SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE February 16, 2000 1:32 p.m. MEMBERS PRESENT Senator Mike Miller, Chairman Senator Pete Kelly, Vice-Chairman Senator Gary Wilken Senator Kim Elton MEMBERS ABSENT Senator Drue Pearce COMMITTEE CALENDAR SENATE BILL NO. 127 "An Act relating to scholarships to attend the University of Alaska; and providing for an effective date." -HEARD AND HELD SENATE BILL NO. 254 "An Act relating to heirloom certificates of marriage." -MOVED CSSB 254(HES) OUT OF COMMITTEE SENATE BILL NO. 233 "An Act relating to priorities, claims, and liens for payment for certain medical services provided to medical assistance recipients; and providing for an effective date." -MOVED SB 233 OUT OF COMMITTEE SENATE BILL NO. 244 "An Act increasing the eligible maximum amount for quality school grant funding for school districts; and providing for an effective date." -MOVED SB 244 OUT OF COMMITTEE Alaska Mental Health Board Presentation on the December, 1999 Report by the U.S. Surgeon General on Mental Health PREVIOUS SENATE COMMITTEE ACTION SB 127 - No previous Senate action. SB 233 - No previous Senate action. SB 244 - No previous Senate action. SB 254 - No previous Senate action. WITNESS REGISTER Elmer Lindstrom, Special Assistant Department of Health and Social Services PO Box 110601 Juneau, AK 99801-0601 POSITION STATEMENT: Supports SB 254 Carol Brice, President Alaska Childrens' Trust c/o Department of Community and Economic Development PO Box 112100 Juneau, AK 99811 POSITION STATEMENT: Supports SB 254 Jon Sherwood, Program Officer Division of Medical Assistance Department of Health and Social Services PO Box 110660 Juneau, AK 99801-0660 POSITION STATEMENT: Supports SB 233 Rick Cross, Commissioner Department of Education 801 W 10th St. Ste. 200 Juneau, AK 99801-1894 POSITION STATEMENT: Supports SB 244 Carl Rose, Executive Director Association of Alaska School Boards 316 W 11th Juneau, AK 99801 POSITION STATEMENT: Supports SB 244 and SB 127 Vernon Marshall National Education Association of Alaska 114 2nd Juneau, AK 99801 POSITION STATEMENT: Supports SB 244 Ann Ringstad Director of Government Relations University of Alaska PO Box 755120 Fairbanks, AK 997775 POSITION STATEMENT: Supports SB 127 Jim Lynch Vice President of Finance University of Alaska PO Box 755120 Fairbanks, AK 997775 POSITION STATEMENT: Supports SB 127 Walter Majoros, Executive Director Alaska Mental Health Board 431 N.Franklin Street Suite 200 Juneau, AK 99801-1121 Caren Robinson, Chair Alaska Mental Health Trust Authority 550 W 7th Ave., Suite 1820 Anchorage, AK 99501 Karl Brimner, Director Division of Mental Health & Developmental Disabilities Department of Health and Social Services PO Box 110620 Juneau, AK 99811-0620 ACTION NARRATIVE TAPE 00-5, SIDE A Number 001 CHAIRMAN MILLER called the Senate Health, Education and Social Services (HESS) Committee to order at 1:32 p.m. Present were Senators Pete Kelly, Elton and Miller. The first order of business to come before the committee was SB 254. SB 254-HEIRLOOM MARRIAGE CERTIFICATES ELMER LINDSTROM, Special Assistant to Commissioner Karen Perdue of the Department of Health and Social Services (DHSS), gave the following testimony on SB 254. Several years ago the Legislature passed legislation that allowed for the issuance of heirloom birth certificates. That program has been quite successful and has generated thousands of dollars for the Alaska Childrens' Trust. SB 254 expands that program to allow the sale of heirloom marriage certificates. DHSS collects the funds for the Alaska Childrens' Trust. The DHSS fiscal note estimates additional revenues in the amount of about $270,000. That amount would be offset by the operating costs of issuing the certificates. MR. LINDSTROM noted that Commissioner Perdue suggested, rather than limiting the fee to $25, leaving the bill open-ended to allow DHSS to issue limited or special edition certificates to commemorate particular events. He offered a proposed amendment to allow DHSS to establish the surcharge in regulation and set the amount at no more than the estimated actual cost to DHSS not to exceed the estimated fair market value of comparable artistic rendition. That language would make the fee market driven. He pointed out that the fiscal note assumes that the surcharge will be $25 at the outset. Number 302 SENATOR ELTON said he believes SB 254 is a great idea but he is chagrin that an Alaska adopted child is not eligible for an heirloom birth certificate. He asked DHSS staff to respond to his concern at a later date. CAROL BRICE, Chair of the Alaska Children's Trust, speaking via teleconference from Fairbanks, said the Trust needs to address Senator Elton's concern, as well as a concern expressed about making heirloom birth certificates available for people born in territorial days. She then made the following comments. At a cost of $25 per marriage certificate, the Alaska Children's Trust could deposit as much as $150,000 to $200,000 per year. On the average, 5300 marriages take place in Alaska each year. She asked for committee members' support of the legislation. SENATOR PETE KELLY moved to adopt Amendment 1 proposed by Mr. Lindstrom of DHSS. Amendment 1 reads as follows. Page 1, line 6: Delete "of $25" Insert "established by regulation" Page 1, line 8: Following "registrar." Insert: "(b) The department shall adopt regulations that establish the amount of the fee for each design of an heirloom certificate of marriage. Notwithstanding AS 37.10.050(a), each fee shall be set at an amount that is more than the estimated actual costs to the department not to exceed the estimated fair market value of a comparable artistic rendition." Page 1, line 11: Delete "(b)" Insert "(c)" Page 1, line 14: Delete "(c)" Insert "(d)" Page 2, line 1: Delete "(d)" Insert "(e)" Page 2, line 5: Correct section number. There being no objection, CHAIRMAN MILLER announced Amendment 1 was adopted. There being no further testimony or discussion, SENATOR PETE KELLY moved SB 254 as amended to its next committee of referral with individual recommendations and its accompanying fiscal note. There being no objection, the motion carried. SB 233-MEDICAL ASSISTANCE:LIENS & CLAIMS JON SHERWOOD, Division of Medical Assistance, DHSS, gave the following testimony. SB 233 has two purposes. The first regards DHSS's third party recovery efforts. A federal Medicaid requirement mandates applicants for medical assistance to sign their right to third party recovery to the State of Alaska. The State of Alaska has a duty to exercise that right to recover. Over the years, contractors hired by DHSS to pursue third party recoveries have identified weaknesses in Alaska statutes that prevent DHSS from assuming its rightful place at the table during the settlement of lawsuits. SB 233 amends Alaska statutes to enhance the State's ability to recover money. SB 233 requires recipients to notify DHSS of recovery action, creates an authority for DHSS to place a lien upon such recoveries and gives a precedent to that lien, and gives DHSS the right to take actions in third party recoveries. DHSS believes these changes will increase collections from lawsuits and settlements. MR. SHERWOOD explained that other provisions in the bill pertain to timely filing of claims for provider payment for medical assistance. Currently, providers are allowed up to six months to make claims for payment unless the provider has to bill private insurance first, in which case the deadline is 12 months. SB 254 changes the limit to 12 months for all claims. Providers are forced to do a lot of additional processing when submitting claims if they are unable to get all of the information they need within the six month window. Often these situations occur when patients have a serious illness or have been in an accident and are unable to get Medicaid eligibility information to their provider. SB 254 also allows DHSS, when it finds basis for a good cause exception, to pay 100 percent of a late claim. Current statute limits that payment to 50 percent. DHSS sees this provision as a basic fairness issue - if the provider has a good reason for not filing in a timely fashion, the provider should be entitled to the full payment. Number 920 SENATOR PETE KELLY asked whether Medicaid pays all of the bill. MR. SHERWOOD explained that DHSS would pay the entire bill but it would file a lien in a case where a patient was hit by a drunk driver and received a settlement from a third party - for example, a bar, insurance company, or other business. There being no further testimony or discussion, SENATOR ELTON moved SB 233 from committee with individual recommendations and its accompanying fiscal note. There being no objection, the motion carried. SB 244-QUALITY SCHOOL GRANT FUND INCREASE COMMISSIONER RICK CROSS, Department of Education and Early Development, informed committee members that SB 244 increases the current $16 average daily membership amount paid in quality school grants to $52. The cost of this proposal will amount to about $7.6 million. The quality school grant is a targeted, value added, accountability grant, designed to accomplish the State's goal of bringing accountability and high standards of student achievement in Alaska's public schools. In 1998, when the Quality School Initiative and grant program was established, it was specifically targeted by the Legislature to fund accountability. The accountability grants will jump start the kind of changes that need to occur in Alaska's schools to ensure that all students reach high standards. COMMISSIONER CROSS said the State will save $19.9 million this year as the result of three changes: declining school enrollment; increased local property values which have shifted the responsibility for school funding from the State to local communities; and increases in federal Impact to Aid payments that Alaska receives. School districts anticipated higher revenues this year and have had to make significant adjustments to their budgets to accommodate for the loss of revenue. Some districts are facing as much as $4 million in reductions in expenditures. The $7.6 million of grants will give school districts money to raise standards and student achievement, and it will allow teachers to spend more time on task with students. In 1998, Minnesota allocated $70 million to help school districts implement new standards. Last year, the Washington State Legislature passed a $113 million package of initiatives to support reforms. In 1999, the Connecticut Legislature passed a budget that added $70 million to help schools get better results. The State of Louisiana set aside $200 million for reforms which amounts to about $256 per student. These states, and a number of others, are recognizing that additional resources are needed to support schools as they raise standards and hold students and teachers accountable. He hopes Alaska will do the same. Number 1239 SENATOR WILKEN pointed out that DOE submitted a zero fiscal note although the cost of the increase will be $7.6 million. COMMISSIONER CROSS explained the zero fiscal note reflects the fact that the Governor's budget for the foundation includes the $7.6 million. If a different budget is used, the fiscal note will need to be changed. He noted that the fiscal note contains a statement explaining that the money has been accounted for in the Governor's budget in the Foundation Program. SENATOR WILKEN maintained that fiscal notes are to reflect changes in current spending. SENATOR PETE KELLY agreed that the fiscal note should reflect the $7.6 million. SENATOR WILKEN surmised that the fiscal note reflects a diversion from the normal process and requires users to "connect the dots." CHAIRMAN MILLER agreed. COMMISSIONER CROSS said his understanding is that DOE is to work off of the Governor's budget and therefore the fiscal note is correct. He added that the fiscal note is clear about the costs associated with the bill. CHAIRMAN MILLER stated that the next committee of referral is where the fiscal note will be reviewed. Number 1282 SENATOR PETE KELLY asked if DOE has written its fiscal notes based on the current year's budget or the projected budget in the past. COMMISSIONER CROSS acknowledged that he has not been involved for too many years but he repeated that the rules DOE is to go by require that the fiscal note reflect the cost if the money is not accounted for in the Governor's budget. SENATOR ELTON asked for an explanation of the application process the districts use and the number of districts that have participated in the Quality Schools grant program at the $16 level. COMMISSIONER CROSS replied that all districts have participated in the grant program and the application process was designed by DOE. Each district submits an application explaining how the money will be targeted and on what programs. The districts use the money for various programs that target poor student performance, i.e. summer school programs, tutoring, and extended-day programs. DOE reviews applications and asks for clarification if the use of the money is unclear. The program is not competitive: each district is allotted a specific amount. SENATOR ELTON asked if DOE checks to see whether it is substituting Quality Schools Initiative grant funding for programs that would have otherwise been funded from other sources, thereby freeing up dollars in an existing budget to be spent on functions not related to quality schools. COMMISSIONER CROSS indicated that DOE's auditing of school districts is fairly broad but is getting better as time goes on. If DOE found a district was substituting quality school money for a different program funded through a different grant, it would question that expenditure. Number 1497 SENATOR ELTON commented that he is not opposed to the concept of SB 244, but he sees several ways to tackle this problem. He noted that if DOE does not audit to ensure that the additional money will be spent on academics, then Senator Wilken's approach (SB 198) might be better. COMMISSIONER CROSS said he supports Senator Wilken's bill but he is asking for support of SB 244 because it will ensure that money is targeted to meet an immediate need that school districts face. Regarding the auditing, DOE follows up to make sure the districts are providing the services they were given the grant money for. CARL ROSE, Executive Director of the Association of Alaska School Boards (AASB), expressed support for SB 244 for the following reasons. Many school districts anticipated the $19 million that is not forthcoming so they are going through severe budget reductions as a result. Two issues face Alaska school districts: operational costs and the quality initiatives that have been mandated. The quality initiatives serve a purpose but will require school districts to address student achievement on the upcoming exams. He does not believe Alaska will see wholesale success on those exams at the start. As younger students go through the bench marking process at the third, sixth and eighth grades, they will be ready for the qualifying exam. He is very concerned about remediation for those students who do not fare well in the new system. The AASB supports both SB 244 and SB 198. Each bill addresses a different issue: one is categorical through grants, the other gives districts latitude for operations. Alaska has the responsibility of ensuring that its students are as successful as possible in our global economy. SENATOR ELTON asked if remediation programs would be eligible for funding from a quality school grant. MR. ROSE said the question of why students do not score well on the upcoming exam and what we can do to help those students will be on the table. Providing those students with more of the same is probably not the answer so the AASB is looking at new strategies. SENATOR ELTON asked if the grant money is used for remediation, whether the district would receive $52 per student who needed remediation or whether it would get $52 per ADM in the district which could be used to remediate fewer students. MR. ROSE said he believes each school district will come up with strategies they feel will meet their students' needs and they will apply to DOE. Number 1880 VERNON MARSHALL, NEA-Alaska, stated support for SB 244 and commended the committee for acting on SB 198. The Senate HESS committee has been the first committee to step to the plate and try to deal with the school funding issue as it applies to 2001 and beyond. The school year of 1999-2000 will probably be remembered as the year of the "test." In March the first exit exam will be administered and he assumes that before the end of the school term, the bench mark testing at grades 3,6, and 8 will occur. The next significant date will be the year 2002 because the exam given in March will be given to seniors and determine whether they receive a diploma. During that year every school will be designated. The next two years are years of opportunity. Test results will be available in the fall of the year 2000 and at that time educators will have to review the results and look at the curriculum to educate better. The issue of remediation will also have to be addressed. He hopes the remediation programs in place in Fairbanks are replicated throughout Alaska because that model is held up with respect. The average teacher salary in Alaska has fallen to $47,100. The average is decreasing, but the money saved does not appear to be used for other personnel services by school districts. He suspects that much of that money is being plowed into remediation, curriculum realignment, and other things. He asked for support of SB 244 and said it is a good coupler with SB 198. There being no further testimony or discussion, SENATOR WILKEN moved SB 244 with individual recommendations and its accompanying fiscal note. There being no objection, the motion carried. SB 127-UNIVERSITY OF ALASKA SCHOLARSHIPS ANN RINGSTAD, Government Relations Director for the Statewide Office of University Relations, University of Alaska (UA), stated support for SB 127 and made the following comments. This legislation came before the committee in a different form last year. It allowed the UA to get from high schools the names and addresses of students who qualify for the Alaska Scholars Program. SB 127 will put the Alaska Scholars Program into statute and it repeal statutory language about other scholarship programs that may or may not be in effect right now. CHAIRMAN MILLER noted the committee has a work draft before it labelled "Ford 2/16/00 - GS 1029/D." He asked Ms. Ringstad to address that version (Version D) of the bill. MS. RINGSTAD said Version D aligns the legislation with the program that is in place today. SENATOR WILKEN asked if Version D funds the Alaska Scholars Program out of the Alaska Student Loan Corporation (ASLC) profits. MR. JIM LYNCH, Vice President of Finance for the University of Alaska, replied he does not think this bill does that. MS. RINGSTAD clarified that the Governor has submitted legislation to use proceeds from the ASLC. That legislation does not necessarily state that those funds will be applied to SB 127 but the bill's fiscal note could lead one to believe that some of that money will be used to fund it. The UA plans to fund the program out of its own pocket in FY00 and FY01 and is not asking for general funds until next year. CHAIRMAN MILLER asked if Version D merely sets the scholarship eligibility criteria in statute. MS. RINGSTAD said that is correct. Number 2229 SENATOR WILKEN asked whether there is any connection between Version D and the ASLC proceeds. MS. RINGSTAD replied, "There could be, that could be part of the funds to be used in the future to be paid in the future to pay for a portion of it." CHAIRMAN MILLER asked if anything attaches those funds to this bill. MS. RINGSTAD said there is not. Number 2258 CARL ROSE, Association of Alaska School Boards, stated support for this legislation because it addresses the AASB's concern that education be viewed as a kindergarten through university level experience rather than a K-12 experience. CHAIRMAN MILLER asked Mr. Lynch to come back to the table. SENATOR WILKEN indicated that the fiscal note for Version D (CSSB 127(HES) clearly states that the fiscal note assumes the return of capital payments from the ASLC to partially fund the Alaska Scholars Program. He maintained that language creates a very clear connection between Version D and the Alaska Scholars Program. MR. LYNCH said he has not seen that fiscal note. CHAIRMAN MILLER noted that Mr. Lynch's signature is on the fiscal note. SENATOR WILKEN asked Mr. Lynch when he found out about this scheme. MR. LYNCH replied February 11. SENATOR WILKEN asked Mr. Lynch if he is aware of the debt that the ASLC owes the debt to the State of Alaska. MR. LYNCH replied that he is aware that there is a debt but he does not know the amount. SENATOR WILKEN noted that debt is about $42 million. He asked Chairman Miller if he has received any comments from Diane Barrans of the ASLP about this legislation. CHAIRMAN MILLER said he has not. SENATOR WILKEN made the following comment. I am not particularly concerned about the bill itself - I have great concern about the fact that someone, somewhere decided that they were going to take $6 million that the student loan corporation has worked hard to become profitable and this Legislature and Administration's helped them do that - and as soon as we get $6 million into the plus, we ignore the promises made in the past and we come trumped up with some political deal to fund the Scholars Program because some one person happened to think it's a great idea, and I suggest that we just take this bill and put it in our pockets and leave until all the people can be on board." TAPE 00-05, SIDE B SENATOR WILKEN pointed out that he sits on the ASLC Board and that Board members had a cursory discussion at the August and December meeting about using the $6 million to pay the debt. Suddenly, in February, this has been rolled out to the public as if the entire Board believes this is a good idea. He repeated that he is totally supportive of the Scholars Program but he does not support taking money that should be paying back the people of Alaska without taking the proper steps to get the ASLC on board, as well as its managers and the Legislature. He expressed frustration that Version D short-circuits the entire process. He repeated that he supports making changes to fix the Scholars Program in general, but if legislation is connected to the student loan proceeds, and prior commitments to that money are ignored, he is opposed to it. SENATOR ELTON asked Mr. Lynch and Ms. Ringstad whether the UA could operate the Alaska Scholars Program if it is not enshrined in statute. MR. LYNCH said it is his opinion that the UA could continue to run the program. SENATOR ELTON asked if Senator Wilken's concerns are extant in the legislative body, whether the UA could continue the program until a resolution to the funding source is found. MR. LYNCH noted the bill also contains a few repealers for other programs. SENATOR ELTON asked if those provisions need to be repealed this session. MR. LYNCH said there is a cost associated with those provisions. SENATOR ELTON suggested that Mr. Lynch get back to the committee with those costs and provide information on why the provisions need to be repealed. He agreed with Senator Wilken that the committee should hold on to the bill for awhile. There being no further testimony on SB 127, CHAIRMAN MILLER asked Mr. Lynch and Ms. Ringstad to contact the ASLC and Senator Wilken to discuss the concerns expressed today. Number 2199 CHAIRMAN MILLER announced the committee would hear a presentation by Walter Majoros, Caren Robinson, and Karl Brimner on the December, 1999 report on mental health issues by the Surgeon General. WALTER MAJOROS, Executive Director of the Alaska Mental Health Board (AMHB), introduced Caren Robinson, Chair of the AMHTA, and Karl Brimner, Director of the Division of Mental Health and Developmental Disabilities (DMHDD) in the Department of Health and Social Services. Mr. Majoros distributed copies of the U.S. Surgeon General's Report on Mental Health, published in December of 1999. CAREN ROBINSON stated that the AMHTA, the AMHB, the DMHDD, the Building Bridges Campaign, and the Alaska State Hospital and Nursing Home Association are sponsoring today's presentation. All of those organizations have endorsed the Surgeon General's report and are using it to guide future policies and program development and advocacy efforts. MS. ROBINSON referred to page 3 and pointed out the significance of this report is that very few surgeon generals have published reports, and this is the only report ever written on mental health issues. The Surgeon General considers this report to be of the same level of importance as the Surgeon General's report on smoking. MS. ROBINSON explained the partnerships involved in the creation of the report included SAMHSA, the major federal funding and oversight agency for mental health and substance abuse, and NIMH, the leading federal research agency on mental health and mental illnesses. The planning board included hundreds of consumers, providers and other stakeholders who collaborated to write the report. MS. ROBINSON remarked that the importance of the report is that it helps agencies answer key questions about mental health and mental illness. The report reviewed four main areas. First, it evaluated the national response to mental health - how the U.S.fares in addressing mental illness. Second, it identified barriers to addressing mental illness - the issues that are preventing a more positive response to mental illness. Third, it helped guide future policy and development by reviewing how services are organized and provided. Fourth, it called for action to reduce mental health problems in the nation. MS. ROBINSON said a main point in the report is the importance of treating mental health as a public health issue. This means recognizing that mental health is fundamental to overall health and that mental health disorders are real health conditions. Mental health disorders have an immense impact on a person's health and can be extremely disabling. Also, there is a growing recognition of mental illness as a brain disorder that can be effectively treated like any other health condition. In addition, mental health and physical health are inseparable and impact each other. Number 2060 MR. MAJOROS discussed the continuum of mental health and illness. The report views mental health and mental illness as points on a continuum. In this light, the continuum applies to everyone. First, it is important to look at what is meant by the terms "mental health, mental health problems, and mental illness." Mental health is described as positive mental functioning that results in productivity, positive relationships, and the ability to adapt. Mental health problems are defined as situational or developmental conditions that cause short term distress and impaired functioning a condition that everyone experiences. Mental illness involves alterations in thinking, mood, or behavior which lead to more severe, longer-term distress and impaired functioning. MR. MAJOROS said it is important to note that different points on the continuum call for different interventions that move from prevention and informal supports to comprehensive and long term treatments and supports. In addition, it is important to note that conditions become more disabling as one moves up the continuum. Finally, the cost of services increases as one moves up the continuum. MR. MAJOROS referred to a corrected chart on page 7 that presents the percent of disease burden of disabling diseases. Mental illnesses account for 15.4 percent of the overall years of life lost to major illnesses in our country. The disease burden of mental illness is second only to heart disease and is greater than all forms of cancer added together. SENATOR ELTON asked for further explanation of the percent of disease burden. MR. MAJOROS explained that if all years of lost life from all diseases for everyone in the country were totalled, 15.4 percent of those years would be attributable to mental illnesses. Number 1866 MR. BRIMNER informed committee members of the following facts about mental illness. Up to half of all visits to primary care physicians are due to conditions caused or exacerbated by mental health problems. Approximately 15 percent of all adults with a mental disorder have a co-occurring substance abuse disorder. As many as half of people with serious mental illnesses develop alcohol or drug abuse problems, at some point in their lives. A third fact is that one in five children has a diagnosable emotional disorder. Many problems associated with emotional disturbances in children are best addressed with a systems approach in which multiple service sectors work together in an organized and collaborative way. The incidence of suicide among 15 to 24 year olds has tripled since 1960. This statistic underscores the importance of positive, comprehensive interventions with troubled youth. Last, nearly half of those with severe mental illnesses do not seek treatment. MR. BRIMNER stated that mental health treatment works. Tremendous gains have been made in brain research to better understand the role of the brain regarding health and illness. New medications are more powerful with fewer side effects. Getting help is the key. It is tragic that nearly half of the people with severe mental illnesses do not seek treatment, especially given the fact that treatment is so effective today. MS. ROBINSON stated there are three major barriers to mental health, the first being stigma. A tremendous fear, negative stereotyping and outright discrimination occurs daily for people with mental illness. This stigma prevents people with mental illness from seeking help. The needs of mental health consumers vary across such factors as age, gender, race and culture. All factors need to be acknowledged when identifying the specific needs of each consumer. For example, the elderly population in the United States and Alaska is increasing dramatically. Alzheimers Disease and related dementia, depression and high suicide risk are a few of the important issues to be addressed in regard to the elderly. Financial challenges are another barrier to mental health. The organization and financing of mental health services has been a significant barrier to many consumers. Managed care has often been used to cut costs and reduce access and services to people with mental illness. 90 percent of all policies provide less coverage for mental illness than they do for physical illness. MS. ROBINSON pointed out the Surgeon General has issued a call to action to address these challenges. Our nation needs to continue to build the science base to further advances made in brain chemistry knowledge. Second, the nation needs to have zero tolerance for stigma and to dispell the myths that contribute to that stereotype. It needs to improve public awareness of effective treatment, to ensure an adequate supply of mental health services and providers and to reduce financial barriers to treatment. Services are often unavailable when and where people need them. We need to ensure state-of-the-art treatments. To be effecive, diagnosis and treatment must be tailored to the characteristics that shape a person's identify. People need to know where to turn for help. Increased parody in private insurance in mental and physical health is one way to reduce that barrier. MR. MAJOROS discussed four themes that have been identified that are driving efforts in Alaska to meet the Surgeon General's call to action. Those themes include: making services available locally; providing programs to serve all ages; recognizing that consumers hold the keys to success; and increasing service accountability. The Community Mental Health/API 2000 is a project that will downsize API by moving services into the community for mental health consumers. Through this project, consumers in the Anchorage area will have access to an array of emergency mental health services and for co-occurring disorders. The AMHB, DMHDD and AMHTA are helping to increase training and support for mental health services in rural communities. The Trust is redesigning and enhancing itinerant mental health consultation and support services for rural mental health providers. The Trust will also be hosting a conference in April to provide training, support, and networking for rural mental health providers. The third initiative is decriminalization of mental illness. The Trust is working to develop programs to decriminalize the mentally ill to get them out of the Department of Corrections (DOC) by providing more appropriate supports in the community. Too many people are ending up in jail instead of community-based programs. A jail diversion program has been instituted in Anchorage for mentally ill misdemeanants, as well as a mental health corps. These programs are quite successful and are helping to identify the services needed by mental health consumers to ensure community safety and adequate support. MR. MAJOROS said DHSS has initiated several children's programs to improve mental health care in Alaska. Second, housing with support services to divert mentally adults from API and DOC is being developed. Third, integration of mental health and substance abuse treatment services has begun. Many rural communities are making changes at the local level to integrate their mental health and substance abuse services and, at the State level, a steering committee will soon be formed to support the development of more integrated services for mental health and substance abuse. Last, the Long Term Care Task Force has taken a leadership role in improving the care system for vulnerable adults and the elderly. MR. BRIMNER said mental health consumers hold the key to success. Consumer leadership and significant consumer involvement is becoming a way of life in planning, implementing and monitoring mental health services throughout Alaska. The Trust has funded a consumer affairs position which is a senior management position in DHSS to increase the role of consumers in mental health policy. A second area of importance is recovery focus. Standards for mental health services build on the strengths of consumers and assist them to successfuly live independent and productive lives. Advances that have occurred through science, combined with a powerful consumer and advocacy movement have resulted in a major paradigm shift. Mental health consumers can achieve greater mental health and have more control over their lives. MR. BRIMNER discussed increasing service accountability. Quality assurance monitoring, established by DMHDD in 1996, includes site reviews by review teams, a Medicaid audit, and record reviews for the grant program. The Alaska Legislature implemented performance indicators for measuring outcomes of service delivery. The DMHDD will continue to work with the Legislature to refine these measures to provide useful information. The AMHB and DMHDD are leading a statewide effort to develop common performance measures for public- funded mental health services. MS. ROBINSON concluded the presentation by discussing ways the Legislature can help. Adequate funding for mental health grants and Medicaid is critical. The assisted living bill (SB 73) is a serious priority. AMHTA has allocated $1 million to that program. The mental health parity debate must be cotinued. Many Alaskans cannot get mental health services and they need that coverage. She asked that legislators schedule the parity bill for a hearing. MR. MAJOROS noted that Senator Elton sponsored the parity bill. MS. ROBINSON continued. Basic support services must be funded. Individuals with severe mental illnesses struggle daily to function safely in the community. Support to cover basic needs are critical to their survival. Last, legislators need to take a leadership role in addressing mental health issues in their communities. She thanked committee members for providing the opportunity for the group to present the findings of the Surgeon General's Report. Number 1086 SENATOR WILKEN asked Mr. Majoros what is happening nationwide and with states in regard to the mental health parity issue. MR. MAJOROS said the federal Mental Health Parity Act of 1996 was a major development. That Act requires that annual and lifetime limits in policies must be the same for physical and mental health, but it only applies to employers of 50 or more employees who offer mental health coverage. Several states have built upon that platform and have added coverage. Parity is not a black and white issue - it is a continuum from very limited parity to comprehensive parity. Comprehensive parity means what is provided for physical health must be provided for mental health. 27 states have passed some version of mental health parity legislation. AMHTA understands that progress will be incremental but it must keep the goal as total parity. SENATOR WILKEN asked if Mr. Majoros could name one or two states that have gone far enough down the road to develop dependable data. MR. MAJOROS replied that Vermont has built into its state law an analysis of the implementation of parity. The Vermont Division of Insurance has issued some reports on financial and other impacts of the parity bill. SENATOR WILKEN questioned the chart on page 8 of the report. He noted the percents of disease burden total 63 percent and questioned what the remaining 37 percent is attributable to. MR. MAJOROS did not know the other illnesses that compose the remaining percentage but offered to get that information for Senator Wilken. SENATOR WILKEN maintained that the chart makes a bold statement therefore, if the Legislature is going to use it, it should be verified. MR. MAJOROS agreed. NUMBER 880 SENATOR WILKEN said one concern many people have is that no programs exist for youth who transition out of prison environments. He asked how the State can get to decriminalization and still provide those services that are necessary to that population. MR. MAJOROS noted that the country underwent a major de- institutionalization from the 1960's through the 1980's. The thought was that people with mental health illnesses would be placed in community based settings but, in fact, those people were "trans-institutionalized" into state and federal correctional facilities because there were not enough community services. He thought the State needs to provide medication management for people in criminal institutions because they deserve humane care, but he also believes many people are in prisons because of the lack of community services. MS. ROBINSON added that is a problem in Fairbanks where many people with mental illnesses are waiting to go to API. AMHTA is focussing on Anchorage so that API can be downsized and other doors can be opened for people who need an intensive hospital setting. In addition, AMHTA funded the women's mental health unit in DOC. AMHTA has learned, however, that once those women are ready to leave the correctional institution, they have no support services and end up back in prison. They need to be transitioned to supportive community settings. MR. BRIMNER commented that once DMHDD analyzed why some people were going to jail with regularity was because they were pending hospitalization or transportation to API. DMHDD instituted some services in that area that have eliminated the transportation wait. DMHDD is finding that there are large gaps in services for that population and is attempting to address those. MS. ROBINSON informed committee members that AMHTA provides small community grants for a variety of projects and programs to promote mental health. There being no further business to come before the committee, CHAIRMAN MILLER adjourned the meeting at 3:02 p.m.