Good afternoon, I call this meeting of the house financed from a family and community services subcommittee to order.
I'll let the record reflect that it is 323.
We were hoping to begin at 320.
I think that's pretty good.
It is Thursday, February 5th, 2026.
Present today are Representative Schwanke, Representative Ruffridge,
Representative Mina, representative Fields,
Representative Prox, and myself.
Chair of the Finance Subcommittee, Andy Josephson.
Also present today are our LIO moderator, Renzo Moises,
from the Legislative Information Office,
Valerie Rose, an analyst from
the legislative finance division is with us.
And my committee aid, Aaron Page, is for this.
I'm sure there are others.
As always, please remember to mute your cell phones.
A housekeeping note before we begin our presentation.
DFCS binders have been provided to all committee members.
The contents of the binder were all supposed to own basis
under the documents section of this meeting.
Are there any questions about the binder contents?
Lovely, none.
Okay.
In today's meeting, we will hear three presentations from the department.
First is departmental overview, which will be followed by divisional presentations
from The Alaska Psychiatric Institute and the Pioneer Homes.
I know there was lively discussion about foster care during Tuesday's standing
committee. We will have an opportunity to follow up on that in the
OCS budget review on February 26th. Quite a little ways from now.
Please work with my staff on follow-up areas you'd like addressed.
Our presenters today will be Acting Commissioner Tracey Donpling, Pioneer
Homes Director Dr. Kern McGinley, API CEO Ken Cole, and Assistant Commissioner
Marianne Sweet. Acting commissioner Don Plank and AC Sweet please come forward.
Put yourselves on the record and begin your presentation.
Thank you. Good afternoon chair and committee members for the record
My name is Tracy Donpling. I'm the acting commissioner for The Department of Family and Community Services
We want to thank you for your opportunity to talk about our department budget today as well as the individual budgets for Alaska Pioneer Homes
And the Alaska Psychiatric Institute with me today is assistant commissioner Marion suite who will be leading the presentation today. Thank You
Miss Sweet
For the record, my name is Marion Suites.
I'm the Assistant Commissioner for the Department of Family and Community Services.
And I wanted to thank you for
the opportunity to be here today and present our fiscal year 27 governor's
proposed budget for departmental support services, the Alaska Pioneer Homes and
the Alaskia Psychiatric Institute.
All right, and Ms. Sweet, we're joined by reps, mirrors,
and gray, meaning we have apparently the full committee.
Please proceed.
Thank you.
Presenting with me today will be Dr. Kern McGinley.
He's the director of the Alaska Pioneer Homes.
And later on, we will hear from Ken Cole,
the chief executive officer of The Alaska Psychiatric
Institute.
Thank You.
Departmentals, excuse me.
The Department of Family and Community Services has an overall budget of 511.2 million dollars.
And it's providing funding for our four direct service divisions.
That's the Alaska Pioneer Homes, the Alaskia Psychiatric Institute,
the Office of Children Services, The Division of Juvenile Justice, as well as the Commissioner's Office and Departmental Support Services.
We have a total of 1864 full time positions.
Our fiscal year 27 proposed governor's budget is an increase of 0.2% above our fiscal
year 26 management plan.
Now that seems like a very small increase and that is because we did an analysis and
we reduced uncollectible restricted revenue authority within our budget for fiscal years
27.
Each of our divisions, I will be presenting four slides for each of
our division, so there will an introduction, a overview slide similar to this one,
where I'll briefly go over the overall budget and speak to each individual funding sources.
We will also go for the 27 budget items, and our final slide for
each division will our 27 governor's request, which will include new budget
items as well as technical ones.
All right, we will start with departmental support services.
Slide three.
Slides three, yes, thank you.
With a total of 90 full time positions, Departmental Support Services provides quality
administrative services in support of the department's mission.
We have an overall budget of $42.3 million.
The Talent Acquisition Team is a unit that was created to support efficient candidate-centric hires.
We are still in the pilot process of this working on specific job classes within the Office of Children's Services,
as well as those within departmental support services.
In calendar year 25, we interviewed 391 candidates through this team,
DFCS team members, five of them were within departmental support services, 100 new members
into the Office of Children's Services.
We have expanded the use of image source by implementing an online tracking system for Title 47 orders related to involuntary commitments,
as well as creating an on-line application for the Mental Health Treatment Assistance Program,
which provides funding to designated facilities for individuals who are under an involuntary commitment order.
And we have also implemented the use of SmartSheet,
which is an online project management tool
to build efficiencies and collaboration.
We have created a facility project tracking tool,
which used to track the funded deferred maintenance,
well, the funding construction projects going on
in our 13 facilities.
We are working on developing division budget spend plans,
and we are also using it to
track our department's strategic initiatives.
Question from representative reference. Thank you
Co-chair and chair of this committee
How many members are on the talent acquisition team?
Through the chair representative refuge. We have seven members on our talent. Acquisition team. Thanks
Representative gray.
Thank You through the chairs
I think you said that you interviewed over 300 and hired 100 is that correct follow follow representative gray
I'm just curious because it's something that I've heard and maybe you can confirm or not confirm that one of the reasons why
Good candidates don't end up taking the job is because there's such a delay between
Initially applying for the Job and then
Actually starting the JOB that good candidates will end-up taking a job elsewhere. Is that true?
Through the chair representative gray that is exactly the reason why we created the talent and acquisition team
Having a team that Is hr. Professionals?
Focused on doing these Recruitments has expedited the process so that we are actually
Engaging with candidates quicker. We're interviewing them sooner and able to offer them jobs more quickly
Follow Representative gray. Thank you through the Chair
So is the current hundred that were hired of the 300 applied?
That was, because we were going faster, it wasn't because of the delay.
It was because they weren't the right person for the job.
Miss Sweet.
Through the chair representative Gray, I'm certain that it had something to do with it, right?
Getting them in faster is definitely one of reasons why we would be losing candidates.
I don't know if you're asking about the disparity of there was 391 that we interviewed and we only hired 105, but there is rigorous background checks and other things that would go into play on to why we didn't hire more if that was what you were getting.
Thank you.
Please continue. You were on slide three and the final is that the department of family and community services created the coordinated health and complex care component. This unit is involved in
Excuse me it oversees complex cases involving individuals that are in the department's custody as well as those that
Are at imminent risk of becoming involved with our department?
We work proactively to identify barriers in Alaska's care system and we collaborate and partner with the Department of Health on
Policy and process improvements to ensure better outcomes for Alaskans with complex care
Departmental support services uses a direct and an allocated chargeback model
for a large amount of the services that we provide the department.
These are collected as interagency receipts.
Additionally, we also have mental health trust recommendations within the coordinated health
and complex care component, and these make up the other category on this slide.
Additionally, within the coordinated health and complex care component, they manage our
designated evaluation and treatment and designated
evaluation in stabilization grants, which are funded with general
And then we also manage the dish proportionate share hospital program.
This is funded with general fund match, as well as interagency receipts through an RSA with a department of health so that we can claim Medicaid.
And the remaining expenditures within departmental support services run through our public assistance cost allocation plan and
are spread to both state and federal programs.
On slide five, you will see the fiscal year 26 budget items for departmental support services,
all of which were technical in nature.
We did a transfer of interagency authority from the Office of Children's Services.
It was uncollectible.
Many years ago, the office of children's services paid the childcare support for foster families.
That transition back over to the child care program within the division of public assistance,
We had two items that are mental health trust recommendations, 400,000 as well as the 87.
Those are to fund the positions within our coordinated health and complex care unit.
And then we also have the 750, 000 in UGF that is a temporary increment from 25 through
In the FY 27, I know we're reviewing 26.
Are you asking for a continuation of these talent acquisition positions that you described
earlier?
To the chair, we have evaluated our budget and we will not be asking this funding.
Okay, and I'm told that that the positions or PCNs came from other departments
To the chair they came form other divisions within our department
All right, please continue
Representative step yeah, thank you coach. You're just in through the chairman's sweet. I appreciate you being here
How's it possible to absorb it with?
Within the department when the departments are you maxed out on their inner agency transfer authority to the chair a c-suite
To the Chair representative step
We actually evaluated a number of existing contracts that we had and reduced those and chose to do those services in-house
Namely, there was a few that were within our information technology unit
And we shifted those duties in house. So we were able to save money that way. Oh a quick pause
I think you're through church directory. Um, so basically you've found cost savings in
Stopping third-party contracts and having state employees kind of do that in-house through the chair. AC suite
Through the chair representative step that is correct
We did that evaluation because the funding source was changed from the base to a one-time increments
And it didn't move forward in the fiscal year 27 budget request
I did not want to add that as additional cost to push on to the divisions
I didn t want put the additional burden on our direct service division. So yes, sir. Thank you
It takes us to slide if you're done slide six
Thank you, side six is our 27 budget, proposed budget for departmental support services.
We have three new budget items, the first, I'm sure you're aware is the increases for
the IT classification study that will go into effect on July 1.
The next line item that you see is a portion, so there is
a grant program within the Department of Health Division
of Behavioral Health called the Residential Care
for Children and Youth.
There are some grantees within that program whose services
are aligned with Department
of Family and Community Services.
And so we are transferring a
portion of that grant
program to departmental support to the
Department
of family and community services so that we can maintain
that that
program and continue those services.
A new budget item is in at zero, which is the transfer of positions from the Department
of Administration to all state agencies to assume accounts payable and travel processes.
The remaining items are technical in nature.
It's the same mental health trust recommendations.
Summarized here is 487.
It is the 400 for the Coordinated Health and Complex Care Unit
and then the 87 for our Title 47 coordinator.
And then, the year 27 of our one-time increment
for group home placements for.
individuals with complex needs.
And then here you will notice that there was a reduction of 838,000 in federal receipts.
So this, again, is not a
reduction in any services within the department,
and is
not the reduction
of any programs that we provide.
It was simply
authority that
we have no mechanism to collect from.
Okay.
And when we say restore,
we mean continue.
Is that what we're really saying?
Through the care.
Yes, sir.
Okay,
Slide seven.
Thank you.
On slide seven, you see a representation of the vacancy
and turnover rates for the department for
the last three years.
Now, this is information and data through December,
so it is apples-to-apple comparison.
And one thing to note that this
is the divisions as a whole.
It is not indicative of only our direct or front line
positions.
It's all of positions within the division.
And one thing, in an era of telework, I think direct service agencies such as ours really
do struggle with recruitment and retention, unlike other agencies that have the ability
to offer remote work, our staff are physically in our facilities or out in the field providing
And we know that the work that our department does is very physically and mentally demanding,
so our focus has been on changing the culture and the environment within the department.
And some of the things that we've been doing to achieve that is that division of juvenile
justice maintains an employee-led wellness committee.
Our API has an Employee Engagement Committee as well as a critical stress incident team.
a Wellness and resiliency officer and the pioneer homes focuses on workforce well-being in each of our homes and then each
Of our division prioritizes
additional training for staff
Representative reference for AC suite or miss dumpling
For Casey suite. Thank you.
Thank You chair
I wanted to just address one line on here. That's the office of children's services. You mentioned something about the vacancy rate
We obviously talked about this, as the chair mentioned,
just a couple of days ago, and the vacancy rate was double,
or in some cases, urging on triple of the number
that we see here.
Could you talk to that and why the large discrepancy there?
This week through the chair representative reference
This is a representation of all staff within the division and not just direct services and I I do believe that
Director Guey was presenting on her direct service staff her frontline staff
And so that would be the difference and this is also if I can just add a tiny bit to that
This information through December and i'm not exactly sure when her her statistics were pulled through
follow-up
Yes, thank you chair. So I wanted to go back and sort of attach two things
We've already talked about the talent acquisition team and this vacancy rate
So with the large number of vacancies in what we would call frontline social work staff
Did that did some of the Talent worker or talent?
Acquisition team come directly from frontline Social Work staff
AC suite
Through the chair representative reference, we received positions from the Office of Children's
Services as well as the Alaska Psychiatric Institute. They were not direct line. We did not receive
people. we we receive vacant positions. And last follow up did that help? I mean on some level I
guess the vacancy rate was just taking positions that were added I think in many cases to help.
comply with the law of case caps and or case load caps.
And then you you transfer them obviously not the people
into an into a different team.
A.C. Sweet through the chair representative
The successes that we've seen in hiring staff within the Office of Children's Services has been a huge benefit to the division and
when you're talking
605 positions that the office of children's services has I think that that this the percentage that would have changed in
Moving those positions over was was like
Very very minimal if I'm understanding where you are going
Thank you all right
Slide 8 all right at this time
I'd like to thank commissioner dumpling and I would like
To invite to dr. Kern McGinley the director of the pioneer homes to the table, please
Mr. Chairman before we move on could I ask a question please sure just on the OCS side, so I'm hearing from
U services behavioral health providers that state service oblige authorizations
are affecting their ability to provide services for youth and specifically I've heard that the
state has started using an AI bot to approve service authorizations, which apparently has a
very reliable 100% denial rate. Are you familiar with that?
AC suite. Through the chair, the representative feels I am not.
Okay, well I would appreciate it if the department go back and look at these service
authorisations and actually I have heard from multiple types of health care providers about
I'm hearing that that is not the Department of Family and Community Services. That is our sister agency the department of health even though
It's for kids who are in OCS custody
That's right through the chair
Mr. McKinley
Thanks for your patience
Just be a moment for the record Tracy Dompling acting commissioner
Yes, so even if it is for youth that are in OCS custody, if
it's a.
When you were talking about service authorizations, that rings true to a Medicaid provider, and so that all of that service authorization piece is done through Department of Health, regardless of whether the individuals in the custody of our department, or is in their parental custody.
Could I just make a request to the department?
You may, go ahead.
Okay, through the chair, might I request that you go back to DOH and let them know that legislators have heard the kids in OCS custody are not able to receive care?
because some automated process for state service authorization for kids who need
behavioral health services who are in state custody are not getting them because
of service authorizations are being denied and then let us know what the
status is and what is being done to fix it through the chaired representative
fields yes we can do that thank you yes represent reference since we weren't
moving on I'll ask my final question all right who would you like miss sweet
I guess, well, our fiscal year 26 budget, which I think we're somewhat discussing, one of
the items under frontline social workers in this, so this was last year we went over
this.
It states to complete the position transfer.
This is from the Department of Family and Community Services, OCS, frontline Social Workers,
Funding was reduced in frontline social workers and increased by the same in the administrative services.
So I think our concern in our previous hearing was that there wasn't enough dollars potentially to maybe facilitate funding in
four frontline Social Workers to meet those caseload caps, do we have a dollar amount by which the total budget
Has changed over the last couple of years and I'm that's probably not in the slide deck
Is that something that you can get to us?
Through the chair
Representing a reference we can certainly get you that and and how how far back would you like to see?
Just just the lasts four or five years when over over. The audit time that we were discussing on Tuesday. We can definitely do that. Thank you
Okay, is it dr. McGinley to the Chair, correct? Okay. All right
Dr. McGinley, why don't you take us away here at slide eight, I guess?
Actually, into the chair, that's still me for just a hit.
Still you are.
A.C. Sweet, slide in.
Thank you very, very much.
We have six pioneer homes across the state providing elder Alaskans, a home and community celebrating life through its final breath.
We have 427 full time positions providing care for
a potential of 506 capacity across all of our homes.
And the total proposed 27 budget is $118 million.
The Alaska Pioneer Homes largest source of funding is in the other category.
Interagency receipts are collected from Medicaid claims as well as the Alaska Pinaire Homes
Payment Assistance Program.
We have an RSA with the Division of Juvenile Justice that provides them their pharmacy
services as one with a Department of Labor for the very successful CNA Apprenticeship
Program
Statutory Designated Program Receipt Authority also falls into the other category, and is
where we collect revenue from our pharmacy program.
The majority of the UGF within the Pioneer Homes Budget is in the Payment Assistance
Program with a small portion used to help support operations.
And in our DGF category designated general funds are collected from insurance claims
And additionally, because of the Palmer Pioneer Homes Veterans status,
we are able to receive federal funding from the Veterans Administration.
Okay. It's like 10.
On slide 10, you'll see our fiscal year 26 items for the Alaska Pioneer homes.
We had one item which was to move the statutory designated program or seats
for our pharmacy program into the language section.
And is this so that if there's excess revenue it can be spent?
To the chair, that is exactly that.
We had a couple of years in a row had requested increases
and so we went ahead and moved it into the language section
at a higher amount,
that way if we did have collections that exceeded the amount of authority
we would still be able to spend those revenues.
Okay, slide 11.
Yes, representative reference. Thank you, Mr. Chair. Through the chair, what was the final amount because it was estimated at four million in last year, or I think it
was even two years ago? What was a final, amount for those pharmacy operations at the end of fiscal year twenty five?
A. C. Sweet.
Through
the Chair, Representative reference, I actually don't have that, but I can I
can get that along with our other response to you.
OK, thank you
All right, slide 11.
Right, on slide eleven you will see our fiscal year 27 proposed summary for the Alaska Pioneer
Homes.
The first is a technical adjustment to reduce federal authority within the Pioneer Homes,
again this is not a reduction of any programs or services.
And then the new technical adjustments within
the language section is to change it from the 4 million to an estimated to be 3 million.
Thank you Mr. Chair.
I think we might have answered our question here.
So three million, but the last one was four million.
I guess, can we have a little further explanation?
Something doesn't seem, I know it's a million dollars,
but it just seems wrong somehow.
Why not make them match?
Through the chair, Representative Ruffridge, I believe that when we were meeting with our partners
that it made more sense to change it to an estimated to be rather than a not to exceed and in doing so
they opted to reduce it the three instead of the four.
It still gives the department the same flexibility as we had when it was the not to exceed 4 million
The only difference between the knot to accede and and the estimated to be is if we did actually collect
4.5 million we would not have been able to spend it however if
We collect 3. 5 million
We can and I think that that's the distinction here, sir
All right site 12 I will hand it over to
director Mageely
Thank you. Good afternoon for the record. My name is Dr. Kurt McGinley, and I serve as the director of the Alaska Pioneer Homes.
And I assume this leadership role in June of 2026, 25. Sorry. Prior to joining the
Alaska pioneer homes, I served as a principal of King Tech High School in Anchorage. I spent 27 years in public service with the first half of my career working as
My background special education and educational leadership has provided a strong transition
for me to transition into this role leading the Pioneer Homes.
Throughout my career, I've focused on individuals with diverse and complex needs, supporting
staff development and building systems that promote high quality care and services, and
I'm honored to continue that work in the service to Alaska seniors through the pioneer homes.
We're looking at the Alaska Pioneer Homes Occupancy and our fiscal year average is lower.
The biggest contributing factor for this is the difficulty we have finding direct service
positions at Fairbanks Pioneer Home.
So without the staff to be available for our residents, we're below capacity.
And later on in the presentation, I'll talk about strategies that we are working on to
promote the idea that we need young people going to work in Fairbanks to care for our elders.
Dr. Mcgillan, question from Representative Staff.
Yeah, thank you, Chair. Joseph's in through the chair to Dr Pina. Obviously, one of these
things is not like the other on this slide. Fairly evident we've struggled a lot in retention of
staff at the Fairbank's Pioneer Home to the point which the occupancy rate has dropped.
to 60% probably below 60%, honestly,
by the end of the fiscal year.
And I'm curious as to why, this is not a new thing.
It's been going on for a couple of years.
I am curious why we can staff the others,
but we cannot seem to staff
the Fairbanks one through the chair.
Doctor, through
the Chair to represent a step,
step?
Excuse me.
We've explored this in the last few months and we've actually been looking at the employment
data and there are situations where there
are employment shortages.
So for example, raising canes has built a fast food restaurant in town and they have
not opened the fast-food restaurant because they can't find the employees to work there.
So there is a definite employee shortage.
What we are going to strive and work toward is building career pathways for young people
so it becomes more attractive to work at the Pioneer Home and Fairbanks and that would
be through creating a CNA to LPN apprenticeship program.
Through the chair so I don't miss on harsher. This is kind of an insufficient answer
So two things number one. I'm sure everyone likes fast food chicken
It's a little different between talking about fast-food chicken raising canes and taking care of our elders in the pioneer home
Second thing is the primary issues the wages are uncompetitive to other industries. That's the primer reason
I've talked to hundreds of people who have worked at the Pioneer home
We address this
in the subcommittee process to forward different things.
So I'm curious if there's a plan to address the lack of pay
disparity in this industry to be able to take care of folks
at the Pioneer Home and Fairbanks.
Thank you, through the chair.
Dr. McKinley.
And then Rep Fields.
Through the Chair, to Representative Stapp,
I can't disagree with you on this.
Our wages competitive, I would say they're not.
That's why we would be looking at creating something that would
be more attractive with training benefits.
So in other words, a CNA coming in at $21 an hour
by completing an on-the-job training apprenticeship program
and becoming an LPN, we can increase that wage to $35 an
hour and have a more skilled worker and somebody who would
be, more likely to continue the work in the Pioneer Home
because we've invested in them.
However, attracting the young person to the job
is very difficult when the wage is not as competitive as it would be in other employment sectors.
And the work of an ALA or CNA, as you would know, is a very
difficult work because of the different needs that the residents present on an ongoing basis.
And a lot of our ALAs come to the job without any prior experience.
So it's their first-hand experience working with our elders and getting that on-the-job
training.
So within a very short period of time, they're making the decision whether or not they want
to continue with the work because they are now encountering something that is different
than what maybe they imagined.
Okay.
Through the chair, I was curious if the shortages
and staffing at the Fairbanks home were both direct staff
and contracted staff or if shortages were only among direct
service providers who were direct state employees.
Direct service, like that, through the Chair
to Representative Fields, direct services.
Okay, and then just a follow-up.
Web fields.
CNA to LPN apprenticeship is a great idea.
I appreciate you all working to implement that.
I'm sure it will work.
I am curious if you were also able to do an LOA to raise both the entry and journey worker
salaries.
So both of the CNA and at the LPN level is that something you have considered and I would
be curious how much that would cost so that we could maybe encourage you to that through
the budget.
Thank you.
Dr. McKinley.
Thank you. Through the chair, Representative Fields, we were looking at many options, but
at this time until we can actually get approvals through any processes,
we cannot disclose anything that we currently are working on.
Could I have a closing comment? Briefly. I just want to know how much it costs to raise
wages at the Fairbanks Pioneer home among the CNAs by like $2 per hour, so that
I'm not asking you to get approval, which I am sure you have a very difficult administration to work on.
I just want to know how much it costs, so we can try.
Thank you.
Thank, sir.
A.C. Sweet, that could be added to the same memo on these other topics to be forwarded through the chair to
the members.
All members, but in particular reps referred so far, and
rep feels but all members
reps of Mina for Dr. McGinley.
Thank you, Chair Josephson, through the chair to Dr. McGinley.
Has apprenticeship programs been implemented in the other pioneer homes?
Is this a new situation?
And how are you implementing that with your budget?
Through the Chair to Representative Mina.
Very good question.
So we have had a long-standing CNA program.
It's primarily run out of the Palmer home.
other educational means, such as more remote delivery, and then we would need employees
in each home that are willing to carry out that apprenticeship.
We have the capacity for it that's already been assessed, so it's a matter of investing
more into the educational delivery of that.
When we think about the future of a program apprenticeships-wise that would be partnering
With grant money to support this those conversations have already been underway and the apprenticeship program
Educational delivery would be partnering with have tech in a sword
Thank you
Representative reference. Thank You mr. Sure. I guess I thought we were talking specifically about fairbanks
Did I miss something or we talked about Fairbanks?
That's where there's a large
I was asking if they'd done it in other homes.
Oh, okay.
I guess follow up that, Mr. Chair.
Yes, for representative reference.
So, specifically in this space,
I mean, UAF has a occupational endorsement certificate
for Fairbanks, I don't see any.
Are they just working somewhere else
due to that wage gap that we mentioned,
or do they not have enough graduates
or people seeking that certificate?
If you know Mr.--
Specifically in Fairbank, yeah.
Yeah.
to the chair, through the Chair, to reference.
Another great question.
With senior programs, and I've seen this firsthand
at King Tech High School, we do attract young people
that are interested in this certificate.
Their certificate is earned within one semester.
They do their clinical work.
And then after they earn their certificate, it's a matter of the decision they want to make to go to work and commit to it.
In my tenure with King Tech High School, I saw very few students continuing with the work.
I see a number of students graduating with a certification but not continuing the with work,
I think we've already explored the idea that the wages are not competitive in the sense of working towards not only attracting but retaining.
So, that's an issue.
And then specifically in Fairbanks, the programs that exist, they do have a CNA program.
They do clinical work at the Pioneer Home.
We have not been successful picking up employees in that pathway through UAF.
The reasons for that, again, are the clinical side of it.
They come in, and they experience it, then they may have to make decisions beyond that.
So, the cost of things becomes much cheaper when we move into the direction of in-house
apprenticeship because we're using our own instructors, we can manage it, and we could
be more hands-on with our CNAs in training, in other words, building that relationship
that works towards retaining them.
At page 12, same slide deck, I see that other than Fairbanks,
you're approaching capacity.
And I'm wondering, given the Silver Sonami,
what the state's position is to have a longer wait list
or build more opportunities for pioneers?
Any thoughts on that?
question, please. Sure. So you're out of room because folks are, I guess, pleased with what
Bineer Home offers, which is certainly true. And what does the state take a position about
what to do about that given an increase in the senior population? And I know I'm suggesting
to stay the status quo and just grow the wait list?
To the chair, a very important and critical question because as we know when the data shows
that the aging population in Alaska is staying here and that's going to continue to grow.
With that, we also know that data show that more of our elder population is living with dementia.
and that number will continue to grow as the elder population continues to
grow and stay here in Alaska. So if we want to invest in our elders and provide
them with the quality care that they deserve, then we must explore
other options for our Elders. Our waitlist is long because we provide
We hear that all the time. It feels like home. We want it to be their home
We value who they are and what lives they've led and we honor them
throughout and
You know knowing what I know about this critical need it is a huge
Ask that we think differently about our future and start to think about big capital projects in this direction
Okay, thank you
Yes, thank you. I don't know that we want to get into this too far, but there is a
bill to address the other ways of providing similar services, lower intensity of services
but that home care advice report, I forget the actual number. But 96, okay, Thank you,
I suppose the question would be people in the pioneer's home that could be served at
a facility that provides a lower level of service but an adequate for their needs.
And has that discussion come up?
Dr. McKinley.
Through the chair to representative Prakce.
part of our discussions.
I think it's a worthy discussion.
I would have to look more into the bill as to what it is seeking to provide.
And I do know that home service is adequate to a certain level, but as the needs grow
and the assistance levels increase, at home is not the best answer.
following up sometime I'd like to follow up with you on that to understand that a
little better. Representative Schonke.
Thank you through the chair. Just have a technical question about the Fairbanks
Pioneer home. Can you expand on the issue that I thought I heard last year that one
of the arms of The Pioneer Home had a structural problem and it wasn't filled
because it because of a physical issue with the building. Is that.
So the case dr. McKinley through the to the chair. I'm going to defer to
AC suite
AC sweet through. The chair representative is wonky
I am wondering if you were calling last year when we presented then in addition to
The staffing shortages we had closed a wing because we were doing a carpet remodel
And in doing that we actually we had elders that were within that neighborhood and we
had to do some shifting in order to move them to new neighborhoods so that
we could then remodel that that area of the home. Okay so we're back up to speed
as far as the whole. We are nearly completed with the flooring remodeled
in that in neighborhood.
Follow-up represent schwanke. Is that playing into the vacancy rate as far as the lack of need for the full staff?
If we don't have the home completely
I'm just curious
Either person
Thank you very much through the chair representatives wonky certainly
But additionally, you know, Dr. McGinley needs to evaluate if when we do have that wing fully up and running,
if we have the staff to be able to care for elders that are on the waitlist.
And if you do staff, then he will definitely be moving additional elders into the home at that time.
Thank you.
Representative Fields.
Thank You.
Yeah, I just wanted to note,
I think Representative Strong he was also referring to the broader structural issues and incompatibility of the old Fairbanks home to accommodate.
people with disabilities and honestly we need to it's cheaper. I think the department has done
the studies it is cheaper to replace the building. We should replace
the buildings because otherwise we're risking it shutting down if there's a
safety or structural issue. Um, I just wanted to let Representative Prox know last I saw data
from the Department. The average age was 87 and a very high percentage of Pioneer Home residents
are in need of memory care. So, um,
Pioneer Home Residence could be more efficiently served in a lower QE setting in addition to that the Pioneer
Home is a longstanding practice of supporting people with a range of say memory capacity because that is
healthy for everyone and that so there's also this balance of Resence Health in
addition an straight up monetary consideration but the department has
Try to support health of residents at all ages. The average age of the residence is way higher today than 30 years ago
Through the chair to represent fields if I may you may just to answer your question about the
suitability for access
in Fairbanks
You're you're correct on that the bathrooms themselves for example
They don't provide the space for proper access and proper care when it comes to safety. So yes, there are
That's just one of a few things that I come to mind when thinking about this
Okay, let's go to slide 13
Okay the number of elders served
With our levels of care, which are based on the number of activities of daily living,
the elder needs assistance with, we continue to see the greatest number
of residents receiving a level care of four.
Our levels care from one to five are statistically consistent throughout the years.
As you can see,
we're serving fewer veterans across all homes and at the Veterans' home in Palmer.
And I'll discuss the Alaska Veterans Home in more detail later on in the presentation.
The percentage of elders served who are living with Alzheimer's disease and related dementia is statistically significant.
And this number is expected to grow as the baby-boom generation ages into needing more care.
Okay.
Slide 14.
Mr. Chairman?
Yes.
Representative Proxxon, slide 13.
I just have a side.
There's a group in Fairbanks trying to specifically open a veteran's home.
You've been aware of that effort
Through the chair to representative pracks. Yeah. Yes the state veterans
Administrators have reached out to me and we're gonna have a meeting soon about that possibility
Another conversation, but other reason to follow up
Representative Fields through the Chair, I would just ask to be kept up to date about
Thank you
Okay, slide 14
So we have three different payment types, we're currently seeing more private pay which includes long-term care insurance
Which is incredibly expensive
And and if you miss a payment you're done apparently they they don't like that
That is during the the
Before it's used you must stay current with your payments. Does that sound familiar?
It does, to the Chair, yes, there's, with our residents that have long-term care,
you know, we provide a lot of assistance in helping them understand what they're eligible for.
We provide lot assistance and explaining to families and family members that it's critical if you have
long term care that you pay attention to, the finer details.
All right, slide 15.
The Alaska veterans pioneer home
have the VA
Veterans administration I can be single of 75 percent veteran and 25 percent non-veteran and we're currently at 32.9 percent
Our numbers of veterans may increase in the near future to 45 veterans pending eligibility for benefits approval from the V.A. Which is in motion right now
And there are three levels of funding
that our veterans are eligible for.
There's the domiciliary, or what's called dom care.
There is a VA residential care setting for veterans
who cannot live fully independently.
The veteran does not need full nursing home care,
the veteran needs help with daily living structure
or supervision.
Depending on what level of care the veteran needs they might need nursing level
of Care and this is for a veteran who requires 24-hour skilled nursing due to medical or functional
needs. This is the highest level long-term care support. There's also what's called service
by military service or made worse by
military services
slide sixteen
so this is our waitlist slide here and you'll see we have the active wait list
uh... which uh to define that an applicant with a desire to move into a
home with thirty day within thirty days is placed on the act of waiting list
An applicant who desires to move into a home later is placed on the inactive waiting list.
When an inactive applicant chooses to activate, they are placed in the active list based
on their original inactive application date.
And our numbers have grown quite a bit and are continuing to grow daily because we have
put our forms in more of an electronic form.
and it's made things a lot easier for our population out there that is seeking to get on the wait lists.
Slide 17.
So we have quite a few achievements that we want to brag about here. Expanded training
in dementia care, stigma, person-centered care and geriatric care. We've implemented a new
We've created and implemented an online waitlist application that I discussed in the previous slide
and we've processed a record number of wait list applications of
894 to date and
We have facility maintenance and upgrades that. I want to speak about we have our Juneau Pioneer home
courtyard that is nearly complete. We're waiting on the handrails to come in
They had to be specially ordered and designed for the the way the
patio is the curvature of it is you very unique and those railings are going to
be installed once they get here and the weather gets better and that should be
later on this spring and we're planning a red ribbon event that I will all
invite you to that now and I'll gladly send you an invite when that time comes.
Thank you.
That was installed and we're in the final processes of signing off on the paperwork with the back and forth with
the Veterans Administration, and that was a very successful
roof installation and
the new flooring project in Fairbanks is
Nearly complete. It's been a painstaking process getting there, but we are almost there
Representative Prox
Thank you through the chair kind of a cold question,
We have an increasing number of people on the active waiting list, and I think you said
they would like to be there within 30 days and
We're probably not meeting that goal
Through the chair to representative Prox
So to get on active wait list the
Alaskan would say I can be ready in 30 days if the space or bed is not available in the home within 30
days they would continue to be on the active waiting list until that bed becomes available.
And then they rank their top three choices so within those three
choices we try to make every accommodation we can to find them in bed.
Well, I guess you can get on the inactive list when you're 40 or something like that.
And you are not expecting to need the care for two or three years or a long.
But at some point to get closer and closer, and what are we doing to accommodate these
people, they are either not able to either get
on active list or not being taken care of.
I can go out finding and fishing and stay in the woods for a year and sometime I'm gonna have to be in
the Pioneer's home and there's levels of care between those. I guess that's kind of out of your
wheelhouse. So I am sorry. Let's go figure that one out later.
Con? Through the chair to Representative Prox, I think if I hear what you are saying correctly,
the person who is on the inactive waiting list.
the date in which they sign on to the inactive waiting list that date remains intact and
Then the individual then has to decide when they want to get on the active waiting lists
So that they can have maybe a bed within 30 days
They to sign onto the act of waiting List that starts at age 60 and
I think you raised another you know struggle that
Elder Alaskans have is when is the time?
What time is it, when do I need to really bring myself
to the Pioneer Home?
Right, but as I asked the question, I thought that's actually
for a different discussion, so thank you.
I'd be glad to have that.
Dr. McKinley, on the questions earlier of payment assistance,
remind the committee where that comes from
and are the resources there adequate for the department.
To the chair, I'm going to defer to AC, sweet, AC sweet same question to the
chair. So it we have a component within the Alaska Pioneer homes called the
payment assistance program and it's it 33.6 million I believe and you know
that that's a very difficult question. Chair Josephson
But the level of need against the payment assistance fluctuates on a daily basis because
it fluctuate based off of the elders that we have in our care.
As elders leave and then we get new ones in, if they have long-term care or if there aren't
a Medicaid waiver, then the draw on the Payment Assistance is down and everything is, we
have enough funding.
plenty of funding a week from now.
It's a very difficult thing because it depends on the elders that we have in our care.
Depends on a level of care that they need when they enter the home.
And if they have long-term care insurance, if you have Medicaid,
if have their own private payment, funds available to cover.
So it's very a difficult question to answer, sir.
All right, let's go to the next slide.
And so for our FY2027 focus areas, we're going to continue to improve technology.
We want to complete the install of the call late system in all the homes and what's happening
simultaneously with that is that the cost system requires a lot of Wi-Fi throughout the
homes.
And, so we are engaging in Wi Fi upgrades to make it a very seamless working system because
We want to continue to increase and stay within our goal, which is 95 or better census at any given time,
and by offering application assistance, community outreach, and in particular Alaska veterans in the Pioneer Homes as a continued focus.
And then with the increasing in training, the last bullet point I've already expressed the need and the movement in that direction.
And I hope that next time we're here next year that I'll have a program that is rolled
out with its first cohort, you know, moving towards full-time employment as a certified
LPN.
Representative Reffridge.
Thank you, Chair.
Through the Chair, wondering if you could go through just a couple questions.
First, how long does it take to move pharmacy to cloud hosting?
It looks like, I think it was more on the previous slide, but it's here as well.
What does training look like for a dementia care specialist that maybe changes year over year?
Dr. McKinley. Through the chair to Representative Ruffridge,
the pharmacy cloud hosting is a little bit more technical than I can assist with in clarification,
working to get it to the cloud because with the Cloud is seen with medical
records and documentation as being insecure, unsecured. And so there's a lot
of effort that's going into working towards a cloud-based pharmacy
Was there a second part to your question as well?
I just wanted to know more about training,
but I guess I'm not certain that no, I don't think that.
I was just wondering if there was a time frame
for that to be completed.
I think I feel like I've heard this move pharmacy
to cloud hosting for a while now.
So I dunno what the cost to do that is,
but it sounds like it's been a long-term project.
Through the chair to representative rough Ridge
You're not incorrect in your thought process with this
the
It plan to implement the cloud-based hosting I
Believe it does meet some
Barriers that they need to work through and I'd be glad to provide you with updated information
In consulting with IT on this
Thank you, how many pioneer home pharmacies are there?
Dr. McGinley there is only one and it is in Anchorage at the Anchorage Pioneer home
Thank You follow follow-up. What is the benefit if you only have one pharmacy of cloud hosting?
I will, to the chair, through the Chair,
to Representative Ruffridge,
that I'll have to get back to you on the correct answer
for that.
And then final follow-up.
Yes, final thank you.
Representative.
What is the cost estimated to be to move just in the
cost for IT problem solving to do this project?
Don, maybe that's for my sweet.
Either person through the chair representative reference. I think what I propose is we'll get you the cost
That it'll take and the timeline as well as the benefit to moving to the cloud along with the other questions that will respond to you
Okay, thank you. Thank you
Representative Gray then prox
Thank You through, the Chair to either dr. McKinley or AC suite. Um, I appreciate the
Goal of increasing the veterans census at the Palmer pioneer home. I'm just curious. Are there not veterans on the weight list right now?
Dr. McGinley
Through the chair to representative gray. Yes, there are
And we're prioritizing them to have a bed when it becomes available in at
the veteran's home in Palmer
Thank you
Okay, representative Prox
No, I think I'll wait until the end of the case. We'll go to slide 19 if I may
Through the chair to representative rough Ridge. You had a second party of a question related to dementia care
Yeah, and that would be just to add the chairs discretion
I don't know what our time frame looks like it was just
That can be something we can address on offline, but it's something.
We've talked about again multiple sort of
versions of this presentation has consistently had
new training for dementia care and I now it makes me wonder
if it's new every year or if
it is just an ongoing thing that just maybe we never quite get done.
Do the chair to refresh.
It's more about increasing the capacity of those trained to meet the growing
number of residents that are coming to us that need memory.
and or dementia care and we have one skilled nurse that is designated as the trainer who
is training nurses in the home to be that trainer for others in home but it's a lot
of time consuming work because it is almost a year's worth of a college curriculum for
to provide a high quality level of care for someone who is living with dementia at a level
Yeah, just a little more historic background, so like three or four pioneer home directors
ago, Vicki Wilson up in Fairbanks pioneered this, pioneered the CNA apprenticeship for
dementia care.
At a time when the average age was rising quickly, members may already be aware of this.
It was very successful.
It's great to see and practice today directly respond to the very high age of residents
and the fact that a lot of these residents in the absence of the pioneer homes literally
would have nowhere else in state to receive adequate care
for dementia. So it's a great program and thank you for your continued work on it going
back. Many generations of pioneer home leadership.
Okay. Thank you. All right. Let's take up the next section or division rather. I'd like
to thank Dr. McGinley and I would like to invite CEO Cole to the table please.
Welcome.
Thank you.
For the record, my name is Ken Cole, I'm the CEO of the Alaska Psychiatric Institute.
I started my position last June 2025 and my previous experience in psychiatric hospital
administration expands approximately 25 years, including the state of Colorado, where I spent
CEO of the South Dakota State Hospital. I'm proud to be in Alaska and honored to
be here today. So we welcome you. Thank you all right slide 19. All right for the record Marion
The Alaska Psychiatric Institute has five inpatient units with a total of 80 licensed
beds, 60 for civil, 10 for youth, and 10, for forensic.
And in addition to the 80 license beds within the API, we have increased our service capacity
API has a total of 321 full time positions, providing some passionate healthcare to support
Alaskans in living their best possible lives.
And their fiscal year 27 proposed budget is 66.9 million.
In slide 20, we have the Alaska Psychiatric Institute has two funding categories, UGF,
which is comprised of general funds as well as general fund mental health authority, and
other, which are where we collect our interagency receipts and SDPR.
So our Interagency Receipts are predominantly from the disproportionate share hospital program
and then Medicaid claims.
is from our private insurance and private payers.
Okay.
All right.
On slide 20, we have our fiscal year 26 items.
The one item that we put forward in the bill for last year was an increase in general fund to help support decreasing revenues.
We put 4.4 million dollar ask and we're awarded the 2.2 that you see up here.
And I wanted to thank the legislature for that authorization.
And the hospital in a very good format we are not looking at having a shortfall in state fiscal year 25.
And so I do want to thank you for that additional UGF to help support the Hospital operations.
I do want to take just a minute to talk about what we did and what the outcome is looking
for fiscal year 26.
So we are actually looking at collecting about 5 million more this state fiscal
year than we do in 25.
And what have done is we actually we hired staff in our billing and coding unit.
We evaluated our processes, I think I told you last year that we had hired a contractor
evaluate our billing and our process procedures, and doing that, we created two units within
the billing unit, one that is focusing on appeals and denials and working those cases
and one working on current claims.
Additionally, we worked with providers and we increased our settlement rates and
we streamlined our credentialing process.
All of these have been hugely successful, but I don't want the committee to think that
we're done.
Because we are not.
We're going to keep on building these efficiencies.
We are going keep making sure that we looking at better ways to do our billing and our
coding and revenue collections and doing that as we work towards implementing this
within the Alaska Psychiatric Institute.
A.C. Sweet, I'm curious about something.
So your agency asked for $4.4 million
and received about half that.
And what you've described,
I think, is an outlier in that you don't think
you suffered any prejudice from it.
You got through, you found more collectibles,
through current claim units and denial or appeal units.
And I think it's an outlier because I
think typically if we don't fund something,
it can't happen.
But you're saying that this worked out.
Is that right?
to the chair. It has. I'm exceedingly pleased with the team that we have there and the
chief financial officer and what she's built and revenues that she has been able to collect
under her guidance.
I really do think that were on a good path.
I only make my comment because unless the legislature, unless we're all geniuses, this
may have been an accident. Okay.
that you could make this happen but sometimes it's just good to be lucky and we'll leave it there.
Let's go to slide 22.
Okay. On slide twenty-two the only item that we have in our twenty seven budget proposal
for the Alaska Psychiatric Institute is some budget reductions.
So this is coupled with what we were talking before we did an analysis.
personal services and personal service increases occur every single year through bargaining contracts and
If we have interagency and SDPR Authority those are increased that does not mean that we
Have the ability to collect for them. We can only collect
For you know the the Medicaid claims that
We Can bill for and the insurance claims so this is an evaluation of that and even with the increases that were seeing in Medicaid
Claims and increases, that We're seeing an SD PR these reductions will not
impact our ability to collect.
So I just wanted to make sure that that was very clear,
that these reductions are not going to impact any programs
or services, our abilities to claim.
Okay.
Thank you very much.
I'm gonna go on to slide 23.
All right, slide 20-3.
To the chair, the census at APIs remained fairly stable
We're running at approximately 94% to 96% on all of the adult beds in the hospital,
that would be 70 beds of 80. And the adolescent census, it's a 10 bed unit,
has fluctuated up and down. We've gone up as far as eight to nine beds, we're currently around four
And we're working to understand better what the forces are in the community that have
resulted in reduced referrals to our, sorry, our adolescent unit, so we'll be looking
at that in weeks and months ahead.
We also maintain two wait lists for adult civil patients that are on ex parte orders
and for forensic patients ordered by courts to the hospital for restoration to compensate.
think you're familiar with that pretty well. Those wait lists have gone on now for a while.
The adolescent. Civil wait list tends to fluctuate more. Up and down it's been as high as about 20
to 25 this year and sometimes it can go down to 0 to 5 individuals waiting. One phenomenon that
we've seen over the last four to five years are an increase in patients that we call conversion
That's just a name that we've given to these patients within the hospital.
Under the dynamic and the forensic statutes in Alaska, once an individual is found
incompetent to proceed, there's really no path forward with them.
if our clinical team believes that they're not ready to be released to the community or to
be discharged and that's a clinical decision and it's also a risk decision. So I remember these are
patients that have had criminal charges. Those charges can be as serious as murder, rape, both,
and so we have to make a decision as to whether they can leave the hospital over the last five years
So these are all adults, and so about a half of our adult beds
are occupied by these patients.
We are working for ways to increase the ability
to refer them out to the community.
But we do have challenges, which I'll talk about
in an upcoming slide, in finding adequate placements
for those individuals.
And that's a trend we're going through right now.
Do I call you Dr. Cole or Mr. Colle?
Mr Cole.
Okay.
Mr Col, we've got a couple of questions, but I was very involved in a reform effort two
years ago.
There was a Reform effort completed with a Senate bill and among other things, it did
many things.
But one of its principal things was that I think it required, sort of insisted that
It was, the prosecutor was duty-bound, I think in most circumstances, to consider a commitment
petition, and this all stemmed from a tragic event in Midtown Anchorage that you probably
have heard about.
I guess my, is this the commitment beds?
You said, you didn't use the word commitment, but you said 30 beds were occupied.
left the second half of the situation out so I appreciate your question Mr. Chair.
Those individuals then once they are deemed incompetent to proceed the only way we can retain
them in the hospital is to file an ex parte civil commitment on them. So these 30 individuals
have typically almost in all cases a civil committment under Title 47.
So does that answer your questions?
I still have some anxiety about moving them to off-site to other homes, for example,
and whether they are monitored sufficiently in situations where they've proven to be dangerous.
To the chair, one thing that we've done, and you'll see this in an upcoming slide,
program inside our hospital. It's kind of like a stand-up clinic, if you will. So we have those
individuals that are out in the community. Now, it's a little complicated.
That's not the 30 that're inside the hospital that we're calling conversion patients, but we
have about eight to 10 patients at any given time that
are in mainly any anchor area. They are on unconditional, I'm sorry, conditional release.
under the court. So the Court has listened to our recommendation on what would make the community
safe for them to be out in the Community, and that includes typically placement in an assisted
living facility, conditions, compliance with certain requirements like medication. Sometimes it may
and checking in with the appropriate community mental health provider that's following their case.
So again, one thing we did recently started this January, middle of January was we now have
each of those 8 to 10 come into the hospital API once a month where a psychiatrist lays eyes on them.
And it does a assessment of whether we believe they're still appropriate to be in the community.
In addition, we're always maintaining communication and relationships with those community providers
to find out if there's anything going on with, for example, me that would warrant me to come
back in between that outpatient clinic visit, if you will.
So we are in that process, again, of tightening oversight, and that's what we were doing.
Let's go to a representative Gray, then Mina thank you through the chair.
I have a question about the wait list and I know that in the case of where people need
to be restored to stand trial that they often are held at DOC.
My understanding from conversations with Commissioner Winkleman is that that's very expensive
takes up a lot of DOC resources and DOC is just expected to find that money in their budget because
they're not allowed to bill API for it and I found that really interesting why DOC would be
responsible for paying for the beds that API doesn't have. If you know through the chair
I'm fairly new, but I can't speak to part of the question.
So we have 10 restoration beds that are constantly full.
We have a waiting list and you're right, they're almost always sitting at a DOC bed.
We also have an agreement with DOC to restore up to 10 male individuals at the Anchorage
So, we work with DOC and partnership, I don't know what costs their absorb, well I know
that security and food and the basic non-restoration, nonclinical costs are being either absorbed
or they've been funded to DOC, and AC Sweden maybe tell us that in a minute.
have come as an appropriation to API in the last couple of years so we were
given funding to create an out-patient I'm sorry a jail-based restoration
program at DLC AC suite anything to add through the chair representative great
we've actually I started having conversations with the Department of
Corrections to try to figure out a solution for this problem
What we are in the infancy of those conversations, so I don't really have a resolution at this stage
Follow up, rep, great.
Thank you.
I'll just say that this was in the context
with Commissioner Winkleman about the largest expense
of DOC being for health care and talking
about what are the drivers of the health
care costs in DOC.
And they said, well, us having to pay for these API patients
and their care.
And it was implied to me that they were actually
that their health-care team was providing care
and that it coming out of their budget.
And that, I promise, that I would ask about that.
So, thank you.
Okay.
We've got Representative Mina.
Thank you, Chair.
Joseph, send through the chair two questions.
The eight to ten patients that you said that are on conditional release, is that in your
census count for API?
And my separate question is going, looking at the conversion patients and that
1,400% increase, why do you think that is?
You think it's related to structural reforms with crisis now,
or are there other contributing factors?
Through the chair to Representative Mina,
the answer to your first question is no.
The answer to your second question is we're looking
at what's driving this increased length of stay
for these conversion patients.
Again, we'll be talking about it maybe in the next slide.
There are barriers for discharge that go beyond
our willingness to discharge these individuals.
So another way to put it is our clinical team,
really our physicians, our psychiatrists,
may not feel comfortable discharging.
or any of those 30 patients right now because they don't believe that the appropriate type
of placement exists in the community to ensure that their community, I'm sorry, that community
is safe and that individual will receive the adequate level of treatment that they still
need.
So another way to put it is these individuals have such a long and maybe I don t like to
chronic but it is in some time and some instances that there's no
currently no level of care in the community to meet their needs.
Representative reference.
Yeah, thank you chair through the chair. I appreciate representative
Gray's line of questioning and I think we talked about it quite a bit last year
and obviously a little bit this year already for these forensic wait lists.
What is the average time that an individual,
and I think we talked about this last year,
and maybe I'm confusing it with DOC's presentation,
but how long are they waiting for a forensic assessment
or, you know, to be taken up at API?
Mr. Cole.
Through the Chair, Representative Ruffridge,
I am going to do this by memory,
and it could be inaccurate,
If I'm wrong, I believe it's about 220 days, and an individual can be waiting to be admitted for restoration.
And I think depending on whether it is a misdemeanor or felony, there are court hearings prior to that.
I I there's a 30-day hearing or a 90- day hearing.
I can't recall at the moment.
Are required to occur before the admission to API?
I'm more knowledgeable about what happens once they're in our hospital, so of course, okay.
Representative Prox.
Yes, thank you.
Through the chair with his forensics, where I think we're talking about people that we think should be incarcerated.
in the correction system and I can imagine that it is high relative to other people in
the corrections system but I'm wondering what is the comparative cost in API versus can you
can do this at more expense or less expense than the corrections if we had to build more
The cost per day at API is higher than certainly it is at DOC
there may be a
Model or an opportunity to serve these conversion patients at a let's say a step-down facility
That's not at api that would be at lower cost Per day. However, I'm speculating that that wouldn't be
Less than the Department of Corrections daily costs because those individuals will still require
treatment mental health treatment and
Staffing for medication administration
So they're not it's an interesting situation. They're NOT they are not equivalent to a prisoner
Even though we have lots of prisoners waiting to come in the front door of API
to adequately and best properly care for these individuals that are currently at API,
they're going to need resources and services that
are not at the level of API but are at above the
level DOC's prisons. And that's okay. I have a hard stop at about seven minutes, so
let's go to, oh, Representative Rebridge. Yeah, thank you, Mr. Chair.
I'm sorry for this follow-up question, but that prompted some,
two parts, one, what is the cost per day at API, and two, maybe taken into account that our Medicaid billing is not possible on DOC.
So, we have to pay for those costs at 100% out of state general fund.
So what does the costs per a and then given that you can't bill, are you sure it would be more expensive at an API just to the state General Fund?
Mr. Hill through the chair to represent a rough Ridge complicated question. I'll do the my best to
answer it very quickly.
I will defer to AC suite for the daily cost per day at API because I'm sure she has it on top of her head
regarding the Medicaid reimbursement the federal government does not allow a
psychiatric hospital with more than I am sorry
does not allow a psychiatric hospital to bill for Medicaid for individuals between the ages
of 22 and 64. This is called the Institute for Mental Diseases Exclusion, and it's been
around federal law since the 60s, maybe 70s. So that's factual, which unfortunately prevents
Now, this is where it gets a little nuanced.
Should there be a facility outside the walls of API,
it then depends on the size of the facility
under this federal law, and yeah, the
size the facilities.
And who operates it?
Two criteria.
So just quickly, if we were to operate a
facility inside the wall of
We would not be able to build Medicaid either because CMS will look at that facility as essentially part of API and they'll say your new facility,
I'm not recommending or advocating for, is part API, and therefore you still can't build for Medicaid.
That's another weird number with the federal government.
If it's 16 beds or less, they will pay for Medicaid.
So I don't know if that answers your question
and it a complicated situation,
but I can certainly get you more information if you'd like.
Mr. Chair, boy, you learned something new every day.
I would love to know
if members on this committee had ever heard
that we cannot bill for services and API.
Which makes me wonder how, in Heaven's name, your budget is actually not more than what it is.
Is there any billing that is occurring for API?
That really surprises me, just in general.
Through the chair, through the Chair, I represent a reference.
Certainly there's billing, sorry, going on.
Not to say certainly, but there is for Medicaid patients
under the ages of 22 and over 64.
So we have several patients that are elderly
and then our youth on the adolescent unit,
we can bill for a Medicaid.
So it's specifically from 22 to 64
that the federal government picked years ago and said,
you can't bill that population.
If you run a psychiatric hospital
or even if you're on a private hospital
that's 50% or more psychiatric beds.
We also bill other types of insurances.
I'm going to pass AC Suite to answer the cost per day
question and speak to the revenue and the billing.
AC suite.
Through the chair, representative
And I love that he thought that I would have that off the top of my head,
but I actually do not have
that on the tip of the head so I'm going to have to get that back to you.
But we do claim Medicaid, but for the patients that are at the hospital
that Director Cole had mentioned, and I don't want to talk out of term,
but, I think that we also claim Medicare on certain patients.
So those are what we are allowed to claim for, outside of private.
Representative Greg, thank you, Chair.
So my comments last question is really going off
of Representative Prox's line of questioning,
which, and again, this is going back to my conversations
with DOC, that the process of restoration is very intense
and requires a lot of resources, with the goal
of making the person competent to stand trial.
And what's-
interesting in the comments that represent Proxit,
well, these people are supposed to be in prison,
is that once their, if their competence down trial
and their found guilty and they're sentenced to DOC,
they are not going to have this level
of mental health care once they re in.
And so presumably their severe mental illness
will create problems.
I'm just pointing it out that it's something that we,
we should probably do a whole hearing on what restoration is, what it involves, and I should
probably go do it tour and go see what looks like. But I'm just saying that it's very complicated
because it changes the way DOC functions when you have people who have severe mental illness
that are under-treated. I know I have four minutes and we have three slides and
So, this slide is entitled Discharge Barriers, but what it really is, is the split out of
where patients go when they discharge from API, so over half a go to a private residence
or home.
Hopefully, it's a residence where they came before they were admitted.
to get ready to stand trial.
And if you look at the assisted living facility numbers,
those are pretty low.
Some choose to go back or go to a homeless shelter.
We prefer not to discharge the shelters,
but some patients actually request it.
The other category includes transfers
to hospitals in the community, physical health hospitals,
and some other types of placements.
So what this slide is really trying to say in bullets is,
as the leader of the hospital, want to prioritize finding places
for patients that are not appropriate to be an API.
It's always been a personal goal of mine to try to get folks
out of a hospital if they don't need to either.
It is not efficient use of taxpayer resources.
It certainly not good for them.
So we're looking at what those barriers are
and I've already mentioned several of those.
Okay.
Let's go to the next slide.
Through the chair, what is other?
Yes, it's a catch all category that, honestly, I'm sorry,
through the Chair, represent Mina that is,
could be broken down more, but includes transfers
to other hospitals in Anchorage, yeah.
In the Pioneer homes,
it is a smattering of different types of placements
that are not on the other bark, not in.
Okay, slide 25.
We've done quite a bit this past year at API. I'm very proud of several not all of these
Accomplishments we've talked about the GL based park partnership with DOC
We have been talking with DoC about expanding that partnership. There are some
very good questions about funding and the nuance is a funding, and I
Willing to work with a sweet to get you those details I mentioned the outpatient or the conditional yes
the outpatient clinic that we're running, I'm very happy about that because that's keeping
more frequent set of eyes on those eight to ten individuals. Certainly we have been in good
stead with the Joint Commission and CMS. AC Sweet mentioned revenue collection.
I have instituted quarterly listening sessions for staff where my leadership team three times
we want the staff to come and talk to us and voice their questions and concerns.
Those have been pretty successful. We've done two of those and we have another set of
those coming up in a couple of weeks.
We have developed a performance improvement report which is a standard set
of metrics. It's typical of a private hospital that you see those metrics at Providence or
Tweaking those and the measurement of those, but there are some very good metrics people can see as soon as we get the HIPAA issues ironed out
They'll be on our public website website, and we've reduced
claims with OSHA
Dramatically since 2001 and I just want to look for the data here real quick
So a lost time cases are down to three in 2025 from 29 in 2021
And the reportable cases have dropped from 29 to 13, and that is from COSHA data.
Okay, I think this is the last slide.
15 seconds.
All right, thank you.
No, represent reference.
Just very quickly,
thank You Mr. Chair on that last line.
You had talked about continued reduction of workplace injuries.
Last year we heard that there was 320 incidents of patient staff.
I guess assault or violence that what is that reduction down to now?
Through the chair to represent a rough Ridge
So the metric I provided as I said it is OSHA. We measure at a more gross level if
a patient shoves or grabs a staff a Staff member can record that
So I don't know and we can get to the data on where we're at
with the 329 compared to the day.
Thank you.
Okay.
Quick question from this chair on a patient's right.
Very quick, please.
Thank You Chair Josephson through the chair.
I would just love a brief update about your trading
related to patients' rights and grievances.
I have constituents who are really passionate about this.
Thank.
Thank, you
Mr. Coble get we've invested thanks to a grant from the aha in
Leadership training for both of my team and the supervisors all supervisors in the hospital
I'm very excited about that and we again talking we are talking with doc about expanding the jail-based restoration program
And I mentioned discharge barrier being a goal because the more patients we can discharge,
then the better beds we open up for people that need to be in the hospital stat.
Mr. Cole, I'm recalling my calendar, and I have actually a quarter of an hour more than I thought I did.
So, if you would like to respond to.
I have a question about patients' rights and grievances, anything you'd like to save on record on that topic.
All right, thank you, Mr. Chair.
To represent Mina, could you elaborate a little more on what you like?
Thank you and thank your Josephson now that we have more time.
Yes, I had constituents who are really passionate about patient grievances and
I know a lot of those concerns were integrated with the passage of crisis now.
There is interest in training for staff on their ability to inform patients of their
psychiatric rights and also of the grievance process. I know that there is information on
the within the rooms that the folks are staying at but just if there's an update on on making sure that people who are at API know of
the rights.
Mr. Hill through the chair I represent Mina.
We have not necessarily increased the amount of training to or education to patients about patient rights
But I believe it's been at the top level of any state hospital
I've seen and part of that is I'm fortunate to have two patient writes advocates in the hospital
So for hospital of 80 beds, that's a pretty rich staffing ratio
In South Dakota, I had one patient rights representative for 340 beds.
Not necessarily that that means better outcomes, but I stay in touch with it.
And so we go through the process of if it's a complaint, or if its a formal grievance,
we have a process outlined in writing that meets all of the regulatory requirements.
believe those two patient advocates, I know, because I see them, spend a lot of time on those
five treatment units listening to patients and responding to their questions and concerns.
They could be as simple as I want to mail 50 letters, okay, you know we'll pay for the postage to
allegations, more serious about treatment they've received.
Are we having with this department, just to including the closeout day?
No.
Okay.
Representative Prox.
Yes.
Thank you.
Through the chair, we've mostly talked about what today and what the, and it's way above
what's the public and somebody like me can understand and grasp.
is why and what are the results of what we did.
Can that be incorporated more into the presentations as we go along,
or can we get a little fill-in information?
Mr. Cole.
Through the chair to Representative Prakce,
I'd be more than willing to do that, but I'm searching for an example
So, maybe the root cause of why something moves from one to another, one value to
another?
Mr. Prox.
Thank you.
There was an example on the pharmacy, I think moving the
pharmacy to the cloud.
We did it.
Was kind of what I got out of the discussion.
But I wouldn't know why we did that and because we
did what happened and what were the results of it?
Mark here less expense basically through the chair to representative pracks
That of course was the pioneer homes, right? But you're using it as an example
So just looking at our achievements the reason we want to expand gel-based restoration is to reduce that waitlist and get more individuals that are ill
either
Healthy and back to trial or to appropriate placement
I think I spoke about why we're monitoring conditional release patients.
I'm not disagreeing with you, I just kind of give any examples.
AC Sweet talked about what we did to increase revenue collection.
I've spoken about why I'm holding with more listening sessions for staff.
I actually, I didn't say why because I know that the culture in a psychiatric hospital
comes from two directions from the bottom up and the top down and I am trying to work
on both of those.
I' m not trying.
I AM and part of the way you work on the
bottom-up is listening to staff and being out on
the floor with staff
Data transparency, I inherited a hospital that had no public facing data reporting, really,
except on our website, the Daily Census.
I want to get data out there, as I mentioned, that shows that we are not, we're moving
in the right direction on certain metrics, and just to go into that detail a little more,
when my leadership team and I see that were moving in a wrong direction, for example,
are up this year over last year.
So we do a good job with not putting patients
into physical restraint.
That's pretty rare anymore at API.
But we end up putting patience when they're agitated
and have decompensated briefly in a seclusion room.
So that's just a room where they are by themselves.
There's nothing pejorative, excuse me.
And then of course I've not talked about how we're reducing workplace injuries because honestly I don't know how
We've done that, but I'm gonna find out right
Representative Gray
Thank you. If it's is it okay chair if I ask dr. McKinley to come back
If if mr. Cole is not offended
Then it is okay if he is and we have an issue. No, I have a question about slide 15 dr
McKinlay
Slide 15, slide 15.
So through the chair, I had a lot of questions
about those three levels of funding.
It has been clarified to me that the service-connected
is for veterans who are 70% disabled or more
qualified for this service connected rate.
My question is the 680-39 a day, is that enough?
What is the daily cost of being in a pioneer home?
Dr.
Through the chair to representative gray that is dependent upon the level of service that they receive
But I can tell you that a resident who is receiving a level for care
monthly is
14,000 and some dollars and if
A C suite has a more definitive dollar amount to that by all means.
A.C. Suite.
Through the chair, Representative Gray, I do not have the exact amount, but we will definitely
get that and tell you what that is.
It equates to on a daily rate.
Thank you through the Chair 14,000 divided by 30 is $466, so $680 a day would cover that
level of forecare.
Thank You.
Yes.
For the Acting Commissioner, I want to tell you something, and that is I'm very impressed by these hires.
Very impressed.
I congratulate you on it.
That winds up today's testimony or thanks to all our presenters.
Our next House Finance Subcommittee meeting is scheduled for Tuesday, February 10th at 320.
We'll hear from the sister department, Department of Health's Division of Public Assistance and Senior Disability Services.
At this meeting is adjourned at 509.