Legislature(2003 - 2004)

03/18/2003 03:02 PM House HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
HB 167-ALCOHOLISM AND DRUG ABUSE GRANTS                                                                                       
CHAIR WILSON announced  that the next order of  business would be                                                               
HOUSE BILL  NO. 167,  "An Act relating  to grants  for alcoholism                                                               
and drug abuse programs; and providing for an effective date."                                                                  
Number 1103                                                                                                                     
ELMER LINDSTROM,  Special Assistant, Office of  the Commissioner,                                                               
Department of  Health and Social  Services, testified  in support                                                               
of HB  167.  He explained  that the bill is  very straightforward                                                               
in  that it  requires that  the alcohol  and drug  abuse grantees                                                               
increase their local match to 25 percent from 10 percent.                                                                       
MR.  LINDSTROM pointed  out  that the  fiscal  note reflects  the                                                               
reduction in state support for  these programs, with a savings of                                                               
approximately   $1.6  million.     It   is  assumed   that  local                                                               
communities  will be  successful in  providing for  an additional                                                               
match and  therefore [the department]  would not expect  there to                                                               
be a  reduction in services at  the community level.   He offered                                                               
the  belief that  the grantees  would be  able to  increase their                                                               
local contribution  to the program.   He said this  proposal came                                                               
from the Division  of Alcohol and Drug Abuse as  a result of [the                                                               
department's] budget  exercise earlier in  the session.   He said                                                               
the  25  percent local  match  requirement  is  the same  as  the                                                               
standard for the mental health grant program.                                                                                   
Number 1050                                                                                                                     
MR.  LINDSTROM said  the Division  of Behavioral  Health will  be                                                               
constituted from the existing Division  of Alcohol and Drug Abuse                                                               
and the  existing Mental Health  Program portion of  the Division                                                               
of  Mental   Health  and  Developmental  Disabilities.     It  is                                                               
reasonable that the substance-abuse  grant program and the mental                                                               
health  grant program  would require  the same  25 percent  match                                                               
from grantees.   He  said he  overstated the  case in  a previous                                                               
hearing on  this bill in the  other body.  He  told the committee                                                               
he did  suggest that 25  percent was  the standard across  all of                                                               
the  department's  grant programs,  and  that  is not  the  case.                                                               
There is  wide variation in  what the local match  requirement is                                                               
from  various programs  funded through  the department.   The  25                                                               
percent  is the  standard for  the mental  health grant  program,                                                               
which [the department] believes is the best comparison.                                                                         
Number 0952                                                                                                                     
CHAIR WILSON  commented that there  is a spreadsheet in  the bill                                                               
packet that shows  the amount of reductions for each  area in the                                                               
state.   She  said  it is  very difficult  decision  for all  the                                                               
members in  these days when there  are limited funds and  so many                                                               
Number 0908                                                                                                                     
REPRESENTATIVE  CISSNA referred  to  the  sponsor statement  from                                                               
[U.S.]   Senator   Lisa  Murkowski,   who   was   then  a   state                                                               
Representative, for  the alcohol  tax bill that  was put  in last                                                               
year.   In that  statement, [then-Representative  Murkowski] said                                                               
that she  "introduced the bill  to help offset the  soaring costs                                                               
of alcohol-related  expenses."  Representative Cissna  went on to                                                               
say  Representative  Murkowski  ended her  sponsor  statement  by                                                               
saying, "This legislation  is an important part of  the effort to                                                               
address the  problem of alcohol  and alcohol abuse in  Alaska and                                                               
would  help provide  revenue needed  for the  expanded treatment,                                                               
therapeutic  courts, diversion  programs,  and other  initiatives                                                               
now  under consideration  in  the  legislature."   Representative                                                               
Cissna  commented that  although that  is not  dedicated funding,                                                               
this is  one of  the few  revenue-enhancement measures  that came                                                               
about  last  year, and  the  purpose  was  to provide  funds  for                                                               
programs  that would  curb one  of the  most expensive  habits in                                                               
this state.                                                                                                                     
CHAIR  WILSON agreed  with Representative  Cissna on  that point,                                                               
but noted  that in the original  bill, the tax was  actually much                                                               
higher than the one that passed the legislature.                                                                                
Number 0779                                                                                                                     
REPRESENTATIVE  CISSNA  commented  that  may  be  true,  but  the                                                               
problem has not decreased; if anything, it has increased.                                                                       
CHAIR  WILSON  responded  that  unfortunately  [the  legislature]                                                               
cannot designate  where the funds  go.  She commented  that maybe                                                               
the legislature would have been  able to prevent these reductions                                                               
if the higher tax had passed.                                                                                                   
REPRESENTATIVE CISSNA  said the tax  is in  place.  She  told the                                                               
committee she  has an  amendment she would  like to  introduce at                                                               
the appropriate time.                                                                                                           
CHAIR WILSON told the committee she  wants to be advised ahead of                                                               
time when a member has an amendment.                                                                                            
Number 0711                                                                                                                     
MR.  LINDSTROM  told  the  committee passing  this  bill  is  the                                                               
appropriate thing  to do.  It  is the only statutory  local match                                                               
requirement that  exists.  He said  there is another area  in the                                                               
governor's budget  for FY 04  that he believes will  address some                                                               
of  Representative Cissna's  concerns.    There is  approximately                                                               
$3.5  million  in  alcohol  tax  receipts  for  new  programmatic                                                               
efforts,  and there  is an  expectation that  the program,  under                                                               
[the administration's]  emphasis on maximizing  federal receipts,                                                               
ought to be  able to generate a significant  amount of additional                                                               
federal dollars for the Medicaid  program by leveraging that $3.5                                                               
million.    Mr. Lindstrom  offered  to  get that  information  on                                                               
additional substance  abuse treatment proposed in  the governor's                                                               
Number 0599                                                                                                                     
CHAIR WILSON  referred to  page 1, lines  8-11, which  says, "The                                                               
department may  waive all or  part of the requirement  that state                                                               
money be matched by community  money if the department finds that                                                               
community money is  unavailable and waiver of  the requirement is                                                               
in the best interests of the  state."  She asked Mr. Lindstrom to                                                               
explain that language.                                                                                                          
Number 0544                                                                                                                     
MR. LINDSTROM referred  to a spreadsheet in the  bill packet that                                                               
was labeled "SB  124/HB 167 Increase in  Local Match Requirements                                                               
for  Substance  Abuse  Grants  (Revised  3/12)."    He  told  the                                                               
committee  that  exempted  from community  grant  match  are  the                                                               
community-based  suicide-prevention projects  and those  projects                                                               
that are  less than $30,000.   He said in these  cases either the                                                               
communities do  not have a local  match at all or  other programs                                                               
that are  services for  families would remain  at the  10 percent                                                               
match.   Community prevention services  under $30,000  would also                                                               
remain  at  the  10  percent  match.    Mr.  Lindstrom  told  the                                                               
committee  the  language provides  for  the  department to  waive                                                               
match requirements in full or in part under a hardship.                                                                         
Number 0425                                                                                                                     
REPRESENTATIVE WOLF asked if the  grantees are normally nonprofit                                                               
MR. LINDSTROM answered in the affirmative.                                                                                      
REPRESENTATIVE  WOLF pointed  out that  these organizations  have                                                               
the  ability to  seek  corporate or  federal  grants outside  the                                                               
[state] government sector.                                                                                                      
CHAIR  WILSON  asked  Representative  Wolf to  expand  on  grants                                                               
obtained from sources other than state government.                                                                              
Number 0381                                                                                                                     
REPRESENTATIVE  WOLF  referred  to 501(c)(3)  nonprofit  funding,                                                               
which he  said is virtually untapped  nationwide.  Representative                                                               
Wolf  told the  committee there  was over  $160 million  in grant                                                               
funding that  was not applied  for last  year.  If  the nonprofit                                                               
organizations  in  the state  of  Alaska  were more  enthusiastic                                                               
about  trying to  build  partners, he  said, it  would  be a  lot                                                               
easier to accommodate these programs.                                                                                           
REPRESENTATIVE  CISSNA  asked  if groups  that  this  legislation                                                               
affects are  existing nonprofits  and if  the new  programs being                                                               
suggested by  the governor's legislation  are also  nonprofits or                                                               
are government programs.                                                                                                        
Number 0273                                                                                                                     
MR.  LINDSTROM  replied  that  virtually   all  support  for  the                                                               
substance abuse  treatment programs  are for  "our grant  in aid"                                                               
program to  nonprofits.  He  said he believes the  priorities for                                                               
the  additional funding  are for  women and  children's services,                                                               
particularly for families  that may be involved  in the child-in-                                                               
need-of-aid  system.     He  said  there  is   also  emphasis  on                                                               
adolescent treatment in rural areas.                                                                                            
Number 0221                                                                                                                     
REPRESENTATIVE KAPSNER asked why a 25 percent match was chosen.                                                                 
MR. LINDSTROM  replied that  the suggestion  at the  first budget                                                               
meeting  was that  25  percent was  the standard  in  all of  the                                                               
department's grant  programs.  However,  he said  he subsequently                                                               
learned that  really is  not true.   It is  the standard  for the                                                               
most analogous grant program, which  is for mental health grants.                                                               
He told  the committee there  is a  wide variety of  match rates.                                                               
Mr.  Lindstrom said  it was  stated by  the former  director that                                                               
this is  relatively low;  in looking for  budget savings,  it was                                                               
something that  rose to the  top of the list  as one of  the most                                                               
feasible and least harmful things to propose.                                                                                   
REPRESENTATIVE KAPSNER  asked Mr.  Lindstrom if  he has  rates of                                                               
alcohol consumption  versus crime.   She asked if he  could think                                                               
about that with respect to cost to the state.                                                                                   
MR.  LINDSTROM replied  that  there is  a  wealth of  information                                                               
about  that  subject  and  a recently  published  report  by  the                                                               
criminal justice  assessment commission, which compiles  a lot of                                                               
alcohol-related  statistics.    He  said  he  has  found  in  his                                                               
conversations  with law  enforcement and  corrections staff  that                                                               
there is a very high  percentage of criminal behavior where there                                                               
is substance abuse involved.                                                                                                    
Number 0003                                                                                                                     
REPRESENTATIVE KAPSNER  asked if the department  considered using                                                               
a sliding  scale for the  communities that could least  afford to                                                               
pay for  the services.   For  instance, municipal  assistance and                                                               
revenue sharing  is going to  go down  this year, and  there have                                                               
been  huge decreases  in that  program over  the last  ten years.                                                               
Many  communities  are  not faring  well  with  timber,  mineral,                                                               
tourism, and oil markets such as  they are.  Would the department                                                               
consider a sliding  scale for communities that can  afford to pay                                                               
TAPE 03-26A, SIDE A                                                                                                           
Number 0013                                                                                                                     
MR.  LINDSTROM  said  he  did  not believe  that  there  was  any                                                               
expectation that  local governments would be  stepping forward to                                                               
make up the  shortfall.  It was much more  of an expectation that                                                               
through various  types of fundraising, grants,  and other sources                                                               
of  funds, the  nonprofits would  generate the  additional match.                                                               
Mr. Lindstrom said  that there is an expectation that  all of the                                                               
treatment providers in  the system offer a  sliding-fee scale for                                                               
the  clients who  come  in to  be  served.   This  is the  public                                                               
treatment  system, so  the patients  tend to  be very  low-income                                                               
REPRESENTATIVE  KAPSNER replied  that her  understanding is  that                                                               
communities  would  be  asked  to   pay,  and  asked  if  she  is                                                               
misreading the bill.                                                                                                            
MR. LINDSTROM replied  that the word "community" is  in the broad                                                               
sense of  the word, and  not referring  to local government.   He                                                               
pointed   out  the   exemptions  for   very  small   communities,                                                               
particularly  those communities  that  only  receive the  suicide                                                               
prevention  grant, which  is  approximately  $12,000 to  $17,000.                                                               
There is not the expectation of a match from those communities.                                                                 
Number 0166                                                                                                                     
REPRESENTATIVE KAPSNER  asked what  the waitlist  is for  some of                                                               
these treatments programs.                                                                                                      
Number 0177                                                                                                                     
MR. LINDSTROM responded that there  is an updated waitlist report                                                               
that  he has  not yet  seen.   It  was  due in  January or  early                                                               
February.   He said  he would get  a copy of  that report  to the                                                               
committee.   Mr. Lindstrom  said he  heard discussions  about the                                                               
report  and  believes  the  number is  similar  to  the  previous                                                               
waitlist, which  is very significant  in many areas of  the state                                                               
at  any given  time.   The waitlist  report from  a year  ago was                                                               
about 300 individuals waiting for treatment.                                                                                    
REPRESENTATIVE  WOLF said  for  the record  that  many state  and                                                               
federal   governments   recognize  nonprofit   organizations   as                                                               
community organizations.  The 25  percent match for nonprofits is                                                               
a  comparatively   low  number.    Most   government  grants  for                                                               
nonprofit, community-based organizations start  at 33 percent and                                                               
go up from  there.  He told  the committee he has  seen a two-to-                                                               
one match, so  a 25 percent match  is a low number.   By bringing                                                               
in the community,  the organization has an  opportunity to expand                                                               
understanding  and  knowledge  of   the  care  that  organization                                                               
provides.   He  told the  committee bonding  and stewardship  are                                                               
very  tough to  regulate, and  a  lot easier  to educate  [people                                                               
Number 0340                                                                                                                     
REPRESENTATIVE  GATTO said  the state  spends a  lot of  money on                                                               
substance  abuse treatment  and he  is  curious if  the state  is                                                               
getting anything  out of  it.  Do  [these programs]  cure people,                                                               
and if they  do, is it a  percent or a serious number?   He asked                                                               
Mr. Lindstrom  what the success rate  is over one, five,  and ten                                                               
years,  having people  be drug-free  for 24  and 48  hours before                                                               
they  come back.    Does  [the state]  have  numbers to  indicate                                                               
success in all the money the state spends?                                                                                      
MR.  LINDSTROM pointed  to the  "New Standards  Report of  1998,"                                                               
where  a firm  came in  under  contract and  did a  study on  the                                                               
success  rates of  alcohol  and substance  abuse  programs.   The                                                               
conclusion was  that programs  are effective.   He said  the most                                                               
compelling  discussion he  has heard  on  this issue  was from  a                                                               
previous director of the division,  Ernie Turner, who changed the                                                               
way Mr.  Lindstrom thought  about alcohol  abuse.   Mr. Lindstrom                                                               
said  he and  most  of the  folks in  the  health care  community                                                               
believe  that defining  what success  means is  important because                                                               
alcoholism is a disease that  is chronic, progressive, and if not                                                               
treated  the outcome  is  death.   In  thinking  about any  other                                                               
chronic disease, one  would not ask this kind of  question.  If a                                                               
person  has diabetes  or chronic  diseases and  is treated,  gets                                                               
better,  and then  subsequently  is required  to be  hospitalized                                                               
again,  there  would  not  be   the  suggestion  that  the  first                                                               
treatment was a failure in some sense, Mr. Lindstrom commented.                                                                 
Number 0511                                                                                                                     
MR. LINDSTROM went on to say  that there is recognition that with                                                               
some chronic diseases  there are some people who will  be able to                                                               
go on  and not have  a relapse; however,  it is not  uncommon for                                                               
there  to be  a  relapse.   The  short answer  is  that there  is                                                               
success, but  not 100  percent success, the  first time;  for the                                                               
rest of their lives, that answer is no.                                                                                         
Number 0603                                                                                                                     
REPRESENTATIVE GATTO  told Mr. Lindstrom  he understands  what he                                                               
is saying, but  diabetics are told that unless  they take insulin                                                               
every day  for the rest  of their lives,  they will get  sick and                                                               
die.   If a  person does  not take it  and gets  sick, that  is a                                                               
problem with  a person  who is  abusing himself  or herself.   He                                                               
said he  is more concerned about  a person who is  a diabetic who                                                               
does  the right  thing,  watches his/her  diet, and  occasionally                                                               
comes back.   That  is quite a  different story.   Representative                                                               
Gatto said  he is not expecting  100 percent of anything,  but he                                                               
said he is  expecting a number that  says this is not  a waste of                                                               
state money.   He said the  legislature is spending a  great deal                                                               
of  money and  that he  gets a  lot of  input from  the community                                                               
concerning repeat offenders.                                                                                                    
REPRESENTATIVE GATTO  shared that after  25 years on  the streets                                                               
of Anchorage as a paramedic, he  can tell the first names, second                                                               
names, and  family names of  people who  come back over  and over                                                               
again.   He  offered his  belief that  these individuals  have no                                                               
interest in  any kind of a  cure.  Their main  interest is living                                                               
on the dole.  That is their  primary goal in life.  He questioned                                                               
whether the state  wants to support people whose  primary goal is                                                               
to live on the dole.                                                                                                            
Number 0661                                                                                                                     
MR.  LINDSTROM apologize  for overstating  the  case for  alcohol                                                               
treatment, and he said  he would get a copy of  the report to the                                                               
committee.   He said  treatment does  have good  value and  he is                                                               
well aware  of the situations Representative  Gatto described and                                                               
does not dispute for one second that they [exist].                                                                              
Number 0709                                                                                                                     
PAM  WATTS,  Executive  Director, Governor's  Advisory  Board  on                                                               
Alcoholism   and  Drug   Abuse,  Office   of  the   Commissioner,                                                               
Department of  Health and Social  Services, testified on  HB 167.                                                               
She  said  that while  she  did  not  hear  all of  the  previous                                                               
testimony,  what she  heard was  very  important.   She told  the                                                               
committee  when looking  at legislation  that  changes the  match                                                               
rate  from 10  percent  to  25 percent,  the  committee needs  to                                                               
acknowledge  that  the  Division  of Alcoholism  and  Drug  Abuse                                                               
funding has  been flat  for approximately 10  years.   There have                                                               
been a  lot of discussions about  inflation-proofing funding, and                                                               
that has not been done with  this program.  She said the grantees                                                               
have had cuts over the past  10 years, and this will increase the                                                               
burden on them.                                                                                                                 
MS. WATTS pointed  out that the client population  served by this                                                               
program is either very low-income  or indigent, so while there is                                                               
a sliding-fee scale, the ability  to collect from this population                                                               
is extremely limited.   The Veterans' Administration  used to pay                                                               
for  some of  this treatment;  however, that  is now  impossible.                                                               
Providers used  to be  able to  collect permanent  fund dividends                                                               
from some  of these  folks, but child  support enforcement  and a                                                               
lot of  other important entities  are first  on the list  in that                                                               
regard.    If current  legislation  being  proposed to  take  the                                                               
permanent fund  dividend away from  individuals who  are arrested                                                               
for  driving under  the influence  [passes],  providers will  not                                                               
have  that any  longer  either.   Many of  these  people are  not                                                               
employed.   Ms.  Watts said  she understands  what the  committee                                                               
members  have  said,  that there  should  be  accountability  for                                                               
treatment, and many  times down the road once  they have received                                                               
treatment, become productive,  and can pay for  treatment, "we do                                                               
receive it."                                                                                                                    
Number 0919                                                                                                                     
CHAIR WILSON asked Ms. Watts  how often individuals who have been                                                               
through treatment come back and pay for that treatment.                                                                         
MS. WATTS said when she worked  as a treatment provider for eight                                                               
and  a  half  years  [both residential  services  and  outpatient                                                               
prevention  services], the  big-ticket item  was the  residential                                                               
services.   Unfortunately,  those  are the  people  who are  most                                                               
severely impaired.   That is why  residential treatment sometimes                                                               
is not as  successful as outpatient treatment,  because these are                                                               
really late-stage people.   Many of them  were provided treatment                                                               
on  a sliding-fee  scale,  and some  of them  were  right out  of                                                               
corrections; some of them had no  cash.  They were on a treatment                                                               
plan,  and it  would not  be  very much  a month,  but they  were                                                               
paying something.   If  the individual did  not pay  anything, it                                                               
was turned over to collections.                                                                                                 
MS. WATTS  told of a  provider in Seward  that says if  its match                                                               
rate  goes up,  it will  be very  difficult because  it gets  its                                                               
[matching funds] from clients.                                                                                                  
Number 0930                                                                                                                     
MS. WATTS  responded to Representative  Gatto's question  and Mr.                                                               
Lindstrom's comment on  the New Standards Study,  which does show                                                               
that  Alaska  is  not only  comparable  in  successful  treatment                                                               
outcomes compared  to the  rest of the  country, but  showed that                                                               
Alaska was  slightly above the  national average.  Right  now the                                                               
Mental Health Trust  Authority and the legislature  are funding a                                                               
study  through the  University  of Alaska  to  give more  current                                                               
information  about  treatment  outcomes.     As  soon  as  it  is                                                               
available,  she  said,   she  will  make  it   available  to  the                                                               
Number 1042                                                                                                                     
MS. WATTS strongly encouraged the  committee to keep the language                                                               
intact  that refers  to  the department's  ability  to waive  the                                                               
match  if  the  department  determines that  community  money  is                                                               
unavailable and a waiver is in the best interest of the state.                                                                  
Number 1068                                                                                                                     
MATT  FELIX,   National  Council  on  Alcoholism,   testified  in                                                               
opposition to  HB 167.  He  gave a brief description  of his long                                                               
career in the alcoholism treatment  field.  He told the committee                                                               
he believes this bill is not  needed because the 25 percent match                                                               
is a goal  that most community nonprofits cannot  reach in public                                                               
programs.  He pointed out that  with this population, by the time                                                               
they  need treatment,  most of  their  resources are  gone.   The                                                               
grant-in-aid regulations  under Governor  Hickel found  that this                                                               
is a  very efficient  way of  providing services  and that  it is                                                               
probably done  at a third  of the  cost of providing  services by                                                               
state  employees.   The  grant-in-aid  regulations  by the  state                                                               
require a nonprofit  to charge for those services.   The provider                                                               
is  required   to  use  the   federal  regulations   for  poverty                                                               
guidelines on a sliding-fee scale.   Some of these people can pay                                                               
and  some do.    He said  when  he was  running  the hospital  in                                                               
Juneau,  city  government  provided  some of  the  funding.    In                                                               
Anchorage,  the  city would  receive  the  same grant  and  match                                                               
funding  for programs  or  nonprofits, but  it  was difficult  to                                                               
match because the funds were  substantial.  Since the late 1980s,                                                               
Anchorage has  decided not to  match funding, and since  the late                                                               
1990s, the city of Juneau has decided not to either.                                                                            
MR.  FELIX said  in  rural  Alaska there  has  been  a hard  time                                                               
reaching the 10 percent match.   The people out there do not have                                                               
the  ability  to pay  at  all.   He  said  he  recalls that  some                                                               
individuals paid in fish and handmade products.                                                                                 
Number 1313                                                                                                                     
CHAIR  WILSON announced  that  she would  end  testimony at  this                                                               
time.  [HB 167 was held over.]                                                                                                  

Document Name Date/Time Subjects