HOUSE BILL NO. 172 "An Act relating to admission to and detention at a subacute mental health facility; establishing a definition for 'subacute mental health facility'; establishing a definition for 'crisis residential center'; relating to the definitions for 'crisis stabilization center'; relating to the administration of psychotropic medication in a crisis situation; relating to licensed facilities; and providing for an effective date." 9:32:47 AM Co-Chair Merrick invited Ms. Heather Carpenter to make opening remarks. HEATHER CARPENTER, HEALTH CARE POLICY ADVISOR, OFFICE OF THE COMMISSIONER, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, thanked the committee for continued consideration of the bill and made herself available for questions. 9:33:36 AM Co-Chair Merrick MOVED to ADOPT Amendment 1, 32-GH1730\N.3 (Dunmire, 4/21/22) (copy on file): Page 13, line 10, through page 14, line 1: Delete all material and insert: "* Sec. 26. AS 47.32.010(b), as repealed and reenacted by sec. 79 of Executive Order 121, is amended to read: (b) This [THE FOLLOWING ENTITIES ARE SUBJECT TO THIS] chapter and regulations adopted under this chapter by the Department of Health apply to the following entities: (1) ambulatory surgical centers; (2) assisted living homes; (3) child care facilities; (4) freestanding birth centers; (5) home health agencies; (6) hospices, or agencies providing hospice services or operating hospice programs; (7) hospitals; (8) intermediate care facilities for individuals with an intellectual disability or related condition; (9) maternity homes; (10) nursing facilities; (11) residential child care facilities; (12) residential psychiatric treatment centers; (13) rural health clinics; (14) subacute mental health facilities [CRISIS STABILIZATION CENTERS]." Page 14, line 16: Delete "and Social Services" Insert ", the Department of Family and Community Services," Page 14, line 30: Delete "and Social Services" Insert ", the Department of Family and Community Services," Page 15, line 4: Delete "and Social Services" Insert ", the Department of Family and Community Services" Page 15, line 11: Delete "and Social Services" Page 15, line 17: Delete "and Social Services" Insert "or the Department of Family and Community Services, as applicable," Vice-Chair Ortiz OBJECTED for discussion. Co-Chair Merrick reviewed the amendment. She explained that it addressed some needed changes to the bill to prepare for the impending split of the Department of Health and Social Services (DHSS). Vice-Chair Ortiz WITHDREW the OBJECTION. There being NO further OBJECTION, Amendment 1 was ADOPTED. 9:34:12 AM Co-Chair Merrick MOVED to ADOPT Amendment 2, 32-GH1730\N.4 (Dunmire, 4/21/22) (copy on file): Page 4, lines 13 - 14: Delete "[FOR EMERGENCY EVALUATION]" Insert "for emergency evaluation" Page 8, line 11: Delete "47.30.815" Insert "47.30.865" Vice-Chair Ortiz OBJECTED for discussion. Co-Chair Merrick reviewed the amendment. She explained that it incorporated technical changes made in the Senate version of the bill. Representative Wool was curious why the language "for emergency evaluation" was proposed to be deleted as well as inserted in the same section in the same lines. He thought it seemed redundant. Ms. Carpenter responded that the words "for emergency evaluation" had been previously deleted. The amendment would replace the words back into the text. Co-Chair Merrick indicated Representative Edgmon had joined the meeting. 9:35:01 AM Representative Josephson asked if the amendment would make the bill mirror the Senate version. Ms. Carpenter responded in the affirmative and thought the changes proposed by the Senate were beneficial to the bill and technical in nature. Vice-Chair Ortiz WITHDREW the OBJECTION. There being NO further OBJECTION, Amendment 2 was ADOPTED. Co-Chair Merrick MOVED to ADOPT Amendment 3, 32-GH1730\N.2 (Dunmire, 4/19/22) (copy on file): Page 1, line 2, following "facilities;": Insert "relating to representation by an attorney;" Page 3, following line 30: Insert a new bill section to read: "* Sec. 11. AS 18.85.100(a) is amended to read: (a) An indigent person who is under formal charge of having committed a serious crime and the crime has been the subject of an initial appearance or subsequent proceeding, or is being detained under a conviction of a serious crime, or is on probation or parole, or is entitled to representation under the Supreme Court Delinquency or Child in Need of Aid Rules or at a review hearing under AS 47.12.105(d), or is isolated, quarantined, or required to be tested under an order issued under AS 18.15.355 - 18.15.395, or is a respondent in a proceeding under AS 47.30 [AGAINST WHOM COMMITMENT PROCEEDINGS FOR MENTAL ILLNESS HAVE BEEN INITIATED,] is entitled (1) to be represented, in connection with the crime or proceeding, by an attorney to the same extent as a person retaining an attorney is entitled; and (2) to be provided with the necessary services and facilities of this representation, including investigation and other preparation." Renumber the following bill sections accordingly. Page 14, lines 15 - 16: Delete "secs. 1 - 30" Insert "secs. 1 - 31" Page 15, lines 10 - 11: Delete "sec. 26" Insert "sec. 27" Page 15, line 12: Delete "sec. 26" Insert "sec. 27" Page 15, line 21: Delete "Section 31" Insert "Section 32" Vice-Chair Ortiz OBJECTED for discussion. Co-Chair Merrick reviewed the amendment. She explained that the amendment was at the request of the court system to clarify the role of the public defender. She noted that Ms. Nancy Meade was available for questions about the amendment. 9:35:50 AM Representative Josephson invited Ms. Meade to give her sense of the amendment. NANCY MEADE, GENERAL COUNSEL, ALASKA COURT SYSTEM, provided further detail regarding the amendment. She relayed that Amendment 3 would ensure that when there was a mental health crisis situation and an individual was held involuntarily in a crisis center, the attorney appointed by the court for the individual would be from the public defender's office. There needed to be a statute stating who the appointed attorney would be, and if it was not dictated in statute, the court system would need to pay for the attorney. She wanted to offer clarity that the legal duty was that of the public defender. Vice-Chair Ortiz WITHDREW the OBJECTION. There being NO further OBJECTION, Amendment 3 was ADOPTED. 9:37:16 AM Representative Rasmussen MOVED to ADOPT Amendment 4, 32- GH1730\N.5 (Dunmire, 4/21/22) (copy on file): Page 14, line 26: Delete "and" Page 14, line 29, following "matters": Insert "; and (4) identify methods for collecting and making available to the legislature and the general public statistics recording (A) the number, type, and cause of patient injuries; (B) the number, type, and resolution of patient complaints; and (C) the number and type of traumatic events experienced by a patient; in this subparagraph, "traumatic event" means being placed in isolation or physical restraint of any kind" Co-Chair Merrick OBJECTED for discussion. Representative Rasmussen reviewed the amendment. The amendment would require that statistics of psychiatric patient complaints, injuries, and traumatic events be obtained and shared with the legislature and the public. Vice-Chair Ortiz asked for more detail regarding the impact of the amendment and how it would alter the bill. Representative Rasmussen replied that it would make data more available and the process more transparent. Co-Chair Merrick asked Ms. Carpenter to comment. Ms. Carpenter replied that it directed the department on the statistics that needed to be collected and their public distribution. The amendment fit naturally in the bill. She thought it made sense for the amendment to describe the process in more specific terms. 9:39:40 AM Representative Wool asked if the practice was done with any other patient group in custody in the state. He thought some of the terms seemed too broad, such as "traumatic event." Ms. Carpenter answered that she thought "traumatic event" was appropriate and pointed out that the amendment included a definition of the term. Hospitals were accustomed to reporting on events such as infections and mental health crises and there were already many statistics captured across the board. A consultant would likely be hired to help with public outreach. She shared that meetings would be publicly noticed and tools would be put on a website for the public. Representative Wool asked if statistics regarding mental health holds would be publicly available, such as Alaska Psychiatric Institute (API) holds. Ms. Carpenter would not be able to speak to the statistics related to the Department of Corrections, but API statistics were reported monthly to the court system. The statistics that were required to be reported were different for each hospital, which was the reason the amendment would allow transparency in the process to ensure that reporting efforts would not be duplicated. 9:43:41 AM Representative Wool suggested that API was a state-run facility. People could be committed and held against their will in an API facility. He thought the reporting requirements would be the same at API. Ms. Carpenter responded that Representative Wool was correct that the amendment included entities such as API and Fairbanks Memorial Hospital. It would capture all providers of psychiatric care. Representative Carpenter read the amendment. He thought it did not specifically require the reporting of the information to the legislature. He wondered if the amendment would have the intended affect by making statistics available. 9:46:03 AM AT EASE 9:47:20 AM RECONVENED Ms. Carpenter responded to Representative Carpenter's question. She pointed to page 14, lines 15 through 18 of the bill and explained language would be added to require that statistics be reported to the Senate Secretary and the Chief Clerk. Methods would then have to be identified to determine how to report the statistics to the legislature and general public. Co-Chair Merrick asked if Mr. Steve Williams had any comments. 9:48:16 AM STEVE WILLIAMS, CHIEF EXECUTIVE OFFICER, ALASKA MENTAL HEALTH TRUST AUTHORITY, agreed with Ms. Carpenter's assessment. He emphasized that the amendment would ensure that the rights of patients and patient advocates would be recognized. The Alaska Mental Health Trust Authority (AMHTA) welcomed the addition to the bill. Representative Carpenter was curious about the opinion of Legislative Legal Services. 9:50:02 AM AT EASE 9:52:57 AM RECONVENED Co-Chair Merrick indicated Mr. Andrew Dunmire was available online for questions. Representative Carpenter thought the language in the bill never directly stated that data must be reported to the legislature and wondered if reporting would be required based on the existing language. ANDREW DUNMIRE, ATTORNEY, LEGISLATIVE LEGAL SERVICES (via teleconference), thought Representative Carpenter was correct that the Department of Health and AMHTA would be required to submit a report that identified how to collect the statistics and relay them to the legislature and public. However, there was no obligation to report the data to the legislature in the language of the bill. 9:55:26 AM Representative Carpenter asked if the intent of the amendment was to have the statistics provided to the legislature or ensure that statistics were collected by AMHTA. Representative Rasmussen indicated that the intent of the amendment was to identify and report. She was open to a conceptual amendment. 9:55:56 AM AT EASE 10:00:11 AM RECONVENED Representative Carpenter did not have an objection to the amendment. He thought the intent of the amendment was to make information available to the legislature but was not sure it was what the administration was requesting. He acknowledged there was no technical problem with the amendment. 10:00:58 AM Representative Josephson asked who would own and operate the subacute and mental health crisis facilities. Ms. Carpenter asked whether Representative Josephson wanted to know who owned the statutes or the actual facilities. Representative Josephson responded, "The latter." Ms. Carpenter responded that the individual operators of the subacute and mental health facilities also owned the facilities. She provided some examples of facilities and the ownership, such as Bartlett Regional Hospital being owned by the City and Borough of Juneau (CBJ). She explained that the facilities would operate under the licensures stood up by the Department of Health. Co-Chair Merrick clarified that Amendment 4 was currently being discussed. Representative Josephson asked what part of the amendment compelled the reporting of statistics. He thought it was in section 29 on page 14. Ms. Carpenter indicated that was not what section 29 did. The section created a method to authorize the department to get the statistics and report them publicly and to the legislature. Potential improvements could be made based on the statistics. Representative Josephson responded that it did not change his outlook on the bill. Representative Edgmon referred to page 14 of the bill and relayed his understanding of it. The reporting would be inclusive of the information listed on page 14. He thought the reports would act as a learning tool and a catalyst for improvements. He asked if his interpretation was correct. Ms. Carpenter responded, "Yes, it is." She added that it was important to understand how new facilities would fit into the current system and what changes still needed to happen. The involuntary commitment statutes were outdated. 10:05:16 AM Representative Edgmon thought Ms. Carpenter's response was sufficient. He wondered if the bill was consistent with the bill sponsor's intent. Ms. Carpenter replied that the department had worked with the trust on the language of the bill. Many outside entities were consulted on the bill, such as medical providers and disability law centers. Providers appreciated the novel approach to the issue and being included in the conversation. Representative Carpenter believed the report was based on system improvement, not actionable information or data. He no longer objected to Amendment 4. Representative Rasmussen thought it was a fair starting point for evaluation. The legislature was already being provided with data. 10:07:19 AM Representative Wool read line 28 on page 14 of the bill. He thought it was similar language as that in the amendment. He thought it was acceptable if it simply aimed to assess methods. He wondered about the immediacy of reporting and hoped that people would not be able to identify a person in crisis based on public information. Ms. Carpenter responded that his concerns with privacy would be evaluated as part of the process. She assured him that data privacy would be taken seriously and data collection would be compliant with HIPAA [Health Insurance Portability and Accountability Act]. She thought the ability to see what other providers were doing would be a good tool for the provider community. Co-Chair Merrick WITHDREW the OBJECTION. There being NO further OBJECTION, Amendment 4 was ADOPTED. Vice-Chair Ortiz MOVED to report CSHB 172(FIN) out of committee with individual recommendations and the accompanying fiscal notes. There being NO OBJECTION, it was so ordered. CSHB 172(FIN) was REPORTED out of committee with five "do pass" recommendations and five "no recommendation" recommendations and with a previously published zero fiscal note: FN4 (DPS); and with four previously published fiscal impact notes: FN5 (AJS), FN6 (DHS), FN7 (DHS), and FN8 (ADM). 10:10:51 AM AT EASE 10:13:18 AM RECONVENED