2001 DMHDD RELATED LEGISLATION
Designated Evaluation and Treatment (DET)
SB154 Sponsored by Senator Pete Kelly
This bill repeals the termination date for the DET program.
● The DET program provides payment for voluntary and involuntary inpatient psychiatric services for eligible patients who are imminently at risk for harming themselves or others, or who are so severely impaired by mental health symptoms that they are unable to care for themselves.
● The provision of these services in local communities fits with the objectives of serving consumers closer to home, reducing transportation expenses and increasing privatization of service delivery.
● The regulation process is complete, however the sunset date of July 1, 2001 is quickly approaching. The division seeks the repeal of the sunset clause. The repeal of the sunset clause will allow the state to take advantage of existing federal funding to get the system in place. Federal funds will expire June 30, 2002.
If the sunset clause is not repealed, the following will be lost:
● Clear statutory basis for this important program.
● Authorization of the department to establish eligible services and reimbursement rates;
● Description of application, application review and appeal procedures;Description of procedures for payment for the services provided;
● Clarification of language and definitions to accurately reflect statutory intent;
● Clarification of the responsibilities of the Department;
● Language that establishes who is eligible for assistance for inpatient services:
o Individuals who meet criteria for commitment under current statutes (i.e. danger of harming self or others or gravely disables as a result of mental illness, and is likely to improve with treatment); and
o Individuals whose household income is below 185% of federal poverty guidelines for Alaska and who have no other third party payer.
The loss of current statutory language will send the program back to its original vague and problematic statutes.
Assisted Living Homes (ALH)
SB67 Sponsored by the Senate Rules Committee by request of the Governor
HB107 Sponsored by the House Rules Committee by request of the Governor
HB124 Sponsored by Representative Halcro
The Department of Administration, Division of Senior Services and the Department of Health and Social Services, Division of Mental Health and Developmental Disabilities have joint responsibility for licensing Assisted Living Homes. The departments have developed regulations to improve the licensing process to better assure the safety of residents and to address concerns raised by Assisted Living Home. During the course of developing the regulations several items were identified that require statutory, as opposed to regulatory, changes. These bills would increase protection of consumers by:
● Requiring all Assisted Living Homes which receive public funding to be licensed regardless of the number of clients served;
● Setting standards requiring all agencies receiving state or federal funds to meet minimum requirements including the requirement for background checks on providers, including family members living in the home;
● Allowing for emergency termination of the housing contract of consumers presenting a danger to others in the home, themselves or the home;
● Establishing immunity from liability for acts or omissions in the licensing, monitoring or supervision of a licensed home; and
● Allowing the state to take over operation of a home when the home is non-compliant and leaving the residents at risk.
HB115 Sponsored by Representative Kapsner
SB108 Sponsored by Senator Olson
Many people in rural communities are incarcerated and/or fail to get appropriate treatment to address drug and alcohol problems due to the requirement for Title 47 Involuntary Commitments that a Certificate of Necessity be signed by a medical doctor. In small rural communities there is usually no access to a physician, though many communities have physician assistants or advanced nurse practitioners. These bills contain statutory changes to allow physician assistants and advanced nurse practitioners to sign Certificates of Necessity along with physicians, and to perform other alcohol and drug abuse commitment functions under Title 47.
The division has been working with Rep. Kapsner and Sen. Olson to add a section to change the definition of “mental health professional” (MHP) to include Licensed Social Workers, Licenses Marital and Family Therapists and Licensed Professional Counselors. The current list of professions eligible to do evaluations for civil commitment includes licensed psychiatrists, physicians, psychologists, psychological associates, master’s level psychiatric nurses and master’s level social workers with substantial experience. At the time of the original draft, social workers were not licensed. This bill recognizes the range of professional mental health practitioners, the reality of emergency mental health staffing and protects consumers by enlarging the pool of professionals and ensuring that qualified licensed individuals perform mental health evaluations for civil commitments.
HB174 Sponsored by the Rules Committee by Request of Legislative Budget & Audit
SB135 Sponsored by the Rules Committee by Request of Legislative Budget & Audit
DMHDD has been charged with the gathering of certain confidential client data is essential to the division’s ability to monitor, make management decisions, meet service needs of Alaskans with mental illness, and to comply with legislative expectations for providing accurate performance measure information, while respecting the privacy rights of mental health consumers.
This bill:
● Protects licensed mental health clinicians who report required confidential client data;
● Gives the Department of Health and Social Services the statutory authority to require that mental health centers that receive state funds report certain confidential client data to the Division of Mental Health and Developmental Disabilities (DMHDD), and comply with regulations regarding such data submission;
● Clarifies that confidential client data are considered to be “confidential medical records” and are not open to the public for inspection or copying;
● Requires that mental health providers notify DHSS of emergency situations involving mental health clients—most other states have these requirements;
● Provides access to confidential information regarding consumers utilizing the Mental Health Treatment Assistance Program and requires confidential handling of that information;
● Protects consumers rights to privacy by insuring that confidential information is used and handled appropriately;
● Promotes the health and safety of Alaska’s mental health consumers; and
● Is consistent with the intent of HIPPA and HCFA.
HB 76 Sponsored by Representative Rokeberg
The intent of this bill is to provide additional funding for the API Replacement Project in the amount of $12,000.0 in order to pay for the cost of adding a forensic psychiatric unit to the new hospital. The bill amends the original $29,000.0 appropriation by adding $12,000.0, but appropriates these new funds from the Trust Authority’s mental health trust income account. Finally, the bill also appropriates $200.0 from the general fund to DCED for a grant to the Municipality of Anchorage to study the feasibility of co-locating the offices of the Municipality’s Health and Human Services Department and UAA’s health sciences program and classrooms within the API replacement facility.
HB77 Sponsored by Representative Rokeberg
The bill requires:
· DHSS to design and construct an inpatient psychiatric facility to replace API.
· The replacement facility is to include a forensic psychiatric unit operated by DOC and physically separate from the rest of the new facility. This separate unit would assess and treat “mentally abnormal criminal offenders.”
DHSS is to “cooperate” with DOC, UAA, Providence Hospital in Anchorage, and the Municipality of Anchorage in the design and construction of the replacement API.
HB 130 Sponsored by the Governor
SB96 Sponsored by the Governor
These bills identify funding sources for the $58,750,000 necessary for the construction of the replacement facility. There is presently $19,200,000 available from prior appropriations for this purpose that can be used for the project. In addition, the Mental Health Trust Authority has set aside $3,000,000 that could be used for the project. A lease-purchase agreement would be security for the remaining $36,550,000, which the state would raise through the state bond committee's issuance of certificates of participation.
2001 DMHDD RELATED LEGISLATION
Designated Evaluation and Treatment (DET)
SB154 Sponsored by Senator Pete Kelly
Referred to HES and FIN—passed out of S-HES
Scheduled for Senate FIN Thursday, 9:00
HB219 Sponsored by Representative Fate
Referred to HES and FIN
Scheduled for House HES, Thursday, 3:00
Assisted Living Homes (ALH)
SB67 Sponsored by the Senate Rules Committee by request of the Governor
Referred to HES and JUD
No hearings currently scheduled
HB107 Sponsored by the House Rules Committee by request of the Governor
Referred to STA, HES and JUD
No hearings currently scheduled
HB124 Sponsored by Representative Halcro
Referred to HES and JUD
In H-HES awaiting revisions by the sponsor
HB115 Sponsored by Rep. Kapsner
Referred to HES
Passed H-HES, in Rules awaiting floor
SB108 Sponsored by Senator Olson
Referred to HES
No hearings currently scheduled
HB174 Sponsored by the Rules Committee by Request of Legislative Budget & Audit
Referred to HES and JUD
No hearings currently scheduled
SB135 Sponsored by the Rules Committee by Request of Legislative Budget & Audit
Referred to HES and JUD
Scheduled for Senate HES, Wednesday, 1:30
HB 76 Sponsored by Representative Rokeberg
Referred to FIN
No hearings currently scheduled
HB77 Sponsored by Representative Rokeberg
Referred to FIN
No hearings currently scheduled
HB 130 Sponsored by the Governor
Referred to HES and FIN
No hearings currently scheduled
SB96 Sponsored by the Governor
Referred to HES and FIN
No hearings currently scheduled
Budget Highlights
April 2, 2001
FY 02 Operating Budget
The FY 02 operating budget is now before the full Senate Finance Committee. The information presented below includes only those items where the Senate numbers differ from those of the House:
· Medicaid
· 1,564.7 reduction from Governor’s and House budgets.
· DMHDD Miscellaneous Reductions
· A net reduction of 4.4 which is composed of the following:
· A decrement of 235.6 in GF/MH. This figure is actually the result of transferring 2,319.8 in GF/MH from five designated BRU’s (Manillaq, Norton Sound, SEARHC, Tanana Chiefs and YKHC) that now receive direct legislative appropriations. The 2,319.8 is 235.6 less the cumulative MHDD funds in the designated BRU’s.
· An increment of $231.2 in GF/MH to meet federal/state maintenance of efforts requirements.
· Services to the Chronically Mentally Ill
· A decrement of 394.5 in GF/MH from the Governor’s and House budgets for Katmai Extended Care under the Community Mental Health/API Replacement Project. This would force the State to continue using time-limited federal SAMHSA funds to pay for this service in FY 02
With the exceptions noted above, all the remaining items listed below for the House are the same in the Senate budget.
· Grants: Fully funded at continuation levels.
· Selected Increments:
· General Note: The increments discussed below all involve GF/MH. There are several MHTTAR increments in the FY 02 budget that are not addressed below.
· Medicaid
· $15 million increment (low case growth scenario). See note above re: Senate numbers.
· Psychiatric Emergency Services
· 305.5 in GF/MH for Rural Community Mental Health Centers: This increment, in combination with an internal transfer, will allow for a minimum grant of 200.0 to all rural community mental health centers.
· Service to the Chronically Mentally Ill
· 666.3 in GF/MH for Assisted Living Home rate increases. This is the second of a three step increment funded under SB 73. It brings the reimbursement rate from $50/day to $60/day.
· 394.5 in GF/MH to fund Katmai Extended Care under the Community Mental Health/API Replacement Project. This replaces federal funds that allow six former long-term API patients to be in community-based residential care. See note above regarding Senate not picking up this item.
· Designated Evaluation and Treatment (DET)
· 100.0 increment in GF/MH. 200.0 in MHTAAR and 723.0 in additional federal funds are also included. These increments will fully fund statewide DET services in FY 02.
· Mental Health/Developmental Disabilities Administration
· 69.0 in GF/MH for the Integrated Quality Assurance Program. This is partially offset by a decrease in MHTAAR of 50.0.
· Alaska Psychiatric Institute
· 825.3 in GF/MH to replace the loss of federal DSH funds. There is also an increase in Designated Program Receipt Authority of 423.9. These increases are partially offset by a reduction of 825.3 in MHTAAR.
· The Fast Track Supplemental has passed. It includes the following
· 325.0 to support community based activities to prevent suicide. Funds will be directed to grants, technical assistance and the development of a statewide Suicide Prevention Council. Note that another 600.0 is in the FY 02 capital budget for a new mental health facility for Galena.
· Approximately 15,000.0 for Medicaid.
· The Regular Supplemental Budget will be heard in House Finance on Friday, April 6 at 1:30 p.m. It includes:
· Approximately 71,000.0 for Medicaid; this includes Proshare transfer payments.