ALASKA STATE LEGISLATURE  HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE  January 18, 2005 3:02 p.m.   MEMBERS PRESENT Representative Peggy Wilson Representative Paul Seaton Representative Vic Kohring Representative Berta Gardner MEMBERS ABSENT    Representative Lesil Mcguire Representative Tom Anderson Representative Sharon Cissna OTHER LEGISLATORS PRESENT  Representative Mike Kelly Representative Mike Hawker Representative John Coghill COMMITTEE CALENDAR  OVERVIEW: COMMISSIONER JOEL GILBERTSON OF THE DEPARTMENT OF HEALTH AND SOCIAL SERVICES - HEARD PREVIOUS COMMITTEE ACTION  No previous action to record WITNESS REGISTER    JOEL GILBERTSON, Commissioner Department of Health and Social Services, DHSS Juneau, Alaska  POSITION STATEMENT: Presented the overview of the Department of Health and Social Services. JANET CLARKE, Deputy Commissioner Division of Finance and Management Services Department of Health and Social Services, DHSS Juneau, Alaska POSITION STATEMENT: Offered additional information regarding DHSS technology.   ACTION NARRATIVE CHAIR PEGGY WILSON called the House Health, Education and Social Services Standing Committee meeting to order at 3:02:05 PM. Representatives Seaton, Kohring, and Gardner were present at the call to order. Representatives McGuire and Anderson were excused. Also in attendance were Representatives Kelly, Hawker, and Coghill. ^Overview: Commissioner of Dept of Health and Social Services Joel Gilbertson 3:03:14 PM COMMISSIONER GILBERTSON stated that the mission of the Department of Health and Social Services is to promote and protect the health and well being of all Alaskans. 3:05:25 PM COMMISSIONER GILBERTSON described three principles that guide the department and its agencies. He explained that the principles center on empowerment of the individuals being served and their shift toward self-sufficiency. He also discussed issues specific to the State of Alaska. He mentioned core services provided by the department, including safe assisted living programs, integrated behavioral health systems, and managed health care for Alaskans in need. He stated that the department creates public value and helps to assure that Alaskans are healthy and productive. 3:09:10 PM COMMISSIONER GILBERTSON stated that the department has 3,200 full-time budgeted positions and of those, 1,600 are direct field workers. He highlighted specific agencies and the numbers of employees working for them. He said that the department provides services to 100,000 Alaskans every month, and the total budget in the governor's fiscal year (FY) 2006 budget submission is $1.8 billion. He emphasized the size and importance of the Department of Health and Social Services. 3:14:27 PM COMMISSIONER GILBERTSON described the eight agencies and their directors within the Department of Health and Social Services. He stated that these agencies aim to accomplish the main goal of the department, which is promoting the health and well being of all Alaskans. 3:15:08 PM COMMISSIONER GILBERTSON explained that his discussion will highlight the agencies that are within the department. He began by describing the Alaska Pioneers' Homes and stated that there are six pioneers' homes throughout Alaska. He discussed their expensive annual maintenance needs. He said that a major challenge for the Alaska Pioneers' Homes is Alzheimer's disease and its increasing prevalence. 3:21:38 PM COMMISSIONER GILBERTSON described the Division of Behavioral Health as the second major agency within the department. He stated that this division is an integrated agency that has combined the services of the Division of Alcohol and Drug Abuse, the Division of Mental Health and Developmental Disabilities, and the Office of Fetal Alcohol Syndrome. He explained that this is the first integrated behavioral health system in the state and it recognizes that a significant amount of the consumers in these programs have co-occurring disorders. 3:25:35 PM COMMISSIONER GILBERTSON stated that integrated community agencies are successfully functioning in several areas of Alaska. He offered examples of integrated systems that were able to deliver more services without requiring an increase of funding. 3:27:47 PM CHAIR WILSON inquired as to the department's integrated agencies that have been established and their structure. COMMISSIONER GILBERTSON responded that integrated models are often community-specific. 3:30:12 PM COMMISSIONER GILBERTSON mentioned Synar enforcement. He explained that Synar is federal legislation that mandates states to reduce the illegal sale of tobacco to minors. He described using confidential informants and collaborating with retailers in Alaska. He elaborated on the penalty for an illegal sale rate that is higher than 20 percent. He concluded that the department has successfully brought the illegal tobacco sale rate down below the 20 percent mark and conserved funding grants dependent on a low illegal sale rate. 3:35:24 PM REPRESENTATIVE GARDNER inquired as to the department's ability to predict where illegal tobacco sales will occur and about how confidential informants are chosen. COMMISSIONER GILBERTSON responded that informants are chosen randomly. He described rural communities as having higher illegal tobacco sale rates. 3:38:04 PM COMMISSIONER GILBERTSON addressed the issue of Alaskan children obtaining health and social services out of state. He referred to the "Bring the Kids Home" campaign and clarified that this program will utilize a gate keeping system to make sure that when a child enters Alaska's Behavioral Health System, at a young age, it can direct that child to a local service in his/her community. He mentioned the Alaska Psychiatric Institute (API). He explained the changes associated with the new API building and the shift in the treatment paradigm toward recovery. He discussed API technology advancements that offer behavioral health services to remote communities lacking [behavioral health] facilities. 3:42:43 PM COMMISSIONER GILBERTSON described the third agency within the department as the Office of Children's Services. He described this as an integrated agency. He emphasized that this agency's planning is built around a prevention model. 3:46:43 PM CHAIR WILSON inquired as to how the department deals with program wait lists. COMMISSIONER GILBERTSON explained the program improvement plan of the child protection system. He stated that this program is driven by negotiated performance measures. He discussed upcoming budget requests that would fund new positions within the Office of Children's Services. 3:51:44 PM REPRESENTATIVE SEATON inquired as to the department's budget allowance for information technology. 3:52:34 PM JANET CLARKE, Deputy Commissioner, Division of Finance and Management Services, Department of Health and Social Services, responded that there is a budget request for the purchase of specific hardware. The department is planning to see how it can make improvements on the technology now in use. 3:53:07 PM REPRESENTATIVE SEATON described a situation in Homer in which there are delays with the department's technology. He requested that this situation be addressed further at another time. COMMISSIONER GILBERTSON said that situation will be addressed at a later date. He described the difficulty of working with outdated systems and talked about future replacements where information will be integrated around a common database. He introduced the concept of using an integrated dataset from which the department has access to each agency's data. The aforementioned would empower field workers with relevant background information and provide better services to individuals being served. 3:58:12 PM REPRESENTATIVE GARDNER inquired as to the likelihood of obtaining archived information from this future database. COMMISSIONER GILBERTSON explained that although the goal is to move away from paper, it's a huge undertaking involving massive amounts of data. 4:00:11 PM REPRESENTATIVE SEATON inquired as to how the legislature could update missions and measures and enable programs to move forward. COMMISSIONER GILBERTSON stated his belief that missions and measures should be annually updated. He explained the department's commitment towards performance measures. 4:04:37 PM REPRESENTATIVE SEATON expressed concern that the department could be following outdated missions and measures because updated [missions and measures] have not been adopted by the legislature. He stated his belief that the department should notify the legislature regarding any necessary changes. COMMISSIONER GILBERTSON turned to Health Care Services, which is the agency that administers the Medicaid Program. He referred to the handout, entitled "Fiscal Year 2006 Executive Summary." He explained that legislation is required in order to halt the growth of the state's Medicaid program. He said that the department controls Medicaid reimbursements. 4:09:25 PM COMMISSIONER GILBERTSON described the Juvenile Justice System Agency, which follows a restorative justice model. He described youth facilities within Alaska. Commissioner Gilbertson commented on the need to use data effectively. He described the Detention Assessment Instrument, (DAI), a system the department uses in juvenile justice facilities. The department has implemented the use of an inventory data system that looks at risk factors for youth offense, he related. 4:16:08 PM COMMISSIONER GILBERTSON moved on to the Division of Public Assistance, which promotes self-sufficiency. Welfare reform has been a huge success. He explained that Alaska continues to decrease caseloads and increase clients entering the workforce. He described the immediate benefit as monetary savings [for the state] and future benefits as families who are an integral part of the workforce. 4:20:45 PM COMMISSIONER GILBERTSON turned to the Division of Public Health, and pointed out that Alaska is the only state without quarantine authority. The aforementioned and other Public Health issues will come before the legislature, he noted. 4:22:11 PM COMMISSIONER GILBERTSON described the "Kids don't float campaign" and highlighted its successes in Alaskan waterfront areas. He also described the Senior and Disabilities Services Agency. He stated that the rapid growth of the personal care attendant program is a challenge for this agency. Furthermore, the department's goal of keeping seniors in their homes receiving services is challenging. 4:25:26 PM REPRESENTATIVE GARDNER inquired as to alcoholism and any specific programs existing that deal with Fetal Alcohol Syndrome (FAS). COMMISSIONER GILBERTSON explained that the Division of Behavioral Health deals with alcoholism issues. He stated that Governor Murkowski has requested more funding for substance abuse programs. He addressed the need for prevention programs. 4:30:30 PM CHAIR WILSON commented on the benefit and value of prevention programs. 4:31:13 PM COMMISSIONER GILBERTSON talked about delivering services to improve health outcomes. He discussed the expense involved in the treatment of chronic health problems. He also talked about treatment methods and promoted case management as a means of necessary follow-up treatment. 4:34:07 PM REPRESENTATIVE SEATON inquired as to Medicaid-based programs and the difficulty of finding participating dentists. COMMISSIONER GILBERTSON elaborated on Governor Murkowski's proposal to expand dental services and provide preventative services for Medicaid clients. 4:38:16 PM CHAIR WILSON commented on patients neglecting to honor their appointments with dental providers. COMMISSIONER GILBERTSON agreed that there are many barriers for providers to work through. He stated that Medicaid provider agreements are a challenge for dentists and DHSS has to work with them to find appropriate solutions. 4:40:10 PM REPRESENTATIVE KOHRING stated that he would prefer to see less emphasis on success measurements based on the amount of money spent on programs providing services for Alaskans. He related his preference on focusing on serving people who truly need assistance, including low-income seniors and disabled people who cannot fend for themselves. He opined that the number of Alaskans being served is astounding. Therefore, he respectfully requested that the department demonstrate to the legislature that its programs are serving people who truly need services. 4:41:55 PM COMMISSIONER GILBERTSON clarified that performance measures are not based on the amount spent for programs. He explained that the department focuses on services delivered and the benefit to society. Eligibility is defined by statute, which is determined by the legislature. He agreed caseloads are incredibly high and emphasized that the department promotes self-sufficiency and actively works to enable people to move off of programs. He said that since he has been commissioner, general fund expenditures have been reduced by $160 million dollars. He explained that the department implements the statutes passed by the legislature and will continue to make sure programs are tailored toward self-sufficiency. He related his commitment to the mission of the department, which is the development of healthy and safe communities. He emphasized his willingness to work constructively with the legislature to address issues and provide the level of service needed by the population. ADJOURNMENT  There being no further business before the committee, the House Health, Education and Social Services Standing Committee meeting was adjourned at 4:46:21 PM.