SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE February 11, 1998 9:00 a.m. MEMBERS PRESENT Senator Gary Wilken, Chairman Senator Loren Leman, Vice-Chairman Senator Lyda Green Senator Jerry Ward Senator Johnny Ellis MEMBERS ABSENT None COMMITTEE CALENDAR Presentation by the State Independent Living Council (SILC) SENATE CONCURRENT RESOLUTION NO. 14 Establishing the Alaska Task Force on Parity for Mental Health. HEARD AND HELD PREVIOUS SENATE COMMITTEE ACTION SCR 14 - See HESS minutes dated 4/30/97, 1/30/98, and 2/4/98. WITNESS REGISTER Jim Burton, Chairman State Independent Living Council 1169 Hess Avenue Fairbanks, Alaska 99709 POSITION STATEMENT: Introduced members of the State Independent Living Council. Howard Hedges P.O. Box 779 Homer, Alaska 99603 POSITION STATEMENT: Gave part of the presentation by the State Independent Living Council. Cindy Lynn Box 1758 Petersburg, Alaska 99833 POSITION STATEMENT: Gave part of the presentation by the State Independent Living Council. Joyanna Geisler P.O. Box 2474 Homer, Alaska 99603 POSITION STATEMENT: Gave part of the presentation by the State Independent Living Council. Ruth L'Hommedieu P.O. Box 80127 Fairbanks, Alaska 99708 POSITION STATEMENT: Gave part of the presentation by the State Independent Living Council. Jerie Best P.O. Box 426 Soldotna, Alaska 99669 POSITION STATEMENT: Gave part of the presentation by the State Independent Living Council. ACTION NARRATIVE TAPE 98-10, SIDE A Number 001 CHAIRMAN WILKEN called the Senate Health, Education and Social Services (HESS) Committee to order at 9:05 a.m. Present were Senators Ellis, Leman, Green and Wilken. The first order of business before the committee was a presentation by the State Independent Living Council (SILC). JIM BURTON, Chairman of the State Independent Living Council in Fairbanks, stated SILC is responsible for the concerns and modification services for the disabled who live independently. He introduced Howard Hedges of Homer, Cindy Lynn of Petersburg, Joyanna Geisler of Homer, Ruth L'Hommedieu of Fairbanks, and Jerie Best of Soldotna who would be giving presentations to the committee today on behalf of SILC. HOWARD HEDGES referred to a booklet entitled "Programs for People with Disabilities: FY 99 Interdepartmental Budget Analysis and Recommendations," and specifically to page 10 which pertains to SB 253. SB 253 will allow people with disabilities to purchase, on a sliding fee scale basis, health care coverage through the Medicaid program. Mr. Hedges said many disabled people want to work but risk living without health care coverage because one must be receiving public assistance to be eligible for Medicaid. He explained that in 1993 he had a stroke and became disabled. He had no insurance at the time and his illness decimated his family's finances. After three years of physical and occupational therapy, he was able to return to work. When one returns to work after receiving public assistance for a disability, a one-year clock begins to tick, after which time the assistance is cut off. He began working at the Kenai Independent Living Center and received a salary of $28,800 per year. Private insurance for his family would have cost $705 per month with a $2500 deductible. The Center was unable to provide insurance because it would have equaled 30 percent of its budget, therefore he was laid off. He once again received public assistance and Medicaid and was fortunate because in December he unexpectedly had heart surgery which cost $80,000. MR. HEDGES concluded by saying he would have preferred to continue to work and to pay a sliding fee scale premium for insurance but because of the structure of the Medicaid program, he cannot buy into Medicaid; he has to receive public assistance to be eligible for Medicaid coverage. MR. HEDGES said he is caught in the dilemma of not being able to work so that he can maintain health care coverage through Medicaid. He knows he is high maintenance but he wants to return to work. There are many people in his situation who want to work but do not want to jeopardize their benefits because it is too risky. He urged the committee to support SB 253. CINDY LYNN discussed SB 266, described on page 11 of the Analysis and Recommendations booklet. SB 266 creates a unique opportunity to provide affordable health care for over 11,000 children and 800 pregnant mothers, paid for by individuals and families. SB 266 will also increase funding in over 34 existing programs and will not require a budget increase because the federal government is giving the states an additional 10 percent in Medicaid monies. MS. LYNN informed committee members that SILC supports SB 266 as well as the Governor's Smart Start Program. Alaska has the highest rate of child abuse in the nation. Disabled children are at a higher risk of abuse, families with disabled children have a higher divorce rate, and disabled children have a higher out-of-home placement rate. Money invested in children and families saves state dollars in the long run, by preventing foster care placement, increased court costs, and jail time. MS. LYNN pointed out Alaska is unique in that many people are either self-employed, work seasonally and do not have year-round insurance, or work for employers who do not offer insurance. Many lower income families cannot afford insurance and are ineligible to receive aid. In rural areas, most health care providers are not preferred providers which many insurance companies now require their customers to use. In Petersburg none of the doctors are preferred providers, nor is the hospital, so she must pay a $100 deductible requirement per day when she gets her blood drawn. SB 266 would allow those Alaskans to purchase and pay for Medicaid coverage. Medicaid will pay for preventive care, as well as dental work and nutritional education. Medicaid also pays for emergency transportation which costs $12,000 one-way from Petersburg to Seattle. Number 205 SENATOR ELLIS asked if both SB 253 and SB 266 are in the Senate HESS committee. CHAIRMAN WILKEN answered yes, both were sponsored by the Governor and were referred to the committee last week. JOYANNA GEISLER thanked the committee for considering issues important to SILC and the 88,000 Alaskans with disabilities. She focused her remarks on independent living services, which are described on page 19 of the Analysis and Recommendations booklet. Last year over 1,000 Alaskans received independent living services. at a cost of about $900 per person per year in combined state and federal dollars. The cost of the services to the State was about $400, or 40 cents per person per day. SILC believes the services it provides are cost effective and very important to people with disabilities. Some of those services include assistance with ramp building and home modification, obtaining adaptive equipment, and helping people get back to work. MS. GEISLER explained independent living centers also assist disabled people living in nursing homes who want to move into their own homes. It took 1+ years for SILC to get a 30 year old mother out of a nursing home in Seward because, due to limited resources, staff was only able to go to Seward once a month for a couple of days. The mother is now living at home, and is able to be with her daughter full time. Setting up community supports for people being released from nursing homes takes time. SILC is requesting $100,000 to assist people who request to leave nursing homes, and to help people who are at risk of being placed in nursing homes. The $100,000 would be used to help set up the community supports necessary and this small initial investment will save the State hundreds of thousands of dollars in Medicaid costs. On the Kenai Peninsula, a typical nursing home charges between $100,000 to $200,000 per year. Community living situations are estimated to cost one-third of that amount. SENATOR GREEN asked if the specific purpose of the $100,000 increase is to develop, rather than implement, independent living plans. MS. GEISLER replied the plan would include assisting clients to live on their own by setting up community supports, among other things. CHAIRMAN WILKEN asked what a center for independent living looks like. MS. GEISLER said SILC does not provide residential services. Independent living centers are staffed and governed by people with disabilities. The Kenai Center has offices in Homer, Seward, and Soldotna. The Center receives calls from people with disabilities and family members on a variety of subjects, such as the ADA and social security. The Center does not always provide the direct service but teaches the person to get services themselves and to self-advocate. CHAIRMAN WILKEN asked if the centers are repositories of information rather than homes. MS. GEISLER said they are. Number 301 RUTH L'HOMMEDIEU, from Fairbanks, thanked committee members for passing SCR 19, pertaining to the Alaska Deaf, Hard of Hearing, and Deafblind Council. She referred to page 32 of the Analysis and Recommendations booklet, which contains the Vocational Rehabilitation budget and informed committee members she is requesting an additional $350,000 to the budget. This year the Division of Vocational Rehabilitation is operating with a $130,000 cut in State funds to their budget. That cut resulted in the loss of $130,000 in matching federal funds, so the division has suffered a total loss of $260,000 which was used to provide direct services to clients. She said the $350,000 budget increase will cover the $260,000 loss, plus $90,000 to fund a counselor for the deaf, hard of hearing, and the deafblind, and a counselor for the blind, as well as direct services for that group of people. MS. L'HOMMEDIEU said that last summer she found herself unemployed after working steadily for 15 years. She decided to apply for vocational rehabilitation services and was placed with a counselor who has 150 clients. On the third visit, which took about two months, she was told she qualified for services. On the fourth visit, the counselor informed her there were no funds available to help her. She noted the overall unemployment rate in Alaska is 7.5 percent; it is 66 percent for people with disabilities. She asked committee members to remember that 66 percent when they consider the $350,000 budget increase request. Number 359 JERIE BEST from Soldotna thanked the committee for moving HB 170 out of committee last week. She explained that 4-H youth who train puppies as service animals need the ability to bring those dogs everywhere to be socialized, before the dogs travel elsewhere for specialized training. MS. BEST referred to page 12 of the Analysis and Recommendations booklet regarding enactment of a lemon law for adaptive devices for the disabled. Currently no statute provides consumer protection for people with mobility aid devices. Ms. Best gave ten examples of situations in which people purchased mobility devices that do not work correctly and were unable to receive replacements or refunds. She added these devices are often very expensive and few dealers and repair shops are located in Alaska. She asked committee members to support legislation that provides protection to the consumer, and noted that Representative Green plans to introduce such legislation next week. MS. BEST informed the committee that accessibility to buildings required by the ADA is sorely lacking in Alaska. DOTPF estimates it will cost $50 million to bring state facilities into compliance. The Governor has set aside $1 million in his budget this year for that purpose, which is a start. She described the difficulty she encounters when trying to take care of motor vehicle business which must be done in person. She cannot get inside the building because the door is not wide enough to accommodate her wheelchair. She needs a handicap parking space permit because those parking spaces are the only ones wide enough to get her wheelchair out of her car. She is barely able to see over the counter. She again urged committee members to support increased funding for ADA compliance in state facilities and to support the ADA coordinator who plans to do training and has great ideas for compliance. CHAIRMAN WILKEN noted he received Ms. Best's e-mail message last week. He asked her what makes a wheelchair warranty different than a VCR warranty. MS. BEST answered that wheelchairs are often customized for an individual's needs. CHAIRMAN WILKEN said the analogy would be a person adapting a VCR to his/her home and then not being able to return it. MS. BEST agreed. CHAIRMAN WILKEN stated that ADA compliance in state facilities is one of the top three priorities of the Deferred Maintenance Task Force over the next five or six years. MS. BEST commented the University of Alaska is making great strides with ADA compliance. CHAIRMAN WILKEN thought most legislators agree that the Legislature has used a piecemeal approach to solve this problem. They now have the opportunity to fix it, and to fix it correctly. SENATOR GREEN asked if a new lemon law would require litigation. MS. BEST said she did not think so because statutory protection alone will help individuals to get action. SENATOR LEMAN commented there are examples of situations where governments have tried to impose changes on people in the name of ADA compliance, at great cost with almost no benefit. He thought it is important to review which changes will be most effective in helping people to get access, such as wider doors. MS. BEST said she thought people tend to make ADA too hard when it is actually a very creative law. A town on the Kenai made a dock handicap accessible by filling the large spaces between the planks with wide rope. SENATOR LEMAN admired Ms. Best's desire to find practical solutions and encouraged her to offer that advice to those who consider all of the changes that need to be made to be difficult. MS. BEST said simple solutions do not always work and that each situation is individual. Number 555 MR. BURTON closed by saying that it would take more than 15 seconds to list the different ethnic groups or skin colors of people, but it is the amount of time it takes someone to join the growing minority of disabled people. CHAIRMAN WILKEN thanked Mr. Burton and everyone who addressed the committee. SCR 14 - PARITY FOR MENTAL HEALTH TASK FORCE CHAIRMAN WILKEN announced there were five amendments to SCR 14, and that version H was adopted by the committee at a previous meeting. SENATOR LEMAN moved to adopt amendment #1. SENATOR ELLIS objected and asked for an explanation. TAPE 98-10, SIDE B SENATOR LEMAN explained amendment #1 splits the tasks to be studied by the task force into a more understandable order, and more importantly it requires the task force to identify and define the unmet mental health needs and then recommend ways to measure the effectiveness of treatment. CHAIRMAN WILKEN announced the objection was not maintained, therefore amendment #1 was adopted. SENATOR GREEN moved to adopt amendment #2 (labeled H.1). SENATOR ELLIS objected. SENATOR GREEN explained that amendment #2 requires the task force to determine and define the terms "mental disorders," "mental illness," "serious mental illness," and "mental health consumers" before undertaking its study. Those phrases are not defined in the resolution and can be very broad. SENATOR ELLIS said amendment #2 presumes that those terms are currently undefined yet they may be in the field, in statute, or in regulation. SENATOR GREEN said and if that is the case, those definitions could be used. SENATOR ELLIS clarified that Senator Green was not asking the task force to redefine those terms. SENATOR GREEN emphasized the amendment would require the task force to define those terms for purposes of the work on the report they produce. SENATOR ELLIS removed his objection, therefore amendment #2 was adopted. SENATOR GREEN moved to adopt amendment #3 (labeled H.2). There being no objection to the adoption of amendment #3, the motion carried. SENATOR LEMAN noted he had no objection to amendment #3, but noted the number "5" on line 3 should be number "6." SENATOR GREEN agreed. SENATOR GREEN moved to adopt amendment #4. SENATOR ELLIS objected. SENATOR GREEN explained the Mental Health Parity Act of 1996 did not include chemical dependency disorders. Amendment #4 would delete the inclusion of chemical dependency disorders from the task force's study on discrimination in health insurance policies. The remainder of amendment #4 pertains to the makeup of the task force, because by narrowing the study, a net of three task force members would not be necessary. However, to retain an odd number of task force members, one of the three positions was restored, and she arbitrarily chose one member who is employed as staff to a member of Congress simply to have connection with, and access to information about, mental health parity on the congressional level. SENATOR GREEN repeated she does not think the task force needs to go beyond the boundaries of the Mental Health Parity Act by including chemical dependency disorders. CHAIRMAN WILKEN commented that amendment #4 eliminates the inclusion of tasks related to chemical dependency disorders and by doing so changes the make-up of the task force. Number 448 DON DAPCEVICH, Executive Director for the State Advisory Board on Alcoholism and Drug Abuse, testified against Amendment #4. He stated SCR 14 provides an opportunity to take a look at how chemical dependency is affecting Alaskans, and to do so at no cost to the state. The task force will determine whether there is a cost benefit to including chemical dependency in any changes considered in the future. If there is no cost benefit, the task force's recommendations will reflect that. The Mental Health Trust Authority has offered to share its resources so that the Legislature will examine their beneficiaries, both mental health and chemical dependency beneficiaries. Amendment #4 will prevent any discussion on the issue. Mr. Dapcevich agreed chemical dependency disorders are not included in the Mental Health Parity Act of 1996, but an amendment to include it is being introduced before Congress. Each state taking up the issue of parity is studying whether chemical dependency disorders should be included. Mr. Dapcevich emphasized the Alaska Advisory Board on Alcoholism and Drug Abuse will not know whether to support the issue of parity unless the task force studies the issue. He strongly encouraged committee members to reject amendment #4. SENATOR LEMAN questioned whether there is a way to reword that section by taking the phrase "chemical dependency disorders" out of subsection (1), and creating a separate subsection that identifies the study of the cost benefit relationship of chemical dependency disorders. He believed it will not hurt to look at the issue and identify whether there is a cost benefit. MR. DAPCEVICH thought it would be wise to separate, in the report, chemical dependency issues from mental health issues. He cautioned that excluding task force participation of professionals from the chemical dependency field will provide less than a perfect product in terms of participants and expertise. CHAIRMAN WILKEN said his sense is that although there is some relationship between the two, the issues are different and should be studied separately. He stated he supports the amendment for that reason. He asked Mr. Dapcevich why the relationships between the two cannot be separated. MR. DAPCEVICH thought the two issues can be separated for expediency sake, but the Trust Authority does not distinguish between the beneficiaries, and the parity issues for both groups are the same. Both have artificial caps on insurance, and the rationale for exclusion is the same in many cases. SENATOR GREEN mentioned that the original resolution pertained only to mental illness. She said she is opposed to summarily saying, by implication, that substance abuse is mental illness. If substance abuse leads to mental illness, that needs to be defined in the definition of mental illness. SENATOR ELLIS maintained his objection to the adoption of amendment Ward, Wilken, and Leman voting "yea," and Senator Ellis voting "nay." SENATOR LEMAN said that although he voted for the amendment, he believes Mr. Dapcevich's point is valid. He thought it would be more useful to have people serve on the task force with expertise in chemical dependency disorders, than to create two task forces. CHAIRMAN WILKEN noted SCR 14 has another referral to the Senate Finance Committee. He asked Senator Leman if he would like to offer another amendment at the next meeting. SENATOR LEMAN asked Mr. Dapcevich to provide the committee with a subsection to add that specifically addresses the cost benefit of parity for chemical dependency disorders. Number 398 CHAIRMAN WILKEN said he is very reluctant to include chemical dependency disorders because he thought it would be more beneficial to both issues to keep them separate. He announced SCR 14 will be held until the next meeting on Monday. CHAIRMAN WILKEN offered amendment #5. SENATOR ELLIS objected. CHAIRMAN WILKEN explained the prior amendment eliminated chemical dependency disorders, therefore the annual cost to the state should be $187,272,000 rather than $432,072,000; and the phrase "annually costs the state at least" was changed to specify the actual cost in 1996, to be more specific. SENATOR ELLIS felt the committee's discussion was ironic given the Senate's strong bipartisan support for Sobriety Awareness Month. He agreed with Senator Leman's conclusion that the creation of a second task force to study chemical dependency disorders is unlikely to occur. SENATOR LEMAN questioned how Chairman Wilken obtained the 1996 costs. CHAIRMAN WILKEN said he relied on an estimate from the professionals. There being no further objection, amendment #5 was adopted. CHAIRMAN WILKEN announced SCR 14 will be heard again on Monday, February 16. He adjourned the meeting at 10:18 a.m.