Legislature(2017 - 2018)SENATE FINANCE 532

02/27/2018 09:00 AM FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ SB 105 MARITAL & FAMILY THERAPY LIC. & SERVICES TELECONFERENCED
Heard & Held
+ SB 108 MEDICAL CARE/LICENSING/MEDICAL BOARD TELECONFERENCED
Heard & Held
+ SB 165 COMPREHENSIVE HEALTH INSURANCE FUND TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
SENATE BILL NO. 105                                                                                                           
                                                                                                                                
     "An  Act  relating  to the  licensure  of  marital  and                                                                    
     family therapists;  relating to  professional liability                                                                    
     insurance for  marital and family  therapists; relating                                                                    
     to medical  assistance for  marital and  family therapy                                                                    
     services; and providing for an effective date."                                                                            
                                                                                                                                
10:03:46 AM                                                                                                                   
                                                                                                                                
SENATOR  DAVID  WILSON,  SPONSOR,   read  from  the  Sponsor                                                                    
Statement:                                                                                                                      
                                                                                                                                
     If enacted, Senate Bill 105  would add licensed Marital                                                                    
     and  Family  Therapists  to  the  list  of  independent                                                                    
     licensed  practitioners,   in  order  to   address  the                                                                    
     shortage   of   Medicaid-eligible   behavioral   health                                                                    
     providers  in  the  state,   afford  more  options  for                                                                    
     beneficiaries, and increase access to care.                                                                                
                                                                                                                                
He shared  that approximately  20 percent of  Alaska's adult                                                                    
population  needed  mental  or behavioral  health  services;                                                                    
however, 19 percent  of those in need  received funding from                                                                    
Medicaid  or  the  Behavioral  Health  Fund.  He  said  that                                                                    
research had  shown that  Alaska was  in need  of additional                                                                    
psychiatrists to  meet the state's  mental health  needs. He                                                                    
read from the Sponsor Statement:                                                                                                
                                                                                                                                
     Currently,  licensed  marital   and  family  therapists                                                                    
     (MFTs)  are   only  allowed  to  provide   services  in                                                                    
     community  health clinics  of  physician mental  health                                                                    
     clinics, which  limits the number of  willing providers                                                                    
     in  the  mental  health  care  arena.  SB  105  expands                                                                    
     medical  assistance  reimbursement  services  to  cover                                                                    
     those services provided by MFTs.                                                                                           
                                                                                                                                
     Specifically, SB 105                                                                                                       
        • Designated LMFTs as providers eligible to render                                                                      
          and   bill   for   Medicaid-funded   services   as                                                                    
          independent practitioners under Alaska Statute                                                                        
          47.07.030(b)                                                                                                          
        • Clarifies supervisory requirements for Marital                                                                        
          Family Therapist Licensees                                                                                            
        • Requires Marital Family Therapist Licensees to                                                                        
          carry    Liability   Insurance    for   Regulatory                                                                    
          Investigation  Fees of at least $30,000                                                                               
                                                                                                                                
     In  2016,  the  Alaska  Board  of  Marital  and  Family                                                                    
     Therapy  unanimously  recommended the  statute  changes                                                                    
     contained in SB 105.                                                                                                       
                                                                                                                                
10:09:44 AM                                                                                                                   
                                                                                                                                
GARY ZEPP, STAFF, SENATOR WILSON, discussed the Sectional                                                                       
Analysis (copy on file):                                                                                                        
                                                                                                                                
     Sections 1 &  2 of the bill impact AS  08.63 "Marital &                                                                    
     Family   Therapy"   and   the   subsections   08.63.100                                                                    
     "Qualifications for license  to practice" and 08.63.120                                                                    
     "Authorized Supervisors."                                                                                                  
                                                                                                                                
     Section 1:  "Qualifications for license to  practice" -                                                                    
     AS 08.63.100                                                                                                               
     PAGE  2, LINES  17-25: adds  a supervision  requirement                                                                    
     for martial & family  therapists and clarifies that the                                                                    
     required 1,500  hours of clinical contact  must include                                                                    
     100 hours  of individual  supervision and 100  hours of                                                                    
     group supervision and  that may be conducted  by one or                                                                    
     more supervisors.  The intent is  to allow doctor  A to                                                                    
     supervise and  if Doctor A becomes  unavailable, doctor                                                                    
     B  can  continue the  supervision  a  Martial &  Family                                                                    
     Therapist associate.                                                                                                       
                                                                                                                                
     Section 1 continues on:                                                                                                    
     PAGE 2, LINES 29-31: It  requires not less than $30,000                                                                    
     in professional liability  coverage for the applicant's                                                                    
     regulatory investigation fees in the state.                                                                                
                                                                                                                                
     Section 2: impacts "Authorized Supervisors"                                                                                
     PAGE 3,  LINES 2-18:  expands the group  supervision to                                                                    
     include  professional  counselors,   marital  &  family                                                                    
     therapists,   physicians   who   are  licensed   as   a                                                                    
     psychiatrist,  an  advanced practice  registered  nurse                                                                    
     who is authorized  by the Board of  Nursing to practice                                                                    
     as an  adult or family psychiatric  mental health nurse                                                                    
    practitioner, a psychologist, and a social worker.                                                                          
                                                                                                                                
     Sections 3, 4, & 5  impact AS 47.07 "Medical Assistance                                                                    
     for  Needy Persons"  and  the  subsection AS  47.07.030                                                                    
     "Medical Services to be Provided."                                                                                         
                                                                                                                                
   Section 3: impacts "Medical Services to be Provided"                                                                         
     PAGE  3,  LINE  31:  adds marital  and  family  therapy                                                                    
     services  to the  list of  optional services  available                                                                    
     through  the Dept.  of Health  & Social  Services under                                                                    
     this subsection.                                                                                                           
                                                                                                                                
     Section 4: impacts "Medical Services to be Provided"                                                                       
     PAGE  4, LINES  8-16: adds  a new  paragraph (g)  to AS                                                                    
     47.70.030   to   clarify    that   the   term   "direct                                                                    
     supervision"   may  be   performed  by   one  or   more                                                                    
     psychiatrists, as long as  that supervision takes place                                                                    
     on the  premises of the  clinic 30  % of the  time that                                                                    
     the clinic is open.                                                                                                        
                                                                                                                                
     The  so-called 30%  Rule is  found  in regulation  7AAC                                                                    
     135.030 "Provider enrollment and organization."                                                                            
                                                                                                                                
     Section 5: impacts "Medical Services to be Provided"                                                                       
     PAGE  4, LINES  17-31  & PAGE  5, LINE  1:  adds a  new                                                                    
     subsection  (h)   to  AS  47.70.030  that   allows  the                                                                    
     department  to  reimburse  a  mental  health  physician                                                                    
     clinic for  services provided by a  psychiatrist, or an                                                                    
     individual  who  works  under  a  psychiatrist  and  is                                                                    
     licensed  to practice  as a  professional counselor,  a                                                                    
     martial &  family therapist, a physician  assistant, an                                                                    
     advanced  practice registered  nurse who  is authorized                                                                    
     by  the Board  of Nursing  to practice  as an  adult or                                                                    
     family psychiatric mental  health nurse practitioner, a                                                                    
     psychologist, a psychologist  associate, and a clinical                                                                    
     social worker.                                                                                                             
                                                                                                                                
     Section  6: PAGE  5, LINES  2-7: amends  the uncodified                                                                    
     law to  authorize the Department  of Health  and Social                                                                    
     Services and  the Board of  Marital and  Family Therapy                                                                    
     to adopt  regulations to implement the  changes of this                                                                    
     act.                                                                                                                       
                                                                                                                                
     Section  7:  PAGE 5,  LINE  8:  contains the  immediate                                                                    
     effective  date  for  Section 6  which  refers  to  the                                                                    
     regulation development.                                                                                                    
                                                                                                                                
     Section [8]: PAGE 5, LINE  9: provides for a January 1,                                                                    
     2019  effective  date  for   all  sections  other  than                                                                    
     Section 6.                                                                                                                 
                                                                                                                                
10:13:29 AM                                                                                                                   
                                                                                                                                
Senator Stevens asked for the licensing timeframe to be                                                                         
licensed as a marital and family therapist, and whether                                                                         
temporary licenses could be issued.                                                                                             
Senator Wilson deferred to the invited testimony.                                                                               
                                                                                                                                
10:14:26 AM                                                                                                                   
                                                                                                                                
Senator   Stevens  hoped   that  the   marital  and   family                                                                    
therapists would not  face the same problems  as the medical                                                                    
practitioners of the previously discussed bill.                                                                                 
                                                                                                                                
Co-Chair MacKinnon OPENED public testimony.                                                                                     
                                                                                                                                
10:15:08 AM                                                                                                                   
                                                                                                                                
Senator  von Imhof  assumed that  the insurance  required in                                                                    
Section 1 could be obtained after training was complete.                                                                        
                                                                                                                                
Senator  Wilson  replied  that the  insurance  language  was                                                                    
intended  to  cover  investigative regulatory  issues  after                                                                    
licensure.                                                                                                                      
                                                                                                                                
10:16:08 AM                                                                                                                   
                                                                                                                                
RANDALL  BURNS,  DIRECTOR,  DIVISION OF  BEHAVIORAL  HEALTH,                                                                    
DEPARTMENT OF  HEALTH AND SOCIAL  SERVICES, (DHSS)  spoke in                                                                    
support of the bill.                                                                                                            
                                                                                                                                
10:16:34 AM                                                                                                                   
                                                                                                                                
Senator von Imhof read form the Sectional Analysis:                                                                             
                                                                                                                                
   Section 4: impacts "Medical Services to be Provided"                                                                         
     PAGE  4, LINES  8-16: adds  a new  paragraph (g)  to AS                                                                    
     47.70.030   to   clarify    that   the   term   "direct                                                                    
     supervision"   may  be   performed  by   one  or   more                                                                    
     psychiatrists, as long as  that supervision takes place                                                                    
     on the  premises of the  clinic 30  % of the  time that                                                                    
     the clinic is open.                                                                                                        
                                                                                                                                
Senator von  Imhof whether  the population  of psychiatrists                                                                    
in  rural  Alaska  could support  the  requirement  in  this                                                                    
section.                                                                                                                        
                                                                                                                                
Mr.  Burns   replied  that  the  language   was  in  current                                                                    
regulation. He said  that he was in support  of changing the                                                                    
language at the  direction of the committee.  He stated that                                                                    
the division  was currently crafting language  that was less                                                                    
burdensome to rural clinics.                                                                                                    
                                                                                                                                
10:21:31 AM                                                                                                                   
AT EASE                                                                                                                         
                                                                                                                                
10:21:54 AM                                                                                                                   
RECONVENED                                                                                                                      
                                                                                                                                
10:21:58 AM                                                                                                                   
                                                                                                                                
Senator  Stevens  repeated   his  question  about  temporary                                                                    
licensing and licensing timelines.                                                                                              
                                                                                                                                
Mr. Burns replied that he could not speak to the question.                                                                      
                                                                                                                                
10:22:54 AM                                                                                                                   
                                                                                                                                
KAREN  CUNNINGHAM,  VICE   PRESIDENT,  MARRIAGE  AND  FAMILY                                                                    
THERAPY BOARD, ANCHORAGE  (via teleconference), testified in                                                                    
support  of  the  legislation.  She  stated  that  associate                                                                    
licensure was available; board  approval was required before                                                                    
the  license  could  be  issued   and  there  was  a  2-year                                                                    
supervision period.  She said that  the bill would  make the                                                                    
supervision period more accessible for applicants.                                                                              
                                                                                                                                
10:24:04 AM                                                                                                                   
                                                                                                                                
Senator Stevens directed his question to Ms. Cunningham.                                                                        
                                                                                                                                
Ms.  Cunningham  replied  that  applications  for  associate                                                                    
licensure  were submitted  to, and  approved by,  the board.                                                                    
Before  the application  could  be  submitted the  applicant                                                                    
needed to have a supervision plan  laid out for the board to                                                                    
approve. She  relayed that there were  currently 18 approved                                                                    
supervisors in the state.                                                                                                       
                                                                                                                                
10:25:41 AM                                                                                                                   
                                                                                                                                
KEN MCCARTY, DIRECTOR, DISCOVERY  COVE RECOVERY AND WELLNESS                                                                    
CENTER,  EAGLE  RIVER  (via  teleconference),  testified  in                                                                    
support of  the legislation. He  shared that the  bill would                                                                    
serve a large need in  the state. He expressed concern about                                                                    
the Section 4  language referenced by Senator  von Imhof. He                                                                    
felt that  the language could isolate  telemedicine in rural                                                                    
areas.                                                                                                                          
                                                                                                                                
10:32:08 AM                                                                                                                   
                                                                                                                                
ELIZABETH RIPLEY,  CEO, MAT-SU HEALTH  FOUNDATION, testified                                                                    
in support  of the bill.  She said that there  were critical                                                                    
pieces  missing  for  Alaska's  continued  care  for  mental                                                                    
health  and substance  use disorders;  sadly, main  paths to                                                                    
treatment are  jails and emergency departments.  She relayed                                                                    
that  the  Mat-Su  Regional  Emergency  Department  was  the                                                                    
number  one  portal  in Mat-Su  for  people  experiencing  a                                                                    
behavioral health crisis, in terms  of both volume and cost,                                                                    
even  though  the  department does  not  provide  behavioral                                                                    
health  services. She  shared that  in 2016,  3,443 patients                                                                    
with  behavioral   health  diagnosis  went  to   the  Mat-Su                                                                    
Regional  Emergency  Department,  which  resulted  in  total                                                                    
charges of $43.8 million, not  counting the additional costs                                                                    
for   estimated   law   enforcement,   911   dispatch,   and                                                                    
transportation. She  believed that  the state  could improve                                                                    
the situation by providing care  in lower cost settings. She                                                                    
relayed that  the average annual  growth rate for  visits to                                                                    
the Mat-Su Regional Emergency Department  by patients with a                                                                    
behavioral  health diagnosis  grew 20  percent between  2015                                                                    
and 2017, due  to the opioid epidemic and  lack of treatment                                                                    
access.  She offered  further statistics  to illustrate  the                                                                    
statewide needs that the bill would address.                                                                                    
                                                                                                                                
10:35:52 AM                                                                                                                   
                                                                                                                                
Senator  Micciche  expressed  concern with  the  assumptions                                                                    
made in the fiscal note.  He opined the Medicaid utilization                                                                    
rate in  the state. He  voiced concern that the  state would                                                                    
be exposed to increased overutilization.                                                                                        
                                                                                                                                
Ms.  Ripley replied  spoke of  a project  called The  Alaska                                                                    
Healthcare Blueprint,  which hoped  to take  a bold  look at                                                                    
the   state's   health   objectives.   She   asserted   that                                                                    
collaborative  work  was  being done  with  state  partners,                                                                    
providers,  and local  delegations to  take a  comprehensive                                                                    
view. She contended that significant  research had been done                                                                    
to ensure  that health  care was being  provided efficiently                                                                    
and  effectively. She  stressed the  need for  "whole person                                                                    
care."  She admitted  that there  would  be additional  cost                                                                    
brought on  by the  bill but that  the legislation  would be                                                                    
more cost effective in the long-run.                                                                                            
                                                                                                                                
10:38:47 AM                                                                                                                   
AT EASE                                                                                                                         
                                                                                                                                
10:39:10 AM                                                                                                                   
RECONVENED                                                                                                                      
Senator von Imhof understood that  the cost would be shifted                                                                    
from expensive emergency room visits  to more clinic visits,                                                                    
where  the same  population would  be served,  for the  same                                                                    
ailments but in a different cost environment.                                                                                   
                                                                                                                                
Ms. Ripley agreed.                                                                                                              
                                                                                                                                
10:40:19 AM                                                                                                                   
                                                                                                                                
JON   ZASADA,   POLICY   DIRECTOR,   ALASKA   PRIMARY   CARE                                                                    
ASSOCIATION,  testified in  support of  the legislation.  He                                                                    
stated  that health  centers had  made major  investments in                                                                    
behavioral  health integration  and  whole  person care.  He                                                                    
said that in the last two  years there had been a 25 percent                                                                    
increase  in  the  number of  behavioral  health  providers,                                                                    
encounters,  and  patients;  over 11,000  Alaskans  received                                                                    
routine behavioral  healthcare in Alaska's  community health                                                                    
centers. He lamented  that there was a  shortage of billable                                                                    
providers in the  state; a study completed  in December 2017                                                                    
revealed that  Alaska community heath centers  were short 12                                                                    
to  18 FTE  equivalents,  which translated  into service  to                                                                    
6,000  to   9,000  patients.  He  stressed   that  federally                                                                    
qualified health  centers saved the state  money by allowing                                                                    
same-day appointments  at a single  rate. He stated  that if                                                                    
LMFTs  were  included in  FQHC  Medicaid  billing a  patient                                                                    
could   see  a   medical  provider   and  a   mental  health                                                                    
professional in the  same day, for a  single charge, instead                                                                    
of  a  referral to  two  sperate  charges. He  detailed  the                                                                    
various ways in which the  bill would serve more patients in                                                                    
comprehensive, whole-patient settings.                                                                                          
                                                                                                                                
10:43:53 AM                                                                                                                   
                                                                                                                                
Senator  Stevens  asked  which medical  professionals  could                                                                    
currently bill Medicaid.                                                                                                        
                                                                                                                                
Mr.  Zasada replied  that licensed  clinical social  workers                                                                    
and psychologists could bill Medicaid.                                                                                          
                                                                                                                                
Co-Chair MacKinnon CLOSED public testimony.                                                                                     
                                                                                                                                
Co-Chair MacKinnon  stated that a  new fiscal note  would be                                                                    
crafted for consideration during the next bill hearing.                                                                         
                                                                                                                                
10:45:15 AM                                                                                                                   
                                                                                                                                
Co-Chair MacKinnon solicited further discussion on the                                                                          
current fiscal note.                                                                                                            
                                                                                                                                
Senator Wilson reiterated that the intent of the bill was                                                                       
not to create a new expanded care of treatment but to give                                                                      
patients access to care as primary prevention.                                                                                  
                                                                                                                                
Co-Chair MacKinnon announced that amendments were due the                                                                       
following day by 5pm.                                                                                                           
                                                                                                                                
SB 105 was HEARD and HELD in committee for further                                                                              
consideration.                                                                                                                  
                                                                                                                                

Document Name Date/Time Subjects
SB 105 - Legislative Research - Medicaid Expansion & Behavorial Health Grants.pdf SFIN 2/27/2018 9:00:00 AM
SB 105
SB 105 - Summary of Changes, ver D to ver J.pdf SFIN 2/27/2018 9:00:00 AM
SB 105
SB 105 Sponsor Statement.pdf SFIN 2/27/2018 9:00:00 AM
SB 105
SB108 Letter of Support - Foundation Health Partners 2-7-18.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SB108 Letter of Support Cmmsr Navarre 2-2-16.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SB108 Letter of Support ASMB 2-9-18.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SB108 Power Point Presentation 2-12-18.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SSSB108 Sectional Analysis 2-13-18.cg.jmc.2.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SSSB 108 Sponsor Statment 1-22-18.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SB165 Sponsor Statement.pdf SFIN 2/27/2018 9:00:00 AM
SB 165
SB 165 CMS Letter Approving Alaska's State Innovation Waiver.pdf SFIN 2/27/2018 9:00:00 AM
SB 165
SB 165 ACHI Fund.pdf SFIN 2/27/2018 9:00:00 AM
SB 165
SB165 Sectional Analysis.pdf SFIN 2/27/2018 9:00:00 AM
SB 165
SB 105 - HSS FY18 Behavorial Health Treatment Recovery Grant Reductions.pdf SFIN 2/27/2018 9:00:00 AM
SB 105
SB 105 - Sectional Analysis.pdf SFIN 2/27/2018 9:00:00 AM
SB 105
SB 105 AAMFT Testimony 02232018 Finance.pdf SFIN 2/27/2018 9:00:00 AM
SB 105
SB 108 letter to Senator Giessel.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SB108 SS Letter of Support ASMA 2-27-18.pdf SFIN 2/27/2018 9:00:00 AM
SB 108