Legislature(2003 - 2004)

04/09/2003 01:31 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= 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.                                                                                               

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