SCR 9-MENTAL HEALTH/SUBSTANCE ASSISTANCE PARITY  3:33:36 PM CHAIR WILSON announced the consideration of SENATE CONCURRENT RESOLUTION NO. 9 Recognizing the need for parity in the provision of mental health and substance use disorder medical assistance benefits in the state; and urging the Department of Health to adopt regulations that ensure parity in the provision of mental health and substance use disorder medical assistance benefits in the state. 3:33:51 PM SENATOR FORREST DUNBAR, District J, Alaska State Legislature, Juneau, Alaska, sponsor of SCR 9 gave the following statement: Senate Concurrent Resolution (SCR) 9 emphasizes the importance of behavioral health care within our health systems and calls for Alaska to adopt national parity standards. These standards ensure that behavioral health services receive fair and equal access and coverage compared to other medical treatments. By following these guidelines, we can remove barriers that prevent individuals from accessing necessary care and ensure treatment for behavioral health issues receives equitable treatment, just like treatment for any other health issues. SENATOR DUNBAR acknowledged the committee's strong commitment to behavioral health issues. He noted that the resolution includes discussion of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), as well as non-quantitative treatment limitations (NQTLs). Instead of elaborating further on SCR 9, he asked to defer to the invited testimony, starting with Mr. John Solomon from the Eagle Health Association. 3:35:21 PM CHAIR WILSON announced invited testimony on SCR 9. 3:35:35 PM JOHN SOLOMON, CEO, Alaska Behavioral Health Association, Eagle River, Alaska, stated that he represents the Alaska Behavioral Health Association, a member organization for approximately 90 provider organizations across the state. These providers range from large hospital systems to small regional providers, primarily in the behavioral health field. He added that the association also includes Federally Qualified Health Centers (FQHCs) MR. SOLOMON shared that he is a licensed professional counselor who initially came to Alaska to provide behavioral health care in rural villages. He later became a quality assurance supervisor, responsible for training therapists and ensuring quality care that met accreditation standards. He then advanced to director of behavioral health, where he designed programs, managed funds, and worked to expand access to behavioral health care in the Northwest Arctic. MR. SOLOMON also shared his personal story of being in long-term recovery for over 13 years, having previously struggled with substance use, including methamphetamine and alcohol, and facing homelessness and legal issues. Additionally, he revealed that he has bipolar I disorder, which, as he explained, has both behavioral and medical implications, requiring lifelong treatment. He emphasized that access to behavioral health care is crucial to him, both professionally and personally. 3:37:44 PM MR. SOLOMON moved to slide 2 of the presentation Behavioral Health Parity and explained that he would discuss parity in the context of SCR 9, noting that the term can be misunderstood or conflated with other issues. In healthcare and legislative terms, parity refers to ensuring that behavioral health treatment receives the same access and coverage as medical and surgical treatments. He clarified that the resolution aligns with national standards and would direct the state to remove barriers, ensuring that behavioral health care is treated under the same terms and conditions, regardless of diagnosis, severity, or cause. 3:38:35 PM MR. SOLOMON moved to slides 3 and explained that barriers to behavioral health care can take many forms, often stemming from outdated regulations based on past clinical practices. He noted that when clinical care is written into regulations, they require updates, which hasn't always happened in the behavioral health fielda relatively newer area of healthcare. He highlighted that some regulations involve extensive paperwork and administrative burdens, which may reflect the stigma around being a behavioral health provider. He pointed out that behavioral health providers are sometimes scrutinized in ways that physical health providers are not. He stated these examples of barriers need addressing. 3:39:22 PM MR. SOLOMON moved to slide 4 and explained parity from a client's perspective. He gave the example of visiting a community health center for elbow pain, where in one appointment, a patient can get an intake, a brief assessment, immediate treatment for symptoms, and a plan for further care, including potential referrals. This efficient process is common in physical health care. 3:40:04 PM MR. SOLOMON moved to slide 5 and contrasted this with the experience at community behavioral health centers. A client seeking behavioral health care would first go through an intake and screening, then schedule a second appointment for a full biopsychosocial assessment, which could take hours. The third appointment would involve creating an ongoing treatment plan. This process, often taking months, delays treatment. While there is faster access during a crisis, the system currently offers two extremes: crisis care or a lengthy wait for treatment. He stressed that this structure doesn't address the urgency for those needing behavioral health care before reaching a crisis point. 3:41:10 PM MR. SOLOMON moved to slide 6 and stated that community behavioral health centers handle many Medicaid enrollments, claims adjudication, and documentation standards, which are necessary but applied more strictly than in physical health care. This leads to longer wait times, providers moving to private pay, organizations refusing Medicaid due to workflow differences, and rising service costs from increased administrative time. He expressed concern that budgets are shifting towards hiring more administrative staff instead of clinical staff, which was discouraging as a director. He emphasized the need to focus on outcomes rather than audits when building behavioral health systems. 3:42:09 PM MR. SOLOMON moved to slide 7 a matrix of non-qualitative treatment limiters regarding enrollment and said explained that the Behavioral Health Association examined national standards and parity legislation, seeking a resolution to meet these parity standards. The goal is to ask the Department of Health and its division to address the different burdens and barriers between healthcare and behavioral health. He mentioned they created a matrix to highlight these issues, starting with Medicaid enrollments, noting that community behavioral health often requires 18 different enrollments compared to just one or two in primary care settings like pediatricians. 3:42:59 PM MR. SOLOMON moved to slide 8-9 a matrix of non-qualitative treatment limiters regarding Medicaid claims adjudication processes, documentation standards, reporting requirements, accreditation requirements, state departmental review requirements, rate setting methodologies and service authorizations. He emphasized that community behavioral health follows healthcare documentation standards, which consist of one page of regulations, but adds an extra seven pages specific to behavioral health, along with hundreds of pages in the administrative service manuals, which are entered into regulation. This complexity increases audit risk for providers. He shared that even errors, such as typos in service manuals, have left providers in difficult situations, where they must choose between proper clinical care or adhering to a mistake in regulation, knowing audits could hold them accountable. He proposed creating a committee to review standards and regulations to ensure behavioral health is as accessible as healthcare, while allowing for necessary differences in a thoughtful manner. 3:44:32 PM MR. SOLOMON moved to slide 10 on parity legislation that ensures access and discussed the Mental Health Parity and Addiction Equity Act, passed in 2008 and updated in 2022, noting that 37 states follow it. He explained that states are allowed to pass their own legislation or match parity standards. He mentioned that Wyoming was the most recent state to pass parity legislation in 2019. 3:45:04 PM MR. SOLOMON moved to slide 11 on real world outcomes the Alaska solution. He explained that the proposed resolution aims to align Alaska Medicaid regulations with federal standards and involve the Department of Health, the division, the Alaska Behavioral Health Association (ABHA), and partners in primary and hospital care. The group would work collaboratively to identify areas for improvement and support the division in enhancing care. He highlighted the importance of acting now, citing strong leadership and shared vision within the department. By building a solid framework for behavioral health in Alaska, he anticipated more efficient care, reduced reliance on emergency rooms and correctional facilities, and shorter wait times. He noted that hospitals and primary care often struggle to transfer patients to community behavioral health, particularly those with higher acuity needs. 3:47:08 PM MR. SOLOMON moved to slide 12 on legislation. He stated that SCR 9 emphasizes the importance of parity legislation and references non-quantitative treatment limiters (NQTLs). He explained that NQTLs refer to regulatory and system barriers preventing easy access to care. The resolution highlights these issues and reinforces legislative support for improving behavioral health care access by aligning with federal standards. Solomon stressed the need for collaboration with providers to establish a strong foundation for the future of behavioral health care in Alaska. 3:48:27 PM SENATOR TOBIN expressed curiosity about the absence of a call for parity in travel access within the resolution, despite its relevance to a 2018 Disability Law Center case. She asked for clarification on whether this issue falls under the purview of the resolution or if it was unintentionally overlooked in the materials she reviewed. 3:49:04 PM MR. SOLOMON responded by noting that one of the non-quantitative treatment limiters (NQTLs) involves barriers to care created by regional differences. He explained that the inability to access care due to location is a barrier the parity standards aim to address. He emphasized that the resolution is a collaborative effort with the Department and the division to find solutions together, rather than imposing them. Issues like travel would be included as part of the NQTLs addressed through this partnership. 3:49:58 PM At ease 3:50:06 PM CHAIR WILSON reconvened the meeting. 3:51:10 PM CODY CHIPP, Ph.D., Social Project Support, Alaska Behavioral Health Association, Anchorage, Alaska, shared that while states cannot weaken federal parity laws, they can strengthen them, which is an important consideration. He noted that Alaska's Medicaid plan is exempt from federal parity requirements because it operates as a fee-for-service state. The resolution is not calling for legislation but seeks to partner with the Department of Health and Division of Behavioral Health to address non- quantitative treatment limiters (NQTLs), which create barriers to care. One significant example is the inefficiency of written treatment plans, which differ from medical counterparts who can adjust care plans at each appointment. In behavioral health, changes to treatment plans require amending multiple documents, which could be a warning sign of not meeting federal parity requirements. He also acknowledged the need to address travel barriers, particularly for emergency and non-emergency behavioral health services, as a priority in collaboration with the department and other partners if the resolution moves forward. 3:54:36 PM CHAIR WILSON concluded invited testimony and opened public testimony on SCR 9. 3:55:09 PM DARCI NEVZUROFF, Director of Operations, Behavioral Services Division, Southcentral Foundation, Anchorage, Alaska, testified in support of SCR 9. She stated that Southcentral Foundation (SCF), a tribal health organization serving over 70,000 Alaskans, is one of the largest behavioral health providers in the state, offering over 20 behavioral health and substance use programs. She highlighted the significant administrative and clinical documentation burdens for behavioral health providers, which contribute to long waitlists and hinder access to care. Intake, assessment, and treatment plans for billing purposes can take three to eight non-clinical hours, preventing providers from delivering care. She compared this to medical doctors who do not face similar burdens for longstanding diagnoses like type 2 diabetes, questioning why behavioral health should be treated differently. She urged support for the resolution to align behavioral health care with other healthcare providers and to meet the goals of the 1115 [Behavioral Health Medicaid] Waiver in improving access and quality of care for Alaskans. 3:57:14 PM RONTO RONEY, Director of Behavioral Health, Manilliq Corporation, Kotzebue, Alaska, testified in support of SCR 9. He said he represents tribal health and emphasized the need for parity in behavioral health care access. He noted that while Alaska has made progress in reducing stigma, excessive paperwork still prevents immediate access to care. He called for prioritizing treatment when individuals seek help, handling documentation later, and compared this to how primary care for his children is delivered without delay. He stressed that reducing bureaucracy, especially for youth, will improve access to timely and effective care and urged the committee to streamline the process for all Alaskans. 3:59:30 PM LANCE JOHNSON, COO, Alaska Behavioral Health Association, Eagle River, Alaska, testified in support of SCR 9. He expressed strong support for the initiative and gratitude for the testimony shared. He noted that efforts to improve access to behavioral health services have been ongoing for over 30 years in Alaska and emphasized that now is the time for action. He highlighted the opportunity to collaborate effectively with the Department and Division of Behavioral Health to improve access, pointing out that many people in need are currently accessing services through jails, emergency rooms, and crisis centers. He stressed the importance of providing easier and immediate access to treatment, similar to primary care. 4:00:50 PM DAN BIGLEY, CEO, Denali Family Services, Anchorage, Alaska, testified in support of SCR 9. He stated that in the 21 years he has worked in the behavioral health field he has not seen Non- Quantitative Treatment Limitations (NQTLs) provide a benefit to youth and families. The use of NQTLs creates barriers to care, burdens providers with administrative tasks, and leads to burnout. He expressed concern that these limitations reduce provider willingness to accept Medicaid, increasing strain on those seeking services. He opined that regulations should not dictate care; rather, best practices in training and education should guide care. He looked forward to quality assurance departments focusing on care quality and evidence-based practices instead of regulatory compliance. 4:03:13 PM CHAIR WILSON closed public testimony on SCR 9. MR. WILSON asked if the department is already working on implementing regulations to reduce burdens and paperwork while increasing parity in medical services. He requested clarification on what actions the department is currently taking and what future plans exist regarding this issue. 4:04:09 PM TRACY DOMPELING, Director, Division of Behavioral Health, Department of Health, Juneau, Alaska, stated that the Department of Health has been working on reducing administrative burdens since she took her position last June. Prior efforts were already underway, especially under the leadership of the commissioner and deputy commissioner. The department used the public health emergency to temporarily suspend service authorizations for the state plan and 1115 services. On February 2, the 1115 regulation package went into effect, eliminating most service authorizations and limits for outpatient treatment. 4:04:57 PM MS. DOMPELING noted that the department held listening sessions with providers to discuss eliminating service authorizations for outpatient behavioral health services under the state plan, with hopes of finalizing those changes before the public health emergency ends in May. The department has worked closely with the Alaska Behavioral Health Association to identify regulatory changes to improve parity. She added that the division recently reallocated a position to the regulations section, increasing the team from one to three people to focus on regulatory work and other tasks. She emphasized that while much has been accomplished, significant work remains. 4:06:18 PM SENATOR DUNBAR thanked the previous testifiers and the director, expressing his belief that great progress is being made in the department. He stated that the department is moving in the right direction, which is why he supports a resolution encouraging continued efforts, rather than pursuing a complex statutory or regulatory fix. He commended the department for its work and expressed hope that the resolution would pass, benefiting the Behavioral Health Association. CHAIR WILSON [held SCR 9 in committee.]