Legislature(2003 - 2004)
04/09/2003 01:31 PM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
SB 157-INPATIENT PSYCHIATRIC SERVICES CHAIR FRED DYSON announced SB 157 to be up for consideration. SENATOR LYDA GREEN, sponsor, said SB 157 addresses instate and out-of-state psychiatric facilities, and is particularly directed toward the children of the state who are either on Medicaid or in state custody and must leave Alaska to receive services. This bill requires that those children be placed instate for psychiatric care as long as a suitable place can be found. SENATOR GRETCHEN GUESS asked if the terms "appropriately address" and "unavailable" are strong enough words to use to decide if the clinical diagnosis can be addressed in the state. SENATOR GREEN replied that she thought they provide a moveable target for each individual that would require a very personal evaluation. CHAIR DYSON said he supports this bill, but it seems that the department would never send someone out of state if an instate facility was available and that the bill might be superfluous. He asked what the bill changes. SENATOR GREEN explained that currently the department cannot disallow a person from choosing the facility to which he or she wishes to go, particularly if the person is receiving health care through the Denali Kid Care program. A little over 200 individuals have been placed in outside facilities with no review by a state entity. This bill would require that instate services be exhausted before they are sent outside. It would also encourage groups to either add on to a current facility, like a juvenile psychiatric facility, or do some other form of instate upgrading. MR. BILL HOGAN, Director, Division of Mental Health and Developmental Disabilities, DHSS, supported the concept of SB 157, which affirms the current process the department uses to ensure that instate options are explored before a child is placed out of state. They feel the bill supports and enhances the monitoring of those children once they are placed out of state to determine if they are ready to come back and, if they are, that there is an instate option available. It supports the department's view that children should be served in Alaska, in their own community and as close as possible to their own family. CHAIR DYSON asked why these instate services evolved in the past and whether this piece of legislation removed some of those impediments. MR. HOGAN replied he understands that on occasion, instate options are available and for some reason they are not being taken advantage of at the time. Another issue is whether or not adequate funding is available to build instate capacity. MR. JOHN DUFFY, Manager, Mat-Su Borough, supported SB 157 for all the reasons stated. He said the state is presently sending 350 children out of state. SB 157 will save the state large amounts of money as instate treatment is much less expensive and improves the chances of success in allowing children to be closer to their family support networks. In addition, SB 157 will bring jobs back to Alaska and reduces the risk for additional private sector investment in residential treatment centers by assuring that the state will consider use of them before sending children out of state. CHAIR DYSON asked if he anticipates that a state facility might be started or enhanced in the Mat-Su Valley. MR. DUFFY replied that the borough has been approached by at least two firms that are interested in constructing such facilities out there. MS. KATHY CRONIN RAPOPORT, Regional Vice President, Universal Health Services, supported SB 157. She said she is also responsible for the Universal Health Care facilities in Utah. She concurred that there are over 350 children in residential psychiatric treatment centers in the Lower 48. Northstar Hospital is their inpatient acute care hospital and has 58 patients. Four of them are pending discharge in the next few days. All four are children on Alaska State Medicaid who are being referred to treatment centers outside the state on the recommendation of their caseworker and the outside placement committee. This is happening while Northstar has nine available residential treatment beds. She continued: Referring these kids to treatment centers outside the state has devastating long-term impacts on the children, their families, and ultimately on our state. Mental health treatment should be provided close to home where we can have good coordination for follow-up care with the residential treatment provider and the outpatient provider who will see the patient after discharge. Most importantly, treatment should involve the family. Family treatment is a critical element of children's mental health treatment. Their treatment in the local community is good for the children, their family, and it increases their chances for long-term success... MS. RAPOPORT agreed that bringing children home for treatment will encourage providers in the state to expand existing residential facilities and services and will encourage new providers to enter the market. MS. TERRY KEKLAK said she would answer questions. CHAIR DYSON asked her how much out-of-state placement costs per day. MS. KEKLAK replied that she didn't have any specifics, but most out-of-state rates are in the $325 per day or lower range. She knew of one child who had a rate of $600 per day, based on additional medical needs. SENATOR DAVIS asked her to comment on why children are placed out-of-state. MS. KEKLAK replied that for a service to be paid by the Medicaid program, an interdisciplinary team is required to review the placement and make a recommendation regarding what is in the best interest of the child. They look at whether existing state services are appropriate for that child. With Medicaid, the child travels to the closest available facility that is found to meet their medical needs. All inpatient stays are authorized by an outside contractor who is looking at all the criteria before an out-of-state admission would be approved for payment. SENATOR DAVIS asked if the available instate facility can be turned down in lieu of outside placement and still be covered. MS. KEKLAK replied no. SENATOR GUESS asked if they use the same process for state custody children. MS. KEKLAK replied that those children have a placement committee in addition to the Medicaid requirements. MR. RICHARD RAINERY, Executive Director, Alaska Mental Health Board, stated that the amendment is in concert with the Board's philosophy that the community should be involved with the mental health system. SENATOR GREEN moved to adopt Amendment 1. 23-LS0179\D.1 Lauterbach 12/1/04 A M E N D M E N T OFFERED IN THE SENATE BY SENATOR GREEN TO: SB 157 Page 2, following line 12: Insert a new subsection to read: "(c) When determining whether to authorize admission of a person under 21 years of age to a psychiatric hospital facility or residential psychiatric treatment center, either located within the state or outside the state, the department shall include in its consideration the recommendations of a person selected by the Alaska Mental Health Board established by AS 47.30.661 who is selected for this duty by the board on the basis of being knowledgeable about the availability of beds in the state for inpatient psychiatric services for persons under 21 years of age. The board may not select an employee of the department for this duty." Page 3, following line 10: Insert a new subsection to read: "(m) When determining whether to authorize admission of a person under 21 years of age to a psychiatric hospital facility or residential psychiatric treatment center, either located within the state or outside the state, the department shall include in its consideration the recommendations of a person selected by the Alaska Mental Health Board established by AS 47.30.661 who is selected for this duty by the board on the basis of being knowledgeable about the availability of beds in the state for inpatient psychiatric services for persons under 21 years of age. The board may not select an employee of the department for this duty." There were no objections and it was adopted. MR. RAINERY pointed out that one of the reasons the state doesn't have facilities like this is because sending kids out- of-state is a relatively recent phenomenon and, also, the number of children being sent is no longer a question. SENATOR GUESS moved to pass CSSB 157(HES) from committee with individual recommendations and zero fiscal note. There were no objections and it was so ordered.