SB 191-APPROPRIATIONS: MENTAL HEALTH MR. JEFF JESSE, Executive Director of the AMHTA, spoke via teleconference from Anchorage and said he would review the proposed items in the Governor's budget that were not accepted at the level recommended by AMHTA. CHAIRMAN MILLER asked that state agency staff testify first. MS. JANET CLARKE, Director of Administrative Services at the Department of Health and Social Services (DHSS), gave the following overview of a packet of reports from OMB to explain some of the items that the Governor included in SB 191. The first page is a summary of the budget items included by the Governor in the integrated mental health program. Some items are included as increases because AMHTA and Senate Finance Committee members agreed that AMHTA would initially fund those items but eventually they would be funded with general funds. Two of those items in the DHSS budget are training for residential child care providers and institutional prevention for community developmental disabilities grants. The large increase in general fund items in the DHSS budget is an increase in the Medicaid program related to the API 2000 Community Implementation Plan. Services in Anchorage will be reconfigured to allow community hospitals to pick up some of the services currently provided by API. Another increase of $100,000 was included for training of foster parents who care for severely emotionally disturbed children. Another $100,000 increase is to reopen the Fahrenkamp Center as a residential facility. That facility was built over ten years ago and has been used by the community mental center as office space and for counseling. DHSS has a proposal in the capital budget to remodel the facility so that it can be used for residential treatment. The other major general fund item does not show up in SB 191 but it is related to mental health services. The Governor has proposed a general fund increment to reduce the infant learning wait list. Other increments relate to $3.4 million of AMHTA funds for different activities within DHSS. MS. CLARKE briefly highlighted some of the projects in the summary of the Governor's capital budget for DHSS. The total of DHSS's capital projects amount to $7.5 million. $495,000 was included to reopen the Fahrenkamp residential facility. Stop-gap repairs in the amount of $379,000 are required at API until the state can finalize an agreement to purchase Charter North Hospital. Even if that agreement is finalized today, API will be used for the next two years. Many of the other projects are grant programs that are competitively awarded to different agencies. Number 0896 ALISON ELGEE, Deputy Commissioner of the Department of Administration (DOA), discussed DOA's list of budget items for integrated mental health programs. The general funds in the amount of $126,000 for the Public Defender Agency (PDA) are new to the AMHTA bill but it is not new money for the PDA. This format recognizes that the work done by the PDA when representing indigent clients in danger of involuntary commitment is an expenditure related to services for the beneficiaries of the Mental Health Trust. The rural long term care development project and innovative respite project are continuing projects. DOA "backs out" those projects and then adds them back in each year as a result of AMHTA's funding decisions. DOA is looking for an opportunity to upgrade the ability of the Division of Senior Services to provide quality assurance. DOA has no comprehensive monitoring function for the variety of services it licenses and regulates. This money would allow DOA to put some tools in place so that it could ensure that the services delivered meet the standards to prevent a crisis. Day treatment for the Chronically Mentally Ill Elderly Program is also a continuation of DOA's outreach efforts for the elderly. DOA is building on that work to focus on outreach to elderly with substance abuse problems. The mini grants for beneficiaries with ADRD is a continuing project. The last two projects, funded by the AMHTA, are a project to develop a comprehensive assessment tool for long-term care facilities to reduce paperwork and to create training materials for a family and private guardian member training program. That increment is also reflected in the general funds column in the amount of $355,000 for the Office of Public Advocacy for public guardians. The caseload of Alaska's public guardians is running twice the recommended national average. Right now they are unable to perform the statutory requirement to work with private and family guardian members. The funds would help them reduce the caseload of public guardians and give them that capacity. DEPUTY COMMISSIONER ELGEE noted that two other general fund requests have been proposed: one expands DOA's care coordination function from four to six regions, the other is to implement ongoing training for caregivers in ADRD care techniques. DEPUTY COMMISSIONER ELGEE pointed out a high priority of AMHTA and DOA is to increase the general relief daily rate. That money is being carried in the fiscal note to SB 73. DOA has one capital project for a data integration project. By combining functions previously performed by other parts of state agencies, data bases that were developed for each function will be integrated by the Division of Senior Services to create a comprehensive tracking system. Number 1161 DWAYNE PEEPLES, Director of the Division of Administrative Services in the Department of Corrections (DOC), discussed DOC's requests. This year, DOC has three AMHTA operations in the operating budget. The first two represent third year transitions between AMHTA funds and general fund mental health funds. The first is an 18-bed psychiatric unit set up at the Highland Mountain institution, established in the fall of 1997. This is the final year of the transition and the total operating cost will be $600,000. The second item is again a transition from FY 98 from AMHTA to the general fund for a mental health planner. This position coordinates services for the AMHTA beneficiaries within DOC. The last item is a new proposal to establish a men's substance abuse residential treatment facility within one of DOC's correctional institutions. The $82.9 is a match for federal money in the amount of $236.0. The new facility will provide fairly intense treatment services for 40 to 50 men prior to the end of their incarceration. The only capital budget item being requested by DOC is for a collaborative project with DHSS to develop a telepsychiatry program between 10 rural correctional facilities and 10 mental health centers and psychiatric units in Anchorage. This program will decrease travel costs and increase services by allowing video teleconferencing for diagnosis and treatment with inmates. SENATOR WILKEN asked if the men's residential substance abuse treatment program is a new program. MR. PEEPLES replied it is a new initiative. SENATOR WILKEN asked that Mr. Peeples provide some detailed information for the Finance Committee regarding how the program will be structured and where and how the results will be measured. DEPUTY COMMISSIONER ELGEE mentioned that DOTPF houses a capital appropriation for a grant program for coordinated transportation and vehicles that benefits all four beneficiary groups. All four groups applied to DOTPF for the money provided through this capital project. Number 1353 MR. JESSE referred to a chart entitled "Alaska Mental Health Trust Authority FY01 Mental Health Trust Operating Budget Recommendations not accepted by the Governor." The first item on that chart is a match for the assisted living rate increase. Over $800,000 of AMHTA income has been committed as a match. The general fund portion was not placed in the Governor's budget because it is expected to be funded from the fiscal note to SB 73. Item 5 on the chart is the DOC Men's Sub-Acute Care Unit in the amount of $300,000. This program would build on to a successful inpatient treatment program for the most severely mentally ill inmates at the Cook Inlet facility. The intent of this increment was to provide a higher level of care for those men when they are housed with the general population of inmates. Another item, listed between items 6 and 7, for substance abuse treatment for rural women with children, contains $500,000 of AMHTA funds but does not include the $500,000 general fund match. Usually the trustees are concerned when their proposals to match efforts with the State are not accepted. The AMHTA match remains in SB 191 because of the critical nature of the services. MR. JESSE referred to a chart entitled "FY01 Mental Health Trust Capital Budget Recommendations not accepted by the Governor" and pointed out the Governor's capital budget did not include either the AMHTA $100,000 commitment or the $914,000 general fund commitment for the Adult Day Care Facility in Juneau. AMHTA will be approaching the DOA subcommittee to request that at least $100,000 AMHTA be placed in the budget to allow the planning process to begin. The Governor's Office is concerned that a false expectation of assured construction will be created if the planning money is forthcoming. The $30,000 in item number 3 on the chart is to make the physical modifications necessary to provide treatment programs discussed in the operating budget. Modifications include cell re-configurations and the addition of video equipment to monitor inmates with serious mental illnesses. Three other programs not accepted for the Governor's capital budget involve AHFC programs for mental health trust beneficiaries. He noted that without housing, many of AMHTA's beneficiaries continue to cycle through API, the court system, and other expensive treatment programs. Housing is an essential component when trying to divert people from the emergency service system. MR. JESSE commented on a few issues that are not addressed in SB 191 but are critical to a comprehensive mental health program. Foremost among those issues is the Medicaid budget. There is a significant increase in that formula program but several of the Medicaid options would not be funded - eyeglasses, dental care, hearing aids, and mental health rehabilitation. Those services are the backbone of Alaska's mental health system. The smaller hospital at API and the project to redesign the service system for people with mental health crises are very dependent on the Medicaid component of the budget. A large portion of the general funds for the Medicaid budget were originally from grant funds in the Community Mental Health grant area. AMHTA believes it would be a monumental disaster to lose those critical services. SENATOR ELTON asked whether AMHTA staff will be present during budget subcommittee hearings. MS. CAREN ROBINSON, Chair of AMHTA, said yes. SENATOR WILKEN moved SB 191 with its accompanying fiscal note out of committee with individual recommendations. There being no objection, the motion carried.