are used in the projections. She
stated that the core of budget neutrality is comparing the
estimated cost of services with the waiver to what the cost
would be without it. She noted that for the Behavioral Health
Reform Waiver, the assumption is that providing earlier access
to behavioral health and substance use disorder services reduces
the need for more expensive, acute care later. She added that
these projections rely on complex actuarial analyses conducted
by state-hired contractors and reviewed by federal actuaries.
4:05:58 PM
SENATOR CLAMAN asked whether portions of a demonstration project
eventually become part of the permanent Medicaid program or if
the state continues to renew the 1115 waiver repeatedly.
MS. RICCI explained that whether services from an 1115 waiver
move into the Medicaid state plan depends on several
considerations. There are many reasons why it might not be
appropriate to move services to the state plan. She stated that
services showing strong value may be candidates for transition,
but factors like Medicaid's upper payment limittied to
typically lower Medicare ratescan make some services better
suited to remain under the 1115 waiver. She noted that 1115
waivers offer more rate-setting flexibility, which is important
when designing behavioral health services, and not all state
plan payments are subject to the same limits, adding complexity
to the decision. She added that in other states, 1115 waivers
are often ongoing and amended over time, rather than ending
entirely. Some larger services or goals may end while the waiver
structure remains in place.
4:08:36 PM
SENATOR CLAMAN asked if, based on examples from other states, it
is reasonable to expect Alaska will continue to operate an 1115
waiver alongside the Medicaid state plan with content evolving
over time.
MS. RICCI replied that based on her knowledge that is what she
would expect.
SENATOR CLAMAN asked whether crisis intervention and crisis
residential services, which the legislature developed in
coordination with the department, are included in both the
original 1115 waiver and its renewal.
4:09:18 PM
MS. DOMPELING confirmed that crisis intervention and crisis
residential services remain part of the 1115 waiver. She added
that the department has directed its contractor to review
current 1115 services and recommend which may be suitable for
transition into the state plan. She stated that as services move
out of the waiver, the Division of Behavioral Health plans to
evaluate grant-funded programs to identify promising models that
could be added to the 1115, allowing grant funds to be
redirected toward filling other service gaps identified in past
reports and ongoing gap analyses.
4:10:26 PM
SENATOR GIESSEL expressed concern about the slow pace of
progress since the passage of Senate Bill 74. She said she
agrees with continued use of grant funding as a valuable tool
for testing and evaluating effective treatments and expressed
concern over removing grants entirely. She acknowledged the
reported 48 percent funding increase and 41.6 percent rise in
practitioner enrollment but emphasized that need has grown by an
estimated 90 percent, indicating the system remains under-
resourced. She asked how much the 1115 waiver supports
integrated care models that combine primary care, behavioral
health, and substance use disorder treatment to better address
whole-person care.
4:12:22 PM
MS. DOMPELING acknowledged that behavioral health and substance
use disorder (SUD) services are still largely separate within
the 1115 waiver structure. She highlighted upcoming work to
establish Certified Community Behavioral Health Clinics (CCBHCs)
in Alaska, which integrate behavioral health and primary care
and qualify for an enhanced prospective payment system (PPS)
rate. She explained that CCBHCs must provide services regardless
of an individual's ability to pay, addressing access gaps for
those without Medicaid or private insurance. She agreed that
integration and system improvements take time and effort, noting
the division's limited size and capacity but emphasizing their
ongoing progress despite structural challenges, such as separate
SUD and mental health manuals.
4:14:16 PM
MS. RICCI stated that one of the goals of the Office of Health
Savings is to increase the department's agility in responding to
opportunities and advancing demonstration projects like 1115
waivers. She noted that the Behavioral Health Reform Waiver was
Alaska's first 1115 effort, and the department aims to build on
that experience by expanding capacity within the commissioner's
office to support idea development and implementation. She
emphasized the department's intent to work more quickly and
collaboratively, even though federal processes remain a limiting
factor in overall waiver approval timelines.
4:15:11 PM
SENATOR GIESSEL said she appreciated the distinction between
behavioral health and substance use disorder made by Ms.
Dompeling. She noted that Federally Qualified Health Centers
(FQHCs) are also transitioning toward integrated care models
that include mental health and substance use disorder services.
She asked whether reimbursement rates for FQHCs are being
rebased to reflect this shift and how that process is
progressing.
MS. RICCI stated that the department is working closely with the
Alaska Primary Care Association on reimbursement and rebasing
issues for Federally Qualified Health Centers (FQHCs). She
stated that the department is working closely with the Alaska
Primary Care Association on reimbursement and rebasing issues
for Federally Qualified Health Centers (FQHCs). They are working
to identify through a system and process the addition of
services brought on board. She noted that several FQHCs have
already been rebased over the past two years and that progress
is being made in addressing previously raised concerns.
4:16:43 PM
SENATOR TOBIN referred to slide two and asked about the
negotiation process with the federal government regarding the
Medicaid state plan. She inquired how much notice the state
receives if the federal government reduces funding or changes
how it supports previously approved elements of the plan, and
whether there is a disclosure requirement before such shifts
take effect.
4:17:56 PM
MS. RICCI responded that it is difficult to speak to
hypotheticals, but the department actively monitors changes from
the Centers for Medicare and Medicaid Services (CMS). She noted
that significant federal policy shifts have occurred in the past
and, as new changes are approved and clarified, the department
will respond as needed.
4:18:30 PM
SENATOR TOBIN asked whether federal protections or specific
timelines existsuch as a 30- or 60-day notice periodrequiring
the federal government to formally notify states before making
changes to Medicaid funding or policy. She questioned whether
such requirements are outlined in federal code or if changes
could be implemented informally
4:18:49 PM
MS. RICCI stated that she would need to review the specifics
regarding federal timelines for changing Medicaid policy but
clarified that she is more familiar with the timelines required
when the state initiates change through a state plan amendment.
She explained that the amendment process includes strict
requirements for public notice, tribal consultation, and federal
review, along with opportunities for the state to appeal certain
federal decisions.
4:19:41 PM
SENATOR HUGHES provided historical context on reentry services,
referencing Senate Bill 74 and the work of former legislative
staff and contractors, including Ryan Ray, who focused on
reentry and substance use disorder. She highlighted the
significance of reentry programs following the repeal of Senate
Bill 91 and described a pilot projectSet Free Alaskawhich
began around 2019 with funding from state and federal sources,
including support from Senator Natasha von Imhof and Senator
Lisa Murkowski. She described Set Free Alaska's whole-person,
integrated care model that begins pre-release and continues
post-release with residential services, covering areas such as
primary care, nutrition, family counseling, job training, and
substance use treatment. She encouraged the department to review
Set Free Alaska's outcomes and consider it as a potential model
for replication as they explore reentry services under the 1115
waiver.
SENATOR HUGHES asked how the approximately $390 million in
behavioral health spending in FY 2024 compares to overall
medical spending in Medicaid. She referenced recent discussions
on parity and noted the growing mental health needs in the
state, seeking context on how behavioral health funding aligns
with general medical expenditures.
4:22:23 PM
MS. RICCI stated that Alaska's total Medicaid budget is
approximately $2.8 billion, combining state and federal funds.
She clarified that the $388 million shown on slide 6 includes
around $51 million in state grants, leaving about $333 million
in Medicaid spending specifically for behavioral health
services. So, in context of the overall Medicaid budget, that is
about the amount in comparison to the medical spend.
4:23:01 PM
CHAIR DUNBAR said that if you do the math that is about $2.4
billion spent on medical services. He clarified that the parity
legislation he sponsors is not seeking equal funding between
behavioral and physical health, but rather parity in
administrative processes and service accessibility. He expressed
appreciation for the department's efforts on that front.
4:23:34 PM
SENATOR GIESSEL commented that unaddressed behavioral health
issues often amplify medical conditions, meaning a portion of
the $2.4 billion spent on medical services also relates to
mental health.
4:24:10 PM
MS. RICCI thanked the committee for its continued support over
the years and acknowledged Heather Carpenter for her
contributions to the development and advancement of the 1115
waiver work.
4:24:25 PM
At ease.
SB 44-MINORS & PSYCHIATRIC HOSPITALS
4:24:34 PM
CHAIR DUNBAR reconvened the meeting and announced the
consideration of SENATE BILL NO. 44 "An Act relating to the
rights of minors undergoing evaluation or inpatient treatment at
psychiatric hospitals; relating to the use of seclusion or
restraint of minors at psychiatric hospitals; relating to a
report published by the Department of Health; relating to
inspections by the Department of Health of certain psychiatric
hospitals; and providing for an effective date."
4:25:48 PM
CHAIR DUNBAR opened public testimony on SB 44.
4:26:15 PM
KATHLEEN WEDEMEYER, Deputy Director, Citizens Commission on
Human Rights, Seattle, Washington, testified in support of SB 44
with concerns. She stated Citizens Commission on Human Rights is
a psychiatric watchdog group that supports the main goals of SB
44 to reduce abuse risk, improve family connections, and
increase transparency in psychiatric hospitals for minors. She
advocated for additions to SB 44, including a review of the use
of psychiatric medications, especially powerful or atypical
drugs, and a shift toward non-coercive, drug-free treatments.
She cited concerns about severe side effects of psychiatric
drugs and the lack of objective medical tests to diagnose
psychiatric conditions in youth. She also recommended mandatory
medical screening for minors upon admission to rule out
underlying physical causes of emotional distress and urged
support for an amended version of SB 44.
4:28:11 PM
CHAIR DUNBAR closed public testimony on SB 44.
4:28:28 PM
SENATOR CLAMAN speaking as sponsor provided comments on SB 44.
He responded to earlier questions regarding the term "overseeing
physician" on page 1, line 11, by recommending it be changed to
"professional person in charge," a term used elsewhere in Title
47. He explained that this change would clarify that the
individual making decisions about limiting parent-youth
communication must be a higher-level supervising care provider
such as a physician, physician assistant, or psychologistrather
than the broader treatment team. He stated that an amendment
reflecting this change will be introduced, along with a second
amendment to shift data collection responsibilities noted on
page 2, lines 1824, from the Department of Family and Community
Services to the Department of Health. He also noted that the
Department of Health is available to respond to earlier
questions regarding the use of body cameras or video monitoring
in psychiatric treatment settings.
4:30:33 PM
SENATOR GIESSEL acknowledged the previous testifier's concerns
about the use of psychiatric medications in young people and
agreed that such treatments can potentially cause lasting
changes to neural pathways. She cautioned against prescribing
specific healthcare approaches through legislation. She affirmed
that the testifier raised a valid and important point.
4:31:20 PM
SENATOR CLAMAN expressed agreement with Senator Giesel's
concerns about the risks of legislating specific medication use
for youth. He cautioned against placing restrictions in statute
on particular drugs, noting the evolving nature of
pharmaceutical treatments and the potential for new medications
to show promise initially but later reveal serious issues. He
supported raising concerns about youth medication use but
suggested that such matters are better addressed through
regulation, which offers greater flexibility to adapt over time.
He acknowledged the importance of the issue but was uncertain
how to effectively address it through bill language.
4:32:21 PM
SENATOR GIESSEL referred to SB 44, Section 3, which outlines an
annual report requirement, and suggested it could include data
on the frequency of pharmaceutical interventions. She stated
that adding this information could help identify trends,
encourage self-examination by providers, and support comparisons
to best practices. She noted she would need to consider how best
to phrase the requirement but believed it would prompt valuable
reflection on medication use.
4:32:56 PM
CHAIR DUNBAR commented that, in addition to concerns about
psychiatric medications, there is clear evidence that social
media use is also altering brain chemistry. Although not
directly related to SB 44, he suggested that society should
critically examine the impact of smartphones and digital
platforms on mental health, especially when discussing factors
that affect brain development.
4:33:18 PM
SENATOR HUGHES stated she agreed with both comments by Senator
Giessel and Senator Dunbar. She recalled prior Judiciary
Committee testimony about the use of restraint on minors and
emphasized that expert witnesses clearly stated restraint should
be used only as a last resort and strictly for life safety
situations. She described scenarios where restraint might be
justifiedsuch as preventing a child from self-harmbut raised
concerns about misuse and potential consequences for providers.
She questioned whether the designated "professional person in
charge," as proposed in the bill language, is subject to formal
oversight or disciplinary action if restraint is used
improperly. She shared that parents have voiced concerns about
inappropriate use of restraint and reiterated the importance of
accountability and transparency, including her prior suggestion
about video monitoring.
4:35:22 PM
SENATOR CLAMAN stated that the foundation for the legislation
stems from findings in a U.S. Department of Justice report,
which identified overuse of both physical and chemical
restraints in psychiatric settings. He emphasized that the
bill's notice requirementsto both the Department of Health and
parentsaim to increase transparency when restraint is used,
enabling better oversight and investigation if misuse occurs. He
said the hope is that increased transparency will reduce
reliance on both physical and pharmaceutical restraints. He
added that families have the option to pursue malpractice
litigation if restraint is misused and noted that mandated
reporting will help monitor usage trends and inform whether
overuse continues. SB 44 creates transparency that doesn't
current exist.
4:37:00 PM
SENATOR HUGHES asked whether the licensing boards overseeing the
designated "professional person in charge" have the authority to
suspend or revoke licenses in cases of abuse or inappropriate
use of restraint. She emphasized the importance of
accountability, especially if reporting reveals repeated use at
a specific facility, and questioned whether consequences exist
for individuals misusing their authority.
SENATOR CLAMAN confirmed that consequences do exist within
professional licensing systems for providers who fail to follow
proper practices. He acknowledged that while he does not know
all the specific procedures, he is aware that physicians and
other licensed providers can be brought before their respective
boards when concerns about their conduct arise.
4:38:44 PM
SENATOR CLAMAN asked if the committee wanted to hear from the
Department of Health regarding cameras.
4:39:08 PM
ROBERT NAVE, Division Operations Manager, Division of Health
Care Services, Department of Health (DOH), Anchorage, Alaska,
answered questions on SB 44. stated that the department would
provide a written response to questions about the use of cameras
during restraint procedures, due to overlapping federal and
state regulations. He explained that when the Division of
Healthcare Services receives a complaint regarding improper use
of restraint, an investigation is conducted by the Health
Facility Certification and Licensing program. If the
investigation finds that a specific licensed professional was
responsible for the inappropriate restraint, the case is
referred to the relevant professional licensing board for
further review and potential action.
4:40:18 PM
CHAIR DUNBAR [held SB 44 in committee.]
4:40:34 PM
There being no further business to come before the committee,
Chair Dunbar adjourned the Senate Health and Social Services
Standing Committee meeting at 4:40 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SHSS 1115 Medicaid 1.30.24.pdf |
SHSS 1/30/2025 3:30:00 PM |