Legislature(2017 - 2018)ADAMS ROOM 519

04/17/2018 09:00 AM FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Recessed to a Call of the Chair --
+ HB 224 REEMPLOYMENT OF RETIRED TEACHERS & ADMIN TELECONFERENCED
<Bill Hearing Canceled>
-- Public Testimony --
+ SB 185 REEMPLOYMENT OF RETIRED TEACHERS & ADMIN TELECONFERENCED
Moved CSSB 185(EDC) Out of Committee
-- Public Testimony --
+ HB 119 AIDEA:DIVIDEND TO STATE;INCOME;VALUATION TELECONFERENCED
Heard & Held
-- Public Testimony --
+ HB 409 DMV ID CARDS & REGISTRATION FEES TELECONFERENCED
Moved CSHB 409(FIN) Out of Committee
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= SB 105 MARITAL/FAMILY THERAPY LIC & MED SERVICES TELECONFERENCED
Heard & Held
+= SB 92 VESSELS: REGISTRATION/TITLES; DERELICTS TELECONFERENCED
Moved HCS CSSB 92(FIN) Out of Committee
CS FOR SENATE BILL NO. 105(FIN)                                                                                               
                                                                                                                                
     "An  Act  relating  to the  licensure  of  marital  and                                                                    
     family therapists;  relating to medical  assistance for                                                                    
     marital and family therapy  services; and providing for                                                                    
     an effective date."                                                                                                        
                                                                                                                                
10:18:40 AM                                                                                                                   
                                                                                                                                
SENATOR DAVID WILSON, SPONSOR, introduced himself.                                                                              
                                                                                                                                
GARY  ZEPP, STAFF,  SENATOR DAVID  WILSON, provided  a brief                                                                    
bill summary.  The bill provided expanded  behavioral health                                                                    
access to Alaskans. He shared  there had been testimony from                                                                    
therapists,  emergency room  (ER)  doctors, school  district                                                                    
administrators,  and federally  qualified health  centers in                                                                    
Alaska. The  bill would improve and  streamline the training                                                                    
for associates  to become fully licensed  marital and family                                                                    
therapists  to help  provide expanded  access to  behavioral                                                                    
health services.  The bill was  not being touted as  a cost-                                                                    
savings measure,  but as a  way to help Medicaid  clients in                                                                    
need  of  behavioral  health  services  that  were  severely                                                                    
lacking.  However,  there  was  great  potential  for  cost-                                                                    
savings  if individuals  could  be  diverted from  emergency                                                                    
rooms.  He  detailed  that  in   2016  the  Mat-Su  Memorial                                                                    
Hospital  had  spent  $43.8  million   on  ER  services.  He                                                                    
detailed the costs had covered  about 1,300 patients with an                                                                    
average  cost  of  $12,721 per  person  for  one  behavioral                                                                    
health  assessment. In  a clinical  setting the  cost ranged                                                                    
from $150 to $250.                                                                                                              
                                                                                                                                
Mr. Zepp referenced a 2017  document titled "Alaska Medicaid                                                                    
Facts  and Figures"  published by  the Department  of Health                                                                    
and Social  Services (DHSS) (copy  on file). He  shared that                                                                    
in  2016 Medicaid  patients cost  Alaska ER  facilities $233                                                                    
million and $245  million in 2017. He  stressed the patients                                                                    
were Medicaid clients  the state was already  paying for. He                                                                    
explained if the  individuals could be diverted  from the ER                                                                    
by  expanding  access  and  getting  them  into  a  clinical                                                                    
setting there was  a great potential for  savings. He shared                                                                    
there  had  been  great  support for  the  bill  by  various                                                                    
healthcare  providers  and  it  had passed  the  other  body                                                                    
unanimously.  He  spoke to  support  by  ER doctors,  family                                                                    
therapists,  the state  Board of  Therapy, and  the national                                                                    
Board of  Marital and Family  Therapists. He noted  DHSS had                                                                    
provided a letter addressed to  the committee providing more                                                                    
detail on the  bill [letter from the  Division of Behavioral                                                                    
Health Director Randall Burns dated  April 13, 2018 (copy on                                                                    
file)].                                                                                                                         
                                                                                                                                
10:22:51 AM                                                                                                                   
                                                                                                                                
Representative   Wilson  stated   that  the   committee  had                                                                    
received  a  letter  [from  the   Division  of  Health  Care                                                                    
Services  Director  Margaret  Brodie dated  April  19,  2018                                                                    
(copy  on   file)]  stating  that  the   bill  would  expand                                                                    
[Medicaid services]  and that it  would be necessary  to ask                                                                    
permission from  the federal government to  add the service.                                                                    
She  asked  what  the process  entailed.  Additionally,  she                                                                    
wondered  about the  process of  going back  to the  federal                                                                    
government  to  remove  the  service if  the  bill  added  a                                                                    
substantial cost and no savings.                                                                                                
                                                                                                                                
MARGARET   BRODIE,  DIRECTOR,   DIVISION   OF  HEALTH   CARE                                                                    
SERVICES,  DEPARTMENT OF  HEALTH  AND  SOCIAL SERVICES  (via                                                                    
teleconference),  answered that  the  bill  would require  a                                                                    
state plan amendment;  it would be an update  to the current                                                                    
state  plan.   If  anticipated  savings  did   not  come  to                                                                    
fruition,  a  new state  plan  amendment  would be  made  to                                                                    
remove the providers' ability to provide the services.                                                                          
                                                                                                                                
Representative  Wilson stated  that savings  had been  shown                                                                    
for HB 25. She wondered why  it was so difficult to estimate                                                                    
potential savings under HB 105.                                                                                                 
                                                                                                                                
Mr. Brodie replied that it  was difficult to project savings                                                                    
for SB  105 because  it was not  possible to  anticipate who                                                                    
would  be utilizing  the services.  She explained  that with                                                                    
other bills the department was  able to look at individuals'                                                                    
diagnoses and  what procedures were  being done in  order to                                                                    
identify who would be able to utilize the services.                                                                             
                                                                                                                                
Representative  Wilson was  concerned about  the $1  million                                                                    
fiscal note.  She was hoping  to get a  better understanding                                                                    
of potential  savings because  now the  committee understood                                                                    
the  service  would  be  added  [to  the  list  of  Medicaid                                                                    
services]. She  stated the  process was  long and  the state                                                                    
did not know  how easy it would be to  remove the service if                                                                    
the savings  did not come  to fruition. Given  that Medicaid                                                                    
was  currently  one  of  the  biggest  [cost]  drivers,  she                                                                    
believed  the committee  should  be  concerned about  adding                                                                    
more services.                                                                                                                  
                                                                                                                                
Co-Chair Foster  noted the committee  would break  for floor                                                                    
session.                                                                                                                        
                                                                                                                                
CSSB 105 (FIN)  was HEARD and HELD in  committee for further                                                                    
consideration. [Note: the bill  was heard again beginning at                                                                    
2:20 p.m.]                                                                                                                      
                                                                                                                                
10:26:37 AM                                                                                                                   
RECESSED                                                                                                                        
                                                                                                                                
12:52:29 PM                                                                                                                   
RECONVENED                                                                                                                      
                                                                                                                                
Co-Chair Foster  relayed that the  committee has  posed some                                                                    
questions earlier on SB 105,  which were being worked on. He                                                                    
relayed the bill would be heard last on the agenda.                                                                             
                                                                                                                                
CS FOR SENATE BILL NO. 105(FIN)                                                                                               
                                                                                                                                
     "An  Act  relating  to the  licensure  of  marital  and                                                                    
     family therapists;  relating to medical  assistance for                                                                    
     marital and family therapy  services; and providing for                                                                    
     an effective date."                                                                                                        
                                                                                                                                
2:20:33 PM                                                                                                                    
                                                                                                                                
Co-Chair  Foster  noted the  committee  had  heard the  bill                                                                    
earlier in the meeting.                                                                                                         
                                                                                                                                
Co-Chair  Seaton   mentioned  his  earlier   question  about                                                                    
whether the bill would require a plan amendment.                                                                                
                                                                                                                                
Co-Chair Foster remarked that the  bill sponsor had asked to                                                                    
hear   from  Elizabeth   Ripley  with   the  Mat-Su   Health                                                                    
Foundation.                                                                                                                     
                                                                                                                                
ELIZABETH  RIPLEY, CEO,  MAT-SU  HEALTH FOUNDATION,  WASILLA                                                                    
(via  teleconference), spoke  in  support of  the bill.  She                                                                    
read from prepared remarks:                                                                                                     
                                                                                                                                
     The foundation shares ownership in Mat-Su Regional                                                                         
     Medical Center and invests its profits back into the                                                                       
     community to improve the health  and wellness of Mat-Su                                                                    
     residents. The Mat-Su  Health Foundation fully supports                                                                    
     SB  105  because  it  will  help  our  citizens  access                                                                    
     behavioral health  treatment services  through marriage                                                                    
     and family  therapists to get  care early  before their                                                                    
     problems   escalate  to   a   crisis   stage.  In   the                                                                    
     foundation's   2013  Mat-Su   community  health   needs                                                                    
     assessment,  Mat-Su residents  told us  their top  five                                                                    
     health  issues were  all related  to mental  health and                                                                    
     substance  abuse.  They  asked  us  for  a  coordinated                                                                    
     system  of care  that  makes  treatment for  behavioral                                                                    
     health more  readily accessible.  Instead, the  way our                                                                    
     system currently works,  Mat-Su Regional Medical Center                                                                    
     is  the   number  one  portal  in   Mat-Su  for  people                                                                    
     suffering from a behavioral health problem.                                                                                
                                                                                                                                
     In 2016 alone, 1,196  patients with a behavioral health                                                                    
     diagnosis, 46  percent of which were  on Medicaid, went                                                                    
     to  the  Mat-Su  Regional  emergency  department  (ED).                                                                    
     These patients  had a total  of 3,227 visits  and their                                                                    
     charges   totaled   $14   million,  not   counting   an                                                                    
     additional  cost  of  $1.6 million  estimated  for  law                                                                    
     enforcement,  911 dispatch,  and transportation.  If we                                                                    
     can intervene  early with a system  where all residents                                                                    
     can get  timely access to a  behavioral health provider                                                                    
     we can save pain, suffering,  and money. By example, an                                                                    
     individual  session  for  Medicaid  is  $75,  while  an                                                                    
     average  charge for  a behavioral  health  ED visit  is                                                                    
     $4,370.  Granted  an  individual needs  more  than  one                                                                    
     visit early  on to  prevent a crisis,  but even  if you                                                                    
     paid  for  ten  visits  at $750  you  would  be  saving                                                                    
     $3,600. The  prevalence of mental health  and substance                                                                    
     abuse problems  and crises is increasing  in the Mat-Su                                                                    
     and  statewide.  The  average annual  growth  rate  for                                                                    
     visits in our  ED by patients with  a behavioral health                                                                    
     diagnosis grew 20 percent from  2015 to 2017 due to the                                                                    
     opioid   epidemic  and   lack   of  treatment   access.                                                                    
     Additionally,  from   2014  to   2017  the   number  of                                                                    
     behavioral health assessments  required for patients in                                                                    
     crisis in  our ED grew  from 349  to more than  1,000 -                                                                    
     all  in  a hospital  that  does  not currently  provide                                                                    
     behavioral healthcare.                                                                                                     
                                                                                                                                
     This legislation  could bring the appropriate  level of                                                                    
     care  to people  who  need help  when  a problem  first                                                                    
     starts instead of after it  develops into a crisis. The                                                                    
     Mat-Su Health Foundation is actively  doing its part to                                                                    
     build a  complete behavioral  health continuum  of care                                                                    
     that's  fully  staffed  with caring  professionals.  We                                                                    
     offer  scholarships  to  train  new  behavioral  health                                                                    
     providers  and invest  to help  our nonprofits  provide                                                                    
     badly   needed   services.   We  are   financing   care                                                                    
     coordination projects to keep people  out of the ED and                                                                    
     institutional  care  and  work to  advocate  for  smart                                                                    
     policy like SB  105. We hope you will  move this timely                                                                    
     and important legislation forward. Thank you.                                                                              
                                                                                                                                
2:24:54 PM                                                                                                                    
                                                                                                                                
Co-Chair  Foster  invited  the  sponsor  and  staff  to  the                                                                    
testimony table.                                                                                                                
                                                                                                                                
SENATOR DAVID WILSON, SPONSOR, introduced himself.                                                                              
                                                                                                                                
GARY ZEPP, STAFF, SENATOR DAVID  WILSON, noted that Director                                                                    
Margaret Brodie  with the Division  of Health  Care Services                                                                    
could  provide  an  answer   to  Co-Chair  Seaton's  earlier                                                                    
question  about  whether  the legislation  would  require  a                                                                    
change in the state Medicaid plan.                                                                                              
                                                                                                                                
Co-Chair Foster  intended to take  questions for  Ms. Ripley                                                                    
first.                                                                                                                          
                                                                                                                                
Co-Chair  Seaton presumed  a  large  portion of  individuals                                                                    
coming into  the Mat-Su hospital  were there for  drug abuse                                                                    
reasons.  He asked  if marital  and  family therapists  were                                                                    
licensed to treat  opioid and other drug abuse.  He asked if                                                                    
it would open a treatment avenue for the health foundation.                                                                     
                                                                                                                                
Ms. Ripley  shared her understanding that  the primary focus                                                                    
of  marital   and  family  therapists  was   mental  health.                                                                    
Frequently,  mental health  and substance  abuse cooccurred.                                                                    
It  was  necessary to  treat  the  underlying cause  leading                                                                    
someone to  self-medicate. She  believed marital  and family                                                                    
therapists  would have  the ability  to  address the  mental                                                                    
health component vital to addressing substance abuse.                                                                           
                                                                                                                                
Co-Chair Seaton asked if marital  and family therapists were                                                                    
licensed to treat mental health.                                                                                                
                                                                                                                                
Ms. Ripley replied, "that's my understanding."                                                                                  
                                                                                                                                
2:27:33 PM                                                                                                                    
                                                                                                                                
Mr.  Zepp  noted  that  Ms.  Brodie  could  answer  Co-Chair                                                                    
Seaton's  question from  earlier  in the  day regarding  the                                                                    
state Medicaid plan.                                                                                                            
                                                                                                                                
MARGARET   BRODIE,  DIRECTOR,   DIVISION   OF  HEALTH   CARE                                                                    
SERVICES, DEPARTMENT OF HEALTH  AND SOCIAL SERVICES, replied                                                                    
there  was no  cost to  do a  state plan  amendment for  the                                                                    
addition or deletion of a  service. The department had staff                                                                    
to  ensure the  state complied  with the  state plan  at all                                                                    
times.                                                                                                                          
                                                                                                                                
Co-Chair Seaton asked how difficult  it would be to delete a                                                                    
service if the bill did not accomplish what was intended.                                                                       
                                                                                                                                
Ms.  Brodie   answered  that  the  process   was  easy;  the                                                                    
Department of Health and Social  Services (DHSS) would write                                                                    
a new state  plan and submit it to the  Centers for Medicare                                                                    
and Medicaid Services (CMS).                                                                                                    
                                                                                                                                
Representative Wilson asked when  the state had last deleted                                                                    
a service from its Medicaid  plan. Ms. Brodie responded that                                                                    
she would have to follow up with an answer.                                                                                     
                                                                                                                                
Representative Wilson  stated the legislature had  asked the                                                                    
question frequently and  had always been told  proof of need                                                                    
for the  deletion of a service  and what kind of  a negative                                                                    
impact it would have on  individuals using the service would                                                                    
have to  be provided. She was  amazed to hear that  it would                                                                    
be easy  to remove  something from the  plan because  it had                                                                    
not  been  the  understanding  since she  had  been  on  the                                                                    
committee.  She asked if  marital and family therapists were                                                                    
currently  able  to do  anything  in  the behavioral  health                                                                    
realm  and to  bill Medicaid  if they  were working  under a                                                                    
clinic.                                                                                                                         
                                                                                                                                
Ms. Brodie answered in the  affirmative. She elaborated that                                                                    
the services  could be billed  to Medicaid if provided  in a                                                                    
clinic  or the  service could  be provided  anywhere if  the                                                                    
therapist was serving a duly  eligible Medicare and Medicaid                                                                    
recipient.                                                                                                                      
                                                                                                                                
Representative  Wilson  asked  for verification  that  if  a                                                                    
therapist was  already able  to bill  Medicare and  a client                                                                    
also    had    Medicaid,    the   therapist    could    bill                                                                    
Medicare/Medicaid  even  though  they  were not  part  of  a                                                                    
clinic.                                                                                                                         
                                                                                                                                
Ms. Brodie  agreed. She added  that the state would  pick up                                                                    
the copayment.                                                                                                                  
                                                                                                                                
Representative Wilson  asked for verification that  the bill                                                                    
only pertained  to therapists  with an  independent practice                                                                    
and clients with Medicaid but not Medicare.                                                                                     
                                                                                                                                
2:30:57 PM                                                                                                                    
                                                                                                                                
Ms. Brodie  responded in the  affirmative pertaining  to the                                                                    
recipient. The  provider would also  have to be  enrolled in                                                                    
Medicare.                                                                                                                       
                                                                                                                                
Representative  Wilson  referenced   the  fiscal  note  that                                                                    
specified  there  were  100   licensed  marital  and  family                                                                    
therapists in Alaska.  She wondered if there  was a database                                                                    
showing the  number of independent  therapists who  may want                                                                    
to take Medicaid patients.                                                                                                      
                                                                                                                                
Ms.  Brodie  deferred to  the  DHSS  Division of  Behavioral                                                                    
Health.                                                                                                                         
                                                                                                                                
Representative Guttenberg  surmised that the reason  for the                                                                    
bill was not to expand  the services provided by marital and                                                                    
family therapists,  but to expand  the group  of individuals                                                                    
receiving  the  benefits the  therapists  had  to offer.  He                                                                    
referenced   the   fiscal   note   that   extrapolated   the                                                                    
anticipated number of individuals  who would use the service                                                                    
and what the  cost would be. He wondered if  there was a way                                                                    
to estimate what  the cost avoidance would be.  He looked at                                                                    
the 633  estimated recipients and  considered what  the cost                                                                    
would be  for the individuals  to go to the  emergency room.                                                                    
He explained that in the future  it would be helpful to look                                                                    
back and know what the savings  had been. He wondered if the                                                                    
avoidance cost could be reflected in the fiscal note.                                                                           
                                                                                                                                
Ms. Brodie replied  that she could do a  calculation, but it                                                                    
would not  be 100  percent accurate. She  could take  all of                                                                    
the emergency  room visits and could  extrapolate the number                                                                    
of  individuals   who  had  received   a  diagnosis   for  a                                                                    
behavioral health disorder. However,  not all providers were                                                                    
comfortable giving  that type  of diagnosis;  therefore, the                                                                    
figure would be off some.                                                                                                       
                                                                                                                                
Representative  Guttenberg  stated  that in  the  future  it                                                                    
would  be helpful  to look  back to  see what  the avoidance                                                                    
cost had  been in the  five years  since the passage  of the                                                                    
bill.                                                                                                                           
                                                                                                                                
Co-Chair  Seaton  asked  if  Representative  Guttenberg  was                                                                    
suggesting  including  a requirement  for  a  report to  the                                                                    
legislature in the bill.                                                                                                        
                                                                                                                                
Representative Guttenberg  thought it  would be a  good idea                                                                    
in  order to  know in  the future  what avoidance  costs had                                                                    
come  from  the legislation.  He  hoped  the department  was                                                                    
looking at  avoidance costs to  understand other  places the                                                                    
state needed to expand or contract services.                                                                                    
                                                                                                                                
2:34:50 PM                                                                                                                    
                                                                                                                                
Mr.  Zepp  believed the  state  was  on  the verge  of  what                                                                    
Representative Guttenberg was asking  for through a separate                                                                    
bill (SB 74) and the  federal 1115 Medicaid waiver the state                                                                    
had  recently  submitted.  The  waiver  was  just  upon  the                                                                    
shortage of  behavioral healthcare and trying  to manipulate                                                                    
the system to demonstrate  a project and redefine behavioral                                                                    
healthcare and  address the shortages throughout  the state.                                                                    
He believed  the components were  addressed in  the 130-page                                                                    
document submitted to the federal government by DHSS.                                                                           
                                                                                                                                
Co-Chair Seaton  was trying to determine  if the legislature                                                                    
would be  getting information back  on the  effectiveness of                                                                    
expanding a  service. He asked if  the reporting requirement                                                                    
needed  to be  more specific  than a  generalized report  on                                                                    
behavioral  health.  He  wondered if  the  department  could                                                                    
provide  the  requested  information  in  a  report  if  the                                                                    
legislation passed.                                                                                                             
                                                                                                                                
Ms.  Brodie  replied  that  the  report  would  need  to  be                                                                    
specialized  because   it  could  get  lost   in  the  other                                                                    
activities the  department was undertaking with  waivers and                                                                    
Medicaid reform. She relayed that  the report was definitely                                                                    
something  DHSS  could provide;  if  the  department knew  a                                                                    
report was due it could compile the data beforehand.                                                                            
                                                                                                                                
Representative  Wilson  pointed   to  research  in  members'                                                                    
packets  from   the  Division  of  Behavioral   Health  that                                                                    
mentioned an existing report. She  believed the report could                                                                    
help the legislature contemplate  what should be included in                                                                    
another  report.  She  stated   the  legislature  should  be                                                                    
concerned that  in 2016 as  a result of  Medicaid expansion,                                                                    
statewide  payments  to   behavioral  health  providers  was                                                                    
$8,641,000, while  in 2017 expansion brought  in $25,173,825                                                                    
to  providers  statewide.  She stated  the  number  was  far                                                                    
beyond $25 million. She thought  it was necessary to be very                                                                    
specific  when determining  what the  report would  include.                                                                    
She wondered if Representative  Guttenberg was talking about                                                                    
only  marital and  family  therapists  or behavioral  grants                                                                    
throughout   the  state.   She  remarked   there  had   been                                                                    
significant discussion  in the committee on  where the money                                                                    
was going  and whether the  state was seeing any  return for                                                                    
its money  in terms  of opioid and  other issues  related to                                                                    
behavioral   health.  She   added  that   the  problem   was                                                                    
increasing as was the cost.                                                                                                     
                                                                                                                                
2:38:02 PM                                                                                                                    
                                                                                                                                
Representative  Wilson  mentioned  a  document  regarding  a                                                                    
Medicaid expansion  legislative research grant (copy  not on                                                                    
file). She  stated the  document specified  the DHSS  was in                                                                    
the  process  of  developing a  reporting  tool  that  would                                                                    
enable  the  legislature  to get  the  type  of  information                                                                    
[Representative  Guttenberg was  requesting].  She asked  if                                                                    
the tool had been finished.                                                                                                     
                                                                                                                                
RICK   CALCOTE,  MENTAL   HEALTH   CLINICIAN,  DIVISION   OF                                                                    
BEHAVIORAL   HEALTH,  DEPARTMENT   OF   HEALTH  AND   SOCIAL                                                                    
SERVICES,  ANCHORAGE (via  teleconference), replied  that he                                                                    
did not have  the information; the tool  was being developed                                                                    
elsewhere in the department.                                                                                                    
                                                                                                                                
Representative Wilson  was uncertain who to  talk to because                                                                    
the report  she was  referencing anticipated the  tool would                                                                    
be operational  by early  2018. She  wanted to  know whether                                                                    
the tool had  been developed and what  information the state                                                                    
had.  She thought  the tool  could help  determine how  much                                                                    
money would be  diverted. She believed the  bill needed more                                                                    
work.                                                                                                                           
                                                                                                                                
Vice-Chair Gara understood  the need to expand  the group of                                                                    
people providing mental health  services. He asked if adding                                                                    
marital family  services would add  marital counseling  as a                                                                    
covered service.                                                                                                                
                                                                                                                                
Senator Wilson  answered that marital and  family therapists                                                                    
were  licensed  to  provide  myriad  services.  He  provided                                                                    
examples including  psychotherapy, group  psychotherapy, and                                                                    
substance abuse  counseling dealing with family  dynamic. He                                                                    
clarified that  it did not  have to  be limited to  a family                                                                    
unit, but  included whatever the  therapist was  licensed to                                                                    
do.  He continued  that marital  and family  therapists went                                                                    
through similar  schooling to  social workers,  and licensed                                                                    
professional counselors. Marital  and family therapists went                                                                    
through the same licensure  requirements through their board                                                                    
and  could  provide the  scope  of  services throughout.  He                                                                    
stated  it was  more  than family  counseling. He  explained                                                                    
that  like a  car mechanic  that could  treat more  than one                                                                    
limited issue on  a car, marital and  family therapists were                                                                    
licensed  professionals  who  were able  to  provide  myriad                                                                    
services.  He  believed  Director  Randall  Burns  with  the                                                                    
Division  of Behavioral  Health had  addressed the  issue in                                                                    
his letter [to the committee  co-chairs dated April 13, 2018                                                                    
(copy  on file)].  He reiterated  that the  services marital                                                                    
and family therapists could provide were expansive.                                                                             
                                                                                                                                
2:41:54 PM                                                                                                                    
                                                                                                                                
Co-Chair Seaton was  concerned that getting a  big report on                                                                    
behavioral health  services across the state  would lose the                                                                    
essence  of  whether  expanding  services  for  marital  and                                                                    
family  therapists  helped  the  system  and  decreased  the                                                                    
amount of  behavioral health services provided  in emergency                                                                    
rooms.  He  was trying  to  determine  whether requesting  a                                                                    
report  in   the  four-year  timeframe  would   provide  the                                                                    
information  on give  the information  to determine  whether                                                                    
the  system had  improved and  what  the cost  had been.  He                                                                    
thought looking at the overall  system would lose the detail                                                                    
about what was needed pertaining to the topic.                                                                                  
                                                                                                                                
Ms. Brodie  responded that after  the bill's  effective date                                                                    
there should be  one full fiscal year before  the report was                                                                    
required. She  believed going out  four or five  years would                                                                    
be  too long.  She explained  there  were a  high number  of                                                                    
Medicaid   reform  initiatives   underway;  therefore,   she                                                                    
recommended tracking  the information from the  beginning in                                                                    
order to  receive actuals in  the report. The  savings would                                                                    
show  up in  healthcare  services  Medicaid, not  behavioral                                                                    
health  Medicaid. The  savings  would also  show  up in  the                                                                    
Department of  Corrections, law enforcement, and  the Office                                                                    
of  Children's  Services. She  did  not  know whether  those                                                                    
agencies would  have the ability  to track  the information,                                                                    
but Medicaid would.                                                                                                             
                                                                                                                                
Representative  Wilson stated  that the  bill only  included                                                                    
marital  and family  therapists  working independently.  She                                                                    
asked  if there  was a  way  to track  only the  individuals                                                                    
under the bill.                                                                                                                 
                                                                                                                                
Ms.  Brodie answered  there  would  be a  way  to track  the                                                                    
individuals  through  the  bill  because  it  would  require                                                                    
building  specialized  business   rules  into  the  Medicaid                                                                    
Management  Information  System  (MMIS). She  detailed  DHSS                                                                    
could use  the same rules  to track  who was paid  under the                                                                    
bill.                                                                                                                           
                                                                                                                                
2:45:34 PM                                                                                                                    
                                                                                                                                
Representative  Wilson asked  how many  states had  tried to                                                                    
take extras out of their plan and had been denied.                                                                              
                                                                                                                                
Ms. Brodie  did not  know any states  that had  been denied.                                                                    
There were states that had  lengthy discussions with CMS and                                                                    
had  been required  to prove  access. However,  other states                                                                    
were far  ahead of  Alaska in  behavioral health  issues and                                                                    
already had the infrastructure.                                                                                                 
                                                                                                                                
Representative Wilson requested  information on the criteria                                                                    
required to remove any extra services.                                                                                          
                                                                                                                                
Vice-Chair  Gara stated  that  he had  first  been told  the                                                                    
purpose  of the  bill had  was to  allow marital  and family                                                                    
therapists  to  provide  behavioral  health  services.  More                                                                    
recently he had  been asked if the bill  would cover marital                                                                    
counseling through Medicaid.  He asked if the  intent of the                                                                    
bill was  limited to allowing marital  and family therapists                                                                    
to provide  direct behavioral health  services or  to expand                                                                    
the services provided through Medicaid.                                                                                         
                                                                                                                                
Senator  Wilson confirmed  the original  intent of  the bill                                                                    
was  to  allow  therapists  not practicing  in  a  community                                                                    
behavioral  health  clinic  the  ability  to  bill  Medicaid                                                                    
through the  optional service.  The bill  would allow  a new                                                                    
provider type to be added  to the list of licensed providers                                                                    
that  could bill  Medicaid, just  like  a licensed  clinical                                                                    
social worker  could bill for marital  and family counseling                                                                    
through group therapy.  Other non-marriage family therapists                                                                    
could bill for  the same services that  those providers bill                                                                    
for as well.                                                                                                                    
                                                                                                                                
2:48:51 PM                                                                                                                    
                                                                                                                                
Co-Chair  Seaton asked  whether  January 2020  would be  the                                                                    
appropriate  report deadline  if  the bill  passed with  its                                                                    
current effective date.                                                                                                         
                                                                                                                                
Ms. Brodie thought  it would be better to line  the due date                                                                    
up with the  department's other Medicaid reports  due at the                                                                    
end of November.                                                                                                                
                                                                                                                                
Co-Chair  Seaton  asked for  the  year.  Ms. Brodie  replied                                                                    
2020.                                                                                                                           
                                                                                                                                
Co-Chair Seaton  asked for  verification that  the following                                                                    
was  an  adequate parameter  for  DHSS  to design  the  data                                                                    
collection:   a   report   to   the   legislature   on   the                                                                    
effectiveness  and the  cost-effectiveness of  providing the                                                                    
services allowed under the bill  by the authorized providers                                                                    
and the  impact on  diversion of  services provided  in more                                                                    
costly settings.                                                                                                                
                                                                                                                                
Ms. Brodie replied in the affirmative.                                                                                          
                                                                                                                                
Representative  Wilson communicated  she  had a  forthcoming                                                                    
amendment.                                                                                                                      
                                                                                                                                
2:51:06 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
2:51:39 PM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
Co-Chair   Foster   stated   there  would   be   forthcoming                                                                    
amendment.  He set  a deadline  of 5:00  p.m. the  following                                                                    
day.                                                                                                                            
                                                                                                                                
Senator  Wilson  relayed  that the  bill  had  been  brought                                                                    
forward  to  address  behavioral  health  shortages  in  the                                                                    
state.  He  emphasized  there was  an  extensive  line  [for                                                                    
behavioral  health  services]  and he  encouraged  committee                                                                    
members to reach out to  their communities to learn how long                                                                    
it  took for  someone to  get scheduled  for an  integrative                                                                    
behavioral  health assessment.  He  stated  the wait  ranged                                                                    
from several weeks  to one month depending on  what a person                                                                    
needed to be  seen for. He noted  that residential substance                                                                    
abuse  treatment facilities  had  long  waitlists. The  bill                                                                    
would help open a second  door for individuals to access and                                                                    
lessen  the   burden  of  Alaskans  seeking   mental  health                                                                    
services. He thanked the committee for hearing the bill.                                                                        
                                                                                                                                
Vice-Chair Gara thanked Senator Wilson for his patience.                                                                        
                                                                                                                                
CSSB 105(FIN) was HEARD and HELD in committee for further                                                                       
consideration.                                                                                                                  
                                                                                                                                
Co-Chair Foster reviewed the schedule for the following                                                                         
day. He recessed the meeting to a call of the chair [note:                                                                      
meeting never reconvened].                                                                                                      
                                                                                                                                

Document Name Date/Time Subjects
HB119 Sectional Analysis ver A 3.28.18.pdf HFIN 4/17/2018 9:00:00 AM
HB 119
HB 119 Supporting Documents Presentation Slides 3.27.18.pdf HFIN 4/17/2018 9:00:00 AM
HB 119
HB119 Supporting Documents - AIDEA GASB Examples 03.27.18.pdf HFIN 4/17/2018 9:00:00 AM
HB 119
HB119 Supporting Documents - AIDEA Historic Dividend Comparison Existing to Proposed 03.27.18.pdf HFIN 4/17/2018 9:00:00 AM
HB 119
SB185 Sponsor Statement 4.14.2018.pdf HFIN 4/17/2018 9:00:00 AM
SB 185
SB185 Sectional Analysis ver. D.PDF HFIN 4/17/2018 9:00:00 AM
SB 185
SB185 Explanation of Changes Ver. A to Ver. D 4.14.2018.pdf HFIN 4/17/2018 9:00:00 AM
SB 185
SB185 Support Doc - Fiscal Note Explanation Graphic 4.14.2018.pdf HFIN 4/17/2018 9:00:00 AM
SB 185
SB185 Support Doc - 10 Year Utilization Summary 4.14.2018.pdf HFIN 4/17/2018 9:00:00 AM
SB 185
HB 409 Sponsor Statement 4.16.18.pdf HFIN 4/17/2018 9:00:00 AM
HB 409
HB409 Sectional Analysis 4.16.18.pdf HFIN 4/17/2018 9:00:00 AM
HB 409
SB 92 Explanation of changes Ver I.A to Ver M.pdf HFIN 4/17/2018 9:00:00 AM
SB 92
SB 92 HCS WORKDRAFT vM.pdf HFIN 4/17/2018 9:00:00 AM
SB 92
SB 185 Matt Moser Testimony NEA.pdf HFIN 4/17/2018 9:00:00 AM
SB 185
SB 185 Supporting Document Conduent .pdf HFIN 4/17/2018 9:00:00 AM
SB 185
SB 185 Supporting Document Retention.pdf HFIN 4/17/2018 9:00:00 AM
SB 185
CSSB 105(FIN) DHSS' Alaska ER Report_2017.pdf HFIN 4/17/2018 9:00:00 AM
SB 105