Bridges Final Report

Legislative Session


The legislative session ended without much fanfare The beginning of the session brought some uncertainty about the operating budget with major concerns regarding the Department of Health and Social Services. The majority members of the Legislature were committed to the last year of their five year fiscal plan to cut the operating budget. Their plan was to save $30 million in general funds in FY01 with possible cuts to Medicaid, mental health ants, Denali KidCare and other programs.

The final outcome however was much more positive than expected This was primarily due to the Departments ability through the use of creative financing of Medicaid funds to increase federal funds by more than $26 million. This took pressure off of other possible cuts within the Department.

The Medicaid Services budget ended with $475,224,300 of combined general funds and federal funds This was an Increase of approximately 6% over FY01 and was due to creative financing by the Division of Medical Assistance.

Funding to Community mental health grants ended at the Governors requested amount of $1 ,223.800. With the following appropriations also at the Governors requested amounts: Psychiatric Emergency Services at $7,259,600, Designated Evaluation & Treatment $2,326,000, SED Services at $7,556,400 The only program cut was to Services/Chronically Mentally Ill funded at $1 1824,200, which was a loss of $203000 or ~1.7%.

The Departments final budget ended wIth a 2.4% increase from the Governors request.

HB 149 parity for mental health under insurance moved from the House H&SS Committee in the final days of the legislative session. The bill had hearings Last session and there was a commitment by Pep. Dyson, to bring it to the fill committee for a vote this year.

The majority of the session was spent trying to secure the 4 votes needed to move the bill from Committee. Finally there were commitments by several Republicans on the Committee to not vote against moving the bill from Committee. Those two Republicans arid the two Democrats insured it would move. The bill did move without much fanfare and ended in the House Labor & Commerce where it was to late in the session to hold a hearing.

There is much work that needs to be done on this issue for next session. A majority member must be found to introduce it possibly in both Houses, work during the Interim should include educating legislators about the need for parity and also about the programs that enable mental health consumers to reintegrate into the community and find jobs.

SB 19 a limited version of parity for mental health, introduced by Sen Kim Elton, Juneau was never heard in the first committee of referral It was introduced during the 19% session was introduced this session and past after many changes to the original intent of the bill it was introduced at the request of a Doctor who wanted to build an out-patient medical center in Fairbanks and Anchorage. The existing certificate of need program requires a new certificate if construction costs are over $1 million. The original bill would have changed that to $7 million thus allowing anyone wanting to build a medical facility up to $7 million to do so without a certificate of need

The mental health community was concerned about the possible impact new construction might have on the Medicaid program, specifically new nursing home beds. It was determined in past legislative sessions that when you build nursing home beds, Medicaid would have to pay for them whether they were full or not.

Through several different configurations of the bill and much opposition by the mental health community, the Hospital & Nursing Home Association and many individual hospitals, the bill was changed so that it was acceptable. The final bill would only allow an ambulatory surgical center to relocate to a new site In the same community without obtaining a certificate of need with no additional bed capacity allowed.

HR 325 relating to claims and liens for Medicaid services passed both Houses unanimously. This bill, which was reintroduced at the request of the Department of Health arid Social Services, would extend the time to file claims under Medicaid from 6 months to 12 months. This could help mental health programs recoup funds expended on Medicaid eligible recipients. There was also a section in the bill which addressed the states position on liens where Medicaid recipients were involved.

HB 253. relating to school disciplinary and safety program passed the legislature after going through 5 different versIons and several floor amendments This bill was co sponsored by several House and Senate members and required each school district to adopt a written school disciplinary and safety program

Mental health advocates were very concerned with early versions of the bill which did not take into consideration behavior by students with mental health problems. Working with the prime sponsor of the bill, Rep Fred Dyson, an amendment was adopted in the House Judiciary Committee that required that the program developed to address the needs of students for whom mental health or substance abuse may be a factor to noncompliance with the program Other additions put forward by the mental health community required that policies be included to comply with the Individuals with Disabilities Education Act and that there be a procedure for review and revision of the school disciplinary and safety program.

With these amendments the bill was acceptable to the mental health community.

The Surgeon Generals Report on Mental Health was released in late 1999 and became a vehicle for educating legislators about the nation's response to mental Illness, identifying serious barriers faced by persons with mental illness and the call to action for proactive responses to mental illnesses. Two hearings were held before the House and Senate H&SS Committees which expanded on the report A team of presenters, which included Waiter Majoros, Director AMHB, Caren Robinson, AMHTA board member, and Karl Brimner, Director DMHDD, provided an effectIve power poInt presentation to the Committees.

HB 211 patient protection legislation introduced by Rep. Norm Rokeberg had a rough start last year but passed the legislature this session. During the 2000 session it moved very slowly until recently and then picked up steam. The bill has gone through many versions and floor amendments but ended up in good shape.

The original bill had strong utilization review language which would have guaranteed a review by a licensed health care provider trained in the specialty or sub specialty pertaining to the health care service involved The Insurance Industry was able to convince legislators that this would have been very costly. The language was changed to require any licensed health care provider do the initial utilization review. However we were able to get language in the internal appeal process, which occurs if a patient is not satisfied with the original utilization review decision, that requires someone with the same professional license as the provider treating the covered person. Internal review is required within 72 hours if it's an emergency or 18 workIng days if It Is not.

Another section requIres an external appeal. similar to the proposed Federal legislation, and requires a "Clinical Peer" be involved. Clinical peer Is defined in the bill as a health care provider who is licensed to provide the same or similar health care services and who is trained in the specialty or sub specialty to the services provided.

Confidentiality became a big issue at one point in the debate over this legislation and was clarified to ensure that the bill does not prohibit exchange of medical information between health care providers for the purposes of providing health care services yet insures confidentiality among the insurer.

HB 211 does not impact companies that are self~insured and qualify under URISA.

Another patients' rights bill also passed this sessIon, HB 121, introduced by Rep Con Bunde, which addresses consumers' rights under Insurance when seeing dentists. The bill

requires that utilization review be done by a dentist.

HB 272 relating to tax assessment of low income housing projects and tax credits passed the legislature. This bill addressed a problem that had arisen in the state whereby municipal tax appraisers were assessing low-income housing on property valuation rather than on an income based approach. The majority of these projects received funding through tax credits and other low interest loans that were based on guaranteeing low rents to low-income people. As property values increased the non-profits, which operate these housing projects were caught with increasing tax assessment and no ability to raise rents or they would not be complying with the loans under which they received funding.

The bill went through several versions. Anchorage Mayor Rick Mystrom strongly opposed the bill, however bankers from across the state came together to support this bill.

The final version allows communities to opt out of the income approach to evaluating low­income housing projects for purposes of assessments only if they are built In the future. Evaluation of existing low-income tax credit projects must be assessed on the income basis formula.

SB 73 relating to assisted living homes was introduced by Senator Mike Miller of Fairbanks and several other Senators. It would impact assisted living homes with 15 or fewer beds.

This piece of legislation was a tribute to Sen. Miller who will not be running for the Senate again. The bill would change the rates paid to assisted living facilities and went through several versions before it finally passed

In its final form the bill has a three year staggered increase in payments for assisted living. The first year raises it to $50 per day, next year to $60 and the fInal year to $70.

HB 260, introduced early in the session by Rep. John Coghill, Fairbanks, would have rolled back the Denali Kid Care Program from 200% of the federal poverty level to 100%. There was literally a human cry from around the state during the hearings held on this Issue in House H&SS Committee. With enough pressure on the Committee the bill never moved out of It's first committee of referral and thus died.

HB 161 the reduction in benefits legislation which was Introduced during the 1999 session passed both Houses but was held in the limbo file waiting for the House to concur in the Senates amendments never saw the light of day. During the interim a basic support coalition came together and put pressure on legislators to let the legislation die. During the 2000 legislative session there were concerns the House would concur or move the BiII to Conference Committee to work out the differences between the two versions. This did not happen and the bill died in Speaker Porter's limbo file.