Legislature(2023 - 2024)BUTROVICH 205
04/26/2023 01:30 PM Senate JUDICIARY
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| Informational Hearing on Department of Justice Investigation of the State of Alaska's Behavioral Health System for Children. | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
SENATE JUDICIARY STANDING COMMITTEE
April 26, 2023
1:32 p.m.
MEMBERS PRESENT
Senator Matt Claman, Chair
Senator Jesse Kiehl, Vice Chair
Senator James Kaufman
Senator Cathy Giessel
Senator Löki Tobin
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
INFORMATIONAL HEARING ON DEPARTMENT OF JUSTICE INVESTIGATION OF
THE STATE OF ALASKA'S BEHAVIORAL HEALTH SYSTEM FOR CHILDREN.
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
DR. ANNE ZINK, Chief Medical Officer
Department of Health
Anchorage, Alaska
POSITION STATEMENT: Contributed to the Informational Hearing on
the Department of Justice Investigation of the State of Alaska's
Behavioral Health System for Children.
HEATHER CARPENTER, Policy Advisor
Department of Health
Juneau, Alaska
POSITION STATEMENT: Contributed to the Informational Hearing on
the Department of Justice Investigation of the State of Alaska's
Behavioral Health System for Children.
FARINA BROWN, Acting Director
Division of Behavioral Health
Department of Health
Anchorage, Alaska
POSITION STATEMENT: Responded to committee member questions
about behavioral health challenges in Alaska.
JEN GRIFFIS, representing self
Fairbanks, Alaska
POSITION STATEMENT: Delivered the presentation, Behavioral
Health Systems of Care.
SHELLEY EBENAL, Chief Executive Officer
Foundation Health Partners
Fairbanks, Alaska
POSITION STATEMENT: Delivered the presentation, Interior
Pediatric Behavioral Health Summit.
ACTION NARRATIVE
1:32:18 PM
CHAIR MATT CLAMAN called the Senate Judiciary Standing Committee
meeting to order at 1:32 p.m. Present at the call to order were
Senators Kaufman, Giessel, and Chair Claman. Senator Tobin
arrived immediately thereafter and Senator Kiehl arrived during
the course of the meeting.
^INFORMATIONAL HEARING ON DEPARTMENT OF JUSTICE INVESTIGATION OF
THE STATE OF ALASKA'S BEHAVIORAL HEALTH SYSTEM FOR CHILDREN.
INFORMATIONAL HEARING ON DEPARTMENT OF JUSTICE INVESTIGATION OF
THE STATE OF ALASKA'S BEHAVIORAL HEALTH SYSTEM FOR CHILDREN.
1:32:55 PM
CHAIR CLAMAN announced the consideration of the Informational
Hearing on Department of Justice Investigation of the State of
Alaska's Behavioral Health System for Children.
1:34:08 PM
DR. ANNE ZINK, Chief Medical Officer, Department of Health,
Anchorage, Alaska, offered the presentation titled "Alaska's
Efforts to Improve Behavioral Health Outcomes for Children." She
stated that the presentation will address the behavioral health
needs for children in Alaska. She clarified that the foregoing
was not the department's legal response to the Department of
Justice.
1:34:52 PM
DR. ZINK began with slide 2, "Behavioral Health Funding." She
stated that the Department of Justice focused on Medicaid
funding so the presentation would took but it was important to
note that the four sources need to be thought of collectively.
Medicaid, grants, general fund expenditures, and other
payers are the State's primary tools to support a
broader range of services and provide Alaskans with
access to services not typically covered by Medicaid.
1:35:22 PM
SENATOR GIESSEL asked if committee members should hold their
questions until after the presentation.
DR. ZINK replied that their preference was to take questions
after the presentation.
1:35:42 PM
HEATHER CARPENTER, Policy Advisor Department of Health, Juneau,
Alaska, revisited slide 2, "Behavioral Health Funding." She
reminded the committee that three funding structures exist under
Medicaid in Alaska; these are the state plan and two waivers.
The state plan provides the bulk of services for which Medicaid
is paid; the 1915C home and community based service waivers are
tailored to individuals who require an institutional-level of
care; and the federal government's demonstration 1115 behavioral
health waiver that is tailored to the whole system and allows
the state to make wholesale changes, which brought in a new
service array that allowed behavioral health services billable
to Medicaid.
1:36:55 PM
MS. CARPENTER moved to slide 3, "Medicaid Behavioral Health
Services in Alaska."
• Alaska is a Medicaid fee-for-service state.
• Alaska relies on non-government entities to provide
most direct care services.
• Service availability depends on whether providers
offer those services, and which payment mechanisms
they accept.
• Rural geography and diffuse population centers pose
significant challenges to the provision of
behavioral health care services.
1:38:04 PM
MS. CARPENTER spoke to slide 4, "1115 Demonstration Waiver
Improved Access to Behavioral Health Services."
Improvements:
• Allows state to cover services not typically covered
by Medicaid.
• Expands Medicaid-covered services to include at risk
Alaskans.
• Reduces reliance on late-stage crisis services.
• Emphasis on early-stage outreach, prevention, and
intervention.
• Uses innovative services delivery systems.
Unrealized Benefits:
• The second part of the waiver went into full effect
in May 2020 through emergency regulations, 2 months
after the start of the pandemic.
• Utilization of all the 1115 waiver could only begin
once reimbursement became available in May 2020.
• Benefits of the 1115 waiver are still being
implemented by a growing number of providers.
• Plan submitted to CMS [Centers for Medicare &
Medicaid Services] for waiver renewal February 27,
2023.
1:40:57 PM
DR. ZINK spoke to slide 5, "Three Key Focus Areas Going
Forward."
• Medicaid Reimbursement Structure and Participation
• Expanding Methods of Service Delivery and Facility
Types
• Establish and Expand Crisis Stabilization Services
1:42:13 PM
MS. CARPENTER spoke to slide 6, "Medicaid Reimbursement
Structure and Participation."
• Increased Rates for 1115 Services.
• Increased Rates for Home and Community Based
Services.
• Rebased Rates for Home and Community Based Services.
• Rebasing Rates for Community Behavioral Health
Providers.
1:42:53 PM
MS. CARPENTER spoke to slide 7, "Expanding Methods of service
Delivery and Facility Types."
1) Increase utilization of existing services.
2) Fully implement new telehealth statute and
regulations.
3) Additional non-Medicaid efforts:
Psychiatric Emergency Services (PES) Program.
Broadband Task Force.
Stakeholder Engagement.
Provider Education.
4) Identify and address gaps in the continuum of care.
Fully implement HB 172, 1115 and other areas of
effort.
DR. ZINK remarked that infrastructure dollars are tied to
healthcare workforce dollars. She recommended utilizing every
level available to ensure housing, broadband and telehealth
services across the state. The Medicaid waivers require many
different pieces to come together.
1:45:39 PM
DR. ZINK discussed slide 8, "Crisis Stabilization Services
Reduce the Need for a Higher Level of Care."
1) Statewide crisis call center.
2) Centrally deployed, 24/7 mobile crisis teams.
3) 23-hour and short-term stabilization.
1:47:21 PM
MS. CARPENTER spoke to slide 9, "Supporting Alaskans Close to
Home."
1) Today, there are 73 children on Medicaid receiving
care out of state.
2) Since December 2020 (start of DOJ investigation),
Alaska has reduced the number of children on
Medicaid receiving care out of state by 25.5%.
3) Out of state care is an option of last resort.
4) Children placed out of state are closely monitored
by dedicated staff to coordinate care and ensure
facility compliance.
1:48:36 PM
DR. ZINK continued to slide 10, "Improving Complex Care
Coordination." She reminded the committee that systems do not
always meet the needs of the patient. She acknowledged that the
Department of Justice report did not include many heartbreaking
stories about children wishing to be closer to home. She
highlighted that the challenges brought forward in the report
exist in the state and across the nation. She revealed that the
Improving Complex Care Coordination project was initiated by the
Department of Health and the Department of Family and Community
Health Services. Residing within the project is the crisis
response team, which is a multidisciplinary team that meets
weekly to address patient needs.
DR. ZINK shared that the team reviewed three cases this week.
She noted that one case involved a multitude of behavioral
health clinicians, both in-state and out-of-state, with no
unified plan for the child. The second case involved a patient
in an inpatient psychiatric facility requiring discharge and
three-on-one services. Numerous funding types were braided
together to provide the three-on-one service type allowing the
patient to move back into the community. The third case involved
a series of payment structures without a mechanism to include
room and board and behavioral health needs. The crisis response
team addresses solutions to meet patient's needs today.
DR. ZINK revealed that the complex care advisory group addresses
methods of improving the systems. She mentioned possible
solutions such as payment systems or regulation changes that
allow for data-driven and informed decisions about regulations,
statutes and license types. Another collaboration includes the
complex care advisory group that works with the state and a
multitude of partners to participate in providing facilities and
needed services. The teams look for real-time solutions and
partner with external stakeholders to constantly reiterate and
change Alaska's services. She noted that the efforts do not
replace the Complex Care Collaborative or the multi-sector state
coordination group.
1:52:24 PM
MS. CARPENTER spoke to slide 11, "Tribal Collaboration."
• Tribal collaboration is essential in addressing
Alaska's behavioral health needs.
• Tribal Health Organizations (THO) are vital partners
in providing services in their regions and
communities.
• For many rural communities, THOs are the only
Medicaid enrolled provider.
• DOH and DFCS have designated tribal liaison
positions.
• Alaska Medicaid utilizes the Medicaid Tribal Task
Force, Tribal Behavioral Health Directors, and
Medicaid Tribal Consultation to partner with tribes.
1:53:04 PM
DR. ZINK discussed slide 12, "Near Term Efforts in Progress."
• Developing Infrastructure for Complex Care Coordination.
• Increase Utilization of Waivers.
• Increase Behavioral Health Infrastructure.
• Developing Workforce.
• Improving Provider Support
1:55:56 PM
DR. ZINK spoke to slide 13, "What's Next?"
• Initiate a steering committee to determine goals,
recommended approach, and timeline, and outline
necessary resources to develop statewide and
regional plans.
• Focus on statewide and regional services.
• Draft plan will be shared publicly, welcome robust
public comment statewide, and involve listening
session in specific regions.
• Final plan be shared with the legislature and other
governmental agencies.
1:56:58 PM
SENATOR GIESSEL referenced slide 2 and asked what percentage of
behavioral health funding is derived from Medicaid.
1:57:23 PM
MS. CARPENTER replied that she would need to work with the other
payers and follow up with the data. She noted that the
departments lacked an all-payor claims database to track the
percentage. She stated that Medicaid covered over one-third of
Alaskans and a large portion of children.
1:57:58 PM
SENATOR GIESSEL commented that not every Medicaid beneficiary
receives behavioral health services.
MS. CARPENTER agreed.
SENATOR GIESSEL asked about the challenges the department had
with its computer data systems. She asked if those challenges
were identified in the DOJ report.
MS. CARPENTER asked if she was referring to the eligibility
system.
1:59:42 PM
SENATOR GIESSEL replied that she was referring to the payment
system that is audited annually.
MS. CARPENTER responded that the department publicly
acknowledged the challenges with the vendor Optum. She stated
that the federal government did not identify that Optum was part
of the problem, but instead highlighted the issue of too few
providers delivering the necessary community services. She
acknowledged that when providers are not paid in a timely
manner, the stress leads to diminished service delivery. She
remarked on the importance of paying providers in an accurate
and timely manner. She stressed that the department was taking
every step possible within the contractual process to hold Optum
accountable.
SENATOR GIESSEL highlighted the errors the department makes when
submitting claims to the federal government. She stated that the
repayments identified in the audits were concerning.
2:00:06 PM
DR. ZINK agreed that the state must have transparent and
reliable data sources. She added that the state employs two
additional data sources: the Alaska Automated Information
Management System (AKAIMS) and the Health Information Exchange
(HIE). She stated that the department was making strides in
streamlining and improving both data management systems. She
highlighted the importance of data systems for enabling data-
informed decisions. She asked Acting Director Brown if she had
anything to add.
2:01:24 PM
FARINA BROWN, Acting Director, Division of Behavioral Health,
Department of Health, Anchorage, Alaska, stated that the DOJ
findings did identify the administrative services organization
as an area requiring better administration and oversight of
claims adjudication. She noted that the division continues to
work with Optum on claims adjudication. She mentioned that the
department was currently involved in a corrective action with
Optum regarding the ongoing claims adjudication issues. She
acknowledged that the claims payments have contributed to the
difficulty with providers offering services across the state.
She recognized the criticality of the waiver's success and
acknowledged that without remediation, slow growth would
continue.
2:02:56 PM
SENATOR GIESSEL asked about slide 8, bullet 3, "23-hour and
short-term stabilization." She expressed concern about patients
reaching the end of the 23-hour stabilization period. She
wondered about the next step for those people.
2:03:37 PM
CHAIR CLAMAN highlighted that Senator Giessel sponsored crisis
stabilization legislation.
MS. CARPENTER agreed that legislation passed last year and in
2020 were heralded by both Senator Giessel and Senator Claman.
Responding to Senator Giessel's query about the 23-hour
stabilization period, she explained that if a person is not
stabilized and continues to meet the criteria for the
involuntary hold, they would be transferred to a short-term
crisis residential center. For larger facilities, the next level
of care is available on site. She highlighted that a lack of
wraparound community services leads to a new chokepoint in the
system. She stressed the need for a full-spectrum care
continuum, so Alaskans are ensured behavioral health care as
close to home as possible. The hope is for quick stabilization
and discharge to community providers.
2:05:25 PM
SENATOR GIESSEL highlighted the importance of residential
treatment and partial hospitalization options.
DR. ZINK shared that the state saw an increase in Designated
Evaluation and Treatment (DET) facilities. She quoted national
data stating that the 23-hour facilities will stabilize 70
percent of patients. She added that the 23-hour stabilization
facilities can offer support for people discharged from API and
requiring transitional care in rural areas.
2:06:53 PM
SENATOR GIESSEL stated that partial hospitalization is intended
to provide programmatic day therapy.
2:07:14 PM
SENATOR TOBIN referred to the DOJ report that mentioned site
visits in 2022. She asked about the inconsistencies noted on
slide 4 with the 1115 waiver dictated by current data points.
She pointed to the statement, "emphasis on early-stage outreach,
prevention and intervention." She understood that the hope was
to prevent the need for crisis services. She noted that the DOJ
report mentions the school-based services and early community
and home interventions. She wondered about the department's
efforts related to accessible providers in schools. She wondered
about preventative options. She highlighted the report's mention
of cultural competency. She asked how the legislature could
ensure that a cultural component was a key part of the effort.
2:09:03 PM
MS. CARPENTER responded that the departments have designated
tribal liaisons in the commissioners' offices. Each division and
department has tribal liaisons, and the culturally relevant care
is of great importance. She added that tribal providers are
often the only providers in the rural communities. She reminded
the committee that the state is not a direct service provider.
MS. CARPENTER explained that delivering Medicaid services in
schools is a complex issue. She noted that past audit findings
led to federal repayments. She stated that the steering
committee will address the issue of administering services in
the schools. She added that the Centers for Medicare and
Medicaid Services (CMS) has rules about services delivered in
schools. She advocated for a collective approach to designing
school-based Medicaid services. She highlighted the flexibility
and options through SB 74. She mentioned the possibility of
approaching the federal government for permission to offer
school-based Medicaid services. She noted the challenges in
obtaining, licensing, and housing new behavioral health
providers. She deferred to Acting Director Brown for information
about preventative services and efforts.
2:12:07 PM
MS. BROWN responded that the early components of care aspect of
the waiver focus on the use of at-risk criteria. She stated that
once an individual has to reach the threshold of severely
mentally ill or severely emotionally disturbed, the behavioral
health condition is deteriorating. She noted the essential
aspect of ensuring that individuals can engage in waiver
services and providers can be paid before an adult or youth
reaches the threshold of Severe Mental Illness (SMI) or Severe
Mental Disorders (SMD). She mentioned the addition of the
service known as Home Based Family Treatment that allows for a
family to engage in services based on a social determinate of
health that allows a provider to bill for services. The
treatment plan strives to catch individuals upstream before
symptoms cascade. She added that many state behavioral health
providers derive a large percentage of revenue from school-based
services. She informed the committee that school-based services
are often billed on an outpatient fee-for-service continuum. The
billing mechanism does not allow the state to publish concrete
data about the revenue Alaskan providers receive.
2:15:02 PM
MS. BROWN responded to the query about cultural relevance. She
remarked that the department requires all services to be
culturally relevant. The waiver requires continuing education to
meet the culturally relevant criteria for qualified addiction
professionals. She added that providers must meet the Substance
Abuse and Mental Health Services (SAMHSA) guidelines, which
include being culturally relevant and influenced.
2:15:56 PM
SENATOR TOBIN expressed appreciation for the attention to
cultural relevance. She reported reading Alaska Native elder
literature stating that young people require education that
respects all components of their psyche, including their spirit,
language, and food. She requested more data related to slide 9,
indicating that 73 children are receiving services via Medicaid
outside the state. She wondered about past data points related
to children who are receiving Medicaid services out of state.
2:17:17 PM
CHAIR CLAMAN requested the data going back to 2014.
2:17:35 PM
MS. CARPENTER offered to provide the data points. She
highlighted that before the Bring the Kids Home initiative in
2004, there were 965 kids that were out of state. Reducing that
number to 73 shows the work the department has put into this
over the last 20 years.
DR. ZINK offered to provide detailed information about the 1115
grant waiver. She also described the new Office of School Health
and Safety and Office of Healthy and Equitable Communities. The
latter recognizes the varying cultural needs in different
regions.
2:19:06 PM
SENATOR KIEHL joined the meeting.
2:19:13 PM
CHAIR CLAMAN referenced the official response to the Department
of Justice letter. He commented on the reality of the decision
Alaska made years ago to contract out almost every feature of
behavioral health coverage. He observed that absent massive
investment to bring more of these services in-house, the state
has to rely on outside entities to provide these services. In
connection with that, he mentioned the criticisms related to
Medicare and Medicaid rates. He asked if the state has the same
issues getting providers for Medicaid that it has getting
providers who will accept Medicare.
2:20:36 PM
MS. CARPENTER stated that rates are a complex art. She advised
that in Alaska, Medicaid does pay more than Medicare. Another
consideration is that the host of services the department offers
are subject to Centers for Medicare & Medicaid Services (CMS)
upper payment limits. What this means is that when somebody is
facing an upper payment limit, it's necessary to prove to CMS
that the payment isn't actually above Medicare. Most individuals
do not understand the nuance and that the state has to
oftentimes pay lower than Medicare.
2:22:04 PM
DR. ZINK highlighted that rates are important, but there are
many different factors related to providing services within a
state. Providers need to be connected to specialty services but
they also need a volume of kids that they serve regularly.
Further, the payment systems between private insurance and
Medicaid need to align enough that similar care can be provided
day-to-day so the payer type doesn't become an issue.
2:23:16 PM
CHAIR CLAMAN referred to the official response to the Department
of Justice (DOJ). He asked whether there would be a plan with a
more specific focus on children.
2:23:51 PM
DR. ZINK replied that the vision to address the DOJ report is
for children and behavioral health services. The hope is to
build on that to provide support for physical, mental, social,
and cultural health. The department is talking with other
regional workers about how they can help support this effort.
CHAIR CLAMAN commented that children can often get lost when
there are larger numbers of adults.
2:24:25 PM
SENATOR GIESSEL referenced Ms. Brown's statement about the
difficulty parsing out who was getting care in school-based
services. She asked whether there was a specific code for that.
MS. BROWN replied that school based services are distinct but do
not represent the full continuum of behavioral health services
being provided in schools. There is the nuance between using
place of service school and place of service 99, and DBH is
working with providers to ensure proper coding.
SENATOR GIESSEL underscored the importance of school funding so
these venues are available for children to receive these
services.
CHAIR CLAMAN invited Jen Griffis to offer her perspective as a
parent with a child in the system.
2:26:34 PM
JEN GRIFFIS, representing self, Fairbanks, Alaska, delivered the
presentation, "Behavioral Health Systems of Care, A Parent's
Perspective." She explained that she adopted two girls from the
foster care system and that one of her daughters had behavioral
problems. By the time her daughter was six years old, the
behavioral problems began to eclipse her parenting abilities.
She stated that her husband was a physician, and she was an
educator, so they understood systems and research. Even though
they had money and privilege, they were unable to find
appropriate and available services. She and her husband were
concerned for the family's safety. After months without answers,
they landed on in-patient hospitalization as the only option.
They drove three hours to the nearest pediatric psychiatric
hospital and left their six-year-old daughter with strangers.
She noted that the hospitalization in 2012 was followed by two
more over the next six weeks. She tried piecing together support
options and attempted a therapeutic home setting, but intensive
community services were lacking statewide. After multiple
treatment failures, the family sought residential treatment
options. Following placement in residential treatment, the
family worked with the case management team to transition her
daughter back into the community. This was never successful; her
daughter's intense level of needs did not match the available
community services. The lack of residential treatment options
meant that she grew up in multiple facilities in multiple states
over several years.
MS. GRIFFIS informed the committee that she served as a parent
representative for the plaintiff's mediation team during a
lawsuit in Idaho, fighting for better mental health options for
children in the state. She participated in mediation meetings
for over a year before transitioning into the settlement
agreement with planning and implementation of the new children's
behavioral health system. She continued to support various
aspects of the implementation for the next eight years.
2:32:00 PM
MS. GRIFFIS stated that during her time advocating for the new
system, her family continued to struggle to access the right
level of services for their daughter. She experienced the
impacts of the system she was advocating to change. She
expressed pride in her efforts to infuse the parent voice in
every aspect of the children's behavioral health system in
Idaho. She noted that other parents' words, ideas, and
experiences were central to the planning, design, and evaluation
of the system. She offered to provide the committee with greater
context for systems of care and thoughtful recommendations
related to the planning process in Alaska.
2:33:00 PM
MS. GRIFFIS spoke to the slide titled, "What is a System of
Care."
• Term "system of care" was first used by Stroul and
Friedman in 1986
• Core values of a System of Care
Family-driven and youth-guided
Community-based
Culturally and linguistically competent
• Guiding principles for a System of Care
broad-base of services, individualized, least
restrictive, family/youth engagement, cross-
system collaboration, care management,
developmentally appropriate, transition-age
supports, prevention, continuous quality
improvement, protects individual rights, non-
discriminatory
2:35:12 PM
MS. GRIFFIS continued to the slide "System of Care
Implementation."
• Challenges:
o Unequal implementation across states
o Limited access to community-based services in
certain populations
children with a higher-level of need
families in rural communities
• Result:
o Investigations and lawsuits across the country
related to a lack of community-based services and
continued reliance on residential treatment
2:36:28 PM
MS. GRIFFIS spoke to the slide "Alaska's Strengths."
• Medicaid waivers
• Relationships with tribal partners and other
stakeholders
• State-level legislation
crisis intervention
telehealth opportunities
2:37:10 PM
MS. GRIFFIS spoke to the slide "Lessons from Other States."
• Parents and youth should be equal partners, at the
treatment level and at the system level.
• Medicaid is a funding source, not a system design.
• Person-centered data tells stories and transforms
systems.
2:39:40 PM
MS. GRIFFIS spoke to the ripple effect of stories when services
are not available. When the right level of care is available at
the right time, the ripple effects can be success in education,
positive relationships, and goals for the future. She stressed
the need for collaboration and intention to transform children's
mental health systems.
2:40:42 PM
SENATOR TOBIN emphasized the importance of qualitative data
because focusing solely on quantitative data misses the stories.
2:41:15 PM
SENATOR GIESSEL applauded the speaker.
CHAIR CLAMAN thanked Ms. Griffis for highlighting that this is
very person-based and it's a reminder that children are the
state's greatest resource.
2:42:25 PM
CHAIR CLAMAN moved to the next presenter and explained that
Shelley Ebenal was invited because the hospital's capital
request focuses on providing mental health services for
children.
2:43:24 PM
SHELLEY EBENAL, CEO, Foundation Health Partners (FHP),
Fairbanks, Alaska, delivered the presentation, "Fairbanks
Memorial Hospital Inpatient Behavioral Health Expansion
Proposal." She advised that FHP operates Fairbanks Memorial
Hospital, Denali Center, and Tanana Valley Clinic. She relayed
that the Department of Justice investigation was a new twist on
an old problem. She reinforced that the heart of the problem is
that children are in crisis.
2:44:57 PM
MS. EBENAL displayed slide 2 which shows the logos for the 56
participants in the Interior Pediatric Behavioral Health Summit.
2:45:17 PM
MS. EBENAL moved to slide 3, "Visualizing Gaps in Our Continuum
of Care." The graphic provides a visual of the gaps in the
existing continuum of care in the Interior. It shows substantial
gaps in residential and stabilization treatment for children.
She relayed that FHP was proposing an adolescent behavioral
health unit and the expansion of the adult unit. State funding
is required for this expansion.
2:45:46 PM
MS. EBENAL reviewed slide 5, "Capital Request Summary."
Capital Construction Expense: $5,400,000
$3.4 Million State Capital Request
$1.0 Million Alaska Mental Health Trust Capital Request
$1.0 Million Rasmuson Foundation Capital Request
$5.4 Million
2:46:18 PM
MS. EBENAL spoke to slide 6, "Pediatric Service Gap."
Every day we are boarding pediatric behavioral health
patients in the Emergency Department (ED).
• The average length of stay for these patients is
114.94 hours.
• Emergency Departments are not conducive
environments for appropriate evaluation and
psychiatric treatment of children or adults.
• Almost all of these patients would qualify for
treatment in a pediatric inpatient unit and avoid
transfer outside of the community or State.
• There is no adolescent inpatient psychiatric care
for the children in Interior and Northern Alaska.
2:46:56 PM
MS. EBENAL continued to slide 7, "Pediatric Service Gap
Continued."
FMH sees about 350 unique pediatric patients for a
primary behavioral health reason each year who need
multiple days of care. Patients stay in the emergency
department as our case managers search for appropriate
treatment placement outside of Fairbanks.
Almost all of these patients would qualify for
adolescent inpatient behavioral health care. FHP
estimates that each patient's inpatient stay would be
4-7 days, creating an average daily census of a
minimum of 3.8 patients per day. That means our unit
would be at capacity every day of the year. Creating
this access to inpatient care within Northern Alaska
and Interior Alaska would give relief to a region that
doesn't currently have options for pediatric patients.
Capital funding will allow reconstruction of existing
space following strict and expensive Federal
Guidelines for a four-bed child psychiatric unit
within Fairbanks Memorial Hospital.
2:48:04 PM
MS. EBENAL moved to slide 8, "Emergency Department Seclusion
Room." She acknowledged that the picture of the exclusion room
should disturb everyone. It's a rubber room without amenities
where the individual is physically safe until they can be placed
appropriately. A psychiatrist once described the room as the
place where children are warehoused until they can be placed.
2:48:30 PM
MS. EBENAL spoke to slide 9, "Adult Service Gap."
The current makeup of the FMH adult inpatient
Behavioral Health Unit (BHU) is located on the 4th
Floor at FMH. It consists of 20 inpatient beds; four
beds provide intensive care and sixteen beds provide
intermediate care.
• Over the last three years, the acuity of our
adult behavioral health patients has continued to
escalate.
• More patients require admission to the intensive
unit, prior to moving out to the intermediate
unit.
• Due to limited beds in the intensive unit, more
adult patients must remain in the emergency
department without full treatment while awaiting
placement in the appropriate location.
• We are also often unable to accommodate acute
patient transfers from other locations due to our
space limitations.
2:49:13 PM
MS. EBENAL continued to slide 10, "Adult Service Gap Continued."
It includes a line graph that shows the average daily census for
the Intermediate Behavioral Health Unit in blue and the
Intensive Behavioral Health Unit in red.
The proposal is to add 2 additional acute care rooms
to the 4 room intensive care unit for a total of 6
rooms to meet the adult treatment needs.
When an adult patient meets the criteria for
admission, they are transferred by the emergency
department to the behavioral health unit. The average
census by month in 2022 for the behavioral health unit
was 12.2, but in some months, it was as high as 15.
That is taxing on our 20-bed unit, especially when
only 4 of those beds can accommodate patients needing
higher acuity care.
The blue line represents patients in the intermediate
unit. The red line represents patients in the
intensive unit. These two numbers together represent
the average daily census for the behavioral health
unit (BHU).
2:49:47 PM
MS. EBENAL discussed slide 11, "Facility Upgrade Proposal." The
approximate capital expense is $5.4 million. It shows the floor
plans for the proposed pediatric inpatient unit with low and
high acuity care areas.
She highlighted that the solution for the current situation has
to involve both the state and communities. The challenges are
considerable. FHP could open a new unit right now, but wouldn't
be able to staff it. The proposal is to build a four-bed unit
next to the inpatient unit so resources can be shared.
Psychiatrists on staff are board certified for child psychiatry.
The proposal is also for two more acute beds to take the
pressure off the Emergency Department.
MS. EBENAL thanked the state and administration for helping from
an operational perspective and expressed hope that capital help
would also be forthcoming.
SENATOR GIESSEL commented that the information in the last two
presentations moved the committee. She stated that the finance
committee was working hard to restrain the size of the dividend,
which would make it possible for these kinds of improvements and
delivery of services. Everyone would benefit.
CHAIR CLAMAN stated that he had no intention of supplanting the
role of the finance committee in making such decisions, but the
Fairbanks presentation in particular highlights a plan for the
long term. He agreed with Senator Giessel's comments about where
the state is spending its money.
2:53:31 PM
There being no further business to come before the committee,
Chair Claman adjourned the Senate Judiciary Standing Committee
meeting at 2:53 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Overview of Alaskas Behavioral Health System of Care for Children Report DOH & DFCS 4.1.2023.pdf |
SJUD 4/26/2023 1:30:00 PM |
|
| Alaskas Efforts to Improve Behavioral Health Outcomes for Children Presentation for Senate Judiciary 4.26.2023.pdf |
SJUD 4/26/2023 1:30:00 PM |
|
| Griffis Presentation to Senate Judiciary 4.26.2023.pdf |
SJUD 4/26/2023 1:30:00 PM |
|
| Griffis Handout to Senate Judiciary - System of Care Definition and Philosophy 4.26.2023.pdf |
SJUD 4/26/2023 1:30:00 PM |
|
| Foundation Health Partners Presentation to Senate Judiciary 4.26.2023.pdf |
SJUD 4/26/2023 1:30:00 PM |