SB 48 APPROPRIATION: MENTAL HEALTH PROGRAM  CHAIRMAN WILKEN introduced SB 48 as the final order of business before the committee. JEFF JESSEE , Executive Director of the Alaska Mental Health Trust Authority (AMHTA), informed the committee that the primary mission of the Trust Authority is to manage the trust in perpetuity to enhance the lives of its beneficiaries. Mr. Jessee began his review of the FY98 Mental Health Budget Overview document. (See Attachment A) Mr. Jessee identified the beneficiaries of the Trust, which represent a broad group not limited to mental illness. The comprehensive mental health program is broader than the beneficiaries. Mr. Jessee emphasized that prevention is essential for a long term strategy which is evident in the Trust's budget recommendations. Mr. Jessee explained that the AMHTA income account consists of three percent of the Trust fund balance at the Alaska Permanent Fund Corporation plus 100 percent of Trust land income. The Trust land office is $300,000 over the projected income for FY97 which totals $1.3 million. Mr. Jessee reviewed the sheet in Attachment A which specifies where the funds go. The colored sheet in Attachment A clarifies how the Trust develops budget recommendations per the existing structure of planning. Recommendations from various groups are made to the Trust who then develops a strategic funding plan. TAPE 97-29, SIDE A Number 008 Mr. Jessee explained that the separate appropriation bill for mental health is basically program budgeting. Separate programs for each beneficiary group was created which allowed focus on the specific technology and funding mechanisms to meet that group's needs. However the negative impact of that separation was the loss of the ability to integrate the services between populations. For example, dual diagnosis such as a person with alcoholism and a mental illness could lead to that persons exclusion from one portion of the treatment. A program budget attempts to obtain a comprehensive view of the services and then integrate the services which result in budget recommendations. Mr. Jesse reviewed the funding priorities listed in Attachment A. The closure of the Harborview Developmental Center is a high priority. The difficulty in transitioning out of institutional care is that the end result is apparent, but that transition requires double funding. The institution must be run at full capacity while building up the community alternatives. With Harborview, the Trust used Trust income to facilitate the transition to the community based delivery system. Therefore, general fund monies were freed to be placed into community programs. Now that the population of Harborview decreases so does the Trust's income support. In FY98, everyone should be transitioned from Harborview. Mr. Jessee believed that a similar strategy should be utilized with the downsizing of API. Number 091 Mr. Jessee also mentioned the consumer outcome funding priority. The trustees want to quantify the effect of the funding. For example if there is an employment program, how many people were placed into jobs. Therefore some of the projects attempt to obtain that outcome information. Once that information is available, the Trust and the Legislature has the basis to make rational funding decisions based on the outcomes. Mr. Jessee continued with the AMHTA budget recommendations included in Attachment A. Mr. Jessee stated that the AMHTA Authorized Receipts column are for important areas not extras as some believe. The General Fund/Mental Health column illustrates the focus on building the infrastructure which the state needs to provide for a comprehensive program. Mr. Jessee pointed out that Alaska has a huge aging population which can be illustrated in the money requested for case management and increased respite care for seniors. This is an attempt to avoid the more costly institutions. The suggestions for the general fund are focused on strategic improvements in the manner in which services are delivered. Mr. Jessee turned to the Capital Budget recommendations included in Attachment A. Again the Trust has tried to partner with the state; to use the Trust's funds as often as possible to match general funds. Mr. Jessee believed the match process worked well because it ensures that there is a consistent direction. Number 159 SENATOR WARD asked if the $50,000 for the UN Conference would be utilized for providers to come or for people from Native communities to come. JEFF JESSEE clarified that the money will attempt to get people from rural areas, primarily consumers, to participate in that conference. Mr. Jessee stressed that the intent is not to subsidize providers. SENATOR WARD asked if any of the appropriations went out to RFPs. JEFF JESSEE explained that virtually all of the money flowing from the Trust goes to administrative agencies, either the DHSS or the Commission on Aging. The majority of those dollars are placed on a RFP for competitive grants. In further response to Senator Ward, Mr. Jessee clarified that under the settlement AMHTA could freely spend funds without legislative appropriation. Mr. Jessee did not want to create a set of grant administrators that would duplicate the grant administrators that already exist within state government. Therefore, AMHTA is working with those agencies as surrogate administrators. Mr. Jessee pointed out that grants under $10,000 that are awarded three times a year are decided upon by the staff, off budget. Mr. Jessee discussed the outcomes measures area which are done off budget in order to ensure that the trustees have control. SENATOR ELLIS requested that Mr. Jessee explain the $1 million offer to Medicaid services and comment regarding the cuts proposed by the House to Medicaid services. JEFF JESSEE explained that the trustees have tried to assist the state in turning on Medicaid options such as vision and dental. AMHTA is offering $1.5 million Trust income to match a similar amount from the state to access a similar amount from the federal government. With regards to the proposed Medicaid reductions, Mr. Jessee expressed concern that would eliminate the possibility for the state and the Trust to work together to turn on those options. CHAIRMAN WILKEN said that he would entertain a motion. SENATOR GREEN moved to report SB 48 out of committee with individual recommendations. Without objection, it was so ordered. There being no further business before the committee, the meeting was adjourned at 10:55 a.m.