HB 138-BEH. HEALTH CRISIS SURCHARGE & FUND  3:22:24 PM CHAIR MINA announced that the first order of business would be HOUSE BILL NO. 138, "An Act establishing a behavioral health crisis services surcharge; establishing the behavioral health crisis services fund; and providing for an effective date." 3:22:37 PM The committee took a brief at-ease at 3:22 p.m. [During the at- ease, Chair Mina passed the gavel to Representative Mears.] 3:23:20 PM CHAIR MINA, as prime sponsor, read the sponsor statement for HB 138 [included in the committee file], which read as follows [original punctuation provided]: Alaska is confronting a significant behavioral health crisis, having the nation's highest rates of youth suicide and the second highest rates of adult suicide. Additionally, while most U.S. states have seen a decline in opioid-related deaths in recent years, Alaska's rates have nearly doubled. House Bill 138 proposes the establishment of a $0.98 monthly surcharge on each wireless and wireline telephone number and creates a dedicated Behavioral Health Crisis Services Fund. This initiative aims to enhance the state's capacity to respond more appropriately to mental health emergencies, building upon the behavioral health crisis system of care framework established in HB 172 (2022). At $.98 per line, HB 138 is estimated to generate $6-8 million annually in predictable, sustainable funding. Currently, Alaska's behavioral health crisis services rely heavily on dwindling general fund dollars, unstable or temporary grant funding, and insufficient Medicaid reimbursement rates. As Alaska has transitioned to leveraging Federal dollars through 1115 Medicaid waiver services, there has been a significant decline in funding to Behavioral Health Treatment and Recovery Grants. This financial instability has led some providers to discontinue or delay the implementation of crisis services. By establishing a consistent funding mechanism through the proposed surcharge, Alaska can ensure the sustainability and expansion of its behavioral health crisis response system. The proposed surcharge would support critical services, including the 988 crisis hotline, mobile crisis teams, crisis stabilization centers, and culturally-appropriate outreach, programs, and services. These services are essential for providing immediate assistance to individuals experiencing mental health crises, reducing the burden on emergency departments, law enforcement agencies, and the correctional system. These funds would also facilitate the recruitment and retention of behavioral health professionals, offer specialized training, and support public awareness campaigns to destigmatize mental health issues. Adopting the behavioral health crisis telecommunication surcharge in House Bill 138 is a critical step toward strengthening Alaska's mental health infrastructure. It offers a sustainable funding solution to enhance crisis response services, ensuring that individuals in need have access to timely and effective support. By investing in this initiative, Alaska can improve public safety, reduce the strain on emergency services, and provide better outcomes for those experiencing behavioral health crises. 3:29:00 PM KATY GIORGIO, Staff, Representative Genevieve Mina, Alaska State Legislature, on behalf of Representative Mina, prime sponsor, gave the sectional analysis [included in the committee packet] for HB 138, which read as follows [original punctuation provided]: Section 1. Establishes Article 5 under Title 43 - Revenue and Taxation, Chapter 98 - Miscellaneous Provisions, to establish the Behavioral Health Crisis Services Surcharge in AS 43.98.080   Subsection (a) establishes a telecom fee of $.98 per month for each wireless telephone number and wireline telephone.   Subsection (b) provides that the telephone company shall impose the surcharge to each customer with a billing address in the state and collect the surcharge from the customer. Customers may not be subject to more than one surcharge per line. A customer with more than 100 lines are subject to the surcharge on no more than 100 lines.   Subsection (c) specifies that the telephone company shall clearly state the surcharge on the monthly telephone bill. The Regulatory Commission of Alaska may not consider this surcharge as revenue of the telephone company and has no jurisdiction over behavioral health crisis services.   Subsection (d) specifies that the telephone company shall remit the amount collected to the Department of Health no later than 60 days after the end of the month in which the surcharge was collected. The telephone company may deduct and retain the greater of 1% of the amount collected or $150 to support the administration of surcharge collection.   Subsection (e) states that the telephone company is not obligated to take legal action to enforce collection of the surcharge. However, if the telephone company attempts to collect an unpaid debt from customer, the company shall also collect the unpaid surcharge. If a customer pays only a portion of their bill, the surcharge amount shall be prorated accordingly. The telephone company shall also provide an annual report to the Department of Health with detailed information on customer non-payment amounts. The telephone company is not liable for uncollected surcharges.   Subsection (f) the Department may require an annual audit of the telephone company's records concerning the collection and remittance of the surcharge. Subsection (g) establishes the Behavioral Health Crisis Services Fund in the general fund. The Department of Administration shall account for this fund separately. The Legislature may appropriate the annual estimated balance of the fund to the Department of Health for the specific behavioral health crisis response purposes outlined in subsections (1)-(7) including support for the crisis call center, mobile crisis teams, crisis stabilization centers, workforce development, training, education, and other services.   Subsection (h) states that nothing in this section creates a dedicated fund.   Subsection (i) includes the definitions for "local exchange access line," "local exchange telephone company," "wireless telephone," "wireless telephone company," and "wireline telephone."   Section 2. Provides for an effective date of July 1, 2025 3:32:25 PM REPRESENTATIVE MEARS announced that the committee would hear invited testimony. 3:32:37 PM CAITLIN HOCHUL, Vice President of Public Policy, Inseparable, testified in support of HB 138. She provided statistics on suicide in the country, emphasizing that Alaska has the second highest rate of suicide of all fifty states. She stated that calls to 988 are "funneled" based on intensity of need, as most calls are treated by a 988 responder and some are forwarded to emergency services. She said that funding created by HB 138 would allow communities to tailor their crisis responses to their own individual needs and cultures. 3:35:36 PM THEA AGNEW BEMBEN, Special Assistant, Municipality of Anchorage, testified in support of HB 138. She described the crisis response framework employed in Anchorage, including their outreach to the homeless community and their dispatch centers at both the police and fire departments. She emphasized the overdose deaths and opioid crisis facing Anchorage and she urged the committee's support for HB 138. 3:38:55 PM MS. BENBEN, in response to a series of questions from Representative Prax, clarified that a call to 911 or 311 rings dispatch at the police department, and those calls can be transferred to 988 and/or the fire department. She emphasized that these entities collaborate closely with one another. She said that 211 is used to gain health and social services information and it is a non-emergency phone number. She added that 211 responders are trained to transfers callers to 988, 911, or 311, as needed. 3:43:18 PM DENNIS LASLEY, Secretary, Anchorage Police Department, described his deep personal commitment to suicide prevention and mental health advocacy. He explained that the state must do more to divert individuals in a mental health crisis from law enforcement and toward the care they really need. He said that most of the mental health calls his dispatch center receives do not require a police officer, but that is the only option his center has to send. He stated that HB 138 would provide a sustainable solution by generating the funds needed to maintain a Crisis Now response model statewide. He added that HB 138 would create a predictable line of support for the mental health services needed by Alaskan communities. 3:47:33 PM MR. LASLEY, in response to a question from Representative Prax, stated that the Anchorage Police Department and fire department both have access to behavioral health specialists available to join officers in response to mental health calls. He clarified that the fire department dispatch center is contacted when a mental health crisis is not a threat to public safety, while the police department responds to those calls involving public safety concerns. He said that the core function of officers paired with mental health physicians during their shift is to respond to mental health crises. He added that the core function of those mental health physicians is also to respond to mental health crisis calls. 3:52:15 PM REPRESENTATIVE SCHWANKE asked when the mobile crisis team was established in Anchorage and how much it costs annually. 3:52:52 PM MS. BEMBEN responded that she would need to gather more information to provide the total annual cost of the mobile crisis team. She said that the initial expansion of the mobile crisis team required approval from the Anchorage Assembly for an additional alcohol tax of $1.4 million. She added that Anchorage also has a $6 million contract to support six positions between the two departments and that much of the public health workforce is supported by a state grant. She said that the Anchorage Police Department established the mobile intervention team in 2000 and the Anchorage Fire Department established the mobile crisis team in 2001. 3:56:15 PM MS. BEMBEN, in response to a series of questions from Representative Prax, said the seven clinicians are located at the police department and six are located at the fire department who are dedicated to mobile crisis teams. She stated that the Anchorage 911 system receives about 221,000 calls a year. She added that 21,000 of those calls were responded to by the mobile crisis team and 2,500 were responded to by the mobile intervention team in 2024. Ms. Bemben agreed with Representative Prax that the existing mental health resources in Anchorage are not meeting the demand by the community. She described the harm reduction program that the Municipality of Anchorage has implemented to disperse Narcan, a life-saving drug for those experiencing opioid overdose, throughout the community. She referred to a program employed by Paterson, New Jersey, that provides individuals with substance abuse disorders with immediate treatment. 4:05:09 PM BRENDA HANNAH, Strategic Prevention Framework Grant Manager, 988 Athabascan Suicide Response, testified in support of HB 138. She emphasized the impermanence of federal and state grants currently supporting mental health resources in Alaskan communities, and the need for a 988 surcharge under HB 138 to sustain those resources. She also explained the need for culturally relevant suicide prevention programs. 4:07:50 PM MS. HANNAH, in response to a question from Representative Ruffridge, stated that she is a grant director and her job is to make 988 more culturally relevant to Alaska Native people. 4:08:22 PM MS. HANNAH, in response to a series of questions from Representative Prax, stated that Crisis Now provides a mobile crisis team in Fairbanks. She said that the Fairbanks Native Association (FNA) is working to make 988 culturally relevant to Alaska Native people and that Careline Alaska actually answers the 988 calls. She emphasized that 911 responders cannot answer mental health calls in the same way that 988 responders are trained to do. 4:11:35 PM REPRESENTATIVE RUFFRIDGE asked about the current cost of operating 988 call centers and how many there are. 4:12:08 PM MS. GIORGIO listed the variety of funding sources for 988 call centers. 4:12:48 PM TRACY DOMPELING, Director, Division of Behavioral Health, Department of Health, responded that there is one main call center which is funded through a $2.8 million contract. She said that the Department of Health (DOH) is trying to work with Centers for Medicare and Medicaid Services to leverage federal match dollars to reduce the cost to operate that call center. She said that calls to Careline, 988, and another number come into that call center. MR. DOMPELING, in response to a series of questions from Representative Ruffridge, stated that it is a federal requirement for each state to have a 988 call center. She said that there has been an increase in 988 calls over the last few years and that the call responders have all been trained to do so. 4:17:44 PM MS. DOMPELING, in response to questions from Representative Prax, stated that the contract for the Careline Alaska does sit within the Division of Behavioral Health. REPRESENTATIVE PRAX commented that it is very difficult to distinguish the differences between each of the mental health phone lines. 4:18:59 PM REPRESENTATIVE MEARS responded that 211 was created to help individuals sort through those differences to determine which resource will best serve them. 4:19:08 PM MS. DOMPELING, in response to a question from Representative Fields, stated that she does not know how the amount of revenue for the call center itself compares to the revenue for the services that individual would be directed to through a call. 4:19:54 PM CHAIR MINA responded that HB 138 would create a fund for those services. REPRESENTATIVE FIELDS stated that he would like to know how much more HB 138 would be able to accomplish besides funding the cost of the 988 call-line. MS. DOMPELING responded that funding comes in many ways to support mental health resources. She suggested potential gaps in funding that the revenue generated by HB 138 would be able to fill. 4:22:45 PM CHAIR MINA, in response to Representative Prax, said that HB 138 would create a new fund for mental health services, but there is a complexity regarding how that new funding would relate to Medicaid in particular. 4:23:31 PM MS. DOMPELING added that it could be complicated to [streamline] all the funding sources because there is nothing prohibiting these mental health services from seeking grant funding from outside of the state. 4:24:22 PM REPRESENTATIVE MEARS emphasized that at least some mental health services in Anchorage receive funding through alcohol tax, adding another complexity to the variety of funding sources. REPRESENTATIVE PRAX said that the public would perceive the surcharge as being solely for the 988 number, not the 911 number, while they are integrated. He expressed a desire for more clarity regarding where the funds produced under HB 138 would go. 4:26:01 PM CHAIR MINA concurred that public education is important. She said that she thinks there is already public awareness that there is a 911 surcharge everyone pays, and she hopes HB 138 would replicate that awareness and funding for 988. 4:27:03 PM REPRESENTATIVE GRAY said that individuals would be charged about $1 per month per phone line under HB 138. CHAIR MINA, in response to Representative Gray, clarified that a family plan of three would be charged about $3 each month. REPRESENTATIVE GRAY observed that families with more phone lines would feel the impact of HB 138 more than those with less phone lines. 4:28:41 PM REPRESENTATIVE RUFFRIDGE said that HB 138 would have a very quick effective date which would drive up the capital expenditure for implementation. He asked if the effective date should be pushed back further to reduce the capital expenditure by at least half. 4:29:40 PM BRANDON SPANOS, Deputy Director, Tax Division, Department of Revenue, responded that with an implementation date further in the future, HB 138 would cost taxpayers less. He added that the surcharge would be unique to the Tax Division but it would be treated like any other tax in its filing and processing. 4:31:30 PM MR. SPANOS, in response to Representative Mears, stated that an effective date of December 2025 or later would not be considered expedited. 4:32:34 PM MS. GIORGIO, in response to concerns from Representative Schwanke, stated that phone companies would report their receival of surcharge payments under HB 138 for the State to be able to determine where discrepancies in funds expected versus funds received stem from 4:34:24 PM MR. SPANOS responded that AS 43.05 gives the Tax Division the authority to audit. Therefore, it would be allowed to conduct audits regarding 988 surcharges. 4:35:43 PM CHAIR MINA added that her goal is for the language of HB 138 to parallel the of AS 29.35.131 regarding surcharges for 911 calls. 4:36:11 PM MS. GIORGIO apologized for possibly misspeaking when reading the sectional analysis earlier, possibly replacing Department of Administration with Department of Health. REPRESENTATIVE SCHWANKE asked what would happen if people do not pay the 988 surcharge. MS. GIORGIO responded that if a customer chose not to pay the surcharge, the State would not force the telecom company to pursue that 98 cents. 4:38:18 PM MR. SPANOS, in response to Representative Prax, stated that he would follow up regarding how soon he expects to hear back from the Regulatory Commission of Alaska (RCA). 4:39:11 PM REPRESENTATIVE MEARS announced that HB 138 was held over.