ALASKA STATE LEGISLATURE  JOINT MEETING  HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE  February 1, 2011 3:01 p.m. MEMBERS PRESENT  HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE Representative Wes Keller, Chair Representative Alan Dick, Vice Chair Representative Bob Herron Representative Paul Seaton Representative Sharon Cissna Representative Bob Miller Representative Charisse Millett SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE Senator Bettye Davis, Chair Senator Dennis Egan Senator Johnny Ellis Senator Kevin Meyer Senator Fred Dyson MEMBERS ABSENT  HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE All members present SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE All members present COMMITTEE CALENDAR  OVERVIEW(S): DEPARTMENT OF HEALTH AND SOCIAL SERVICES - HEARD ALASKA STATEWIDE INDEPENDENT LIVING COUNCIL - HEARD GOVERNOR'S COUNCIL ON DISABILITIES & SPECIAL EDUCATION - HEARD GOVERNOR'S STATEWIDE SUICIDE PREVENTION COUNCIL - HEARD PREVIOUS COMMITTEE ACTION No previous action to record WITNESS REGISTER ALISON ELGEE, Assistant Commissioner Central Office Finance and Management Services Department of Health and Social Services Juneau, Alaska POSITION STATEMENT: Presented a PowerPoint overview of the Department of Health and Social Services. BARBARA HENJUM, Director Division of Juvenile Justice Department of Health and Social Services Anchorage, Alaska POSITION STATEMENT: Answered questions during the Department of Health and Social Services overview. DUANE MAYES, Director Central Office Division of Senior and Disabilities Services Department of Health and Social Services Juneau, Alaska POSITION STATEMENT: Answered questions during the Department of Health and Social Services overview. ANDI NATIONS, Executive Director Statewide Independent Living Council of Alaska Anchorage, Alaska POSITION STATEMENT: Presented a PowerPoint, "An Overview of The Alaskan Independent Living Network" and answered questions about the council. COURTNEY WESTBERG, Advocate/Consumer Anchorage, Alaska POSITION STATEMENT: Testified and answered questions during the Alaska Statewide Independent Living Council presentation. JOYANNA GEISLER, Executive Director Kenai Peninsula CIL Homer, Alaska POSITION STATEMENT: Testified and answered questions during the Alaska Statewide Independent Living Council presentation. ELIZABETH LEE, Advocate/Consumer Yukon Kuskokwim Health Corporation Bethel, Alaska POSITION STATEMENT: Testified and answered questions during the Alaska Statewide Independent Living Council presentation. MILLIE RYAN, Executive Director Governor's Council on Disabilities & Special Education Division of Senior and Disabilities Services Department of Health and Social Services Anchorage, Alaska POSITION STATEMENT: Presented a PowerPoint and answered questions on Disabilities and Special Education. KATE BURKHART, Executive Director Statewide Suicide Prevention Council Juneau, Alaska POSITION STATEMENT: Testified and answered questions during a presentation on the Statewide Suicide Prevention Council (SSPC). ACTION NARRATIVE 3:01:52 PM CHAIR WES KELLER called the joint meeting of the House and Senate Health and Social Services Standing Committees to order at 3:01 p.m. Representatives Keller, Millett, Miller, and Dick, and Senators Davis, Ellis, Egan and Meyer were present at the call to order. Representatives Herron, Seaton, and Cissna, and Senator Dyson arrived as the meeting was in progress. [Chair Keller passed the gavel to Chair Davis.] ^OVERVIEW(S): DEPARTMENT OF HEALTH AND SOCIAL SERVICES OVERVIEW(S): DEPARTMENT OF HEALTH AND SOCIAL SERVICES  3:03:08 PM CHAIR DAVIS announced that the first order of business would be the continuation from the meeting of January 27, 2011, of the Overview by the Department of Health and Social Services. 3:04:49 PM ALISON ELGEE, Assistant Commissioner, Central Office, Finance and Management Services, Department of Health and Social Services, continued with the PowerPoint, "2011 Alaska Department of Health and Social Services Overview," [Included in members' packets] and spoke about "Health Care Services," slide 7. She reported that the Division of Health Care Services employed 134 staff, and managed the majority of the Medicaid program. She pointed out that the division provided the rate reviews and the systems maintenance for all the Medicaid facilities, and it managed the contract for the third party payer which processed all the Medicaid claim payments. She listed some of its challenges: maintaining sufficient provider enrollment to meet the program needs with reasonable rates, and setting the provider payment rates to encourage provider participation without compensating for services at rates higher than necessary. She declared that Health Care Services was working to develop a strong tribal health system. She directed attention to the big effort for completion of the Medicaid management information system. She established that federal compliance and program requirements were stricter than ever. She introduced Kimberli Poppe-Smart, Director of the Division of Health Care Services. 3:08:11 PM MS. ELGEE, referring to slide 8, "Juvenile Justice", reported that the division had 479 staff, with 8 youth detention facilities and 16 juvenile probation offices. She emphasized the constant struggle with recruitment, and noted a concern for retention for senior management positions. She shared the success for keeping more juvenile offenders out of the institutions. She reported on efforts to understand and reduce recidivism, with an emphasis on strengthening families. REPRESENTATIVE MILLER asked about the difficulties with recruitment. MS. ELGEE replied that workforce retention and recruitment was often location specific, and was especially acute in the health professions. BARBARA HENJUM, Director, Division of Juvenile Justice, Department of Health and Social Services, replied that there were different issues in statewide recruitment. She pointed to the successes with using video recruitment. 3:12:47 PM MS. ELGEE directed attention to slide 9, "Public Assistance." She reported that the Division of Public Assistance had 535 full time staff, primarily eligibility technicians for public assistance programs, with 15 full service field offices, serving more than 174,000 clients. She listed the eligibility programs to include: Medicaid, senior benefit program, heating assistance, food stamps, and temporary assistance. She stated that the divisional challenge was to meet the increasing caseloads with the existing resources. She spoke about the change in the business process to a methodology called "Lean", and she touted its success. She projected changes for the eligibility work when the Patient Protection and Affordable Care Act was implemented. 3:16:17 PM CHAIR DAVIS asked if there was any federal money to pay for a new system to implement the Patient Protection and Affordable Care Act. MS. ELGEE expressed hope for a 90 percent federal payment for that portion of the system which was directly attributable to Medicaid eligibility. 3:17:20 PM MS. ELGEE addressed the next slide, "Senior & Disability Services," (slide 10) and stated that the division managed four Medicaid waiver programs, which served 4800 people. She listed the four waiver programs: children with complex medical conditions, adults with physical disabilities, older Alaskans, and developmental disabilities. She spoke about the Adult Protective Services program. She pointed out the various other programs which were administered through the Division of Senior and Disabilities Services. She stated that the biggest challenge was for meeting the corrective action plan by the Centers for Medicare and Medicaid Services (CMS). 3:19:48 PM REPRESENTATIVE CISSNA offered her belief that the Division of Senior and Disabilities Services had endured a number of crises over the years. She reflected on the lack of a long term plan. 3:22:23 PM DUANE MAYES, Director, Central Office, Division of Senior and Disabilities Services, Department of Health and Social Services, replied that the Commission on Aging was actively developing a five year plan. He lauded the new leadership for moving the department in the right direction. 3:23:59 PM ACTING COMMISSIONER STREUR reflected that the Division of Senior and Disabilities Services had earlier been in a crisis to provide service without the resources, but that recently the CMS director had stated that the division was now a model waiver program. He spoke of the need for not only a plan, but for a "doing." 3:25:26 PM REPRESENTATIVE CISSNA expressed her concern for the seniors in her community. She emphasized the need for seniors to feel safe, healthy, and confident. She asked to be notified of the planning results. 3:26:21 PM CHAIR DAVIS asked about if there were any recommended changes to the waivers which were up for reauthorization. ACTING COMMISSIONER STREUR replied that he would address this later. ^ALASKA STATEWIDE INDEPENDENT LIVING COUNCIL ALASKA STATEWIDE INDEPENDENT LIVING COUNCIL  3:29:19 PM CHAIR DAVIS announced that the next order of business would be a presentation by the Alaska Statewide Independent Living Council. 3:30:28 PM ANDI NATIONS, Executive Director, Statewide Independent Living Council of Alaska, presented a PowerPoint entitled "An Overview of The Alaskan Independent Living Network" [Included in members' packets] and introduced the other members of the council. 3:31:27 PM COURTNEY WESTBERG, Advocate/Consumer, directed attention to slide 1, "Independent Living Philosophy," and stated: All Alaskans, regardless of disability, should have control over their life choices and their independence. They should be able to decide what they need and determine what is best for themselves. She offered her belief that "disability is a natural part of the life experience." She shared her experiences as a provider to people with disabilities. She stated that the independent living movement was a local grass roots movement to give individuals the right and responsibilities to make the choices they deemed best for themselves. 3:33:23 PM JOYANNA GEISLER, Executive Director, Kenai Peninsula CIL, pointed to slide 2, "Vital Components of the Independent Living Philosophy." She stated: If we live long enough, we will each of us experience a disability in our lives. So, while our services are for people, specifically for people and families with disabilities, we know that the entire community in which we provide services can also benefit from our services. She described a successful systems advocacy venture with a local cab company for expanding its fleet to include lift equipped minivans. 3:35:20 PM ELIZABETH LEE, Advocate/Consumer, Yukon Kuskokwim Health Corporation, referenced slide 3, "Alaskan Independent Living Partners," and listed the many partners working with the council. She described slide 4, "Alaska Statewide Independent Living Council (SILC)," and explained that SILC was established as a non-profit by the Rehabilitation Act of 1992. She read the SILC mission: "To ensure that Alaskans with disabilities live independently and are fully integrated into the mainstream of society." 3:36:26 PM MS WESTBERG moved on to slide 5, "Alaska SILC Composition and Responsibilities," and explained that the members were appointed by the Governor. She established that the main goals and responsibilities of the board members were: "to develop, implement, and evaluate the State Plan for Independent Living... as well as to expand and improve the IL network across the whole state of Alaska." 3:37:10 PM MS. GEISLER described slide 6, "Alaskan Centers for Independent Living," and shared that these centers were the organizations which provided service to the people and families with disabilities. She listed the centers: Access Alaska in Southcentral, Southwest, the Aleutians, and the Interior regions; Southeast Alaska Independent Living Center (SAIL) in the Southeast region; Independent Living Center (ILC) in Kenai Peninsula, Kodiak Island and Valdez/Cordova areas; and, Arctic Assess in Nome and the Northwest Arctic Borough. She moved on to slide 7, which depicted a map of the "Regional Service Areas." 3:38:49 PM MS. GEISLER indicated slide 8, "Each Center for Independent Living," and said that each center was a unique, non-profit organization. She shared that the majority of board members and staff have disabilities. She announced that "any body of any age with any disability" was eligible for these services. 3:41:07 PM MS. NATIONS referred to slide 9, "Each Center for Independent Living Offers Five Core Services," and announced that Alaska had added a fifth core service. She shared that information and referral were the first service an individual would receive when they entered an independent living center. She spoke about the support groups, and the peer counseling. She expressed the need for individual and systems advocacy. She declared that independent living skills were vital to living on your own. She declared that deinstitutionalization was the core of independent living, as people could stay in their own home and their own community. 3:44:41 PM MS. GEISLER reported that all of the centers offered technology, slide 10, "Assistive Technology," which included canes, walkers, and wheelchairs. She gave some examples of various technologies. She moved on to slide 11, "Centers for Independent Living," and spoke about the listed services, which included housing, transportation, health care, and financial assistance. 3:49:57 PM MS. NATIONS offered slide 12, "Independent Living Partners," stated that the "centers for independent living are much more than providing direct service, they are providing connections," and pointed to the list of agencies, which included the Alaska Deaf Council, AgeNet, and the Alaska Mobility Coalition. ^GOVERNOR'S COUNCIL ON DISABILITIES & SPECIAL EDUCATION GOVERNOR'S COUNCIL ON DISABILITIES & SPECIAL EDUCATION  3:52:02 PM CHAIR DAVIS announced that the next order of business would be a presentation by the Governor's Council on Disabilities & Special Education. 3:54:10 PM MILLIE RYAN, Executive Director, Governor's Council on Disabilities & Special Education, Division of Senior and Disabilities Services, Department of Health and Social Services, presented a PowerPoint, "Overview Governor's Council on Disabilities & Special Education [Included in members' packets]. She presented slide 1, "Council Mission," and stated that the mission was "to create change that improves the lives of people with disabilities." She shared that the council was not a direct service provider, but it gathered service providers to meet the needs. She pointed out that the council worked with the service providers to find better ways to do business, and it advocated for needed changes. 3:55:16 PM MS. RYAN referenced slide 2, "Council Members," and stated that the council had 27 members, who were appointed by the governor. She noted that 60 percent of the members were individuals with disabilities or family members of individuals with disabilities. She shared that the remainder of the members were representatives from state agencies. 3:56:14 PM MS. RYAN directed attention to slide 3, "Council Responsibilities," and described its five roles: State Council on Developmental Disabilities, State Advisory Panel on Special Education, State Interagency Council on Infants and Toddlers with Disabilities, Governing Board of the Special Education Service Agency (SESA), and the Beneficiary Board of the Alaska Mental Health Trust Authority. She noted that Alaska was the only state to integrate all of these into one council, which, she opined, was very efficient. 3:58:53 PM MS. RYAN identified slide 4, "Tools Used to Achieve Mission," and described the activities of the council, which included gathering community and stakeholder input, conducting research and data gathering, and providing testimony about how legislation will impact people with disabilities. She reviewed slide 5, slide 6, and slide 7, "Example of Council in Action," and gave an example of how the council operated, which included listening to public testimony, convening an ad hoc committee, researching work done in other states, and putting the recommendations into an initiative. 4:02:36 PM MS. RYAN observed that slide 8, "Number of AARC Web Site Page Views by Fiscal Year," reflected the rapid increase for web site viewings in the last two years. 4:03:17 PM MS. RYAN furnished slide 9, "Number of Board Certified Behavior Analysts (BCBAs) Practicing in Alaska," which depicted the projected increase in BCBAs because the legislature had invested in training. 4:04:59 PM MS. RYAN reported on slide 10, "Complex Behaviors Hub," and stated that Alaska had 11 individuals currently living in out- of-state institutions for developmental disabilities. She shared that the Council had recommended establishing a complex behaviors hub which would provide comprehensive diagnostic and testing capacity, individualized triage services, technical assistance to providers, and case-specific consultation and training services. 4:06:51 PM MS. RYAN confirmed that the Council was the governing board for the Special Education Service Agency (SESA), as noted on slide 11 and slide 12, "Special Education Service Agency." She shared the two policy recommendations from the Council: remove the sunset provisions from the SESA statute, and change the funding formula for SESA. 4:08:22 PM MS. RYAN moved on to slide 13, "2010 Harris Poll Findings," and detailed the national poll which had compared people with and without disabilities. She directed attention to the differences for employment, socializing, and access to health care. She stated that this would influence the Council's new state plan. 4:09:17 PM MS. RYAN reflected on slide 14, "Upcoming Challenges," and emphasized the challenge for developing actions and policies that would improve the lives of thousands of Alaskans with disabilities. She stressed that Alaskans with disabilities needed to be properly equipped with tools, skills and opportunities to successfully live the same everyday lives as other Alaskans. 4:09:42 PM SENATOR MEYER asked who a constituent would call for help if they had needs which were not being met. MS. RYAN replied that the Council, the Stone Soup Group, or the Disability Law Center of Alaska could be contacted. 4:10:41 PM MS. RYAN, in response to Representative Herron, explained that the career exploration day was an opportunity for youth with disabilities to shadow workers in careers which interested them. She expressed her desire for this to be a state-wide opportunity. 4:11:42 PM MS. RYAN, in response to Representative Herron, pointed to the lack of available services in rural Alaska, and noted the establishment of an ad hoc committee. She shared that the committee plan was focused on technology, training, and transitions from school to adult life. ^GOVERNOR'S STATEWIDE SUICIDE PREVENTION COUNCIL GOVERNOR'S STATEWIDE SUICIDE PREVENTION COUNCIL  4:13:13 PM CHAIR DAVIS announced that the final order of business would be a presentation by the Statewide Suicide Prevention Council. 4:14:07 PM KATE BURKHART, Executive Director, Statewide Suicide Prevention Council, gave a brief history of the SSPC, and an update on its most recent conference. She reported that the SSPC was established in 2001, in response to a need for solutions and for support to communities experiencing a high rate of suicide. She listed the 12 voting members and the 4 non-voting members. She pointed out that SPCC was an advisory council to the legislature and the governor: To advise with respect to actions to improve health and wellness for Alaskans around the state by reducing suicide; to broaden awareness of suicide and the risk factors that lead up to it; to enhance suicide prevention services and programs throughout the state; to develop healthy communities through comprehensive, collaborative; community-based and faith based approaches; to develop and implement a statewide suicide prevention plan; and to strengthen existing and build new partnerships between public and private entities to advance suicide prevention efforts in the state. She reported that the council had met in Dillingham, Anchorage, Fairbanks, Kotzebue, Juneau, and Toksook Bay. She reported that the Statewide Suicide Prevention Summit, which included partnerships with many private and public agencies, was the first time that the state and tribal suicide prevention systems had come together, with a priority of listening to diverse groups of people. 4:22:48 PM MS. BURKHART declared that "people engaged in suicide prevention feel alone." She reported that the SSPC prioritized connections, in order to better improve communications among groups and resources. She elaborated on the rapid formation of a Ketchikan based suicide prevention group with the support and mentoring from other groups. She noted that Alaska Children's Services in Anchorage had partnered with the Alaska State Troopers to ensure that the Troopers received special prevention and intervention training. She shared that the Alaska National Guard had worked with Southeast Alaska communities to teach Applied Suicide Intervention Skills Training (ASIST), another prevention and intervention model. 4:25:42 PM MS. BURKHART pointed out that a big achievement for the council was the increased openness and willingness to talk about suicide in Alaska. She observed that this was the first SSPC presentation to the Alaska State Legislature. She declared that there was now a greater level of comfort for sharing ideas. 4:27:40 PM MS. BURKHART stated that SSPC had transitioned to a new strategic focus: prioritizing the coordination of efforts for connections and partnerships; focusing on maintenance of open dialogue through media and awareness; offering training of the necessary skills and tools to identify and intervene appropriately; and improving prevention programming. She emphasized that the statewide suicide prevention plan also needed to be updated. She affirmed the importance of the SSPC central message that "every person's life has value." 4:32:37 PM [CHAIR DAVIS returned the gavel to Chair Keller.] 4:34:03 PM ADJOURNMENT  There being no further business before the committee, the House Health and Social Services Standing Committee meeting was adjourned at 4:34 p.m.