HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE April 29, 1999 3:05 p.m. MEMBERS PRESENT Representative Fred Dyson, Co-Chair Representative John Coghill, Co-Chair Representative Carl Morgan Representative Tom Brice Representative Allen Kemplen MEMBERS ABSENT Representative Jim Whitaker Representative Joe Green COMMITTEE CALENDAR * HOUSE CONCURRENT RESOLUTION NO. 11 Relating to substance abuse treatment for offenders in the criminal justice system. - MOVED HCR 11 OUT OF COMMITTEE HOUSE BILL NO. 15 "An Act relating to disclosure of information about certain children; and amending Rule 22, Alaska Child in Need of Aid Rules." - MOVED CSHB 15 OUT OF COMMITTEE * HOUSE BILL NO. 162 "An Act relating to confidential mental health records; relating to mental health services and programs; relating to liability for payment for mental health evaluation and treatment services; and providing for an effective date." - MOVED CSHB 162 OUT OF COMMITTEE HOUSE BILL NO. 16 "An Act transferring to the Department of Health and Social Services the authority to license all assisted living facilities; eliminating the authority of the Department of Administration to license assisted living facilities; and providing for an effective date." - HEARD AND HELD (* First public hearing) PREVIOUS ACTION BILL: HCR 11 SHORT TITLE: SUBSTANCE ABUSE TREATMENT FOR OFFENDERS SPONSOR(S): REPRESENTATIVES(S) DYSON Jrn-Date Jrn-Page Action 4/26/99 1004 (H) READ THE FIRST TIME - REFERRAL(S) 4/26/99 1005 (H) HES, JUD 4/29/99 (H) HES AT 3:00 PM CAPITOL 106 BILL: HB 15 SHORT TITLE: FOSTER PARENT RIGHTS TO DISCLOSE INFO SPONSOR(S): REPRESENTATIVES(S) ROKEBERG, Dyson Jrn-Date Jrn-Page Action 1/19/99 21 (H) PREFILE RELEASED 1/8/99 1/19/99 21 (H) READ THE FIRST TIME - REFERRAL(S) 1/19/99 21 (H) HES, JUDICIARY 3/16/99 (H) HES AT 3:00 PM CAPITOL 106 3/16/99 (H) HEARD AND HELD 3/16/99 (H) MINUTE(HES) 3/18/99 (H) HES AT 3:00 PM CAPITOL 106 3/18/99 (H) MEETING CANCELED 4/24/99 (H) HES AT 10:00 AM CAPITOL 106 4/24/99 (H) SCHEDULED BUT NOT HEARD 4/29/99 (H) HES AT 3:00 PM CAPITOL 106 BILL: HB 162 SHORT TITLE: MENTAL HEALTH; RECORDS; TREATMENT SPONSOR(S): REPRESENTATIVES(S) KEMPLEN Jrn-Date Jrn-Page Action 3/26/99 583 (H) READ THE FIRST TIME - REFERRAL(S) 3/26/99 583 (H) HES, JUD, FIN 4/29/99 (H) HES AT 3:00 PM CAPITOL 106 BILL: HB 16 SHORT TITLE: LICENSURE OF ASSISTED LIVING FACILITIES SPONSOR(S): REPRESENTATIVES(S) CROFT, Dyson Jrn-Date Jrn-Page Action 1/19/99 22 (H) PREFILE RELEASED 1/8/99 1/19/99 22 (H) READ THE FIRST TIME - REFERRAL(S) 1/19/99 22 (H) STATE AFFAIRS, HES 2/24/99 307 (H) COSPONSOR(S): DYSON 4/13/99 (H) STA AT 8:00 AM CAPITOL 102 4/13/99 (H) HEARD AND HELD 4/13/99 (H) MINUTE(STA) 4/15/99 (H) STA AT 8:00 AM CAPITOL 102 4/15/99 (H) SCHEDULED BUT NOT HEARD 4/20/99 (H) STA AT 8:00 AM CAPITOL 102 4/20/99 (H) SCHEDULED BUT NOT HEARD 4/22/99 (H) STA AT 8:00 AM CAPITOL 102 4/22/99 (H) SCHEDULED BUT NOT HEARD 4/27/99 (H) STA AT 8:00 AM CAPITOL 102 4/27/99 (H) WAIVED OUT OF COMMITTEE 4/27/99 1034 (H) STA REFERRAL WAIVED 4/27/99 1034 (H) REFERRED TO HES 4/29/99 (H) HES AT 3:00 PM CAPITOL 106 WITNESS REGISTER DONALD DAPCEVICH Governor's Advisory Board on Alcoholism and Drug Abuse P.O. Box 021571 Juneau, Alaska 99802 Telephone: (907) 586-2173 POSITION STATEMENT: Presented HCR 11. ALICE JOHNSTONE, Legislative Chair Governor's Advisory Board on Alcoholism and Drug Abuse 213 Shotgun Alley Sitka, Alaska 99835 Telephone: (907) 465-4667 POSITION STATEMENT: Presented HCR 11. JANET SEITZ, Legislative Assistant for Representative Norman Rokeberg Alaska State Legislature Capitol Building, Room 24 Juneau, Alaska 99801 Telephone: (907) 465-4968 POSITION STATEMENT: Presented HB 15. RUSSELL WEBB, Deputy Commissioner Department of Health and Social Services P.O. Box 110601 Juneau, Alaska 99811 Telephone: (907) 465-3030 POSITION STATEMENT: Testified on HB 15. MARCI SCHMIDT 2040 Fishhook Road Wasilla, Alaska 99654 Telephone: (907) 357-3618 POSITION STATEMENT: Testified on HB 15. JAN RUTHERDALE, Assistant Attorney General Human Services Section Civil Division (Juneau) Department of Law P.O. Box 10300 Juneau, Alaska 99811 Telephone: (907) 465-3600 POSITION STATEMENT: Provided information on HB 15. SARAH SHORT, President Families First Partnership 5535 North Street Anchorage, Alaska 99518 Telephone: (907) 561-5976 POSITION STATEMENT: Testified on HB 15. GINA MACDONALD, Special Projects Coordinator Central Office Division of Mental Health and Developmental Disabilities Department of Health and Social Services P.O. Box 110620 Juneau, Alaska 99811 Telephone: (907) 465-3370 POSITION STATEMENT: Testified on HB 162. SHANNON O'FALLON, Assistant Attorney General Human Services Section Civil Division (Juneau) Department of Law P.O. Box 110300 Juneau, Alaska 99811 Telephone: (907) 465-3600 POSITION STATEMENT: Testified on HB 162. ROBERT B. BRIGGS, Staff Attorney Disability Law Center of Alaska 230 South Franklin Street Juneau, Alaska 99801 Telephone: (907) 586-1627 POSITION STATEMENT: Testified in support of HB 162. WALTER MAJOROS, Executive Director Alaska Mental Health Board Office of the Commissioner Department of Health and Social Services 431 North Franklin Street, Suite 201 Juneau, Alaska 99801 Telephone: (907) 465-3071 POSITION STATEMENT: Testified in support of HB 162. JEFF JESSEE, Executive Director Alaska Mental Health Trust Authority 555 West Seventh Anchorage, Alaska 99501 Telephone: (907) 269-7960 POSITION STATEMENT: Testified in support of HB 162. JANET CLARK, Director Division of Administrative Services Department of Health and Social Services P.O. Box 110650 Juneau, Alaska 99811 Telephone: (907) 465-3082 POSITION STATEMENT: Provided information on HB 162. PAT CLASBY Alaska State Hospital and Nursing Home Association 211 Fourth Avenue, Suite 114 Juneau, Alaska 99801 Telephone: (907) 463-6753 POSITION STATEMENT: Testified in support of HB 162. ACTION NARRATIVE TAPE 99-46, SIDE A Number 0001 CO-CHAIRMAN DYSON called the House Health, Education and Social Services Standing Committee meeting to order at 3:05 p.m. Members present at the call to order were Representatives Dyson, Coghill, Morgan, Brice and Kemplen. HCR 11 - SUBSTANCE ABUSE TREATMENT FOR OFFENDERS Number 0163 DONALD DAPCEVICH, Governor's Advisory Board on Alcoholism and Drug Abuse, came forward to present HCR 11 saying they brought this resolution to the attention of the committee early in the session when the Division of Alcoholism and Drug Abuse Advisory Board presented issues around the state. Number 0226 ALICE JOHNSTONE, Legislative Chair, Governor's Advisory Board on Alcoholism and Drug Abuse, came forward to present HCR 11 saying about 80 percent of the prisoners are either under the influence of addictive drugs or alcohol at the time of their arrest, or they have that problem, and it related to their offense. Although there is treatment in the prisons for people now, it is not adequate. They would encourage the legislature to establish treatment in all the prisons so that they can address this issue to teach the prisoners how to live a better lifestyle and get unaddicted, so they can be productive citizens when they get out of jail and not have any other violations that would put them back in jail again. She indicated that this will cut down the costs of prisons and incarceration. CO-CHAIRMAN DYSON asked if they have any data from other jurisdictions showing that alcohol treatment in prison really works, and recidivism goes down. Number 0406 MR. DAPCEVICH answered that the most comprehensive study is the Cal-Data study which studied treatment in general, but some of that study extended to the prison system. It is true that there is some reduction in recidivism among inmates who participate in treatment activities while in prison. This resolution calls for looking at what they are doing to make sure that it is addressing the problems and is resulting in lower recidivism. If it doesn't, then they need to change what they are doing. MR. DAPCEVICH noted that they also need to look at the possibility of re-engineering what they do in looking at trading hard beds for soft beds in the prison system. Those soft beds would have concurrent treatment going on. There is already a partnership between the correction system and the advisory board for women's treatment. All the women in need of treatment at Hiland Mountain Prison have been provided a full continuum of alcohol treatment, targeting specifically the issues of fetal alcohol syndrome (FAS), the issues of child abuse for those women, who when they come out of prison may or may not have some relationship with their children again and may or may not be at risk for FAS births. MR. DAPCEVICH said that they want to provide the women good service while they are in prison, and they want to link community services to those women as they come out. The program at Hiland Mountain Prison links the institutional probation officer, the community probation officer and the treatment program in the community before the woman leaves prison so that there is a continuum of service after she leaves. He hopes this initiative will address those issues, and they will be able to get hard data for Alaska. The answer to the question is yes, and the Department of Corrections could provide the hard data. Number 0616 CO-CHAIRMAN DYSON asked if most of the prisons already have Alcoholics Anonymous (AA) chapters. MR. DAPCEVICH answered yes. CO-CHAIRMAN DYSON asked what percentage of the prison population chooses to participate in AA. Number 0661 MR. DAPCEVICH answered in 1997, the program provided clinical assessments to 1,577 inmates; 1,681 received education programs and those led to assessments so there were a few more; 807 received outpatient services. The new Hiland Mountain project is expected to provide services to 64 inmates at any given time. There are waiting lists for those services in the criminal justice system. They don't know how many people are coming into the system with problems because no assessments are done on entrance into the prison system. CO-CHAIRMAN COGHILL asked if some inmates are mandated to the AA treatments. MR. DAPCEVICH answered there are some mandates for treatments but not within the prison system. There are mandates for treatment for people who are involved in unlawful activity pre-sentencing, and there are some contingencies for treatment laid out as a part of parole, but he doesn't believe there are any mandates while in prison. Number 0798 CO-CHAIRMAN COGHILL noted that HCR 11 calls for sanctions for those who refuse to cooperate. He said that is strong language, yet it is weak language on getting a standardized screening information process. He wondered if that was on purpose. MR. DAPCEVICH answered that it is with purpose. They are not looking at those who want service, they are looking at providing service for those who need service as determined by the criminal justice system first. Number 0876 REPRESENTATIVE BRICE made a motion to move HCR 11 from the committee with individual recommendations and zero fiscal note. There being no objection, HCR 11 moved from the House Health, Education and Social Services Standing Committee. HB 15 - FOSTER PARENT RIGHTS TO DISCLOSE INFO Number 0914 CO-CHAIRMAN DYSON announced the next order of business as House Bill No. 15, "An Act relating to disclosure of information about certain children; and amending Rule 22, Alaska Child in Need of Aid Rules." Number 0928 JANET SEITZ, Legislative Assistant for Representative Norman Rokeberg, sponsor of HB 15, came forward to present the blank committee substitute (CS) 1-LSO131\D for HB 15. The previous bill would have allowed the foster parents to talk to the legislators. With the assistance of the Department of Health and Social Services (DHSS) and their legal counsel, they have come up with this proposal which says if foster parents feel that a proposed placement is not in the best interest of the child, they can approach a judge and ask that judge to look at the matter. Then the judge can either uphold the department or agree with the foster parent. It is a safety valve for foster parents. Number 1039 REPRESENTATIVE BRICE made a motion to adopt the proposed (CS) for HB 15, version 1-LSO131\D, Chenoweth/Lauterbach, 4/14/99, as a work draft. There being no objection, Version D was before the committee. MS. SEITZ told the committee that the DHSS has requested an amendment that would remove the term "out-of-home caregiver" wherever it appears in the legislation. She indicated that Representative Rokeberg would not oppose that. Number 1090 RUSSELL WEBB, Deputy Commissioner, DHSS, came forward to testify saying they have worked with the sponsor to provide a safety valve for a very limited, and narrow range of cases, recognizing that no one is perfect, and there may be instances where the DHSS makes a mistake. They want to provide an opportunity for foster parents who have information that indicates that a department's decision about a child's placement will risk the health or safety of the child, to have a safety valve in a very limited range of cases. Number 1135 REPRESENTATIVE BRICE asked what the current grievance procedures are for foster parents to address their concerns. MR. WEBB answered currently their grievance procedures through their regulations do not allow a foster parent to grieve a change in placement. REPRESENTATIVE BRICE asked if Version D will give the DHSS an ability to provide that grievance procedure. Number 1183 MR. WEBB said they are attempting to fix a very small problem. They are specifically not attempting to provide party status to a case to foster parents. They clearly do not want to provide foster parents with the right to intervene in a case; they want to give them a safety valve. REPRESENTATIVE BRICE asked is there a step down from court. Number 1244 MR. WEBB answered there is, and there are several safety valves discussed previously. There is an opportunity for foster parents to raise their concerns to parties to the case, including the child's guardian ad litem (GAL). Other avenues also exist. In this instance, the foster parent believed that they were not heard either by the DHSS or the child's GAL. CO-CHAIRMAN COGHILL asked for the reason for removing out-of-home caregiver. Number 1297 MR. WEBB answered that they want to narrow this down because foster parents have a different relationship to children than a residential care provider or care provider in an inpatient psychiatric facility. Those people have a different relationship to the child, and potentially have a financial interest in the child remaining in a placement, and they want to narrow it so the safety valve exists, but it is very limited. MR. WEBB suggested that the amendment remove the words "out-of-home caregiver" on page 2, lines 2, 5, and 6, and 8. REPRESENTATIVE BRICE asked why they want to take out "out-of-home caregiver." MR. WEBB answered if a provider had concerns and reported it to the DHSS, they would be interested in the information, but they wouldn't necessarily have the information about a change in placement. REPRESENTATIVE KEMPLEN asked for some examples of an out-of-home caregiver. MR. WEBB replied a residential care provider, Alaska Children's Services in Anchorage, Charter North, or a relative, but relatives have different status to bring their concerns up. REPRESENTATIVE KEMPLEN pointed out that the word "caregiver's" on page 2, line 3 should also be removed since it refers to the "out-of-home caregiver." Number 1604 MR. WEBB agreed. He pointed out another reason for removing those words because it gives an avenue for a for-profit entity to bring the matter to the court's attention, when the for-profit entity might have a financial interest in the issue. CO-CHAIRMAN DYSON asked Ms. Seitz how the sponsor would feel about the amendment. MS. SEITZ responded that the sponsor is interested in narrowing this to foster parents. Number 1733 REPRESENTATIVE BRICE made a motion for a conceptual amendment to strike the words "out-of-home caregiver or caregiver's placement" on page 2, line 3, 5, 6 and 8. There being no objection, the amendment was adopted. CO-CHAIRMAN DYSON asked Mr. Webb if they support this process. MR. WEBB reiterated that they are not creating party status for foster parents. They are creating a safety valve that would be applied in a very limited number of cases. If HB 15 were interpreted to mean that anytime the foster parent disagreed with the placement decision made by the DHSS, the foster parent could go to court, the department would be opposed to it. If it is applied in those circumstances where foster parents have credible information that indicates that the DHSS is making a bad decision, they can bring that information to the court, and the court can evaluate it. If the court believes that it has credibility, the court can grant a hearing on it. It would be a very small number of cases. He indicated that they would need some advice from the Department of Law to look at this closely, but he indicated that now they are getting close to their intention. CO-CHAIRMAN DYSON commented that HB 15 goes to the Judiciary Committee next and that would be an appropriate place for that discussion. Number 1894 MARCI SCHMIDT testified via teleconference from the Matanuska-Susitna (Mat-Su) Legislative Information Office (LIO) asking if, under this proposed CS, they are no longer allowing foster parents to discuss the case with the legislators. Number 1918 MS. SEITZ agreed this is an entirely new draft because of the concerns raised about the Title IV-E funding that they would lose under the first bill. MS. SCHMIDT said she would rather have the original language of HB 15 put back in; it is vital for the safety of their children. It seems a shame that they are so concerned about dollars rather than children. She supports the original language being put back in. Number 2018 JAN RUTHERDALE, Assistant Attorney General, Human Services Section, Civil Division (Juneau), Department of Law, came forward to testify saying that the proposed CS does fix the problem of federal funding. She is concerned that they are heading down the road giving foster parents party status; this bill doesn't do it, but foster parents are hired by the Division of Family and Youth Services (DFYS) to provide temporary shelter, but they are not parties themselves. However, last year HB 375 gave several rights to foster parents, one being the right to get notices and an opportunity to be heard in hearings and also to get notice in the change of placement. Now this bill allows them an additional right to petition the court to object to a placement in certain circumstances. MS. RUTHERDALE pointed out that this applies in cases when no one else agrees with the foster parents. She noted some problems: it will pull everybody into court when they may not need to; it may be a frivolous motion to the court. If they are called into defend it, it could require DFYS to go on record as defending their position which is defending the parent. It is possible that later the case could change and they sought to terminate parental rights, the DFYS is now on record of testimony saying "Look how great this parent is." It also raises questions if this somehow allows the foster parents to have court-appointed attorneys if they can't afford their own attorney. She asked if the foster parents will be allowed to practice law without a license or do they have a right of appeal. There might be a fiscal note from the court. Since this is a work draft, the Department of Law hasn't submitted a fiscal note, but she estimated conservatively that there could be 40 cases which could cost $18,000. CO-CHAIRMAN DYSON asked Ms. Rutherdale if a foster parent can now go to court to protest a placement. MS. RUTHERDALE answered as a practical matter, yes. They have to go through parties. This bill doesn't seem to be necessary, but foster parents are being allowed in court anyway. TAPE 99-46, SIDE B Number 2240 SARAH SHORT, President, Families First Partnership, testified via teleconference from Anchorage saying she agreed with Marci Schmidt that the original text of the bill was better for the child's best interest. Any external review of DFYS is an absolute necessity. Anything to aid the child should be done. She pointed out that the foster parents spend more time with the children than other people that are parties to the case. She said she believes that the process now does not work. There is no external review because they have taken away the Foster Care Review Board. She pointed out that sometimes children are at Alaska Children's Services for one to two months before they are placed in a foster home, and she wondered why they wouldn't be allowed to have adequate input since they have daily interaction with these children. MS. SHORT stated that the foster parents should have access to any legislator because they set the laws, and they should know every single thing about these children out there in crises. The DFYS profits from keeping children in care so she doesn't understand why they wouldn't allow the other for-profit groups to have a say. She believes that the foster parents have better insight than most of the case workers and guardians ad litem. They need to be able to openly communicate, and she urged them to go back to the original language. Number 2034 CO-CHAIRMAN DYSON asked if she did not want the foster parents to be able to go into court. Number 2031 MS. SHORT said they should be able to tell not only the court but also the legislators. She agreed that HB 15 is a good bill, it just needs to be able to open up a little bit more and also include the out-of-home caregivers. REPRESENTATIVE BRICE agreed with Ms. Short that the Foster Care Review Board is important, and it is needed. But the important distinction between the two drafts before them are that the legislators do not make decisions on the disposition of a child in state custody, the courts do. The foster parents need to be able to have access to the courts, and the proposed CS does that. Number 1939 REPRESENTATIVE BRICE made a motion to move the proposed CSHB 15, version 1-LSO131\D, Chenoweth/Lauterbach, 4/14/99, as amended, out of the committee with individual recommendations. There being no objections, CSHB 15(HES) moved from the House Health, Education and Social Services Committee. Number 1916 CO-CHAIRMAN DYSON commented that strongly over his objection they eliminated the Foster Care Review Board, which was a major protection and safety valve, and it worked well in some cases. He appreciates the sponsor and the DHSS working together on this. He agreed the original bill had some merit, but he is not going to go against the sponsor and amend it. HB 162 - MENTAL HEALTH; RECORDS; TREATMENT Number 1817 CO-CHAIRMAN DYSON announced the next order of business as House Bill No. 162, "An Act relating to confidential mental health records; relating to mental health services and programs; relating to liability for payment for mental health evaluation and treatment services; and providing for an effective date." Number 1805 REPRESENTATIVE KEMPLEN, sponsor, presented HB 162 saying the purpose of this legislation is to provide the necessary, statutory changes on three features concerning mental health services. It clarifies client eligibility for mental health services, it establishes procedures for determining eligibility, processing applications, and paying claims, and it offers a conduit for mental health services to eligible clients through a community-based program. It provides adequate funding for evaluation and treatment services for a community-based program. He noted that the Department of Health and Social Services (DHSS) can answer any technical questions. The fiscal note reflects an agreement between the department and Alaska Mental Health Trust Authority (AMHTA). Senator Ted Stevens has come through with some of the necessary funding for this program. He mentioned that there are letters of support in the committee's packets. Number 1634 GINA MACDONALD, Special Projects Coordinator, Central Office, Division of Mental Health and Developmental Disabilities, Department of Health and Social Services, came forward to testify. She told the committee that this legislation emphasizes the inpatient services for people who are at risk of harming themselves or others, or are severely impaired by their mental health condition at the time they are hospitalized. The department is looking to fund the inpatient services for those people in private hospitals throughout the state. In order to do that in an organized, clear and consistent way, the DHSS wanted clarity in the statute about eligibility and payment structure and the service delivery aspects of this program. The DHSS has been doing this for years, but this allows them to do it in more organized way. As the Alaska Psychiatric Institute (API) is downsized, they are going to need those services in Anchorage and throughout the state, for the short-term hospitalization for patients in danger of harming themselves or others. REPRESENTATIVE BRICE asked what the current standards are for eligibility for a facility to be reimbursed for designated evaluation and treatment (DET) services. Number 1562 MS. MACDONALD answered there are two aspects of the bill in terms of standards. One is clinical in terms of harm to self or others and the other is eligibility in terms of income level. Currently the clinical standards are the same. Historically, they have provided services for people who are committed under the court order to be in the hospital. In the past year, they have also been providing services for people who would be committed if they decided to leave the hospital, but they choose to stay in the hospital and receive services voluntarily. They want to support that because it is clinically more appropriate for the patients to make that choice, and they know they would be committed otherwise. Number 1505 REPRESENTATIVE BRICE asked if it is appropriate to categorize the designated evaluation and treatment services as a mental health emergency room. MS. MACDONALD answered that it is more of an inpatient level. The emergency room level would be more of an assessment prior to admission into a hospital facility. This is one step beyond the emergency room level. There would be an inpatient stay, the patient would remain overnight and during that time, there is an extended evaluation process that happens. It does serve a community emergency response function in that it does provide a local place for someone in crisis to go and be safe and be evaluated. Number 1444 SHANNON O'FALLON, Assistant Attorney General, Human Services Section, Civil Division (Juneau), Department of Law, came forward to testify saying she does mental commitments in southeast Alaska. They do commit people for up to 30 days at Bartlett Regional Hospital, a designated treatment facility. It is the shorter term treatment, and people who are in crisis there are in imminent danger of harming themselves or others. Number 1421 REPRESENTATIVE BRICE asked how HB 162 will establish the clinical standards by which services will be provided to those people. Number 1406 MS. MACDONALD answered that under the authority of this statute, the DHSS will be able to establish standards for those services provided on an inpatient basis, but that is just part of the picture. There are services provided on an inpatient basis, and then there is the outpatient component of the service delivery for people who are in crisis. REPRESENTATIVE BRICE asked how HB 162 is going to keep someone in crisis from going to jail, and how does HB 162 direct that individual into the appropriate level of care. Number 1360 MS. MACDONALD answered that it gives hospitals a more steady source of funding for serving these patients so they are able to anticipate that capacity more readily. The biggest part of this bill is that it assures hospitals that they will have funding for providing services to indigent patients. If they don't have the capacity to do that, they haven't created a structure to be ready for them. REPRESENTATIVE BRICE asked what the financial eligibility standards are currently for the state to reimburse a designated evaluation facility. He asked how the department pursues that funding. Number 1278 MS. O'FALLON replied that once the facility has tried to pursue payment through a third party payer or go to court to try to collect money from the patient, and those things haven't worked out, the hospital will submit their bill to the state. If the person appears to be indigent, the department will pay for those services. MS. MACDONALD said the definition of who is eligible has been in dispute. The need for clarity is what has brought this bill about. Number 1112 ROBERT B. BRIGGS, Staff Attorney, Disability Law Center of Alaska, came forward to testify. He explained that the Disability Law Center provides legal representation for persons with disabilities in legal matters relating to their disability. They also work to effect systems change for persons with disabilities when they can. His involvement with the issue of the liability for mental health treatment for someone who has been involuntarily committed began with a client, who walked through his door, and presented him with a large amount of bills saying he can't pay these bills. The Disability Law Center has had a history with past mental health commitments where the DHSS had paid the bills of people who couldn't afford to pay them. When he presented a claim to the DHSS, they declined to provide any assistance. MR. BRIGGS indicated that the Disability Law Center felt that was not an implementation of an existing statute so they filed a lawsuit. As part of that lawsuit, they sought regulations from the DHSS to implement AS 47.30.910 which, in their view, contains a provision for requiring the DHSS to determine the ability of persons to pay for the costs of involuntary commitment, whether they are committed involuntarily, or whether they are committed "voluntarily-in-lieu" of an involuntary commitment. He uses "voluntarily-in-lieu" admission to cover the class of person who is presented to the hospital, a doctor informs that person that they do meet the criteria for involuntary commitment, and the doctor is going to commit them unless they agree to go voluntarily. Number 0998 CO-CHAIRMAN DYSON asked if there are different benefits for a voluntary versus involuntary commitment. MR. BRIGGS answered under the existing statute, in their view, there is not. The statute applies to both people who are involuntarily committed, and those who are committed in lieu of an involuntary commitment. CO-CHAIRMAN DYSON asked the same question about the proposed bill. Number 0971 MR. BRIGGS answered that HB 162 would clearly state that the benefit would be equal. There is a dispute over the interpretation of the statute he cited. This bill goes a long way to limiting that dispute and making it clear that both people who are voluntary committed in lieu of an involuntary admission, as well as those people involuntarily admitted, are subject to the relief measure. That is the upside of this bill for people who have mental disabilities. The downside of the bill is that under existing law there is no income cap on the eligibility for the benefit. This addresses a question What is the income criterion under existing law? It is simply stated in the statute "ability to pay," and there is no income cap. This bill would clearly state a cap on this benefit. MR. BRIGGS explained that in deciding to advocate on behalf of passage of this bill, one has to take into consideration both sides. The Disability Law Center speaks in favor of the bill simply because they believe that it is going to be of more benefit to more people to be assured that their voluntary admission will have access to the same level of benefits as somebody who is involuntarily committed because it will encourage voluntary treatment. CO-CHAIRMAN DYSON asked Mr. Briggs why he doesn't like the income cap. Number 0857 MR. BRIGGS answered there is a large group of people who may have some source of income, but they are the working poor. Those people could benefit also from this program. He said the fiscal climate may not be correct for establishing a threshold at 200 percent of poverty, but as the fiscal climate changes, he will be back advocating that they increase the cap. CO-CHAIRMAN DYSON asked Mr. Briggs if the cap were five times the poverty level would that be okay. MR. BRIGGS answered absolutely, but he is not certain that it would be acceptable. He suggested a hybrid approach to having an income cap, and then having an ability-to-pay formula that compares a variety of factors, including the total amount of unexpended bill, total income, easily liquidated cash and other assets. Number 0748 REPRESENTATIVE KEMPLEN made a motion to adopt the proposed committee substitute (CS) for HB 162, version 1-LSO761\H, Lauterbach, 4/29/99, as a work draft. There being no objection, Version H was before the committee. Number 0715 REPRESENTATIVE BRICE indicated he is supportive of the hybrid approach for those who don't fit under HB 162. CO-CHAIRMAN DYSON agreed it would be good, but he advised Representative Brice to be wise about not slowing down the process. REPRESENTATIVE BRICE agreed they needed to be wary of expediency, but they also need to ensure they are doing what they are supposed to do in addressing the needs of the people. He agrees they have a readily acceptable solution to the issues. MR. BRIGGS noted that Version H does resolve the issue of who is eligible for the benefit as compared to involuntary and voluntary-in-lieu admissions, but the eligibility threshold is not clear. Not only does someone have to have an income less than 185 percent of a poverty guideline, there is not a clear definition of which poverty guideline is being referred to, and there are potential interpretations of several poverty measures, so some correspondence from the DHSS on exactly which poverty guideline is intended would help that ambiguity. MR. BRIGGS indicated that the existing statute talks about the ability of a person to pay. This bill instead substitutes the phrase of "eligibility based on someone lacking the ability to pay or contribute to the payment of charges," which isn't fundamentally different from the concept of ability to pay. One of the reasons they filed the claim against the DHSS was because they felt there was a need for regulations that interpret the concept of ability to pay. There is recognition that there still is a need for those regulations; the bill in its current form does require regulations. Number 0513 MR. BRIGGS noted that there is not a deadline on when those regulations must be adopted. He suggests that they ask the DHSS what may constitute the factors that they will look at in determining ability to pay. He suggests looking at the magnitude of the overall liability, the income available to the liable person as well as their assets. MR. BRIGGS informed the committee that he will forward his definition of ability to pay to the committee. The other element of this bill is to provide a clear and efficient mechanism for funding the privatization of a state function. There is still one ambiguity in the bill that should be clarified. He is not sure of the intention of the paragraph on page 4, lines 22-26. He indicated it is intended to say that if a liable person does not provide the necessary information, the DHSS may issue an administrative order imposing liability on that person. He has language that might more clearly state that which he will provide in writing to the committee. MR. BRIGGS pointed out another aspect of this bill that has not been talked about is the reality that under existing law there is a cap on what hospitals may charge for the services rendered under the range of statutes from AS 47.30.670 through AS 47.30.915. He highlighted the language on page 4 of his written testimony that limits what charges may be imposed to "the actual cost of care and treatment." That term has a specific definition within the existing statute. That provides some measure of protection to consumers that this involuntary treatment will not cause charges that are outrageous and unreasonable. The new language in Version H is contained on page 2, line "Charges assessed for services provided under AS 47.30.670 - 47.30. 915 when a patient is hospitalized at a state-operated facility may not exceed the actual cost of care and treatment." Version H proposes a change in the cost cap. He is not prepared today to oppose that change. MR. BRIGGS is concerned that when there is a cost cap that is available to someone who is treated at a state-operated facility, and it is not available to a patient who is hospitalized at another facility, there is a potential equal protection problem. It is entirely possible that in practice, the costs incurred by patients at private facilities under this bill may be less than those charges incurred at a state-operated facility. They don't know. MR. BRIGGS is no expert on the ways hospitals are constrained in their billing practices by Medicare, Medicaid and other fiscal constraints. He pointed out it is a change in law, and there is a potential equal protection problem that can only be discerned as the bill is implemented. He urged the committee to pass this bill this year, and he remains committed to work to reach a consensus on this bill. TAPE 99-47, SIDE A Number 0008 WALTER MAJOROS, Executive Director, Alaska Mental Health Board, Office of the Commissioner, Department of Health and Social Services, came forward to testify in support of HB 162. This bill is critical and at the center of the effort to downsize API from a 79-bed facility to a 54-bed facility. This can only be done by transferring some of the functions now being provided at API into the community. One of the most important of those is acute-care hospitalization services that now can be provided within community hospitals that are being provided in API. It is important to recognize this as a form of privatization. MR. MAJOROS pointed out that there will be a primary focus on the implementation of these services in the Anchorage bowl area because there are no inpatient psychiatric services of this nature to serve the involuntary patients in the Anchorage area. Approximately 85 percent of the admissions to API are from the Anchorage bowl area; there is a very strong need to provide this service within the Anchorage area. The services will also extend to other parts of the state, including Fairbanks, Juneau and some of the more rural areas. MR. MAJOROS noted that there are problems with the current law in the perceived lack of clarity on eligibility for the current program and payment practices. The hospitals need to know under what circumstances they can bill for services and receive payment for those services. MR. MAJOROS stated that the board is very supportive of the issue of voluntary status. Right now the statute encourages people to convert from involuntary to voluntary status, and it does not make sense to the board that someone can say to a patient "we want you to convert over to voluntary status, but in the process of doing that, you lose the possibility that the state will reimburse for the service." They are in favor of this service being available to people who are involuntarily committed, and those who come voluntarily, but meet those same criteria which is danger to self or others or gravely disabled besides being mentally ill. MR. MAJOROS stressed the importance of the partnership that has gone into the construction of this bill. There have been six or seven meetings over the past two weeks between representatives of the DHSS, the mental health board, the mental health trust authority, the hospital association, consumers, advocates of disability law, and they have worked hard to bring about a consensus on the draft bill. The changes could go on indefinitely, but he encouraged the committee to move the bill forward in its present form because it will make a significant improvement. It is an appropriate compromise. MR. MAJOROS stated that this bill allows services to be given to consumers closer to home and closer to their natural support systems. It would allow them to receive these services more readily in community hospitals throughout the state including rural areas. This bill is cost effective, and there are leveraged resources that are being applied to this. There is no state fiscal impact initially; the services will be provided exclusively through federal funds. Mr. Majoros also pointed out that community hospitals are able to bill Medicaid so it will create an additional revenue source that doesn't presently exist for API. Number 0487 JEFF JESSEE, Executive Director, Alaska Mental Health Trust Authority, testified via teleconference from Anchorage saying this is an important bill to the trustees. They have worked to develop a community-based system to take the place of some of the API beds, and this legislation is essential to carry out the goals of that effort. It will bring clarity to the funding mechanism that they need in order to assure both the beneficiaries and the agencies and corporations that they are hoping will take on these responsibilities, that the money will follow the client from the state hospital to the community-based designated evaluation and treatment facility. MR. JESSEE agrees there could be improvements to HB 162, but time is short, and by adding amendments at this point the bill would not be consistent with the one in the Senate, and they are concerned that that could result in the bill not passing. The trustees have expressed their willingness to continue to look at how this bill is implemented. As they get data and information about the impact of these areas that people have expressed concerns about, then they will be in a better position to come back and jointly recommend any necessary changes to the legislation in the future. MR. JESSEE encouraged them to pass the bill out of the committee, and he hopes it passes this year. They are planning to begin spending several million dollars of federal funds, and part of what they have assured Senator Stevens is that they will have the infrastructure in place to implement these community services. This bill is a very essential part of that effort. Number 0682 REPRESENTATIVE BRICE asked Mr. Jessee what the trust authority is doing to ensure that hospitals that are currently providing designated evaluation and treatment programs aren't turning away people who are in crisis. MR. JESSEE answered the number one thing that is being done is the attempt to pass this legislation to bring more clarity to the funding role for designated evaluation and treatment. Once there is clarity as to how one component fits into the overall continuum of care, then they can start to integrate the other services that have to work together in tandem with that. This bill provides, at this point, the best delineation of that for designated evaluation and treatment that they have been able to develop. Number 0919 JANET CLARK, Director, Division of Administrative Services, Department of Health and Social Services, came forward to testify. She reiterated how important designated evaluation and treatment are to the long-range plan. They have developed a five-year plan that has three components: It deals with the building part of API and providing a new facility at API; the second component deals with the actual downsizing of the API hospital from 79 to 54 beds, and the third piece is the community piece which designated evaluation and treatment is just one piece. MS. CLARK noted that the fiscal note shows that in fiscal year (FY) 2000 and FY 2001 they have secured federal funds to reconfigure the community mental health system. She referred them to page 2 of the fiscal note. More than $1 million outlined in the governor's budget are federal funds that would go toward designated evaluation and treatment. Those federal funds are available again in FY 2001 to fully implement this reconfiguration. In FY 2002 the federal funds are not available, so the DHSS will be back in front of the legislature saying now that they have been able to reconfigure services, the legislature will need to consider that funding request at that time. Number 1071 PAT CLASBY, Alaska State Hospital and Nursing Home Association, came forward to testify in support of HB 162. They were one of the groups at the meetings in the past two weeks. The committee substitute is a compromise of that group who has met in the last two weeks. They all would probably have liked to have gotten more in the bill, but they are proud of the fact that they have a bill that they can all agree on and support and hope that the legislature moves it forward. Number 1130 REPRESENTATIVE BRICE asked how will the hospitals collect their bills on someone who can't pay. He really is asking them to say they would appreciate some sort of sliding fee scale so the hospitals don't end up paying the whole bill. MS. CLASBY said the hospitals do want to be protected financially as they provide the services. This bill has come a long way to increase the kind of financial situation those hospitals were in prior to getting this bill introduced as far as getting reimbursed from the state. Perhaps the Finance Committee can look at that. They would have liked a higher income limit. Number 1309 REPRESENTATIVE BRICE made a motion to move CSHB 162, version 1-LSO761\H, Lauterbach, 4/29/99, from the committee with individual recommendations and attached fiscal notes. Number 1320 CO-CHAIRMAN COGHILL commented that they are expanding an entitlement here. With the questions and expectations that federal government monies are going to come, and they are obligating a future legislature. He doesn't object to moving it, but he might object on the floor. CO-CHAIRMAN DYSON added that whatever is ongoing is subject to appropriations by the legislature. There are no commitments beyond that. There being no objection, CSHB 162(HES) moved from the House Health, Education and Social Services Standing Committee. HB 16 - LICENSURE OF ASSISTED LIVING FACILITIES Number 1368 CO-CHAIRMAN DYSON announced the next order of business as House Bill No. 16, "An Act transferring to the Department of Health and Social Services the authority to license all assisted living facilities; eliminating the authority of the Department of Administration to license assisted living facilities; and providing for an effective date." He indicated that HB 16 would be held over for further hearing. ADJOURNMENT Number 1374 There being no further business before the committee, the House Health, Education and Social Services Standing Committee meeting was adjourned at 4:55 p.m.