SFIN-260506-0900

[FOREIGN LANGUAGE] Call Senate Finance Committee to order. Today is May 10th. We're in the State Capitol Senate Finance Room. Present today are Chairman Olson, Chairman Sidman, Senator Kiel, Senator Merrick, Senator Kaufman, Senator Cronkite, myself, Senator Hoffman. We have two pieces of legislation that we're going to deal with today.

The first is HB 36, foster child psychiatric treatment. HB 52, minor and psychiatric hospitals. HB 36, foster child psychiatric treatment, this is the first hearing on this piece of legislation. I invite Representative Gray to the table to tell the committee what he's trying to do to us.

Thank you, Chairman Hoffman, Chairman Olson, Chairman Steadman, and members of the Senate Finance Committee for hearing House Bill 36 today. What House Bill 36 does is close a gap in Alaska law. Current Alaska law allows a foster child admitted to a short-term psychiatric facility to be held there for long periods of time without any review that they actually need to be in that place. There are some foster kids who do require long-term inpatient psychiatric care, but they should be transferred to a long-term residential facility. They should not be held in a short-term one.

There are unfortunately some very sad, horrific stories from Alaska's past, uh, from foster kids spending months and in some cases years in quote-unquote short-term facilities. And the question is why? How has that happened? Well, the facility is able to bill Medicaid about $1,000 per night for the child. And from OCS's perspective, that's, these kids often have behavior problems, they're difficult to place in foster homes.

These overworked OCS caseworkers who have a large caseload Well, they know that kid is safe in that facility and they can worry about their other cases. So that's how without the state saying that it needs to be reviewed, the kid can just end up there. And one particularly egregious case, Katrina Edwards from 2012 to 2013, the facility was able to bill $330,000 to Medicaid to keep her there for her 13th and 14th birthdays when she did not need to be there. In 2018, a superior court case, Hooper Bay versus Lawton, resulted in an injunction that said that the review must happen within 30 days. So from this Superior Court case, we started trying to review them at 30 days' time.

We didn't always meet that mark, but in February 2024, in the case of Quinnahawk versus OCS, the Supreme Court said that there is no doubt the children in OCS custody are at substantial risk of being hospitalized for longer than they need, or when they do not need to be hospitalized at all. "Clarifying the legal protections for a vulnerable population of children in state custody is of utmost importance." The Supreme Court has said we must close this loophole. In that Supreme Court case and that decision, they said that 30 days is too long. What House Bill 36 does is says that these children's cases need to be reviewed within 7 calendar days. This is a compromise position.

I introduced this bill in a previous legislative cycle with a 72-hour requirement. We have compromised on 7 calendar days. There are many entities involved in a child in need of aid case, and so this allows for that extra time. There is a provision in the bill that says they can have a 7-day extension. I want to say it on the record as a sponsor of the bill, it is my intent that that 7-day extension is rarely used.

In cases where they absolutely cannot have that hearing within 7 calendar days, then the bill allows for an additional 7 days. But it is not the intent that these kids are going to a 14-day wait. It should be as quickly as possible within that 7-day window. The bill also requires the child be appointed an attorney. That is the practice, but it's not the requirement.

So we're already doing that, but this bill just says you have to do it. The bill also requires adding an item to a report that the legislature already requires. This bill requires OCS report how many kids in state custody are held in out-of-state residential facilities. And then finally, the bill creates a new type of foster care license, treatment foster homes. This part of the bill was added in a previous committee by the administration, and there's someone from DFCS who can speak more to that type of license if it require.

Again, I'm super appreciative for you guys hearing House Bill 36 today. I'm happy to answer any questions, and my staff, Kyle Johansen, can walk through the section, if it be the will, Mr. Chairman. Thank you. Do members of the Senate Finance Committee have questions of the prime sponsor at this time?

Seeing none, we will go to invited testimony. The first individual that's invited to testify to the Senate Finance Committee is Amanda Mietiewa.

Maybe I mispronounced that name. Mietiewa. Mietiewa. Please identify yourself for the record and proceed with your invited testimony.

Co-chairs and members of the Finance Committee, thank you for allowing time for testimony on on House Bill 36 this morning. For the record, my name is Amanda McTeever. I'm the director of Facing Foster Care in Alaska, and I also have lived experience in the foster care system and as a former foster and adoptive parent here in the state. I'm testifying this morning in support of House Bill 36, specific to the provisions of foster youth placed in hospitals for acute psychiatric care. House Bill 36 came at the request of foster youth themselves.

And as Rep. Gray alluded to, it closes a longstanding gap for youth who linger in hospital settings unnecessarily, oftentimes because of lack of foster home options. For several decades now, foster youth have complained, and they've made headlines, for hospital stays where there was no foster home available. Foster youth placed in these settings report that they're being subjected to unnecessary mental health diagnoses, physical restraint, chemical restraint, and seclusion, and bearing witness to other children being physically restrained, chemically sedated, and thrown in places like what they call the quiet room. These experiences create compounded trauma for already traumatized children that we should really be working to protect and help them heal. In addition to the ruling by the Alaska Supreme Court, There was also an investigation by the United States Department of Justice into Alaska that found Alaska overutilizes these settings.

House Bill 36 would require that foster youth get a hearing within 7 calendar days of placement so a judge can hear the facts and determine if youth need to remain in a, in an acute setting to stabilize or if they need to be released for a lower or higher level of care. So as it stands now, you get a hearing within 30 days of placement in an acute setting. We sometimes see that young people are getting a hearing, or they're getting released on the 29th day ahead of ever having a hearing, and likely don't meet the criteria to be in that placement. The state noted in their fiscal note that House Bill 36 would actually lead to a cost savings by reducing the number of youth experiencing experiencing lengthy stays in these hospitals. When young people are in an acute setting and no longer meet the criteria for Medicaid to pay for it, the state pays for that out of UGF.

And so, you know, this is upward of $1,000 a day. And also noted in the fiscal note, this could be 90 admissions of young people a year. So getting youth before a judge early to hear the facts, hear from the clinician, hear from the state, and really make a decision early about appropriate level of care will fix a lot of these challenges where youth are just lingering out and waiting for a placement option. And the state is really hemorrhaging money in these situations, and we're creating more trauma for young people. Thank you for allowing time for testimony.

Thank you for that testimony. Um, before we proceed, I'd like to I would like to tell the committee that we have two individuals that are available for questions if so desired. That would be Kristi Wolgely with DFCS in the room, as well as General Counsel for the Alaska Court System, Nancy Mead. We will proceed with invited testimony. Barbara Malchik.

The legal committee facing Foster Care Alaska is online. Barbara, please identify yourself for the record and proceed with your invited testimony.

Good morning and thank you for the opportunity to testify this morning. My name is Barbara Malschick and I'm calling from Anchorage. I am here as a member of the board of directors of FFCA to testify in support of HB 36 as it relates to the psychiatric hospitalization of youth. Um, I sort of feel like I don't have anything left to say because Representative Gray and Ms. Matevier covered it all so well, but I do want to say that we support this bill because it fills the gap in our statute and because it strikes is a good and fair balance between keeping youth safe when they're in a crisis situation while protecting their constitutional rights. Just to add a little bit about my background, in addition to being involved with FSPA since its beginning over 20 years ago and being on their board since they incorporated as a nonprofit advocacy organization in 2012, My entire career was spent— over 25 years spent as a guardian ad litem and supervising attorney representing the best interests of foster youth.

So, both in my capacity as GAL and attorney and as a member of the board of directors, I've come into contact with literally thousands of foster youth and heard their stories. Many of these youth have been in psychiatric hospitals, sometimes repeatedly. Some of them needed to be there, some of them did not, but they were all came away even more traumatized than when they started. So as I said, I don't have much to add. The statute that's proposed, HB 36, covers all the important things that the Supreme Court wanted in it, so that while giving OCSE authority to place a child who's in crisis into a hospital without getting prior court approval, it does require appointment of an attorney.

It requires immediate— this is important— immediate notification within 24 hours of the placement to all the parties in the child's need of aid case. So they know what's going on with the youth that they care about, and they can come together and try to find a less restrictive setting for the youth. And then, of course, the meat of the statute— the bill would be to have the hearing within 7 days. SSDA would have preferred it to be shorter, but as Representative Gray said, it was a compromise. Um, there are so many people involved in the case that sometimes it's difficult to get them all together within a very short time frame.

7 Days gives the opportunity for the child to be stabilized. It gives the opportunity for people to come together and be looking for a long-term solution to what the child's needs are. Um, it's my hope that this bill will get to the full floor, that, um, the House and the Senate can come to an agreement on all of its elements, and with fingers crossed that it could actually pass discussion. It's much needed and long overdue. Thank you.

Thank you, Barbara Melchik. We will open the public hearing at this time. Is there anyone online that would like to testify?

We have one individual, Kelly Richardson.

Please identify yourself and Please proceed with your testimony. Yes, thank you so much, Senate Finance Committee. My name is Kelly Richardson and I am with the Citizens Commission on Human Rights. We serve Alaska, Montana, and Washington. House Bill 36 in version C has added treatment foster care.

This is dramatically complicated. The original House Bill Bill 36 and requires further amendment before the system should be enacted. Creating a new level of treatment for youth in foster care should not be treated lightly. The current draft lacks needed safeguards and oversight, which could lead to further abuse. Eliminating abuse was the impetus for the original bill.

There are some of the issues that are not addressed in version C draft that legislators should consider. This current draft, Version C, creates a new treatment foster care model but leaves youth vulnerable because it contains no statutory guardrails on diagnosis, medication, treatment planning, oversight, or family, family tribal involvement. Everything is left to DSCS regulation, which means the safeguards are optional, optional, changeable, and unenforceable. The treatment foster system as drafted will be a continual problem due to lack of guardrails. It becomes a pipeline into unnecessary psychiatric labeling and medication, especially in a system already under pressure to reduce hospital stays.

This legislation should be amended to provide protections, safeguards, and accountability, not just a placement system for address youth. We have provided amendment language in the information that we have sent in, but it does address these particular points. There needs to be non-drug requirements first. So non-drug interventions first. Needs to be trauma screening, diagnostic guardrails.

Psychotropic medication oversight, youth rights, family involvement standards, and independent clinical review. The age of consent for youth should remain at 18 unless claims of abuse are driving the youth to seek help. Thank you so much for allowing this testimony. Thank you for that testimony. We will allow the prime sponsor to to respond to Kelly Richardson's testimony after we complete public testimony.

Is there additional people online? Are there individuals in the audience that would like to testify on this piece of legislation?

Seeing none, we will close the public hearing and go to Representative Gray. Do you have comments on Kelly Richardson's testimony at this time. Thank you, Chairman Hoffman. I think the person who could best speak, since the part of the bill that she's talking about is the new type of foster treatment home, would be Chrissy Vogeli from the Department of Family and Community Services. If it's okay to have her respond, that would be my preference.

Chrissy, can you identify yourself for the record and introduce yourself and provide us with a response. Good morning, everyone. My name is Chrissy Vogel. I am the senior policy advisor for the Department of Family and Community Services. I do believe the Senate and all of you here know well that the Department of Justice did issue a report stating that Alaska does not have enough community-based services for children who, who require these specialized services.

Alaska is also the only state that has not had a— does not have a defined treatment foster care program. We do have the services already. We do utilize a traditional foster care license for delivering these services, and we do have agencies providing these services, assisting the foster parents, training the foster parents, and again providing specialized services to kids. This license is needed in order to provide alignment between what the requirements would be for foster care, or for treatment foster care, through the regulatory process and the Medicaid requirements so that we would be able to offer a really comprehensive, cohesive program. This program is also available to all children, not just children in state custody.

[FOREIGN LANGUAGE] While the person who provided public testimony stated that there should be more statutory guidelines, I would like to note that for the most part with all licenses, it's through the regulatory process that we provide for those guidelines. And the regulatory process does offer public comment. We do take into consideration how people feel like the program should be designed. We are working quite closely with the agencies who are providing these services to determine determine what those regulatory guidelines would be. And this is based off of national standards.

Because again, this is throughout the country. This is not just a new concept here. And again, I would like to note, we are in desperate need of community-based services for children. This is one of those solutions that can be offered. Thank you, Ms. Vogely.

Do members of the Finance Committee have questions of Ms. Vogely at this point? Senator Keehl. Thank you, Mr. Chairman. I guess, Ms. Vogely, just to look at the definition that is in the bill, the treatment foster home, is it limited to 4 children or 4 children with these extra needs?

So with the definition that's in the current CS, that's limited to 4 children. It isn't well defined, but we would limit it to 4 children with the specialized needs. It would not be for 4 children with specialized needs and then 6 children without. That would be a lot to handle. Typically these homes would be limited to a very small amount of children due to their level of need.

Senator Giel. Thank you. I notice that determining the need, you have to have a state license or certification. Would we require that of the foster parent at the treatment foster home, or is it the sort of the, for lack of a better word, medical plan that's determined and then services are delivered by the foster parent? Help me understand how that works.

Ms. Fogley. Certainly. Through the Chair to Senator Keel, so what we would require is that the assessment of the child to determine their level of need be done by a licensed medical professional who could to determine what their level of need is. And then it would be the agencies who are providing these services would train the foster parents to, to be able to provide services to that child based on their specific needs. So the treatment foster parents may not be licensed professionals.

Frequently they are. We do have a lot of nurses who choose to, to do this, but it would be that licensed medical professional do the assessment for sure. The services could be provided by anyone who is trained to be able to do that. So it sounds pretty clear, correct me if I'm wrong, that the foster parent, the foster home, that's not the person prescribing, setting the course of plan. That's all done by licensed professionals who oversee that?

Through the chair, Senator Keele, that's correct. Thank you, Senator Keel. Further questions? Senator Kaufman. Thank you.

We were talking numbers, you know, number of kids. I'm just wondering magnitude of like on an annual basis, how many cases do you think? So if—. I don't know if the current system suppresses enrollment in these processes or enables it, but what do we think we'll have quantity-wise on an annual basis? [FOREIGN LANGUAGE] Through the chair, Senator Kaufman, to be honest, I am not clear on the number of children that are currently utilizing the system because it is open to all children.

And we right now, we only really track the children that are in custody who are utilizing the services in these homes. I would say that frequently the agencies that run these homes to turn families and children away because they don't have the bed space. So this is a highly utilized program or highly utilized service. And if we had more homes, there would be more children who would be utilizing them. Senator Kaufman.

Thank you. Thank you, Senator Kaufman. Additional questions of Ms. Vogely? Seeing none, we will go to Fiscal notes before we hear closing comments from the sponsor. Senator Keogh.

Thank you, Mr. Chairman. There are two fiscal notes on House Bill 36. The first I have is from the Department of Family and Community Services, Children's Services Management. They give a zero fiscal note, no additional costs or revenues from the bill.

The second fiscal note I have is from the judicial branch in the trial courts. They also assign a zero fiscal note, no costs— no incremental costs or revenues. They note that they estimate about 110 additional hearings per year total and can absorb that with existing resources. Thank you, Senator Kiel. Do members of the Finance Committee have questions on the any other fiscal notes at this time?

Seeing none, I invite the prime sponsor, Representative Gray, back to the table for any closing comments that you might have before we set this bill aside. Chairman Hoffman and members of the committee, thank you so much for hearing House Bill 36 today. Thank you. We will set this bill aside for further consideration at a later time. That brings us to the second item on today's agenda.

That being HB 52, minor psychiatric hospitals. This is the first hearing on this piece of legislation. I invite the prime sponsor, Representative Dilbert, and any individuals she may want to assist her to the table to introduce the legislation to the committee.

Good morning, Chair Hoffman and members of the Senate Finance Committee. For the record, Maxine Dibert, Representative for Downtown Fairbanks, House Thank you for bringing House Bill 52 before the committee this morning. This bill is somewhat of a follow-up to the bill that we just heard. This bill does have a Senate companion, Senate Bill 44, which was heard by the committee last session. There are a few differences between the legislation, one being a recent amendment that we adopted on the House floor.

Floor. House Bill 52 was crafted after a scathing report was released by the Department of Justice in 2022 finding the state of Alaska was in violation of Title II of the Americans with Disabilities Act, which was just mentioned in previous testimony. Additionally, there was a 2004 Alaska disability loss Center summary of findings report showing a concerning overuse of seclusion and restraint tactics used on youth in Alaska's psychiatric hospitals. These issues disproportionately affect Alaska Native children in our state who make— who made up one-third of the minor patient population in fiscal year 2020. The bill before you establishes tangible measures that will bring basic safeguards for minor patients and ensure there's transparency, communication, and accountability between the minor, the parent, or their legal guardian, and those charged with their care who are institutionalized.

So the 4 measures that this bill kind of addresses. Number 1, mandating a minor's right to confidential communication with their parent or legal guardian or approved adult for at least 2 consecutive hours per week. Number 2, it requires Department of Health to conduct at least 2 annual unannounced inspections of each psychiatric hospital hospital in our state. During these inspections, they must conduct private interviews with at least half of the minor patient population. Subsection A, um, this amendment adopted on the House floor also requires that a standardized age-appropriate wellness check on minors be conducted to identify any signs of abuse during these interviews.

Number 3, the bill also requires the Department of Health to prepare an annual report to the legislature containing information on the types of seclusion and restraint used on minor patients. Subsection A, the Department of Family and Community Services must also provide data on the number of minors in state custody receiving both in-state and out-of-state residential psychiatric care to include in the report. And number 4, lastly, Mr. Chairman, the bill requires hospital staff to provide written notification to the Department of Health and the minor's legal guardian within 72 hours of any seclusion or restraint that was used on a minor. And with that, I would like to thank the committee again for their time today. My staff and I, as well as representatives from both the Department of Health and Department of Family and Community Services, are available to help with any questions that we have with this legislation.

Thank you, Representative Dybert. Does any individual member of the Senate Finance Committee have questions for the from the prime sponsor at this time? Seeing none, we will go to invited testimony.

On the line we have Ben Mallott, President of the Alaska Federation of Natives. Mr. Mallott, please identify yourself for the record and present your invited testimony to the Senate Finance Committee.

Good morning, Chairman Hoffman. Can you hear me all right? Yes, we can.

Awesome. Thank you. Good morning, San Francisco lead co-chairs and Marcin Dymberg. For the record, my name is Ben Marlotte. I have the honor of serving as President of the Alaska Federation of Natives, or AFN.

AFN represents 196 Federated Tribes, 154 groups, corporations, 11 regional tribal nonprofits, through membership, it's about 180,000 Alaska Natives. I really want to thank Roxanne Byrd for her leadership on this bill. Yesterday was the Missing and Murdered Indigenous Women's National Advisory Day, Awareness Day, and in a roundtable with Senator Sullivan announcing a new DOI sexual order It became really apparent that we're not setting up young Naskans for success who are in our system. HB 52, as Brooke, as Representative Dyberg has stated, really focuses on 3 reforms. One, it reduces the risk of abuse by having more transparency.

It allows just basic access for families to reach and communicate with their youth and children and family who are in crisis in the system. And also, you know, also really improves transparency. This bill is really a small step in the right direction, but the transparency that this bill brings, I think, will allow additional changes for us to strengthen the system later on. Again, I'm going to keep it pretty short because I think we're going to divert has mentioned most of what the bill does. From the AFN standpoint, this is just one piece of the puzzle to make and create a safe space and also state for our children to grow up.

With that said, I want to thank you again for hearing this bill. I encourage you to pass it out of committee and also want to thank again Representative Ivor for her leadership in this. Bhuna chieftain. Thank you, Mr. Molat. Available for questions from the committee, we have Matthew Thomas, a nurse consultant with the Division of Health Care, as well as Christy Vogli.

Do any members of the Finance Committee have questions at this time?

Seeing none, we will Proceed with the public testimony. Is there anyone online that would like to testify at this time? No. Let me see, we have— Call the meeting back to order. There is no one online to testify at this time.

Is there anyone in the audience that would like to testify on this piece of legislation? Seeing none, we will close the public hearing. And before we have closing comments by the prime sponsor, Senator Keele, fiscal notes. Thank you, Mr. Chairman. We have 3 fiscal notes for Senate— Excuse me, House Bill 52.

They are numbered 4, 5, and 6. Fiscal Note 4 is from the Department of Family and Community Services, Probation Services and Juvenile Justice. They have a zero fiscal note. Fiscal Note 5 is our second one. That's also from DFCS.

That's in Children's Services Management. They also assign a zero fiscal note to the bill. Fiscal Note 6 is our third one. That's from the Department of Health. It is in Health Facilities Licensing and Certification.

They estimate a cost of $225,800 UGF for one additional full-time position and some training. That is a number that continues ever so slightly down, $222,800 in the out years. And they will need to change some regulations. Thank you, Senator Keogh. Does any member of the Senate Finance Committee have questions regarding the fiscal notes?

Seeing none, Representative Dibert, do you have any closing comments? Thank you, Chair Hoffman and Finance Committee members, for hearing the bill today. I'm proud of this legislation. It's been years in the making. 4 Years and a lot of work in the House to get it where it is today, working with the departments and my staff.

So I just want to say, anabaasi, thank you for hearing this. Thank you, Representative. That concludes our work on this piece of legislation and concludes the work of the committee this morning. Our next meeting is scheduled for this afternoon. Noon at 1:30 if needed.

Is there anything else to come before the committee at this time? Seeing none, we are adjourned.