SENATE BILL NO. 154 "An Act relating to mental health treatment facilities; repealing the termination date of the mental health treatment assistance program; and providing for an effective date." This was the first hearing for this bill in the Senate Finance Committee. WENDY HALL, Staff to Co-Chair Kelly read a statement into the record as follows. The designated evaluation treatment program is a critical component to the continuum of mental health services in Alaska, particularly for indigent persons with mental illness who are being civilly committed or meet the criteria for civil commitment. Through this program, many poor people with mental illnesses, who do not qualify for Medicaid, are able to receive services in community hospitals across the state closer to their families and local support systems. Without [this] program, it would necessary to transport many consumers in crisis to Alaska Psychiatric Institute to receive evaluation and treatment services. Ms. Hall then stated that this bill repeals the sunset date of existing statute to allow continuation of this program. ELMER LINDSTROM, Special Assistant, Office of the Commissioner, Department of Health and Social Services, testified that the department is in full support of the bill and appreciates the legislature's adoption of the original legislation. Co-Chair Kelly inquired about the fiscal note. Mr. Lindstrom replied that although the fiscal note shows the full cost of the program in FY 02, these costs are included in the Senate version of the FY 02 operating budget. He noted that the program has increased over time, as expected. He shared that a non- general fund source has been used to fund the bulk of the program over the past year. He pointed out that this fund source expires at the end of the current fiscal year but that an alternate non- general fund source has been identified and would be used to continue the program. Co-Chair Kelly clarified that the fiscal note represents the full cost to operate the program rather than the increase of the previous year, due to the sunset date. Mr. Lindstrom affirmed. Co-Chair Kelly asked the increased general fund cost compared to the previous year. WALTER MAJAROS, Director, Division of Mental Health and Developmental Disabilities, Department of Health and Social Services, stated that the fiscal note contains a general fund increment of $100,000 and a Mental Health Trust Authority (MHTA) fund increment of $200,000. He expanded on Mr. Lindstrom's comments, noting the non-general fund source is available through a "creative use of a federal self-insurance program." Co-Chair Kelly surmised that in a normal situation, the fiscal note amount would be approximately $100,000. He again pointed out that the appearance of a higher amount is because the program is otherwise concluded at the end of the current fiscal year unless extended through this legislation. KARL SANFORD, Assistant Administrator, Fairbanks Memorial Hospital, testified via teleconference from Fairbanks in support of the legislation. He listed the decrease in the number of patients transported out of the community over the past two and one-half years. He surmised this program has resulted in cost savings for the state due to quicker access to care for mentally ill patients as well as a continuity of providers for these patients. He spoke of the quality of care provided, which is possible because of the provider's familiarity with their situations and needs. He asserted, "The health of the community is better off for that." Mr. Sanford added that the reduced number of patients transported to the Alaska Psychiatric Institute (API) has increased the level of service provided at that facility as well. Co-Chair Kelly asked the number of patients transported from the Fairbanks Memorial Hospital to API during the last year compared to the number the year prior. Mr. Sanford answered approximately 70 transfers occurred in the year 1999, reduced to five in 2000. R. DUANE HOPSON, MD, Medical Director of Mental Health, Fairbanks Memorial Hospital, testified via teleconference from Fairbanks in favor of the bill. He spoke of the consequences of delayed treatment for mental illness, which he noted increases the cost to the patient and sometimes increases the necessary hospitalization time. LIZ WOODYARD, Registered Nurse and Manager, Inpatient Unit, Fairbanks Memorial Hospital testified via teleconference from Fairbanks to emphasize the benefits of family involvement in treatment of mentally ill patients. GARTH HAMBLIN, Chief Financial Officer, Bartlett Regional Hospital, testified in Juneau in support of the bill, stressing that the program allows treatment of the mentally ill within their own communities. PAT CLASBY, Alaska State Hospital and Nursing Home Association, testified in Juneau in favor of the legislation. She gave history of the previous two years of the program. She listed the primary providers as Fairbanks Memorial Hospital, Bartlett Regional Hospital, the Kodiak hospital, and the Yukon-Kuskokwim Health Center in Norton Sound. She added that other smaller facilities in the state also provide services to patients in the civil commitment process prior to transport to a regional treatment facility of the API. She opined this program is "the modern approach to care at the local hospital" and avoids transports to the state-facility in as many cases as possible. She stressed that if this program continues it would become the primary aspect of continuing mental health care. Senator Ward commented that he fully supported the program and noted that members of his family benefited from it. He asked if the state receives reimbursement for services provided to Native Alaskan patients. LENORD ABEL, PHD, Program Administrator, Mental Health Services, Division of Mental Health and Developmental Disabilities, Department of Health and Social Services, responded that the federal government, "truly is the payer of last resort." He explained these funds are used only after it is determined that the patient is not eligible for any other services. Senator Ward stressed that many people are not receiving these services because the funds run out. He emphasized that Alaskan Natives have a right to this service. He asserted that the MHTA has a responsibility to Natives to provide services and informed that if the Trust does not pay, the state must pay. He opined that the federal government should pay this cost. Co-Chair Kelly asked Senator Ward to assist in monitoring this legislation as it progresses through the House of Representatives. Senator Ward agreed to do so. Senator Green asked if this program is related to Medicaid. Mr. Abel replied that it is not, and explained this program is intended to help indigent persons, who do not have Medicaid coverage or private insurance. Senator Hoffman wanted to know how this program impacts other communities in the state not mentioned. Co-Chair Kelly answered that because patients from Fairbanks and Juneau are not occupying beds at API, more space is available for patients from other communities. Senator Green offered a motion to move SB 154, 22-LS 0748\A from Committee with accompanying $2,652,100 fiscal note from the Department of Health and Social Services. There was no objection and the bill MOVED from Committee. AT EASE 9:37 AM / 9:48 AM