Legislature(2009 - 2010)CAPITOL 106

03/16/2010 03:00 PM HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Presentation: Using HIT for TELECONFERENCED
Evidence-based Medical Practices,
by Dr. Alex Cahana
<Above Item Removed from Agenda>
Moved CSHR 14(HSS) Out of Committee
Moved CSHB 328(HSS) Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
Moved Out of Committee
         HB 328-TRAUMATIC BRAIN INJURY:PROGRAM/MEDICAID                                                                     
3:37:04 PM                                                                                                                    
CO-CHAIR HERRON announced  that the final order  of business would                                                              
be  HOUSE  BILL NO.  328,  "An  Act establishing  a  traumatic  or                                                              
acquired brain injury  program and registry within  the Department                                                              
of  Health   and  Social   Services;  and   relating  to   medical                                                              
assistance  coverage  for  traumatic   or  acquired  brain  injury                                                              
JEANNE OSTNES, Staff to Representative Craig Johnson, Alaska                                                                    
State Legislature, read from the sponsor statement:                                                                             
     House  Bill  328 establishes  a  traumatic  or  acquired                                                                   
     brain injury  program and registry in the  Department of                                                                   
     Health  and  Social Services.    Alaska has  no  program                                                                   
     specifically  to deal with  brain injury and  yet Alaska                                                                   
     has one of  the highest rates in the nation.   Annually,                                                                   
     there  are 800  Alaskans hospitalized  with a  traumatic                                                                   
     brain  injury  each  year   resulting  from  falls,  car                                                                   
     crashes,   domestic   violence,  All   Terrain   Vehicle                                                                   
     crashes, and  snowmachine crashes, among others.   There                                                                   
     are   an   approximately  equal   number   of   Alaskans                                                                   
     suffering  from acquired brain  injuries resulting  from                                                                   
     stroke, aneurism, or tumors.                                                                                               
     Alaska  urban and  rural residents,  including  military                                                                   
     are  being   discharged  to  their  homes   with  little                                                                   
     understanding  of brain  injury  or access  to  in-state                                                                   
     rehabilitation,   severely  impacting  their   families.                                                                   
     Limited  education about  the injury,  learning to  cope                                                                   
     with  a  person who  has  changed,  overwhelming  stress                                                                   
     from insurance,  bureaucracy, and financial  burdens and                                                                   
     change   in    family   roles   may    render   families                                                                   
     With  appropriate  and available  care,  rehabilitation,                                                                   
     community  and family support,  even the individual  who                                                                   
     is most  severely injured  can live  at home, return  to                                                                   
     school or work,  or engage in meaningful  and productive                                                                   
     Funding  a Traumatic  or Acquired  Brain Injury  (T/ABI)                                                                   
     Program  gives authority  to the  department to  collect                                                                   
     data  on the injured,  positioning  the state to  access                                                                   
     Medicaid funds  for T/ABI.  Medicaid services  for T/ABI                                                                   
     will be matched  50% by federal funds.   The bill allows                                                                   
     for  streamlining  department  services  and  activities                                                                   
     that  are unique  to T/ABI.   This  would better  assist                                                                   
     families and  individuals with  T/ABI in knowing  how to                                                                   
     access services and supports.                                                                                              
     Early  treatment may  reduce future  medical and  social                                                                   
     costs.   Without appropriate services,  some individuals                                                                   
     with T/ABI  may pose a  threat to themselves  or others.                                                                   
     Without assistance,  individuals with  TBI often  end up                                                                   
     homeless,  in  jail  or  in   nursing  homes.    Service                                                                   
     coordination,  rehabilitation, and appropriate  supports                                                                   
     can help to minimize these risks.                                                                                          
3:40:53 PM                                                                                                                    
REPRESENTATIVE  T. WILSON asked  if there would  be any  costs for                                                              
the new registry.                                                                                                               
MS. OSTNES  directed attention  to the  fiscal note, which  stated                                                              
that 60 percent of the cost was covered by Medicaid.                                                                            
3:41:39 PM                                                                                                                    
CO-CHAIR  HERRON noted  that  there were  still  questions on  the                                                              
fiscal note.                                                                                                                    
3:42:52 PM                                                                                                                    
JESSI CHAPMAN, speaking  through a dyna box, related  that she had                                                              
suffered a  TBI in  2006 and was  now a  mute and a  quadriplegic.                                                              
She said  that after her  accident she  was not given  much chance                                                              
for any  recovery.  She relayed  that her grandmother  brought her                                                              
home, and nursed  her until she  came out of her coma  many months                                                              
later.   At that point,  she had to  return to Seattle  many times                                                              
for  surgery and  therapy,  as neither  was  available in  Alaska.                                                              
She noted  that she  was still classified  as a  child, so  that a                                                              
waiver  was   available.    She   said  that  her  age,   and  her                                                              
grandmother's strong  advocacy for her,  was the only  reason that                                                              
the therapies became  available.  She indicated  that her injuries                                                              
were neurological,  and because  of waivers,  she was now  able to                                                              
move her  extremities and speak  a little.   She pointed  out that                                                              
it was  necessary to  have a case  manager, as  you could  not get                                                              
appointments  without referrals.   She  pointed out  that, if  you                                                              
have  no resources  and  limited  cognitive capabilities,  it  was                                                              
extremely   difficult  to  get   any  help.     She  shared   that                                                              
neurological  testing was  not available  in Alaska.   She  stated                                                              
her support for HB 328.                                                                                                         
3:46:46 PM                                                                                                                    
PAT  CHAPMAN (Jessi's  grandmother)  informed  the committee  that                                                              
she collected  the data  on brain injuries  and other  traumas and                                                              
that  she  worked  in  the  emergency  room.    She  stressed  the                                                              
importance  of getting services  to people  who had suffered  TBI,                                                              
especially  those who were  not hospitalized,  so that  they could                                                              
return to being contributing members of the community.                                                                          
3:48:23 PM                                                                                                                    
BOYD  MACFAIL, Legislative  Affairs Coordinator,  said that  ABATE                                                              
would support  HB 328, but that  there was some language  to which                                                              
they were opposed on  page 4, lines 7 - 8.  He  asked that "to the                                                              
prevention of traumatic  or acquired brain injury  and" be removed                                                              
from  the bill.   ABATE  was concerned  that this  would become  a                                                              
means  for the  legislature  to impose  mandatory  helmet laws  on                                                              
motorcyclists.   He stated that ABATE  was not opposed  to the use                                                              
of helmets,  and advised  riders to  wear helmets; however,  ABATE                                                              
was opposed  to the  idea of  mandatory helmet  laws.   He offered                                                              
his  belief  that the  mandatory  helmet  laws would  not  prevent                                                              
brain  injuries because  of the  impact to the  brain upon  sudden                                                              
contact.  He stated  support by ABATE for HB 328,  if that section                                                              
was removed.                                                                                                                    
3:51:31 PM                                                                                                                    
ROBERT  LADA,  Neurologist,  Providence   Alaska  Medical  Center,                                                              
stated that  a more  coordinated effort for  TBI patient  care and                                                              
options was  necessary.  He reported  that most TBI  patients were                                                              
not hospitalized and  received little follow up care.   He pointed                                                              
out  that, when  injuries  were  not obvious,  it  resulted in  an                                                              
inability to find  treatment and therapy.  He declared  a need for                                                              
better initial evaluation  for a greater success to  recovery.  He                                                              
stated the need  for the collection of more data.   He offered his                                                              
support for HB 328.                                                                                                             
3:53:58 PM                                                                                                                    
ELENA RATH, Board  Member, Alaska Brain Injury  Network, explained                                                              
that  the  Alaska  Brain  Injury Network  was  a  statewide  group                                                              
working to help  people find the necessary resources,  and to help                                                              
set goals  for the  best brain  injury practices  in Alaska.   She                                                              
shared  her  personal  experiences   with  brain  injuries.    She                                                              
supported the  increase of  case managers  and data collection  in                                                              
HB 328.                                                                                                                         
3:55:33 PM                                                                                                                    
KRISTIN  ENGLISH,  Chief  Operating  Officer,  Cook  Inlet  Tribal                                                              
Council (CITC), said  that CITC supported HB 328  and the creation                                                              
of a  traumatic brain injury  program in  Alaska.  She  cited that                                                              
TBI  often  resulted  in  long  term  disability  and  a  loss  of                                                              
socially  appropriate behavior.   She noted  a strong  correlation                                                              
between  TBI  and  substance  abuse.   She  pointed  out  that  46                                                              
percent  of the  patients  at  the residential  treatment  program                                                              
were  reported with  some sort  of TBI.   She said  that this  was                                                              
consistent with statewide  records.  She opined that  HB 328 would                                                              
establish  an information  data base  and a  funding mechanism  to                                                              
access federal funds.                                                                                                           
3:58:34 PM                                                                                                                    
CHRISTIE ARTUSO,  Director Of  Neuro Science Services,  Providence                                                              
Alaska Medical Center,  reported that HB 328 would  facilitate the                                                              
collaborative efforts  of the Alaskan health providers  to provide                                                              
services  for   TBI  patients  whose   needs  had   been  somewhat                                                              
neglected.   She estimated  that  10,000 people  may have  mild to                                                              
moderate  brain injury not  requiring hospitalization.    She said                                                              
that the  estimate  for those requiring  care  this year was  more                                                              
than 1,000  patients.   She said  that it  was necessary  for case                                                              
managers  to   coordinate  care,   community  reentry,   cognitive                                                              
therapy, and  a supportive  environment.   She stated  her support                                                              
for HB 328.                                                                                                                     
4:00:29 PM                                                                                                                    
The committee took an at-ease from 4:00 p.m. to 4:01 p.m.                                                                       
4:01:42 PM                                                                                                                    
JILL  HODGES,  Executive  Director, Alaska  Brain  Injury  Network                                                              
(ABIN),  said that  HB  328  established a  longitudinal  registry                                                              
which establishes brain  injury as an acute and  chronic long term                                                              
condition.   This would allow  measurement of brain  injuries over                                                              
time,  and  a determination  of  which  services had  helped  each                                                              
individual.  It  would also establish a statewide  traumatic brain                                                              
injury  program,   which  would  allow  direct  support   for  TBI                                                              
patients.  She  pointed out that this would immediately  allow for                                                              
coordinated  case management  of  360 Alaskans,  would  contribute                                                              
federal funding,  and would serve  both urban and  rural Alaskans.                                                              
She  directed  attention   that  case  management   would  now  be                                                              
delivered  by non-profit,  community  providers.    She noted  the                                                              
increased  workforce  enhancement   for  coordinated  care.    She                                                              
established  that  TBI patients  could  recover for  a  meaningful                                                              
life, given  the proper  treatment and support.   She  stated that                                                              
"HB 328 is the  mechanism to help families move  forward with life                                                              
after brain injury."                                                                                                            
4:07:24 PM                                                                                                                    
JOANNE  GIBBENS,  Deputy  Director, Central  Office,  Division  of                                                              
Senior  and  Disabilities  Services,   Department  of  Health  and                                                              
Social Services,  in response  to Co-Chair  Herron, said  that the                                                              
administration's  position on  HB 328  was neutral.   She  relayed                                                              
that  an  upcoming  amendment  would  address  concerns  that  the                                                              
definition of  case management meet  the federal definition.   She                                                              
reported  that HB 328  allowed HHSS  to bill  for case  management                                                              
services for  individuals with TBI  and Acquired TBI.   She stated                                                              
that  the fiscal  note  was a  projection for  the  number of  new                                                              
people  that would  be served,  and the  case management  services                                                              
for  those  currently being  served.    She  said that  there  was                                                              
currently  a waiver  service  for  about 100  TBI  patients.   She                                                              
pointed  out   that  this  was   referred  to  as   targeted  case                                                              
management by Medicaid.                                                                                                         
4:09:49 PM                                                                                                                    
REPRESENTATIVE  T. WILSON  asked for  an explanation  to a  waiver                                                              
4:09:58 PM                                                                                                                    
MS. GIBBENS  said that  the federal  government allowed  states to                                                              
apply  for  services  to  populations  that  waive  other  federal                                                              
requirements.   These waivers  meet specific  criteria for  levels                                                              
of care  and financial  eligibility, and  they enable  specialized                                                              
populations  to   receive  specialized  services   which  are  not                                                              
available  to everyone  on Medicaid.   She  gave an  example of  a                                                              
nursing facility level of care waiver.                                                                                          
4:11:37 PM                                                                                                                    
REPRESENTATIVE T.  WILSON directed  attention to the  fiscal note,                                                              
and asked if the physicians were paid.                                                                                          
MS. GIBBENS explained  the funding, and pointed out  that, in this                                                              
case, the department already had the existing staff.                                                                            
4:12:44 PM                                                                                                                    
REPRESENTATIVE    HOLMES,    noting   the    increased    Medicaid                                                              
projections, stated  that the legislature was struggling  with the                                                              
mandatory  versus the optional  Medicaid  services.  She  proposed                                                              
that  it  might be  necessary  to  ask  Department of  Health  and                                                              
Social  Services to  prioritize  any Medicaid  budget  cuts.   She                                                              
questioned the accuracy of the fiscal note.                                                                                     
4:15:03 PM                                                                                                                    
MS. GIBBENS,  in response to  Representative Holmes, said  that it                                                              
was  difficult to  know the  costs  in advance,  but she  believed                                                              
that existing resources would allow for the projected cost.                                                                     
4:15:49 PM                                                                                                                    
CO-CHAIR  KELLER  asked  to clarify  that  the  expanded  Medicaid                                                              
costs  would  be split,  with  the  federal government  paying  60                                                              
percent.   He asked if the  projected cost division of  50 percent                                                              
from the federal government was because of the stimulus money.                                                                  
4:16:20 PM                                                                                                                    
MS. GIBBENS agreed.                                                                                                             
4:16:27 PM                                                                                                                    
CO-CHAIR  KELLER asked  to clarify  that the  costs per capita  on                                                              
the  fiscal  note were  low  because  HB  328 only  reflected  the                                                              
increased cost for case management.                                                                                             
4:17:23 PM                                                                                                                    
CO-CHAIR KELLER  asked if this  would lead to additional  services                                                              
for TBI patients.                                                                                                               
MS. GIBBENS  replied that HB 328  focused on case  management, and                                                              
did not add any additional services.                                                                                            
4:18:14 PM                                                                                                                    
CO-CHAIR KELLER  agreed with Representative  Holmes that  it would                                                              
become necessary to determine a level of future funding.                                                                        
4:19:11 PM                                                                                                                    
MS. GIBBENS,  in response to  Representative T. Wilson,  said that                                                              
DHSS had  determined $250 for case  management services to  be the                                                              
per month per patient cost.                                                                                                     
4:20:39 PM                                                                                                                    
MS.  GIBBENS, in  response to  Representative  T. Wilson,  replied                                                              
that  the  $100  was  per existing  patient,  as  opposed  to  new                                                              
patients, who would need ongoing case management.                                                                               
4:21:41 PM                                                                                                                    
MS. GIBBENS, in  response to Representative T.  Wilson, pointed to                                                              
the fund  source section and explained  that the 39  percent state                                                              
match was  listed in  the general  fund.   She explained  that the                                                              
total amount was  for the case management and  that the difference                                                              
in the  subsequent years was due  to the different  federal dollar                                                              
4:23:23 PM                                                                                                                    
REPRESENTATIVE SEATON  asked if  the state currently  had Medicaid                                                              
case management for other diseases.                                                                                             
MS.  GIBBENS offered  her  belief  that targeted  case  management                                                              
existed for pregnant women, and for early infant learning.                                                                      
4:24:19 PM                                                                                                                    
JON   SHERWOOD,  Medicaid   Special   Projects,   Office  of   the                                                              
Commissioner,  Department of  Health and  Social Services  (DHSS),                                                              
added  that  targeted case  management  also  included  behavioral                                                              
health  for  severely emotionally  disturbed  children,  substance                                                              
abuse,  and severely  chronically  mentally ill.    He offered  to                                                              
supply the complete list of targeted case management.                                                                           
4:24:59 PM                                                                                                                    
REPRESENTATIVE  SEATON  asked  whether autism  and  diabetes  were                                                              
also included.                                                                                                                  
MR.  SHERWOOD  said  that  he  was  not  aware  of  targeted  case                                                              
management  for these  groups specifically,  and  he would  report                                                              
whether either was included within another group.                                                                               
4:25:28 PM                                                                                                                    
REPRESENTATIVE  SEATON  asked if  being  in statute  guaranteed  a                                                              
priority status during a budget reduction.                                                                                      
MR. SHERWOOD  replied that  the current  statute for cost  control                                                              
was  discretionary   in  allowing  DHSS  to  make   reductions  in                                                              
"amount, duration,  and scope of services."  He  shared that there                                                              
was no  longer a priority  list of services.   He noted  that DHSS                                                              
had  discretion   to  make  reductions   in  amounts   of  service                                                              
available.  He pointed  out that if HB 328 was  not in statute, it                                                              
might  not  become  a  service,  but that  it  would  not  have  a                                                              
4:27:23 PM                                                                                                                    
CO-CHAIR  HERRON  commented  that   DHSS  did  not  need  all  the                                                              
4:27:58 PM                                                                                                                    
REPRESENTATIVE  HOLMES,  referring  to  the two  new  DHSS  staff,                                                              
asked what  their responsibilities  would be  if the bill  did not                                                              
MS.  GIBBENS  replied  that  both   had  other  care  coordination                                                              
4:28:41 PM                                                                                                                    
CO-CHAIR HERRON closed public testimony.                                                                                        
4:28:50 PM                                                                                                                    
CO-CHAIR  HERRON   moved  to  adopt   Amendment  1,   labeled  26-                                                              
LS1355\E.3, Mischel, 3/2/10, which read:                                                                                        
     Page 2, line 25, through page 3, line 6:                                                                                   
          Delete all material.                                                                                                  
          Insert "services furnished to assist individuals                                                                      
     who   reside  in  a   community  setting   or  who   are                                                                   
     transitioning to  a community setting to gain  access to                                                                   
     needed   medical,   social,   educational,   and   other                                                                   
     available services;"                                                                                                       
4:29:11 PM                                                                                                                    
REPRESENTATIVE SEATON objected for discussion.                                                                                  
4:29:20 PM                                                                                                                    
MS.  OSTNES   explained   that  Amendment   1  allowed  the   case                                                              
management definition  to conform to federal language  for federal                                                              
funding purposes.                                                                                                               
4:29:56 PM                                                                                                                    
REPRESENTATIVE SEATON removed his objection.                                                                                    
There being no objection, it was so ordered.                                                                                    
4:30:12 PM                                                                                                                    
CO-CHAIR  KELLER   moved  to  adopt   Amendment  2,   labeled  26-                                                              
LS1355\E.l, Mischel, 3/1/10, which read:                                                                                        
     Page 4, lines 7 - 8:                                                                                                       
          Delete "and laws pertaining to the prevention of                                                                      
     traumatic or acquired brain injury and"                                                                                    
          Insert "pertaining"                                                                                                   
CO-CHAIR HERRON objected for discussion.                                                                                        
CO-CHAIR  KELLER offered  his belief  that there  was no value  in                                                              
the deleted passage.                                                                                                            
4:31:14 PM                                                                                                                    
REPRESENTATIVE  SEATON agreed that  prevention was important,  and                                                              
asked if  the evaluation  of the  laws was in  the purview  of the                                                              
Alaska Brain Injury Network (ABIN).                                                                                             
4:32:09 PM                                                                                                                    
MS.  OSTNES acknowledged  that  the ABIN  did  research for  other                                                              
data  regarding the  TBI population.   She  did not  know if  ABIN                                                              
reviewed  the   laws.    She   suggested  a  possible   conceptual                                                              
amendment to only delete "traumatic."                                                                                           
4:32:50 PM                                                                                                                    
REPRESENTATIVE  SEATON reflected  that  his desire  was to  ensure                                                              
that  the  law  and  other  mechanisms  for  prevention  were  not                                                              
neglected.  He removed his objection.                                                                                           
4:33:46 PM                                                                                                                    
CO-CHAIR HERRON asked for the sponsor's position.                                                                               
4:33:53 PM                                                                                                                    
MS.  OSTNES  responded  that Representative  Johnson  agreed  with                                                              
Amendment 2.                                                                                                                    
4:34:06 PM                                                                                                                    
REPRESENTATIVE  HOLMES  expressed  agreement  with  Representative                                                              
Seaton,  and stated  that she did  not read  the proposed  passage                                                              
for deletion in  Amendment 2 as a law for the  passage of helmets.                                                              
She  suggested  a  review  of  the  current  laws  for  a  broader                                                              
encouragement of prevention.                                                                                                    
4:34:50 PM                                                                                                                    
CO-CHAIR KELLER  offered his  belief that  this statement  was not                                                              
an appropriate  part of  the program  that was being  established.                                                              
He  declared  that the  amendment  was  not "a  statement  against                                                              
evaluating laws pertaining to prevention."                                                                                      
4:35:22 PM                                                                                                                    
A roll  call vote was taken.   Representatives Cissna,  Holmes, T.                                                              
Wilson, Lynn,  Seaton, and Keller  voted in favor of  Amendment 2.                                                              
Representative Herron  voted against  it.  Therefore,  Amendment 2                                                              
was adopted by a vote of 6-1.                                                                                                   
4:36:44 PM                                                                                                                    
REPRESENTATIVE T.  WILSON expressed concern with  the fiscal note.                                                              
She  declared  that  this  was   "opening  up  another  door  that                                                              
eventually we  may have to tell  people we can't afford  to do any                                                              
longer."  She  expressed appreciation for the bill  with a concern                                                              
for its maintenance.                                                                                                            
4:37:05 PM                                                                                                                    
REPRESENTATIVE SEATON  reminded the  DHSS about its  commitment to                                                              
respond about the priority of retention for services.                                                                           
4:38:12 PM                                                                                                                    
CO-CHAIR  KELLER  moved to  report  HB  328,  as amended,  out  of                                                              
committee  with individual  recommendations  and the  accompanying                                                              
fiscal  notes.   There  being no  objection,  CSHB  328 (HSS)  was                                                              
reported  from  the  House Health  and  Social  Services  Standing                                                              

Document Name Date/Time Subjects
HR14_packet.pdf HHSS 3/16/2010 3:00:00 PM
HB328_packet.pdf HHSS 3/16/2010 3:00:00 PM
HB 328