SB 240-SCHOOL DISTRICT MEDICAL ASSISTANCE  3:18:46 PM CHAIR PRAX announced that the next order of business would be CS FOR SENATE BILL NO. 240(HSS), "An Act allowing minors 16 years of age or older to consent to behavioral health and mental health services; authorizing school personnel to recommend a behavioral health or mental health professional to a child 16 years of age or older; and relating to medical assistance coverage for rehabilitative, mandatory, and optional services furnished or paid for by a school district on behalf of certain children." 3:19:32 PM EMILY RICCI, Deputy Commissioner, Department of Health, on behalf of the bill sponsor, Senate Rules by request of the governor, introduced SB 240 to the committee. She explained that Section 5 of CSSB 240(HSS) is identical to HB 343, which the House Health and Social Services Standing Committee heard earlier in the current legislative session. She said that CSSB 240(HSS) would remove the existing requirement that Medicaid may only reimburse schools for services that are covered in an eligible student's individualized education plan (IEP). She emphasized that the intent of CSSB 240(HSS) was to expand the number of services for which a school might be able to seek Medicaid reimbursement. 3:20:46 PM SENATOR CATHY GIESSEL, Alaska State Legislature, on behalf of the bill sponsor, Senate Rules by request of the governor, shared her experience working as a nurse practitioner within high schools and middle schools in Anchorage. She explained that one of her most pertinent tasks in those schools is to screen the students for mental health conditions like anxiety, depression, or suicidal ideation and said that she is able to refer that student for behavioral health support if any of those screening tools indicate a positive diagnosis. She clarified that she was describing background information as a means to explain the amendment she was about to recommend to the committee and emphasized that mental health needs have risen since she had started providing care in the Anchorage School District (ASD) nine years ago. She provided specific examples of personal situations that might affect a student's mental health and said that often, parental consent is a major barrier to proper treatment of a student's mental health condition. She emphasized that one out of five students in Alaska have reported a suicide attempt and explained that the amendment she was recommending to the committee was the result of her experience working as a clinician in the district. She read through a series of proposals that could be made with the amendment and described their necessity. She shared a series of prepared statements by various mental health entities in Alaska and emphasized that the amendment to CSSB 240(HSS) would empower both children and parents to improve Alaska's collective mental health. 3:41:56 PM REPRESENTATIVE FIELDS asked how age 16 was chosen instead of age 14 or lower. SENATOR GIESSEL answered that 16 was a more palatable age for practitioners in Alaska. 3:42:55 PM REPRESENTATIVE SADDLER asked why 16-year-old Alaskans shouldn't be allowed to be prescribed their own mental health medication. SENATOR GIESSEL replied that it is her philosophical belief as a clinician that children are being medicated too much and said that counseling is extremely effective. REPRESENTATIVE SADDLER asked which was more effective: counseling or mental health medication. SENATOR GIESSEL answered that there is no comparison between counseling and mental health medication. 3:47:08 PM REPRESENTATIVE MINA commented her affirmation of the value of counseling, especially for people who are not experiencing a crisis and asked what percentage of at-home abusers are, for example, parents, caregivers, and foster parents. SENATOR GIESSEL said that she does not have that information. 3:48:28 PM REPRESENTATIVE RUFFRIDGE asked where schools are going to find mental health professionals to employ, given a declining public school budget and a lack of qualified professionals in Alaska. SENATOR GIESSEL answered that schools in Alaska would hire clinicians and pass the cost off to Medicaid. She said that the primary intention of SB 240 was to increase the amount of social workers in public schools without any extra cost to the schools. REPRESENTATIVE RUFFRIDGE asked how CSSB 240(HSS) would help rural students in Alaska experiencing mental health problems. SENATOR GIESSEL replied that the state would work collaboratively with tribal health entities and provide telehealth services to students in need of them. 3:55:10 PM REPRESENTATIVE SADDLER asked whether there is evidence to support that behavioral health intervention lowers the rate of suicide. SENATOR GIESSEL answered that there is no way to track the number of suicides prevented and explained that behavioral health treatment is meant as an intervention to stop mental health issues before they develop into suicidal ideation. 3:59:49 PM REPRESENTATIVE FIELDS commented on Representative Saddler's question by referencing a meta-analysis found through an online search engine and other studies that find that talk therapy reduces the risk of suicide. 4:00:58 PM REPRESENTATIVE RUFFRIDGE said that he has reservations with the age of consent being 16 with regard to a child's agency in their own medical decisions and asked what the barrier to proper children's mental health treatment in Alaska is. SENATOR GIESSEL answered that the main barrier to proper mental health treatment of a child is often the parents' inaction and the child's reluctance to receive any treatment at all. She explained that there are many adverse consequences that come from a child who might not have access to behavioral health services and said that the goal of CSSB 240(HSS) is to prevent a child from "going over the waterfall" of mental health. REPRESENTATIVE RUFFRIDGE recalled that he had things that he didn't want to share with his parents and shared his concern that a barrier might still exist in CSSB 240(HSS) for kids to trust the process of mental health treatment. 4:07:37 PM The committee took an at-ease from 4:07 p.m. to 4:09 p.m. 4:09:03 PM CHAIR PRAX opened public testimony on SB 240. 4:09:24 PM STEVEN PEARCE, Director, Citizens Commission on Human Rights, testified in opposition to SB 240. He explained his background in mental health advocacy and psychiatric care. He shared his belief that it would be dangerous to allow students aged 16 and older to make their own psychiatric decisions. 4:13:15 PM HEATHER IRELAND, Executive Director, Anchorage School Based Centers, testified in support of SB 240. She said that the bill's provision to allow for students aged 16 and older to consent for their own psychiatric care is important and urged the committee's support of the proposed legislation. 4:15:25 PM The committee took an at-ease from 4:15 p.m. to 4:16 p.m. 4:16:19 PM CHAIR PRAX, after ascertaining that there was no one else who wished to testify, closed public testimony on SB 240. 4:16:59 PM CHAIR PRAX moved to adopt Amendment 1 to CSSB 240(HSS), labeled 33-GS2369/B.1, Bergerud, 4/30/24, which read as follows: Page 1, lines 1 - 3: Delete "allowing minors 16 years of age or older  to consent to behavioral health and mental health  services; authorizing school personnel to recommend a  behavioral health or mental health professional to a  child 16 years of age or older; and" Page 1, line 7, through page 3, line 17: Delete all material. Page 3, line 18: Delete "Sec. 5" Insert "Section 1" REPRESENTATIVE FIELDS objected. REPRESENTATIVE FIELDS explained that there are multiple circumstances where it might not make sense or be feasible to get consent from a minor's parents to get care. He noted that the current language in CSSB 240(HSS) directs a healthcare provider that is providing services for someone aged 16-18 to contact the minor's parents regardless of the proposed amendment. 4:21:14 PM REPRESENTATIVE RUFFRIDGE asked whether parental consent was required for the billing of Medicaid services. MS. RICCI answered that SB 240 does not address federal requirements related to the Family Educational Rights Privacy Act (FERPA). REPRESENTATIVE RUFFRIDGE asked whether a clinician providing services to 16- and 17-year-old students would be allowed to be reimbursed by Medicaid if Amendment 1 were not adopted. MS. RICCI replied that the school district would not be able to bill Medicaid for any confidential services provided. 4:24:27 PM REPRESENTATIVE SUMNER asked who would pay for the services provided if Medicaid does not reimburse the service. MS. RICCI explained that it would depend on how the school is providing the service and said that it would most likely fall on the district. 4:25:49 PM CHAIR PRAX asked whether a school might end up with legal liability if a parent does not consent to the services provided to a student. LAURA RUSSELL, Assistant Attorney General, Human Services Section, Civil Division (Anchorage), Department of Law, answered that there are a variety of structures related to behavioral health services and explained that it would be conjecture for her to speculate on which entity might absorb the financial liability of the services that a student has received. CHAIR PRAX asked who would be liable to the parent if a child is not eligible for Medicaid and the school is a legal provider. MS. RUSSELL explained that the statute addressed in sections three and four of CSSB 240(HSS) provide five exceptions in which a student is exempt from obtaining parental consent. 4:29:42 PM REPRESENTATIVE FIELDS directed the committee members' attention to language on page 3, line 15 of CSSB 240(HSS) and explained that the parental consent language would be maintained regardless of whether or not the proposed amendment is adopted. REPRESENTATIVE SADDLER asked who would be responsible for the cost of mental health treatment outside of Medicaid services and asked whether CSSB 240(HSS) would address only children who are covered by Medicaid. MS. RICCI replied that she didn't want to speculate on how the services might be paid for and explained that the proposed amendment is not limited to children covered by Medicaid. REPRESENTATIVE SADDLER asked why the proposed legislation should be passed if there is an uncertainty as to who is meant to pay for the services outlined by the law. MS. RICCI explained that who might pay for the services is greatly dependent on the child, school district, and behavioral health provider and said that it would ultimately come down to whatever contract agreement was reached between the clinician and the school district. 4:34:10 PM REPRESENTATIVE RUFFRIDGE asked whether counseling services are currently funded by public education funding. SHARON FISHEL, School Health and Safety, Innovation and Education Excellence, Department of Education, answered that there is no other funding available beside public school funding. 4:35:55 PM REPRESENTATIVE SADDLER asked how many behavioral health professionals are working within the public school system and what it means for a mental health professional to work within a school system. MS. FISHEL answered by giving a number of examples related to statistics surrounding mental health services in public schools. 4:38:34 PM CHAIR PRAX asked whether there could be liability for a mental health clinician not responding to a known problem of mental health just because the student's parents didn't consent to the treatment. MS. RUSSEL answered that CSSB 240(HSS) and Amendment 1 would neither mandate provisions of services nor create an affirmative duty to provide services, rather the two would provide permissive language to allow a school to provide services if it so pleases. CHAIR PRAX asked whether a mental health clinician would be required to report a parent that doesn't allow their child to seek mental health treatment to the Office of Children's Services (OCS). MS. RUSSEL explained that the proposed legislation and the proposed amendment would not change existing obligations surrounding mandatory reporting. 4:43:57 PM MS. RICCI noted that page three, lines 6 through 8 of CSSB 240(HSS) are addressed by the proposed amendment and require that a clinician note in a student's file any concerns regarding their mental health. REPRESENTATIVE SADDLER pointed to page 2, line 29 of CSSB 240(HSS) and shared his concern that the proposed legislation would allow for Alaskans aged 16 and 17 to give consent. MS. RICCI replied that Section 5 of the proposed legislation would ensure that the extent of the consent a 16- or 17-year-old would be allowed to give would encompass only their own mental health treatment. 4:46:02 PM MS. RUSSEL affirmed that Ms. Ricci's answer was correct. 4:46:51 PM CHAIR PRAX asked whether the proposed amendment would create a greater risk of someone being reported to OCS. MATT DAVIDSON, Legislative Liaison, Department of Family & Community Services (DFCS), answered that the proposed amendment would not change anything related to the duty to report to OCS. 4:48:33 PM REPRESENTATIVE SADDLER questioned where the line is drawn between a parent's responsibility to care for their children and the state's obligation to step in and help students. REPRESENTATIVE MCCORMICK opined that young people are perfectly capable of recognizing mental health issues that they might be facing. 4:52:39 PM REPRESENTATIVE MINA expressed her intention to vote against Amendment 1 and shared her belief that lowering the age of consent for behavioral health services is a good idea. She shared her concern for a scenario in which a child might not be able to get access to care because of a barrier created by the proposed amendment. 4:54:56 PM REPRESENTATIVE RUFFRIDGE shared his support for Amendment 1 to CSSB 240(HSS) and said that he thinks that while CSSB 240(HSS) is not the answer to how to help young people experiencing mental health issues, it is a good place to start. REPRESENTATIVE MCCORMICK proffered that the idea that parents should be involved [in a minor's decisions regarding their own mental health treatment and services] comes from a very privileged perspective. 5:00:05 PM REPRESENTATIVE FIELDS said that if the proposed amendment were to be passed, the legislature would effectively be denying care to children who are living in circumstances of neglect or abuse. 5:00:43 PM REPRESENTATIVE SADDLER shared his understanding that the proposed amendment would not make informed consent mandatory. REPRESENTATIVE FIELDS corrected his previous statement on Amendment 1 and said that it would not be mandatory for a school report. 5:01:57 PM The committee took an at-ease from 5:01 p.m. to 5:07 p.m. 5:07:59 PM REPRESENTATIVE RUFFRIDGE moved to table Amendment 1 to CSSB 240(HSS). REPRESENTATIVE PRAX asked Representative Sumner if he had any objection to Amendment 1. REPRESENTATIVE SUMNER [objected to the motion to table Amendment 1]. 5:08:41 PM The committee took a brief at-ease at 5:08 p.m. 5:08:58 PM REPRESENTATIVE SUMNER removed his objection to the motion to table Amendment 1 to CSSB 240(HSS). There being no further objection, Amendment 1 was tabled. 5:09:32 PM REPRESENTATIVE MCCORMICK asked Chair Prax if there could be an extension of the amendment deadline. CHAIR PRAX said that he would be okay with an extension of the amendment deadline. 5:09:47 PM The committee took two consecutive at-eases from 5:09 p.m. to 5:11 p.m. [CSSB 240(HSS), with Amendment 1 tabled, was held over.]