SB 45-MEDICAID MENTAL HEALTH PARITY  3:52:24 PM CHAIR DUNBAR reconvened the meeting and announced the consideration of SENATE BILL NO. 45 "An Act relating to medical assistance services; relating to parity in mental health and substance use disorder coverage in the state medical assistance program; and providing for an effective date." 3:52:34 PM CHAIR DUNBAR stated SB 45 was first heard in the Senate Health and Social Services Standing Committee meeting on January 28, 2025, and on April 24, 2025, when committee substitute (CS) version I was adopted. He stated he is bringing SB 45, version A, back before the committee and intends to solicit the will of the committee in reporting version A from committee. 3:52:55 PM ARIELLE WIGGIN, Staff, Senator Forrest Dunbar, Alaska State Legislature, Juneau, Alaska, offered the sectional analysis for SB 45, version A: [Original punctuation provided.] Section 1: The state must provide equal coverage and access to treatment for behavioral health issues as for other medical conditions. This is a new subsection (i) to the state statute that governs services provided to Medicaid recipients (AS 47.7.030). The new subsection says the department of health must follow federal behavioral health parity statutes, which are listed in the bill. Section 2: The commissioner of health will comply with relevant parts of the federal behavioral health law, and investigating complaints about behavioral health coverage and checking on possible unequal coverage including: 1. Reviewing state Medicaid regulations to ensure they don't cause unequal coverage of behavioral healthcare. Examples of potential regulations are listed. 2. Comparing how Medicaid coverage works for behavioral health coverage versus physical health coverage. This is a new section to State Medicaid statute (AS 47.07). The new section is 47.07.033 Parity in mental health and substance use disorder benefits. 3:54:21 PM MS. WIGGIN continued with the sectional analysis for SB 45: Section 3: Creates a new reporting requirement for behavioral health and mental health parity. It instructs the Department to send a report by March 1 each year to the legislature. The report will: 1. Describe their process for what "medical necessity" means for both physical and behavioral health coverage. 2. List the rules limiting behavioral healthcare and physical healthcare, numerical or nonnumerical. 3. Decide whether the criteria, numerical and non- numerical, for behavioral health are comparable to physical health benefits, and if they are applied equally. This includes: a. Decisions behind treatment limitations, including limitations that were rejected. b. Evidence used to choose treatment limitations. c. Comparisons between physical and behavioral health care showing that in practice the treatment limitations are evenly applied. d. Share findings that indicate whether the state Medicaid system is complaint with federal parity laws. This is a new subsection (d) to the section of state statute on reports that the Department of Health must periodically give to the legislature (AS 47.07.076) Section 4: requires the Commissioner of Health to submit a one-time report to the legislature by March 1, 2026. The report must: 1. Explain the methodology used to evaluate if Alaska's Medicaid program complies with federal behavioral health parity law. 2. Summarize market review conducted for parity compliance. 3. Describe any steps taken to fix issues or provide education to improve compliance. 4. Be written in non-technical, plain language. 5. Be made publicly available online. This is a new section in the uncodified law. Section 5: requires the Department of Health to submit any necessary amendments to the federal government for approval to update Alaska's Medicaid program to comply with federal behavioral health parity requirements. This is a new section in the uncodified law. Section 6: This section specifies that Sections 1 through 4 will only take effect if the federal Department of Health and Human Services approves the state's Medicaid plan amendments by December 31, 2025. The Commissioner of Health must notify the revisor of statutes within 30 days of receiving federal approval. Section 7: If the federal government approves the Medicaid plan amendments, Sections 1 through 4 will take effect the day after the federal Department of Health and Human Services grants approval. 3:56:52 PM CHAIR DUNBAR opened public testimony on SB 45. 3:57:10 PM LANCE JOHNSON, Chief Operating Officer, Alaska Behavioral Health Association, Talkeetna, Alaska, testified in support of SB 45. He stated that Alaska's Medicaid program, as a fee-for-service state, must follow federal parity laws, though current behavioral health documentation standards are outdated and overly burdensome. He said these requirements delay care unlike medical treatment and apply even when providers bill commercial insurance. SB 45 seeks to align behavioral health standards with medical care over time, ensuring uniform and timely access while addressing systemic issues that, if uncorrected, worsen the behavioral health crisis. 4:00:20 PM MAXWELL MERCER, Grants Director, Community Connections, Ketchikan, Alaska, testified in support of SB 45. He highlighted that the program provides intensive, Medicaid-funded mental health services for youth at risk of out-of-home placement, aiming to keep them in the community, support family reunification, and improve outcomes. However, administrative burdens limit their capacity, allowing them to serve only 20 percent of referred families. 4:02:40 PM CHAIR DUNBAR closed public testimony on SB 45. 4:02:47 PM CHAIR DUNBAR solicited the will of the committee. 4:02:51 PM At ease. 4:03:25 PM CHAIR DUNBAR reconvened the meeting. 4:03:28 PM SENATOR GIESSEL moved to report SB 45, work order 34-LS0146\A, from committee with individual recommendations and attached fiscal note(s). 4:03:54 PM CHAIR DUNBAR found no objection and SB 45 was reported from the Senate Health and Social Services Standing Committee.