Alaska faces serious mental health care challenges. New regulations are unlikely to help.

Much has been written in the ADN lately about the inadequacy of Alaska's mental health care system, including capacity and staffing issues at Alaska Psychiatric Institute, the state-run mental health hospital, and the resulting strain on hospital emergency rooms, especially the Providence Psychiatric Emergency Room.

For more than 40 years, Anchorage Community Mental Health Services has been providing community-based mental health services to the Anchorage area. Community-based services are the least expensive way to address mental health needs, costing an average of $25 per day, or $9,125 per year per client. The same amount covers 4-8 days in acute psychiatric care in a hospital setting, or six days in jail, for special-needs populations.

But there have been long-standing challenges to providing services. Medicaid rates for behavioral health care have not been fully re-based since 1992, and while that process is now complete, we are still waiting for final confirmation from the state for our rates for fiscal 2019. Regulatory requirements result in a
significant amount of work that is not billable at all. A new rule going into effect June 7 requires all documentation to be complete and signed within 72 hours of providing a service, including weekends, meaning staff will need to provide fewer services on their last work day of the week or work overtime to make sure their notes are complete and signed. All of these challenges contribute to difficulty in hiring and retaining qualified staff, as they can work elsewhere for higher pay with fewer requirements.

Another major challenge in Alaska is that a full range of services is not available. There are not great options for patients being released from API who still need a high level of supervision. Some of them end up living in assisted living facilities, paid for by state general fund dollars. These facilities have relied on
funding through a Medicaid program called Recipient Support Services to provide the structure, supervision and monitoring needed to keep these clients, their other clients and the community safe.

Now the Division of Behavioral Health is attempting to change the regulations, so that billing for these monitoring services would not be allowable. With this change, assisted living facilities would no longer be able to house these more challenging clients: some will end up homeless, and the pressure on API will increase.

We know the state is planning major reforms in the mental health care system in Alaska, and we understand the need to control costs. We look forward to continuing to work with the state government and the community to address the spectrum of mental health care needs in our state in a more efficient manner. These recent changes seem to be detrimental to providers, at least in the short term. This will not help move the system forward toward a goal of improving services and access.

Jim Myers is the CEO of Anchorage Community Mental Health Services, Inc.