This hearing of the Senate Health and Social Services Committee will now come to order.
Today is Tuesday, February 10th, and the time is 3.31 PM.
We're hearing a bunch of it's room 205.
Members present are Senator Myers, Senator Tobin, myself, Chair Dunbar.
Vice Chair Giesell is excused and I expect Senator Klayman shortly.
So let the record reflect, we have a corner to conduct business.
Before we begin, I would like to thank Mary Gwen Kawakami, the Senate Health and Social
Services recording secretary, and Susan Quigley from the June LIO for staffing the committee
today.
We have two items on our agenda this afternoon.
First, a presentation from Guide House on Medicaid Rate Reports, then an introductory
hearing on Senator Tobin's Senate Bill 206, an act relating to school suicide policies
and firearm storage.
So we'll begin with our presentation from Guide House.
The folks would like to come and sit.
We have Emily Ricci, the Deputy Commissioner,
Department of Health,
Coy Jones, Project Director from
Guidehouse and Claire Payne Behavioral Health Lead
from guide house.
If you guys would'd like come forward.
We also have in the room for questions,
Poona Suresh, Long-Term Services and Support Lead
and Liz Barabbas.
project manager and federally qualified health center lead.
So thank you all for being here today.
When you're ready, please put yourself on the record
and begin your presentation.
Hi, good afternoon.
For the Record, my name is Emily Ritchie
and I am Deputy Commissioner in the Department of Health.
And I just want to thank the committee
for hearing today's presentation,
as this committee is well aware Alaska's Medicaid program
is a joint federal state program
providing health insurance to low income Alaskans.
As of December 2025, Medicaid covered over 210,000 Alaskans or 1 in 4.
Medicaid provides critical services and essential revenue to healthcare providers,
but it is also a large budget component with a combined federal and state spend of over 3 billion
dollars. It must be carefully managed to ensure the value of the dollars spent aligned with the
And when I started in this role in 2022, we were emerging from the pandemic.
We were beginning to move back into business as usual, but the effects of the
pandemics were very present in our health care sector.
Inflation was impacting all sectors, especially health
care.
Workforce was and remains a critical challenge for health
Behavioral health needs were skyrocketing across the nation,
but particularly among our youth.
And chronic and acute conditions were emerging,
re-emerging really kind of with a vengeance
in terms of the acuity of populations that we're seeing.
And the legislature was responsive.
They increased rates for home and community-based waiver
services beyond the standard inflationary factors
for multiple years, and they supported rate increases
for behavioral health services as proposed by the department.
But we continued to hear from providers that rates were insufficient to cover the services
that they were providing to Alaskans.
And we began to step back and to consider, was there more happening within the underlying
structure of the rate methodology?
Was the methodology reflecting the outcomes that we want to see?
Did we get the structure right?
How can we be sure the future investment in Medicaid
aligns with the gaps that
we have in our system and the
outcomes we wanted to
see and so that's really the foundation of
the Medicaid rate methodology study and what
prompted that and brought that forward?
Like everything in Medicaid, the structure is complicated and we have over a dozen different
right methodologies.
And so to tackle this, we broke the project up into two phases.
The first phase is the focus of today's presentation.
And it includes a focus on behavioral health services, long-term care services and supports,
which include our home and community-based waiver services federally qualified health
centers and transportation services.
We will be addressing other types of rates in Phase 2, which we will build out over the
Work on phase one started last fall.
We brought the contractors on prior to that,
underwent a procurement, and then work started
in earnest last Fall.
The final reports for the behavioral health
and long-term care services and supports were completed.
This last, fall, early winter,
the federally qualified health center reports were
completed and finalized just last week.
The transportation report will be finalized very soon, but the recommendations within
all of these reports have been shared with the stakeholders and the providers that were
impacted.
So we're sharing the information today.
These studies and recommendations are intended to provide information to policymakers and
appropriators.
They're intended as to to provides options and structures to consider when you're evaluating
needs. We have asked the contractor
guide house to provide fiscal estimates for these recommendations to help demonstrate
and to know kind of the order of magnitude for what some of these changes mean or what
some recommendations would mean. Some of
these reflect ideas that I know have been discussed for well over a decade, but we haven't necessarily
been able to put shape to what that could look like, what the considerations are, or
what
There's no expectation from the department that all of these recommendations be implemented.
In fact, I'm not aware of a state who's undertaken a study like this and implemented all
of those recommendations at once, right?
It's really a series of options that we can consider as we move forward and think about
how to structure our funding, again, with the system outcomes that want to see.
I think this is especially important given our fiscal situation and the budget realities
that we face.
So I wanted to shape that history and background as well as how we are thinking about the results
from the rate methodology study prior to handing it over to Guide House.
So with that, I would like to hand the presentation over our partners at Guidehouse to share their
work with the committee.
Thank you.
Hi, for the record, my name is Coy Jones.
I'm a director with Guide House and was the project director for The Study.
I am joined by Claire Payne, who is our behavior health lead, and she'll go over our behavioral
health results.
I just kind of going over kind introducing us to the study.
The only thing I'll add to what Deputy Commissioner Ricci said about the nature of the Study is
you know discussing the comprehensiveness of the scope. So this is a fairly unique exercise
in the sense that the state was interested in looking at all these all of these programs together
which is not often done in other states and that presented some I mean it's a challenge obviously
in terms of scope and thinking about implementation and how to how do you move all
But it does offer an opportunity to look at everything together so that you can have
a standardized approach.
And so our methodology really is aimed at trying to give the state the tools to have
a very consistent reimbursement structure.
With that, just noting this was very much stakeholder driven and very data driven.
Alaska providers were a big partner in this in the sense that they gave us a
lot of data and provide and we had a lot
of forums to talk to providers both tribal and non-tribal providers as well
as other other wider groups of stakeholders including those receiving
services those with lived experiences in their families.
Hold on, let me slow you down just one second.
I want to know for the record,
we were joined about five minutes ago by Senator Klayman.
I have a question for you,
and then we'll go to you Senator Tobin.
Could you just very briefly say for
the public who you are, who is Guide House?
What is the Guidehouse?
So, GuideHouse is a consulting firm,
a national consulting farm.
We work in a variety of areas.
Health is focused for us,
both for state and local government,
health so we've we work in Alaska as well as many of the lower 48 states very good
senator Tobin thank you mr. Chairman and I'm assuming because one of
the the reviews is not yet finalized all of
the information isn't available to the public but could you tell us where if
we're looking to find the actual data the who are the providers that you talk to
who aren't some of that the characteristics of
the Alaskans with lived experience so that folks can actually see some
Mayor where where might we find that we do include a lot of that information in the in
the report and so when it's when the reports are available you'll have that
information. Very good. All right. Thank you. Please continue. Sure.
This is broken down into two phases.
We're at the completion point for phase one,
just very quickly sort of noting these program areas.
We looked at behavioral health.
That includes both mental health services
as well as SUD for children and adults.
S, sorry.
SUD, substance use disorder services, so just want to not get totally lost in the alphabet soup.
And then long-term services and supports are community services for really two key populations,
aging the elderly and physically disabled populations as well as developmental disabilities.
So there's an array of services from both of those populations. And
then looking at a type of clinic, federally qualified health centers, we were looking specifically
payment methodologies that define reimbursement
for those types of clinics.
And then medical transportation,
we're looking at both emergency,
medical, transportation and non-emergency.
And in the EMT, it will sometimes be called,
that's taxis, pair of transit, public transit
and especially in Alaska, lodging and meals
as a part of a client's travel.
So just...
Because of the uniqueness of Alaska in a lot of different ways,
I would like to go over kind of how our stakeholder engagement worked.
We tried to create a lotta different forums.
We had work groups. We have focus groups, we had interviews.
really tried to put a premium on site visits.
And so on the map you see here,
we really try to get out into different parts of Alaska
to talk to as many people as we could.
That was a driving force for us.
And, so, obviously, we spent quite a bit of time
in the Anchorage area, Fairbanks, Juneau,
because that's where all the providers are.
That's what a lot of the population is.
But...
It's a very different perspective from the rural hub cities,
Kotsaboo, Bethel, Dillingham.
Those were important perspectives,
and we really wanted to cover the five or six
regions that make up Alaska.
Another piece just in that demographic cross-section
is we believed it was important to get out
to at least a single village.
And we did make it to a Single Village, which is poor Haydn.
Along with all the incidental things that you learn which was especially important for transportation like sometimes it's hard to get to a village
We you know we really saw that villages have their own perspectives that are different than the rural hubs
That was I can see you nodding your heads. That's not news to you
But it is very important news
To us that that it was really great to have that kind of true on-site
perspective
Yes, Senator Tubin. Thank you. Mr. Chairman at what time of year did you visit?
This would have been in March, so it was rough enough weather
that poor Haydn was actually our third option
because the other two, the weather was too bad
for the plan to get there.
Yeah, it's an interesting choice.
I mean, any village would be interesting,
but I think that's a village that has very few
Alaskans even been to.
It's quite far out there,
any other questions?
Nope, please continue.
Okay.
Just very briefly, there's a...
There's a lot of programs that were incorporated into phase one,
a lotta different methodologies,
I won't get into all the details.
But for a, lot these community services like behavioral health and LTSS,
one of the key issues is, is cost.
And so your cost based or cost informed rates.
But these types of services cost are typically not available.
So a big part of what our rate study involved was actually surveying the providers,
going out and collecting fresh data.
methodologies and our recommendations reflect actual Alaska costs.
So we're not piggybacking off of.
the way that systems work in other states and you'll see in our findings and recommendations
that there are some extremely unique characteristics to Alaska costs but the really the fundamentals
of our approach involved collecting pieces like wages, staffing ratios, understanding
at a service specific basis what it takes to put those kind of to actually deliver those
And so we built up our generally we've built-up our rate recommendations
What you'll see is our benchmarks kind of from that from the bottom that
Fundament all the way up to to all of the cost that it requires to deliver those services
Senator toga thank you, mr. Chairman, and I apologize. I just have lots of questions
I'm curious did you take into facility needs and also broadband needs?
so, we did
In our cost survey very specifically,
we captured those sorts of indirect costs,
like the IT costs those sort of things.
We just given the nature of how the surveys work
and the time constraints you're under,
we tended to ask more general questions
around cost buckets.
So we didn't get into a lot of details
around particular IT cost
that would drive say rural cost versus urban costs.
But we do have a sense given
the scale of each of the providers
like what their relative IT calls are
they're total operations, to take one example,
but we did collect that kind of information.
Okay, thank you.
Please continue.
Okay.
Actually, I'm gonna turn it over to my colleague, Claire Payne,
to Sheila at the Behaviour Health section,
and she'll kind tell us the results there.
For the record, my name is Claire Payne,
Director of Behavioral Health Lead for Guide House.
Yeah, so as my colleague, Koi Jones, referenced here,
so we had the four different groups of services.
And so the rest of our presentation
is gonna kind of follow a similar cadence,
where we're gonna talk about the findings
within each one of those type of service buckets, right?
And then we'll kind comment on
what that means for overall recommendations that, as Senator Tobin commented on,
we have a really robust report for each one of these individual service categories.
I'll tell you behavioral health is about 135 pages. So it may be more information than some
some want to see, but it definitely gets at all of the nitty gritty detail.
So just kind of bucketing on three overall findings for behavioral health.
And again, focusing very heavily on the true reimbursement and the cost of services
was the overall purpose of kind our rate evaluation, right?
And as my colleague Koi mentioned here is that we asked very specific cost questions
to individual providers within the state of Alaska.
So number one finding that
Overall, behavioral health were not saying that there shouldn't be money put into the
system, but one of the key findings is that service reimbursement is actually misaligned.
And it's a big term that we're going to use, and if you read the report, you're
going see, that some services actually have very adequate reimbursement, meaning we did
not find that rates needed to increase for a specific service.
And there's whole slew of services, right?
I'll give you a great example is autism services in the state, right?
We actually found that for specific autism
services, there needed to be like a hundred percent increase in that
reimbursement to cover the cost to provide that service, whereas another
service you may see two percent increased and another one you
may actually see a 15 percent decrease, so there's just a lot of
different volatility in what we saw driving the different reimbursement and
behavioral health.
Another key takeaway is what we call indirect costs.
So.
kind of a nuanced terminology, but it's overhead, right?
It's not necessarily what you're paying a therapist
to provide the service,
but its actually all the other stuff
that providers have to pay to run a business.
So that is administrative costs.
Senator Tobin, you actually mentioned,
broadband, that falls into there as well.
Things related to program support,
which again, a very nuanced term,
but for the professionals that need to work
at the organization that helps support service delivery,
not actually being able to bill for a service.
Thank you, Ms. Payne.
Senator Clayman has a question.
Going back to that, service reimbursement is misaligned
with some services in the number one bullet.
And you referenced autism, but is this a situation
when you might have, for the same provider,
one rate that is reasonable
Within Medicaid and what they're paying the provider in for the same provider providing a different service a rate that is is now what you're described as misaligned
You have through the chair senator clommand so
A little bit of both, actually.
So in the autism spectrum in particular,
again, trying to not get two in The Weeds here,
is that's actually a pretty small provider base, right?
You have to have a very certain licensure
to provide autism services,
and there's not a whole lot of services in that mix,
right, so I actually wouldn't say in
that example specifically that that misalignment
is happening for that provider group.
where you would see it a little bit more,
a, a l-a little differently is maybe for individual therapy,
group services as an example,
have actually been reimbursed very well,
but individual services have not, right?
And that's where the same provider could be providing that service,
but depending on how they deliver that
service the, the rate could been misaligned.
Go ahead. So, just by all you,
so you've got a therapist that provides
both individual, therapy and group therapy.
For the 10 AM individual therapy with patient X the rate is just proportionately low and
two hours later patient x goes to group therapy would the same provider.
And in that circumstance the pay rate reasonable.
Through the chair, Senator Coleman correct.
and it's different from service to service.
So I don't want to make a blanket statement,
because when you actually look at the report
and you see the individual services,
you're going to see
the difference that I'm referring to with some high,
some low, and just depends.
Okay. Okay, please continue.
Yeah. All right.
again, Claire Payne, director for Guide House.
So bullet two, just those indirect costs,
and again that overhead, right?
So this is disproportionately high in Alaska,
and very much understand that costs
are also high on Alaska.
But how we look at this as a comparison to direct care,
meaning again the dollars that are getting paid
to the actual staff providing the service, it's a ratio.
And so what we found is actually for every dollar
40 cents on every dollar goes to this overhead bucket.
We normally see in other states
that being anywhere from 20 to 30 cents.
And so that's a high amount, right?
That there's the high bucket of money
that is being paid out into the system
for those type of costs.
That's question there.
And maybe you get into this later on, but.
Can you get a little bit deeper on that?
What kind of indirect costs tend to be higher here,
even higher relative to our cost of living?
Like for example, are the providers hiring more folks
that to negotiate with the insurance companies
because it's harder to get people insured here?
Is it more sort of like middle management?
What is it that is driving that.
Yeah, through the chair, thank you for the question.
It's honestly across the board.
We saw utilities being very high. We also saw the staff costs being
very have your administrative staff to actually do all the behind the scenes
billing, right? You also have a very heavy transportation element. I mean, it
really is a whole kind of slew and we actually
do break those percentages down in our reports as well, so you can see where
the money is going.
Two of those three examples, like transportation and utilities strike me as part of, we consider
as a part cost of living, and so if we're looking for efficiencies, you know, if
we are looking to reduce that indirect cost, I don't know if that's what you guys recommend,
but you can't really reduce the utility bills,
you cannot reduce transportation costs as medical provider or as Medicaid provider, right?
try to identify in more of the administrative overhead of your staff for billing services
and actually looking at your operating, you know, kind of logistical steps and things like that.
I will say, too, when you have smaller providers, sometimes it's hard to reach
economies of scale, right? We're just where you start to see a little bit of this.
And that's why in our recommendations, we actually did not put in that you necessarily
should reduce this amount in your reimbursement. You should see that carry forward.
But when I get into the recommendations on the next slide,
cost reporting. It's being able to track and monitor this and observe it over time.
Very good. All right. Thank you. Please continue.
All Right. Claire Payne, Director at Guidehouse. So being mindful of time, the last one really
quickly is just lack of historical standards. My colleague Koi talked about that rate methodology,
puzzle piece that we shared, right?
The intention behind that is so you can see
every single component and its cost.
You can what's getting paid to a staff member.
You could see how many different people
are in a group size, you could also see
those overhead assumptions are just commented on very clearly
and there have not been standards to date.
And so now you're kind of level setting that
and moving forward from that point.
Go to the next slide.
So on our next slide here is, okay, those findings,
what does that mean to us, right?
So we bucketed this into three different recommendations
that you'll see in the following slides as well as rates.
So yes, money is a driver,
right, and we already talked about that misalignment.
So, the methodology transition, meaning getting to this building block approach, is one of
our recommendations, right?
We want to provide the state Department of Health with the tools so that as costs change
over time, they have visibility into each one those pieces,
right.
It's not just hire a consultant and you need us every single time but it's giving you
Hold harmless. This is a really fancy consulting term for meaning those rates that we said may experience decreases based on our methodology
You actually keep them where they're at today, right?
Again in in Alaska you have some communities that you only have a couple providers,
Right? So if you start cutting rates down it could have disproportional impacts on certain areas
Rate rebalancing so that's exactly what we're talking about some rates up some rate's down and just looking at your services to figure out
where should money be going and what should be adjusted?
Enhancements, geographic adjustment to the chair.
This is what you were talking about with cost of living.
So right now in the behavioral health space,
there is no geographic adjustments for those rates.
And so how do you actually adjust rates
in some of your very remote areas to account
for some those kind of elevated costs
as well as workforce issues?
How you get people there?
Staff transportation add-on, transportation is a big deal and it's very hard to build in a generalized assumption into a single rate.
So thinking about how you do an enhancement, service definition review, what do you want to pay for and making sure your services are clear.
So providers are delivering the service that you've actually built reimbursement for updates to crisis services.
So building out that crisis continuum and actually having rates that will pay
for the services that we want.
And then last thing here is state operations,
so cost reporting.
Cost reporting is a big deal
because right now you don't have a mechanism
to look at those costs truly over time
and you all have this very tricky perspective
called the upper payment limit
and what you actually can't pay more than Medicare
for very critical services, right?
If you do cost-reporting,
you can actually kind of adjust the bar.
You still have to follow those upper-payment limit rules
but you could actually base those on cost instead
Medicare. Yes sir, you can claim it. Can you go back to what you just said about?
Yeah. That you at some circumstances can't can charge above Medicare and I
live in the world in which I have this sense that Medicare is consistently
way below it everybody else and so what's where are circumstances when you
can bill above medicare even if you're in private insurance world?
Yeah, through the chair, Senator Klobman.
So this is for Medicaid specifically.
So in the Medicaid world,
if I'm a Medicaid provider and I see a Medicare patient,
I have to bill Medicaid for that, right?
Private insurance is gonna be different.
So for certain clinic behavioral health services,
which are really your standard psychotherapies,
like individual therapy, talk therapy.
You cannot bill above Medicare and the medicaid world.
It's a center for Medicare
and Medicaid services rule.
Yes, Senator Myers
I'm sorry senator cleanly you follow up and then you senator Meyer so
If there are providers that are routinely declining to take patients because of the Medicare rates if you have people that
Are in a Medicaid provider?
They're put in the same place if the medicare rate is lower than the Medicaid rate
If they're required to be at Medicare rate, then, you
Potentially push providers in a business or they'd shoot well not on a businesses, but they no longer take
They're no, longer an option for Medicaid recipients right through the chair center comment
That's exactly it right it's a disincentive
And so you do have the opportunity through that upper payment limit to kind of change your baseline
But in order to do that you have to have accurate audited costs right and that's your new baseline
Senator Myers.
Thank you, Mr. Chair, a little bit different tact than where Senator Klayman was going, but I'm somewhat new to this field.
With your recommendations here, how much flexibility do we have with the federal government to put the rates up to where you're suggesting they be?
Yeah, through the chair, Senator Meyer.
So it's a great question.
It really comes down to budget, right?
So we didn't get into a lot of nitty gritty numbers
in this one, but the recommendations and the report
are going to show you is kind of a menu of options,
right, and Deputy Commissioner Ricci commented on this
and that we approached it that way
because we want you to see,
if you just want to do the methodology transition,
how much will that cost the state,
right.
If you want a geographic adjustment,
how many will it cost this state?
And it is dependent on your budget.
I mean, really, what can you afford at this point in time?
And maybe you want to chip a little bit off,
but I went a different direction.
Yeah.
So our budget considerations are always an issue,
especially in current circumstances.
But I'm thinking more along the lines of where
are we going to potentially run into a problem where we want
to make an adjustment of some kind and the feds
are going tell us no.
What did you run in to any situations in your study
where that might be a problems?
Yeah, through the chair, Senator Myers.
So our methodology is fully accepted by CMS.
It's why we do this building block, right?
So we're not gonna go forward with these rates
and then say, that's not accurate.
You can't do it that way.
And so they are, the methodology
is accepted with CMS, we mentioned
we were pretty large firms, 17,000 people.
We've done these type of rate evaluations
in 15 to 18 states at this point,
following this similar type
of methodology, obviously very different
costs and services underlying.
Okay, thank you Senator Myers, please continue
Okay and then
Claire Payne, Director of Guidehouse.
So just last one, and then I'll pass it off to my colleagues,
annual rate updates.
So it's all great to do this at a point in time, right?
Really level set, set yourself up for success in the future,
have the toolkit, have that methodology,
but being able to monitor it over time.
Because hopefully not go with something like COVID
doesn't happen and inflation gets out of control,
but those are things that you need to look out for
and be able look at those changes over
And you also then get a respond to providers, right?
If you have a better pulse on what's happening, and you can look at it every year, you
can be prepared for those type of questions.
Senator Tobin.
Thank you, Mr. Chairman.
For that annual rate update, is it a similar third party analysis that we'd have to purchase from
Guide House or is that something you could do within state resources?
What do you see in other states?
Yeah, through the chair, Senator Tovin?
it depends depends on how many staff you actually have in government to do
something like that right and some of it's very robust like what we just did
here in the last year and a half very
robust right the stakeholder engagement the surveys and all of that
you can do smaller updates we definitely see that in states
some have which um you know state staff can handle on their own and
and so they can't right so it really just depends
Court Jones Director of Guide House for the annual rate updates this is really something that we would contemplate that the state could do
We do have some estimates in there in terms of the FTEs that would be needed
But but yeah, we've kind of shown the road map for for how to update those rates annually
Very good. All right. Let's move on to the next slide. Okay. I'm gonna take it back from this one
behavioral health has some of the more complicated dynamics in terms of
the misalignment. When we go to LTSS services kind of look the services for
for the aging and developmental disability populations.
It's a little simpler.
The way that the methodologies work currently,
ORR and the state of Alaska do collect samples of costs.
And so what we saw generally is that those rates
have kept pace with the costs for the most part.
They're a, they're little under,
but nothing that was, we're talking like one to 2%.
And, so keeping pace, with some,
with a major exception, personal care,
a big chunk of the LTSS dollars.
It's a sort of a fundamental home-based service.
We saw that the rates were really not keeping up with costs,
which probably explains what you've heard,
what may have heard from constituents
around the ability to deliver those services.
What we saw is that rates, according to our benchmark costs
those would need to go up depending on the nature
of that service 30 to 35%.
And so in our recommendations you can see some
fairly significant price tags around LTSS as a whole, but a lot of that is really driven by
personal care. When you look at the wider, wider set of services, the rates are pretty, you know,
pretty close to where we calculated. So we note that in both kind of one and two in our findings.
You'll see recommendations around continuing to collect costs because we do want to know
that the federal access rule CMS is kind changing its requirements around how personal care services
requirements around reimbursement that require 80 80 percent of the dollars the rates to go to direct care staff and so
I'll just kind of note that now personal care is one that the state's gonna want to get right in terms of how how they pay for it and
Monitoring what's actually being paid for
We did make some, based on the findings too,
we find that reimbursement is generally good
for a lot of the services, especially residential services.
But Alaska does not have a
lot differentiation in terms of tiered rates
or acuity, what's so-called acuity adjusted rates.
So that the rate overall is good,
but it may be, it maybe
too good for people with lower needs and not good enough with people for
people of higher needs. So you'll see some of our recommendations are really
following a line of development that SDS is pursuing right now of getting to
better and better processes for identifying the needs of individuals.
LTSS has geographic rate differentials. You'll
see in our recommendation that we're recommending an alternative method.
The current way of doing it's sort of based on a study that's
years old, so we do make some recommendations for updating those.
And then you'll see that I won't get into the...
All the dynamics, but the indirect cost ratios are very similar to what we see in
behavioral health, which is one of the reasons we're going to recommend a cost
reporting system. So we are recommending a transition to the methodology that we
use to establish the benchmarks and rate recalibration based on that, as well as
hold harmless. There are a few services where our benchmarks are little lower.
methodological improvements.
We made some suggestions for the tiered rates
and continuing along the path that the state is taking
for acuity adjusted residential reimbursement
as well as there's some select services
where we're looking for,
we are looking at some improvements
and how administrative fees are paid for
to make those services more available.
One of the key things here for cost-reporting,
we're recommending cost reporting for these services
for sort of different reasons than behavioral health.
One is that access rule that we are talking about.
The state's gonna be on the hook to the federal government
to show where those dollars are going.
And if you don't know what the providers costs are,
then you can't be compliant.
And then we recommend annual administrative rate updates
for the same sorts of reasons as for behavioral-health.
One thing, one thing I do want to know on the administrative processes, LTSS is one of those
few areas where we don't see a lot of tribal investment in these programs. So in behavioral
health, there's a very built out behavioral health network. Same is true for Medicaid transportation.
That's not the case for LPSS. We've just sort of encouraged the state to explore
what opportunities are there because there are probably some significant financial opportunities
well as service delivery improvements
and kind of forging those bonds a little further.
And if there are no questions for LTSS,
I'll move on to the-
I have a question for LTSS.
So, you know, and there,
so this is the previous slide, I think.
Sure.
There are different kinds of long-term care
and different kind's of personal care.
And so, this question might not be based
on what exactly you were studying,
but there there
are groups of
the sort of frontline workers that have come and come to this building and some of them
are represented now and have spoken with their representatives and.
The statement he considered effort to put some more money towards some of these programs in the last few years
And what they reported was that relatively little made it to them in a form of wages
And they felt like it had been sort of consumed above them by owners of some these companies
Priders or perhaps management or I'm not sure what exactly but is that consistent with what you found here with the unusually high
Administrative costs or is it something else that's driving it?
to the chair
I'd say a lot of our findings do support kind of what you're hearing that that 30 to 35% increase
that's almost wholly due to the need for to pay higher wages. That's what's driving those
additional costs. And so even if they're high indirect costs because we account for high
indirect cost and our things there's there just more money needed for for wages and one of the
You, you, as the state, if you implement a cost reporting system,
you will be able to see where the dollars are going because the providers will
be accountable for direct care versus indirect care costs that they incur.
And you'll know what the rate is paying for a little more clearly than you do today.
I'm looking at the deputy commissioner's face or having this conversation.
Maybe she wants to speak about this later.
I am sure she has some thoughts about it, but we'll, we will continue with the
presentation for now.
Sure.
All right, going to FQHC, what our F QHC study really boiled down to was the fact that
there are, there's really two ways to pay for F qHCs, they're sort of a baseline approach
The minute you are on FQHC and approved,
you get a certain payment that just increases very slowly
with according to inflation.
And so those very few providers
who are still on the PPS,
essentially this program is looking at their costs
from say, 1999 or 2000.
And the Medicare economic index is not necessarily
kept up with their real costs.
The issue is that
And so for most providers who've found that the PPS doesn't keep up with their costs,
they've switched the alternative payment methodology, which is also available in Alaska,
and there are not as many concerns with keeping up the costs there.
So for those on PBS, it has not been clear what the mechanisms are.
to move to to do a change in scope or any of those things. So a lot of our I'll just kind of boil
boil it down to our recommendations. We did make a recommendation for a one-time catch-up change
in scopes. For those who are on the PPS, we looked at the fiscal implications of using their
If it seems advisable to them to pursue that catch-up change in scope,
we also suggested some technical assistance to help support
that cost reporting that's needed for the change of scope.
Then a major recommendation we made here was for
DOH to create a policy and a process moving forward,
that really allows the providers to update their PPS rates
when they experience significant changes,
because that pathway was not previously very clear.
I don't see any questions. It's going to medical transfer. Okay, the final kind of final area of review here
Transportation is a really big deal in Alaska, especially air ambulance
more so than any other states so the
problems are unique in alaska and the solutions
need to be as unique, but what we found is that rates have not been regularly updated
for ambulance or lodging, which is another sort of special feature of Alaska system.
So we've found that they're significantly below cost, they are significantly
below Medicare.
back in 2012 they were roughly the same as Medicare those that's eroded since then
Medicare is not famous for being a great payer for medical transportation so
so we looked at some recommendations to beef up basically Medicaid payments
both compared to Medicare and in paying kind of a larger share relative relative to commercial.
commercial reimbursement as well. So because because of the not lack of cost
coverage, we heard from stakeholders that ambulance staffing can be is more and
more of a significant issue. Because of
the lodging rates and just some of
the programmatic challenges of getting those booked, it's very it can
be a spare.
especially during tourist season, hard anywhere in Alaska to get things properly booked and so
especially the rural tribal entities that are involved in doing this, they'll sometimes pay
out of pocket, more out-of-pocket just so that their members can have a place to stay.
And then we saw that especially without estate lodging, there's still a need to go to Seattle
to hotels that will take Alaska Medicaid.
And so we offered some recommendations
to confront the strict reimbursement issue
as well as the policy issues
that can create barriers for travel.
So on our recommendations here,
we're recommending an ambulance rate increase
to 125 in aggregate,
basically the equivalent of 125% of Medicare.
better than most states. Most states will typically pay lower than Medicare. We're recommending
given its importance for Alaska that it's important to pay above Medicare and really
are setting that at 125%. We also have recommended increases to the lodging rate.
as well as currently there's just one rate no matter what time of year we've
also made recommendations for having seasonal rates understanding the the
tourist season as a whole other whole different ballgame wheelchair van
rates aswell and and as with all of our all the recommendations we're looking
at administrative rate updates there you know there are some policy issues
trips that end up not being they're not really emergency personnel is not needed but that's
the only option and so we're looking at ways to make that a little more flexible as well
as escorts used during travel and in order to kind of streamline the process where we've
noted that the state ought to look at its definitions for what a travel event is which
One of the areas where the state could actually see some cost savings is the development of a brokerage model.
So currently it's fee for service that is administered by the State with exceptions of some tribal travel.
There are tribal management offices, TMOs that act in some ways like brokers.
We're recommending sort of expansion of that approach that would have a statewide broker
for the non-tribal population, but give the government the Government partnerships under
which the TMOs operate, sort-of increasing flexibility to book transportation and lodging
pieces.
Fairly lengthy prior authorization processes that can get complex as you know as travel plans get canceled and things
recommending a fee increase to cover the costs of a kind of working
Working each case through the process as well as recommending in areas like Anchorage perhaps Fairbanks
more use of public of partnerships with public transportation to encourage
It buses and thing like that for non-emergency medical transportation
So before we go to the final slide.
Sure.
Which is a thank you.
So did you finalize the report for emergency medical
transportation or is this just non-emergency
and urgent transportation?
To the chair.
This transportation report is for
emergency and non emergency.
Neither has been finalized.
It's one report, but it hasn't been finalized yet.
Hasn't it finalized?
What's the timeframe for it being finalized
We're in late stages, that's what I'll say.
But I hear someone coming.
What would that be, Commissioner?
What if I-
To the chair for the record, this is Emily Ritchie,
Deputy Commissioner with the Department of Health.
So initially, the transportation report
had just been non-emergent transportation.
But as they-
As the guide house began working through the issues, it became apparent that we really needed to add emergency transportation.
So last year, you would have heard us testifying about non-emergent, but we ended up bringing emergent in.
And that should be finalized, I would say within the next few weeks, probably the
next three to four weeks.
It's just quite frankly it's a bandwidth issue in the department right now to get to that final point.
emergency providers who are now struggling to provide their services and we've lost my
understanding is we lost some coverage or some providers because of their inability to make
ends meet. Is that something that you're tracking at the department or?
To the chair that's one of the reasons that we added the emergent aspect to this study and I
think there are some important considerations on the transportation side that are worth discussing.
Other states have looked at opportunities to recognize some of the costs that occur when emergency
emergency transports are coming from a very rural area, it's almost that origination point,
and there are ways that we can enhance the ratio of federal to state funding we receive,
an increase in rates to the emergency transportation providers depending on how we design this.
And Guide House has offered some recommendations on
how to do that that I think should be part of the discussion we have.
Very good.
I have one more question for the Deputy Commissioner and then we'll go to you, Senator Clayman.
So on the prior slide,
the administrative costs and the unusually high administrative cost here, you know,
to what degree have the recommendations by Guide House been sort of accepted by the department
and to a degree do you sort agree with them or what sort
of reforms is a big question so maybe this will be a home they're hearing but what reforms are you
contemplating to address those kind of administrative
to the chair for the record, Emily Ritchie.
I mean, I think it depends on what the underlying costs are.
I thinks some of them do just reflect
the higher cost of doing business and living in Alaska.
There are other costs that I
think everyone would benefit from simplifying.
We have to do that within Medicaid requirements
and CMS requirements.
And I thing particularly as you're seeing an emphasis
on fraud, waste, and abuse nationally,
that means that we have
to make sure that
the requirements we have in place align with all those standards and we
have that now and it doesn't mean that there are room for improvements I think
from a Department of Health perspective and a provider perspective there
are opportunities where we can streamline how we are administering payments for
some of these services.
One area that we are moving forward with is the behavioral health recommendations,
and you'll see there's $10 million, that $ 10 million temporary increment that was included
in the FY26 budget in a supplemental that's proposed, language extends that into FY27.
We are going forward, with promulgating regulations that would update the
behavioral Health rates to do the rebalancing for that rate methodology under the hold harmless.
under the, with the whole harmless approach.
So that is underway and the department,
or the division will also be working to build out
the geographic differential and
the crisis services as part of that first phase.
I think cost reporting is going to continue to be important,
not just for behavioral health,
but also for long-term care services and supports.
Our office of rate review team that manages all of this,
we, when I started, they were
they had far too much work for the number of staff
that they have available to do that work.
And it's not always just about people,
it is also about getting individuals
that have the background and the experience
to some of the complicated work,
so we actually
implemented a contract I think last year and we brought on some contractual
support to help them do that so they're in a position now where they have more
bandwidth but if we're talking about moving to cost reporting and and the
way I thing about it is every five years right now the division will do a
Medicaid providers depending on their rates, right?
So for behavioral health providers,
you've probably heard about rebasing.
And that's where we collect a lot of information,
almost the same amount of
information that we did in the survey,
but sometimes a little bit more with more detail.
For us to stand up, a cost reporting.
program, and use that to inform rates annually, which is what we would need to address the
Medicare issue and behavioral health, we'd need be collecting that information on an
annual basis.
And that's a lot of work for the behavioral healthcare providers and for our team.
If we're using the same approach that we are doing today, right, in the tools which
is effectively an Excel sheet back and forth.
that we can look at, that along with behavioral health or long-term care services providers,
where we try to, I mean, a cringe from using the word automate because I think it's used
but where we could try to automate some of this stuff, right?
So that we're not, we are moving away from entering information into an Excel sheet,
but there's a way to upload information that can be ingested into a system and then analyzed by our team.
So, that's kind of the next step on the behavioral health side,
I think, and long-term care services and supports is like,
how can we get to the cost reporting that
we need but in a ways that is not overly burdensome for both parties?
And I don't know what that looks like yet.
We need to spend some time thinking through that.
All right, good.
Senator Clayman, you had a question?
Just in terms of the study done by Guidehouse,
what is the timeline in which providers will actually
see a rate increase take place?
To the chair, Senator Cleiman, for the record, this is Emily Ritchie.
A lot of that depends on what the state's priorities are.
And I don't say that from the State of Alaska Executive Branch.
I say from a combination of the legislators, the appropriating body, right?
That helps align the budget with the Medicaid system and then what
the department can work and support towards.
So I think some of it depends what our priorities, are there areas of
the system that we really need to focus some resources on?
And do we have the availability of resources for that need?
And I don't envy your jobs because you have tremendous needs,
and we all have finite resources
for how we meet those needs.
I think from our perspective,
behavioral health services specifically
has been an area that we've known as a priority,
a shared priority.
And so that's why we're focusing
on implementing those right recommendations.
That's kind of that first step.
And we had the funding and the budget to do that.
Very good.
Do you have a follow-up, Senator Cleman?
Just for the behavioral health, what's the timeline on those likely being adopted, the new rates?
To the Chair, senator Clemen, for record Emily Ritchie.
So again, with the extension of the language and the supplemental,
that will allow us to carry that $10 million into FY27.
The general fund $ 10 million match, again this also leverages about $20 million more in federal funds as well into the Behavioral Health System.
Most likely, those regulations and the rate updates could take effect at the end of fiscal year 26,
so the beginning of Fiscal Year 27, for that first step of the right rebalancing,
and then we need to work through the geographic differentials,
as kind of, that work will be occurring this spring.
And I'm not sure what the implementation timeline for,
that will, we, need, to, work with behavioral health providers too,
as we outline what that geographic differential approach will look like.
To the chair, Senator Clayman, likely towards the end of the fiscal year I think our goal is by the beginning of state fiscal
year 27.
Okay.
Very good.
Senator Myers.
Thank you, Mr. Chair.
So for our guide house friends here, I'm going to ask a question that's a little bit out of
the scope of study that you did, but since you've been doing these sorts of studies for a while now in multiple
states,
I kind of want to get a bit of your reaction.
Ever since roughly the Affordable Care Act was passed and then implemented over the course of a few years,
we've kind of seen this paradox in the state where government spending as a whole and
state spending in particular with Medicaid has been going up.
But at the same time, we were having fewer and fewer providers within the State.
Obviously, were talking about the pay.
What we're paying providers and maybe some of them are going out of business and leaving state
Deputy Commissioner Ricci just brought up the fact that you know at the same time that we may be giving them more pay
We may
be also then requiring more paperwork on their end which then you
Know increases some other costs increases. Some of their hassle takes some time away from actually treating patients
I'm curious if this is a
a paradox you've seen in other states as well.
If this is specific to Alaska,
if you find that our lower Medicaid rates
are a contributor to that type of problem,
what are the kind of observations you may have
on that paradox that we're encountering?
Through the chair to Senator Myers,
Koi Jones for the record.
We do see a lot of these dynamics in others states.
I think, you know, Alaska is a...
Just there are some there's some specific issues to Alaska. The workforce retention piece is an enormous part of it
that and I'm not sure it's specific to the
to the question of whether you pay enough or not.
There's just a general dynamic there.
I think it's particularly difficult for services
like behavioral health and to a lesser extent, LTSS,
that Medicaid was not originally designed
for these non-medical services.
Like Medicaid, was about paying doctors
and about pay in hospitals.
And so,
You know, the ACA, as you mentioned, it opened up new opportunities to use Medicaid to
continue to fund and expand these non-traditional services and behavior health, and that's where
you get the 1115 waiver with Alaska.
But there's a lot of complexity.
That complexity is not unique to Alaska, those are part of the federal state partnership
And so there is a recognition that these, you know, that
these.
It's just a convoluted system, especially with behavioral health.
One thing I'll note, a big reform, that's what the payment reform and service delivery
reform in behavioral is the rise of what they call CCBHCs, and that is a certified behavioral
health clinic.
That's something that Alaska is currently pursuing.
I think the payments reform piece of that, is meant to cut through a lot of the Medicaid
rid of sort of traditional fee-for-service, so it adds a little administrative simplicity.
You don't have the clinic UPL problems in Alaska that you have now with the CCBHC, but
these are sort-of slow reforms, and I think there is a lot of recognition that the red
tape, no matter how much you spend, that's not the only reason that providers don t participate
in the system.
Any other questions for Guide House?
All right, thank you for being here.
I think your next, your final slide is just,
thank-you, very good.
Do you have any closing comments
or Deputy Commissioner Ricci,
do you any comments?
I would just say, again, I wanna thank the committee
for hearing this topic, getting into some of this stuff,
it's pretty weedsy.
I get really excited reading through this 0.300 plus pages of right methodology reports,
but thank you again for taking time to learn about this. I'm sure we'll be talking about
this for plenty more sessions to come. Absolutely. Oh, actually, I did have one last question
while we're here. When we were talking setting up the cost review system.
And the increased, perhaps administrative burden, or IT requirements of doing something like that.
Is that something we could spend rural health transformation funds on or no?
To the chair for the record, this is Emily Ritchie.
I think that's one of those items where if we are designing a system that is not something that
is simply focused on Medicaid.
right, maybe there are other components, that's an area that we would really need to look
at.
I think the question gets into if it is just a Medicaid system, then that would be eligible
for Medicaid System funding, right?
In some way, shape or form, and that is where we need be very careful about not supplanting
existing funding sources.
So I I it depends on how what the overall objective is of the systems we are creating.
Very good. Okay, thank you guys. Thank you very much for coming. We'll take a brief break while we set up for our next topic
Back on the record at 4.32 p.m. Next up. We will hear Senate bill 206 school
suicide policies firearm storage and we have with the Senator
Tobin or staff Louis Flora
On the phone we
have for questions
Kelly Manning the deputy director the Division of Innovation Education Excellence the Department of Education Early Development
Ramin, Raymond Dunford, Captain State Trooper's Department of Public Safety, Sharon Fischl,
School of Health and Safety Lead, and James Biela, American Foundation for Suicide Prevention
in Bethel.
And actually, I think we're going to have a couple of them provide invited testimony.
So with that, Senator Tobin would you like to put yourself on the record and begin your
Yes, thank you, Chairman Dunbar. For the record, my name is Lukey Gail Tobin, and I have the
pleasure and privilege of representing Senate District I.
For The Record, My name's Louis Flora,
and i'm Staff to Senator Luke Toban.
Well, Mr. Chairman and Committee, the bill before you does something very simple.
It gives time. Time to prevent bad decisions. Decisions that are often made by our most precious
less than 10 minutes. The bill before you does three things, the first is it
creates a fund in the Department of Public Safety that will be available to
families to help provide them a firearm safety storage device.
The second thing it does is, it allows school districts to create their own
locally informed plan if they choose
To notify parents and guardians when their child might have expressed suicide ideation,
maybe inferred they are going to harm themselves or have been bullied.
The third thing the bill before you does is it allows schools to offer these firearm safety
storage devices to the families who may wish to use them.
Our students are in crisis, and this bill provides an option, an opportunity.
It provides time.
Now, before we get to our invited testifier,
and we do have folks who are online to answer questions as the chairman shared earlier,
my teammate Louis Flora is going to walk us through a very brief four-slide power point,
But before we transition to that PowerPoint, I do just want to emphasize this 10 minutes.
Teen suicide is an impulsive act.
There is research that shows that 80% of young people who think about harming themselves
attempt to harm themselves in less than 10 minute.
What we want do is disrupt that 10-minute, so we wanted to save their lives.
the common method that young people in Alaska
use when attempting suicide.
Our hope is that through this very common sense piece of legislation, legislation that we have seen passed in Utah,
that will be able to replicate the results that they see there in their state, which has been a 12% decrease in teen suicide
But that, Mr. Chairman, we will
be happy to walk through with a very brief PowerPoint presentation and also hear from our invited testifier.
Very good.
Yeah, do you want to start it? Okay. All right, mr. Flora if you could please
Yeah if it would be the will of the committee I could also run through the sectional analysis, but I'm
Happy to why don't we do the presentation first and then we can do this section all folks
Louis Florra staff to senator lukee Tobin. This is a going to be a very brief
Slide deck, But I did want a highlight just our Alaska's precarious position with
high suicide rates as you'll see in this slide our age adjusted suicide rate per
hundred thousand people was over 30.8 and that puts us in line with Wyoming and
Montana for high-suicide rates. This is a striking slide I think I've been
looking at it for the last couple days and find it stunning but the
You can notice over the years between 2020 and 2024 the
persistently high rate of youth suicide between the ages of 11 and 19 and then it drops off
significantly as folks mature and
So what we're trying to do with our legislation is provide a funding source for school districts to be able to purchase
or for
To purchase
firearm safe storage devices and there's examples in this slide of cable lock which is generally
about $10 to $50 and trigger locks as well as lock boxes and firearm safes. So there are many options
out there for safe-storage devices. And this was an interesting slide. It's also in your
We're a state with high firearm ownership, obviously, and there are significant, you know,
significant safe storage trends in Alaska and the Northwest Public Health Region has about
94% safe-storage, so that's a good sign. And then I just threw this one in because we do have a
in further conversation with the child advocacy centers.
I believe we're kind of going back to the drawing board
on their involvement in this legislation,
but we did want to, there is a tie-in I
believe with child Advocacy Centers,
the function they serve as well as the school districts
and reporting instances of abuse.
And so we will be going
Subsequently in a future committee substitute and that's all I have unless you would like me to go through the
Sectional analysis. Yeah, let's let go to the sectional
Okay
Senate bill 206 version a section analysis section one men's school safety and discipline statutes at 14 33 220 B
To require that a school employee, student or volunteer who witnesses or has reliable
information regarding harassment, intimidation or bullying report the incident to a child advocacy
center in addition to an appropriate school official. This section also defines child
advocacy center by referencing AS47-170331. Section 2 adds a new section 1433-240,
to safety, the safety and school discipline statutes.
This section authorizes school districts
to adopt a plan to notify parents or guardians
about incidences of harassment, intimidation, bullying,
or suicide threats involving their student.
If a district provides such notification, it must also provide suicide prevention resources
and information on limiting access to lethal means, securely storing firearms and medications
and requesting free safe storage devices from the Firearm Safe Storage Grant Fund.
AS44-29-350 by adding a new subsection B, this section authorizes the Suicide Prevention Council
to advise school districts on appropriate materials and reference lists that
districts may provide to parents or guardians when notifying them of
And finally, Section 4 adds a new Section ES4441O80 to establish the Firearm Safe Storage Grant Fund within the General Fund.
This section directs the Department of Public Safety to manage the fund and use it to purchase and distribute firearm safe storage devices,
such as lockboxes, safes, or cable locks to school districts at no cost.
It specifies that the funds consists of appropriations, grants, and donations,
and that money in the Fund does not lapse.
And with that, I conclude the sectional analysis.
a couple of questions here.
So in section two, the school district
is required to provide to the parent or guardian information
about how to, and then you've got three things.
Limit as soon as access to firearms,
securely store the firearms and how
to request a free safe storage device
from the fire arms safety storage grant fund.
So the School District is requiring
to tell parents how do it.
That's how it's written right for the record Luke you Tobin the senator for district. I
Mr. Chairman the language on page one line 13 indicates the school district may
So this is nothing about required to provide this information to parents or guardians
They may adopt a plan that does provide
This information and the hope and idea is that with the council's support the School District will able to develop a
Structures that they will be able to adequately provide this information to parents whenever medium that is best for them
Whether it's on an app or a through parent teacher conference or through other means so
Very good, but my question isn't really the shall versus may. It's more about who requests
Let's say it said a gun lock
who who request the gunlock of the story of
Of the fund is it the school district that asked for it or is the parent that asks for?
quite understand, because here it says that the school district will give the information
to the parent on how to access that device from the grant fund.
But I thought, unless I'm mistaken, Mr. Flora, you said that that school districts would make
the request and get the item, and then presumably give that item to their parent.
Which way does it work?
Through the chair, Louis Flora staff to senator Lucie Tobin
We wanted to broaden it to make it as permissive. I mean, we want to get these devices in the hands of the
families that need them and so the
Whether it's the parent or the school district
I think and we can modify that in a future committee substitute
But whatever is going to provide these safe storage devices
the most expediently so okay, I
think we're agnostic on the
Okay, so either the school district or the parents could request these items and the fund
would be managed by the public safety administration, is that right?
And then is the thinking that the Public Safety Administration would purchase a number of these
things and sort of have them ready to go, or, the parent or
purchase them and send them, you know.
And if you think about it, that might take a little while if it's a rural school district.
Yeah.
Mr. Chairman, Luke E. Tobin, Senator for District I,
that is a great question and I'm going to give you an example that
is already in practice.
Here in the Juneau School District, students take
a firearm and hunter safety course in sixth grade.
Every student is required to take that course.
As part of that program,
students are offered gun safe storage devices.
And so we wanted to provide an opportunity that school already has these
long. Also, if the school wants to request some from the Department of Public Safety,
if funds are available to purchase them, they have the opportunity to do so.
Or if there's potentially a provider in the community who wants
to donate such devices, that also is a pathway.
Very good. Any questions? Senator Myers.
Thank you, Mr. Chair. So, I mentioned a new presentation that
we're at for people with children in
the house. Anyway, we are at almost 90 percent.
of people have safe storage or practicing safe
storage anyway if I if i read that correctly so my concern here is do we
actually think this is going to move the needle significantly on on safe
storage so I'm trying to see if this
is actually going
to help yeah
Senator Myers, through the chair, again,
Luki Tobin, Senator for District I.
Unfortunately, that 94% rate is not universal
amongst all regions of Alaska.
As we see by this slide,
that's only in the Northwest Public Health region.
So although they have a very high saturation
of safety devices and safe storage options
in their community,
that is now shared by every region across the state.
Senator Myers.
Thank you.
That wasn't the statistic I was looking at.
I'm looking higher up the page, the first bullet where it says, no pun intended, households
with children under 18 years of age are significantly more likely to practice safe storage, 89%.
And so while the state map, and I believe that bottom point there are talking about
families have kids in the home or not.
We're already saying we're at 89% statewide
if you have
kids
in
the
home. So that doesn't seem like we have a whole lot of room left to move.
do we think that this is actually going to move the needle then for those other 11 percent?
Yes, Senator Myers, Luki Tobin, I think one of the important parts of this bill is it's not just
about safe storage, it is also about information and sharing. The key part of it, is that although
families are practicing safe source, they might be...
They might not be universal in that practice.
And the important piece that we want families to know is that when their child is in crisis,
that is the key moment where they should be practicing safe storage.
So although this bill is about creating a tool that may not
be available to all parents, as we see, 89% is not 100% saturation,
it is also about communicating the why you need to be
practicing more in
that moment when your child's in
crisis.
Thank you.
All right, thank you, Senator Myers.
We have, we do have one person online
for invited testimony.
I think we'll go to them now.
Let me see here.
Yeah, We of James Beelah from the Alaska chapter
of the American Foundation for Suicide Prevention.
Mr. Beelo, could you please put yourself on the record
and begin your testimony?
Through the chair, my name is James Biela.
I live in Bethel and I'm testifying today
in support of the Senate Bill 206.
I also the co-founder and volunteer
with the American Foundation
for Suicide Prevention, the Alaska Chapter.
And I am the Vice Chair
for the National Public Policy for AFSP.
Professionally, I've been a full-time
itinerant school social worker
and been in that role for last 21 years.
In my work, I'm on the front line supporting students at risk,
responding to suicide deaths.
I am serving as first-responder in villages following the B steps.
I have seen firsthand the devastated impact on suicide heads
on family schools and the entire communities.
I want to be briefly chair of why this bill matters.
Several years ago,
I responded to a suicide of a student from rural community.
That student had experienced ongoing bullying and showed clear warning signs of suicide.
There hadn't been two prior suicide attempts.
The parents were notified, safety plans were put in place, behavior health, referrals were
made.
But despite all those efforts, the risk escalated faster than anyone can realize and access
to a firearm turned a moment of crisis into a fatal outcome.
This is a conversation I've had far too many times in southwestern rural Alaska.
I sit at kitchen tables with families. I know talking to how to keep their child safe
throughout their pain and especially at night. Knowing there is firearms in the home and in
no walk, no safe, and no local police, they get one quickly. In those moments, access to matters
In fact, his past Thursday, I had a conversation with a 15-year-old who said he wanted to die.
Talking to him to elevate his risk, he said that he had five or ten, four days ago.
He called his mother at school and called and she sat there and tears listening to her son
That is the reality Senate Bill 206 has responded to.
Senate bill 206 is a thoughtful prevention
focus response to what schools and families are facing.
It straightens the reporting responses
to harassment, intimidation, and bullying in schools
and improves parental notification
when students are at risk.
You've spent most of the time in school's
making schools a critical set for early identification
In fact, this past Thursday, that young man was noticed to be withdrawn by a teacher and
was referred to me.
We know suicide is complex and never a result of a single factor.
Mental health conditions such as depression, anxiety, and substance use disorders increase
the risk.
Firearms is the most lethal method of suicide approximately 85 to 90 percent of the suicide
attempts involve firearms. In Alaska, firearms are the leading method
of suicides amongst young people in our youth. According to CDC, Alaska in 2023 had the fifth
highest gun rate in the nation and the highest firearm suicide rate amongst our Alaska native
When we talk about preventing suicide,
we must talk
about firearm safety.
Senate Bill 206 takes a balance
for respectful and evidence-based approach.
Supported schools,
empowering parents and giving families
practical tools to save lives.
Please, I strongly urge you to support
Senate bill 206 and help families
from these unimaginable losses that they face.
I want to thank you for the opportunity
to testify and then open the questions.
Thank you.
James, I apologize for mispronouncing your name earlier.
Of course, we've met several times.
Appreciate it when you come to Juneau as well.
Are there any questions for our testifier?
Don't see any.
Thank-you very much for being with us here today.
Senator Tobin or Mr. Flora, do you have any parting thoughts before we set the spill aside for future consideration?
Once again, Lukey Toban, Senator for District I, Mr Chairman, all I want to do is just remind folks 10 minutes.
And to encourage parents and folks who are listening that if your child is being bullied or they're expressing suicide ideation,
Thank you, Senator Tobin.
With that, we're going to set this bill aside.
We will take it up at a future date along with public testimony.
It sounds like the sponsor would like to do a committee substitute as well, so we'll work on that.
Let me see here.
Okay, thank you everyone.
The next meeting of the Senate Health
and Social Services Committee will be Thursday, February 12th.
We will have a presentation on the Alaska Rural Health
Transformation Program,
specifically an informational session
to support implementation and participation.
This will a joint hearing with the House Health
and Civil Services committee in Davis 108.
Finally, today I'm setting an amendment deadline for HB 27, representative Mina's bill relating to medical care for major emergencies, which you heard last week.
If you're considering any amendments, please have them to my office by 12 p.m. Friday, February 13th.
The time is now 4.53, and this meeting is adjourned.