SB 169-MEDICAID: BEHAVIORAL HEALTH COVERAGE                                                                       
                                                                                                                              
2:48:57 PM                                                                                                                    
CHAIR   WILSON  reconvened   the   meeting   and  announced   the                                                               
consideration  of SB  169.  He noted  the  committee adopted  the                                                               
committee substitute, version J, on March 5, 2018.                                                                              
                                                                                                                                
2:50:46 PM                                                                                                                    
CHAIR WILSON asked if there were any amendments.                                                                                
                                                                                                                                
2:50:50 PM                                                                                                                    
SENATOR BEGICH moved Amendment 1, labeled 30-LS1283\J.1.                                                                        
                                                                                                                                
                          AMENDMENT 1                                                                                       
                                                                                                                                
                                                                                                                                
     OFFERED IN THE SENATE                    BY SENATOR Begich                                                                 
        TO:  CSSB 169( ), Draft Version "J"                                                                                     
                                                                                                                                
     Page 1, line 7:                                                                                                            
          Delete "psychiatrist"                                                                                                 
          Insert "physician"                                                                                                    
                                                                                                                                
     Page 1, line 9:                                                                                                            
          Delete "psychiatrist"                                                                                                 
          Insert "physician"                                                                                                    
                                                                                                                                
2:51:24 PM                                                                                                                    
CHAIR WILSON objected for purposes of discussion.                                                                               
                                                                                                                                
SENATOR   BEGICH   said   the    amendment   deletes   the   word                                                               
"psychiatrist" and  inserts the  word "physician." The  memo from                                                               
Legislative  Legal   shows  that  "psychiatrist"  is   under  the                                                               
definition  of physician.  Alaska  has  fewer psychiatrists  than                                                               
they thought.                                                                                                                   
                                                                                                                                
SENATOR  GIESSEL  reported  that   since  the  last  meeting  she                                                               
accessed  an   Arctic  Mental  Health  Work   Group  report  that                                                               
identified 85 psychiatrists  in the entire state.  This was based                                                               
on a 2015-2016  primary care needs assessment.  She also reported                                                               
that Alaska  has about 140  clinical psychologists,  780 clinical                                                               
social workers, and 80 family  and marital therapists. Alaska has                                                               
about 1,000  clinicians that  could work  under supervision  of a                                                               
physician  or   an  advanced  nurse  practitioner   certified  in                                                               
psychiatric mental health.                                                                                                      
                                                                                                                                
SENATOR MICCICHE said he walked  through how behavioral health is                                                               
charged to  Medicaid. The  savings to  the state  are potentially                                                               
significant with the expanded supervision  provided in this bill.                                                               
He predicted  it will be  in the  millions of dollars.  He stated                                                               
support for the zero fiscal note.                                                                                               
                                                                                                                                
2:54:05 PM                                                                                                                    
RANDALL   BURNS,  Director,   Division   of  Behavioral   Health,                                                               
Department  of  Health  and   Social  Services  (DHSS),  answered                                                               
questions about SB 169.                                                                                                         
                                                                                                                                
CHAIR WILSON asked Mr. Burns if  he saw any potential issues with                                                               
the term physician instead of psychiatrist.                                                                                     
                                                                                                                                
MR. BURNS said he has  no comments about replacing "psychiatrist"                                                               
with  "physician," but  would point  out  that   the Centers  for                                                               
Medicare  & Medicaid  Services has  a  rule that  limits who  can                                                               
supervise clinic services to a physician  or a dentist, if it's a                                                               
dental  practice.  The committee  may  want  to talk  about  that                                                               
correction.  Advanced   nurse  practitioners  can   already  bill                                                               
Medicaid directly.  For just  clinic services,  they may  want to                                                               
limit that to physicians.                                                                                                       
                                                                                                                                
2:55:54 PM                                                                                                                    
CHAIR   WILSON  removed   his  objection.   Finding  no   further                                                               
objection, Amendment  1 was adopted.  He entertained a  motion to                                                               
move CSSB 169 from committee.                                                                                                   
                                                                                                                                
2:56:19 PM                                                                                                                    
SENATOR  VON  IMHOF  moved  to  report CSSB  169,  version  J  as                                                               
amended,  from  committee  with  individual  recommendations  and                                                               
attached fiscal notes.                                                                                                          
                                                                                                                                
2:56:31 PM                                                                                                                    
There being no objection, CSSB 169(HSS) moved from the Senate                                                                   
Health and Social Services Standing Committee.