Legislature(2003 - 2004)

05/08/2003 03:14 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
SB 157-INPATIENT PSYCHIATRIC SERVICES                                                                                         
CHAIR WILSON announced  that the next order of  business would be                                                               
CS FOR  SENATE BILL NO.  157(HES), "An Act relating  to inpatient                                                               
psychiatric services  for persons who  are under 21 years  of age                                                               
and  are either  eligible for  medical assistance  or are  in the                                                               
custody of the Department of Health and Social Services."                                                                       
Number 0243                                                                                                                     
SENATOR LYDA  GREEN, Alaska State  Legislature, as sponsor  of SB
157, explained  the purpose  of the  bill and  answered questions                                                               
from the members.   She told the committee that  SB 157 addresses                                                               
the need and concern about  psychiatric facilities for juveniles.                                                               
Too many  juveniles need services at  psychiatric facilities, and                                                               
currently  there is  a tendency  to  send these  children out  of                                                               
state.   Senator Green  said it  is her  desire to  place greater                                                               
emphasis on  determining if there is  a place in state  for these                                                               
students  where  they  can  remain  closer  to  their  homes  and                                                               
parents, and allow  them to reassimilate into  the community when                                                               
the  time comes.    Having  treatment in  state  would allow  for                                                               
assistance to the  families and other auxiliary  needs that might                                                               
be required when a child requires psychiatric services.                                                                         
SENATOR  GREEN pointed  out  the key  provisions  on the  sponsor                                                               
statement, which  says that the  Department of Health  and Social                                                               
Services  will   not  grant  assistance  or   pay  for  inpatient                                                               
psychiatric care for children under the  age of 21 who are placed                                                               
in  an   out-of-state  facility  unless  adequate   services  are                                                               
unavailable  in the  state.   The  department  will evaluate  the                                                               
types of  services available in  state and  subsequently transfer                                                               
these  students back  to Alaska  when a  room becomes  available,                                                               
unless  the  transfer  would  be  detrimental  to  the  student's                                                               
health, therapeutic  relationship, or clinical needs.   This bill                                                               
would also encourage  those who provide these  services to create                                                               
local facilities so these kids can stay at home.                                                                                
Number 0410                                                                                                                     
SENATOR GREEN  told the  committee that  the bill  identifies two                                                               
classes of individuals.  Section  1 primarily deals with Medicaid                                                               
recipients "in custody  and non-custody."  Sections 2  and 3 deal                                                               
with kids  who are in state  custody.  For  a child is who  is on                                                               
Medicaid there  is one standard,  and for a  child who is  in the                                                               
custody of  the state there  is another  standard.  She  said she                                                               
believes that  the review  process should  be consistent.   State                                                               
regulation currently  mandates the review  process and sets  up a                                                               
review team.   It is a  fairly rigorous system, and  a variety of                                                               
people are required to examine,  review, and determine what is in                                                               
the  best  interest  of  the  child.   It  is  not  an  arbitrary                                                               
decision.   Nor  should it  be.   There are  many steps  that are                                                               
taken  before a  child  is determined  to  be institution  bound.                                                               
Some  of  these  include  foster   care,  special  care,  medical                                                               
treatment, and  group therapy.   There are many  steps, including                                                               
assistance for the  family and the child, to  work through before                                                               
institutionalization is  determined necessary.   These provisions                                                               
are part of the legislation.                                                                                                    
Number 0508                                                                                                                     
CHAIR WILSON  commented that the  state has already  gone through                                                               
several  steps   and  that  those   options  have   already  been                                                               
implemented before this point [institutionalization] is reached.                                                                
SENATOR  GREEN replied  that there  is an  inpatient disciplinary                                                               
team that  would parallel, for  example, an  individual education                                                               
program  (IEP) that  is  designed for  student  education.   They                                                               
review and determine what is needed,  what must be done, and what                                                               
cannot  be  allowed  to  happen.     The  team  would  assist  in                                                               
determining what is the best treatment for that child.                                                                          
Number 0576                                                                                                                     
REPRESENTATIVE  CISSNA commented  that  this  bill addresses  the                                                               
numbers  of youth  who have  been  sent out  of state  relatively                                                               
recently,  as in  the  last ten  years.   She  asked whether  the                                                               
Alaska Youth Initiative (AYI) program relates to any of this.                                                                   
Number 0626                                                                                                                     
SENATOR GREEN responded that AYI is an in-state option.                                                                         
REPRESENTATIVE  CISSNA commented  that  AYI  was historically  an                                                               
extraordinarily successful in-state option  and it is tragic that                                                               
it  is not  available.    She said  she  is  concerned about  the                                                               
language in the  fiscal note [under Analysis] where  it says that                                                               
"this bill  addresses the perception  that our mental  health and                                                               
residential treatment  service system relies too  heavily on out-                                                               
of-state placement".   Representative Cissna said  that those who                                                               
have been deeply involved in  the issue concerning kids' suddenly                                                               
being transferred  out-of-state do not share  the perception that                                                               
it is a fact.  She asked Senator Green to comment on this point.                                                                
Number 0684                                                                                                                     
SENATOR  GREEN replied  that she  could not  speak to  the fiscal                                                               
note  or the  language,  but  she said  that  there  has been  an                                                               
incredible  increase, probably  an anomaly,  since the  advent of                                                               
Denali  KidCare.    Children are  being  transferred  outside  of                                                               
Alaska  without the  interdisciplinary team  focused as  fully as                                                               
would be desired.                                                                                                               
REPRESENTATIVE  CISSNA  asked  if  this  is  being  for  paid  by                                                               
Medicaid funds.                                                                                                                 
SENATOR GREEN responded that is  correct.  Medicaid funding needs                                                               
to be tightened up as well.   This legislation will determine the                                                               
appropriate way of handling these issues.                                                                                       
SENATOR GREEN  noted that Representative  Seaton was  leaving the                                                               
hearing and before he went she  wanted to address a question that                                                               
he  asked  her  staff  about  this legislation.    She  told  the                                                               
committee  that Medicaid  determines how  much will  be paid  for                                                               
treatment.   If  a request  is made  for something  that is  more                                                               
expensive, for example, treatment  that requires that the student                                                               
stay  here versus  sending  the student  out  of state,  Medicaid                                                               
determines the rate.   Senator Green reiterated  that Alaska does                                                               
not have any control over the rate.                                                                                             
Number 0804                                                                                                                     
KATHY CRONEN, Regional Vice  President, Universal Health Services                                                               
(UHS), testified  in support  of SB  157, and  answered questions                                                               
from  committee  members.    She  told  the  committee  that  UHS                                                               
[recently acquired]  North Star Behavioral Health  System ("North                                                               
Star").    Prior  to  her  current position  she  was  the  chief                                                               
executive  officer (CEO)  at North  Star for  the past  18 years.                                                               
She said  she has been  involved daily with/in  decisions related                                                               
to sending  kids outside  of Alaska to  treatment centers  in the                                                               
Lower  48  states.    Currently  there are  300  to  400  Alaskan                                                               
children in residential treatment centers  in the Lower 48.  This                                                               
has  devastating  long-term impacts  on  these  children, on  the                                                               
families, and ultimately  on our state.  Last year  the House and                                                               
Senate  unanimously passed  SCR  21.   This bill  [SB  157] is  a                                                               
formalization of  that resolution to  complete the good  work the                                                               
legislature  started  last year.    Mental  health treatment  and                                                               
follow-up  care  should   be  done  close  to   home,  she  said.                                                               
Coordination between  the residential treatment provider  and the                                                               
ongoing outpatient  treatment provider is essential.   Ms. Cronen                                                               
reiterated  that  it  needs  to   be  done  in  close  proximity.                                                               
Treatment should involve families  because the family's treatment                                                               
is critical  to children's long-term  success.   Family treatment                                                               
that is delivered over the telephone  is just not as effective as                                                               
treatment that is done face-to-face.                                                                                            
Number 0923                                                                                                                     
MS. CRONEN told  the committee that the  legislature's support of                                                               
this bill  will encourage providers like  North Star, Providence,                                                               
or any long-term treatment provider  to expand the number of beds                                                               
because  there  will be  a  commitment  to  keep kids  in  state.                                                               
Valuable Medicaid dollars  are currently being sent  to the Lower                                                               
48, and the state  is losing jobs.  If North  Star were to expand                                                               
beds in Alaska to  meet the needs of the number  of kids that are                                                               
outside, there would be an additional  400 jobs created.  This is                                                               
good  public  policy,  she  said.   It  is  good  for  the  kids'                                                               
treatment; it is good for  families; it keeps Medicaid dollars in                                                               
state; and  it creates  jobs.  Ms.  Cronen said it  is a  win for                                                               
everyone, and she encouraged the members to support the bill.                                                                   
Number 0949                                                                                                                     
REPRESENTATIVE  GATTO said  that  he would  like  to discuss  the                                                               
fiscal note  for the record.   He pointed  out that if  the state                                                               
sends kids  outside of  Alaska, the  state has  to pay  for their                                                               
education; if  the state keeps the  kids here at home,  the state                                                               
pays for  their education.   He  said he does  not know  which is                                                               
more  or less  expensive.   He  asked how  the legislature  knows                                                               
which is more expensive, since the fiscal note says zero?                                                                       
MS.  CRONEN  responded  that  she   can  provide  some  firsthand                                                               
experience because  she is  responsible for  the UHS  facility in                                                               
Provo, Utah.  She said that  30 percent of the student population                                                               
in that  facility is  Alaskan kids.   The  price at  Provo Canyon                                                               
School  is less  than the  price here,  but it  does not  include                                                               
transportation,  nor   does  it   take  into   consideration  the                                                               
treatment outcome of the kids.   The costs can be slightly lower,                                                               
but when adding in the  costs of transportation and education the                                                               
price  is  comparable.   She  said  she believes  the  department                                                               
agrees because it has provided a zero fiscal note.                                                                              
Number 1027                                                                                                                     
REPRESENTATIVE  GATTO  said that  he  has  had discussions  about                                                               
prisoner transfers  to out-of-state facilities where  a number of                                                               
factors  are evaluated  including the  cost, transportation,  and                                                               
the opinion  that there is a  better result if the  prisoners are                                                               
kept  at home.   Is  there any  evidence that  kids that  stay in                                                               
Alaska do better than those sent out of state?                                                                                  
CHAIR WILSON responded  that all the members have to  do is think                                                               
about how  they would feel if  it was their child  being sent out                                                               
of  state.   Would anyone  want  his/her child  to get  treatment                                                               
where the parent could not take part?   She said she thinks it is                                                               
important to look at this legislation  as a policy issue, and not                                                               
look at  the finances.   She said she  believes it is  better for                                                               
the  kids  and  the  families to  have  interaction,  go  through                                                               
treatment together, and try to work  things out.  She pointed out                                                               
that in some instances, parents do  not even have the money to go                                                               
see the kids.   Chair Wilson asked the committee  to look at this                                                               
legislation in that light.                                                                                                      
Number 1093                                                                                                                     
SENATOR GREEN pointed to this  year's supplemental budget wherein                                                               
there  was approximately  [$366,000]  to [$400,000]  supplemental                                                               
request for  educational fees for  out-of-state facilities.   She                                                               
told the  committee that there  was $663,000 in fiscal  year 2002                                                               
(FY 02) and it is expected to  be $866,000 to $870,000 for FY 03.                                                               
The average  cost is $5,160  per student  for an average  of 78.5                                                               
education  days.   Education costs  charged  by facilities  range                                                               
from $38  per day to  $102 per day  in some of  these facilities.                                                               
So if  the $102  rate is  multiplied by  the required  180 school                                                               
days, one can make the leap  very quickly that it is multiples of                                                               
what  the  state  is  providing for  the  education  of  Alaska's                                                               
children in state.  The proposal  is $500,000 for FY 04, but with                                                               
the  continuing increase  of children  going out  of state,  that                                                               
number  will continue  to rise  and certainly  will be  more than                                                               
this year's authorized and supplemental budget of $900,000.                                                                     
Number 1179                                                                                                                     
REPRESENTATIVE CISSNA  commented that  she served on  the Finance                                                               
Subcommittee on Education in 1999  when this issue was looked at.                                                               
At that time  it was more expensive per child  partly because the                                                               
school district  absorbed the  students in  Alaska, but  in cases                                                               
where they  are sent Outside,  the money must  be sent out.   She                                                               
said she was shocked at that time.                                                                                              
REPRESENTATIVE  GATTO asked  how many  of the  children that  are                                                               
sent Outside are returned.                                                                                                      
MS.  CRONEN  responded  that  she believes  that  is  a  clinical                                                               
decision based  on where the  kids are  in treatment and  if they                                                               
are eligible to be returned.                                                                                                    
REPRESENTATIVE GATTO  commented that  there are some  cases where                                                               
it is better to take the child away from the family.                                                                            
MS. CRONEN  replied that  it is  not just  the families  that the                                                               
kids  need  to  be  attached  to.    There  are  many  people  in                                                               
communities that  kids respond to, for  instance, their teachers,                                                               
school  counselor, pastor  or minister,  or  a neighbor.   It  is                                                               
important to keep  kids connected to the healthy  people in their                                                               
lives.  She  said if it is not their  families, and unfortunately                                                               
oftentimes it  is not, then  it is important  to make sure  it is                                                               
someone in their local community.                                                                                               
Number 1313                                                                                                                     
SENATOR  GREEN asked  the members  to look  at page  2, paragraph                                                               
(b), on line 3, where it says:                                                                                                  
      "The department shall, on a monthly basis, evaluate                                                                       
     what types of services are available in the state for                                                                      
     inpatient psychiatric care"                                                                                                
SENATOR GREEN said  on the same page and paragraph  on line 11 it                                                               
says  that the  transfer cannot  be detrimental  to the  person's                                                               
health.    If that  were  the  case,  the  student would  not  be                                                               
transferred.     For   example,  if   there  is   an  established                                                               
therapeutic relationship  or a clinical  need for the  student to                                                               
be Outside,  then the  student would not  be transferred.   There                                                               
would be  a complete review.   She  told the committee  the other                                                               
factor that needs  to be considered in all of  this is that there                                                               
is space available in Alaska.                                                                                                   
Number 1359                                                                                                                     
REPRESENTATIVE  WOLF  moved  to   report  CSSB  157(HES)  out  of                                                               
committee  with individual  recommendations and  the accompanying                                                               
fiscal  notes.   There  being  no  objection, CSSB  157(HES)  was                                                               
reported out of  the House Health, Education  and Social Services                                                               
Standing Committee.                                                                                                             

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