State of Alaska
Fiscal Note
Bill Version: SCS CSHB 172(FIN)
2022 Legislative Session
Fiscal Note Number: 11
(S) Publish Date: 5/15/2022
Identifier: HB172CS(FIN)am-DFCS-DET-5-11-2022 Department: Department of Family and Community Services
Title: MENTAL HEALTH FACILITIES & MEDS Appropriation: Inpatient Mental Health
Sponsor: RLS BY REQUEST OF THE GOVERNOR Allocation: Designated Evaluation and Treatment
Requester: S(FIN) OMB Component Number: 3355
Expenditures/Revenues
Note: Amounts do not include inflation unless otherwise noted below. (Thousands of Dollars)
Included in
FY2023 Governor's
Appropriation FY2023 Out-Year Cost Estimates
Requested Request
OPERATING EXPENDITURES FY 2023 FY 2023 FY 2024 FY 2025 FY 2026 FY 2027 FY 2028
Personal Services 94.9 113.9 113.9 113.9 113.9 113.9
Travel 3.2 3.2 3.2 3.2 3.2 3.2
Services 108.0 108.0 108.0 108.0 108.0 108.0
Commodities 19.0 4.0 4.0 4.0 4.0 4.0
Capital Outlay
Grants & Benefits 600.0 1,500.0 2,700.0 2,700.0 2,700.0 3,900.0
Miscellaneous
Total Operating 825.1 0.0 1,729.1 2,929.1 2,929.1 2,929.1 4,129.1
Fund Source (Operating Only)
1007 I/A Rcpts (Other) 150.0 300.0 300.0 300.0 300.0 300.0
1037 GF/MH (UGF) 675.1 1,429.1 2,629.1 2,629.1 2,629.1 3,829.1
Total 825.1 0.0 1,729.1 2,929.1 2,929.1 2,929.1 4,129.1
Positions
Full-time 1.0 1.0 1.0 1.0 1.0 1.0
Part-time
Temporary
Change in Revenues
None
Total 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Estimated SUPPLEMENTAL (FY2022) cost: 0.0 (separate supplemental appropriation required)
Estimated CAPITAL (FY2023) cost: 0.0 (separate capital appropriation required)
Does the bill create or modify a new fund or account? No
(Supplemental/Capital/New Fund - discuss reasons and fund source(s) in analysis section)
ASSOCIATED REGULATIONS
Does the bill direct, or will the bill result in, regulation changes adopted by your agency? Yes
If yes, by what date are the regulations to be adopted, amended or repealed? 07/01/24
Why this fiscal note differs from previous version/comments:
This fiscal note has been updated to state that the Department of Family and Community Services (DFCS) will administer DES/DET
effective July 1, 2022.
Prepared By: Clinton Lasley, Deputy Commissioner Phone: (907)465-1616
Division: Office of the Commissioner
REPORT Date: 05/11/2022
ED
SFC 05/1 OUT OF
Approved By: Sylvan Robb, Assistant Commissioner Date: 05/11/22
Agency: Department of Health and Social Services
5/2022
Printed 5/15/2022 Page 1 of 4 Control Code: vqMKo
 SCS CSHB 172(FIN) - Fiscal Note 11
FISCAL NOTE ANALYSIS
STATE OF ALASKA BILL NO. HB172
2022 LEGISLATIVE SESSION
Analysis
Introduction of this bill is required to fulfill the departments obligations under the settlement in Case No. 3AN189814 CI
with the Disability Law Center (DLC) on September 3, 2020. The settlement includes a requirement that the department
improve capacity for individuals to receive timely evaluations and treatment in the least restrictive settings.
Crisis stabilization services will free up public safety resources for police and Alaska State Troopers, Department of
Corrections, and the Alaska Court System.
The current system relies on law enforcement, emergency medical services (EMS), and hospital emergency rooms to serve
people in behavioral health crisis. Crisis stabilization services provide an opportunity to divert individuals experiencing a
behavioral health emergency to the appropriate level of behavioral health treatment.
Without these services, law enforcement officers are often the first to respond and continually engage with individuals in
behavioral health crisis, which is largely outside of their scope of training. Increasing the availability of crisis stabilization
services across Alaska allows law enforcement to focus more on crime prevention and other law enforcement activities.
This bill allows a new facility type to seek departmental designation to become evaluation facilities for involuntary
commitment, similar to current Designated Evaluation and Stabilization (DES) and Designated Evaluation and Treatment
(DET) centers, thereby expanding capacity for psychiatric stabilization and treatment.
State regulatory guidance currently allows only hospitals to be designated as DES/DET entities. This bill authorizes
DES/DETlike services to be implemented at nonhospital locations if designated by the department in advance of state
regulation updates. The department will adopt regulations as soon as possible, on or before 7/1/2024. The updated
regulations will allow DES facilities to qualify for federal Disproportionate Share Hospital (DSH) funding.
Funding used to support DES/DET hospitals leverages the DSH fund source, which is also limited to hospitals.
Because not all individuals subject to a civil commitment have insurance, this fiscal note analysis reflects the costs
associated with those individuals who are not covered by a payor including private insurance or Medicaid but require
services through a facility designated as a DES/DET. The 1115 Behavioral Health Medicaid Waiver (1115 Waiver) will pay
for DES/DET services when 1115 Waiver crisis stabilization services are provided by a Medicaid provider with an 1115
Waiver specialty and the patient is a Medicaid patient.
The nonhospital locations contemplated in this bill include a 23hour crisis observation and stabilization center. A 23hour
crisis observation and stabilization center will provide prompt observation and stabilization services to individuals
presenting with acute symptoms of emotional distress for up to 23hours and 59 minutes in a secure environment. A
shortterm crisis residential center is a medically monitored shortterm residential program in a facility that provides 24/7
psychiatric stabilization. This fiscal note serves to compensate providers when there is no other payor source, in an
amount that is sufficient to pay for DES/DET services.
(Revised 11/23/2021 OMB/LFD) Page 2 of 4
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 SCS CSHB 172(FIN) - Fiscal Note 11
FISCAL NOTE ANALYSIS
STATE OF ALASKA BILL NO. HB172
2022 LEGISLATIVE SESSION
Analysis
While a significant number of service recipients will be Medicaid eligible, not all recipients seeking services will be
Medicaid eligible, meaning not all costs incurred will be reimbursable by Medicaid. A facility operating as a DES/DET does
not have the option to refuse service, and therefore will incur unpaid costs. DES/DET facilities use the no wrong door
approach, where any individual, regardless of their ability to pay, will receive services when an individual is ordered there
by the court as a civil commitment.
Traditionally, the department utilizes DSH funding for hospitals that are designated as a DES/DET to cover the costs
associated with providing uncompensated care to individuals who do not have a payor source for services. DSH funding is
a combination of state and federal funding, with the federal portion limited to hospitals and the state portion defined in
Alaska Administrative Code. The proposed DES/DET facilities in this bill that are not hospitals or that are tribal entities will
not qualify for the federal match portion of DSH funding per federal regulations.
Funding will need to be available to cover the services for which federal DSH funding is not available and also to cover
individuals with no payor source. Without this funding, it is unlikely that new entities (nonhospitals and tribal entities) will
become DES/DET providers. The funding reflected in this fiscal note reflects the estimated cost to the department to cover
state general funded DES/DET facilities, as no federal match would be available.
Effective July 1, 2022, DES/DET will be administered through the Department of Family and Community Services (DFCS).
(Revised 11/23/2021 OMB/LFD) Page 3 of 4
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 SCS CSHB 172(FIN) - Fiscal Note 11
FISCAL NOTE ANALYSIS
STATE OF ALASKA BILL NO. HB172
2022 LEGISLATIVE SESSION
Analysis
Some new DES/DET facilities will not qualify for the federal share of Disproportionate Share Hospital (DSH) funding,
because not all facilities are hospitals and some of the facilities will be tribal hospitals which do not qualify for DSH per
federal regulations. The department anticipates that it will cost $300.0 per new DES/DET facility that is added. This
amount reflects the average of DES/DET expenditures from a look back period of 3 years. An average estimate was used
due to an anticipated decrease in the utilization of DES/DET services as a result of 23hour crisis stabilization services.
In FY23, the state anticipates that one hospital and one nonhospital will stand up DES/DET services. The hospital will be
eligible for 50% federal match of the estimated $300.0. The one nonhospital will require 100% state funding of the
estimated $300.0.
In FY24, the state anticipates that there will be one hospital and two nonhospitals to stand up these services. The hospital
will be eligible for 50% federal match of the estimated $300.0. The two nonhospitals will require 100% state funding.
In FY25 FY27, the state anticipates that tribal entities will stand up these services in rural Alaska. Tribal entities are not
eligible for federal match. Therefore, state funding will need to cover the additional four DES/DET entities anticipated for
FY25. The state anticipates that this amount will stay consistent from FY25 to FY27.
In FY28, the state anticipates that more tribal entities, in increasingly rural areas, may provide DES/DET services through
23hour crisis stabilization services. Therefore, state funding increases in FY28 to cover four additional DES/DET entities.
The interagency receipts are supported with federal receipts from the Medicaid appropriation.
Additional costs associated with implementing HB 172:
Personal Services: 1 fulltime employee (FTE) is needed at an annual cost of $113.9. The salary amount will be prorated in
FY23 to reflect a September 1, 2022 hire date.
Health Program Manager II
Range 19 Step C based in Anchorage
Salary: $68,270 Benefits: $45,598 Total: $113,868
Travel: Administrative site visits to assist with the licensure process at an annual estimated cost of $3.2.
Services: Reimbursable Services Agreement (RSA) to the Department of Law, Civil Division at an annual estimated cost of
$90.0. The Department of Law, Civil Division will provide legal services for the Department of Family and Community
Services (DFCS) at the Office of Management and Budget approved FY 2022 rate of $169.16 per attorney hour and $109.22
per paraprofessional hour. In addition, DFCS will reimburse the Department of Law for direct case costs including but not
limited to case specific travel, contractual costs, materials, courier, processing fees, etc. to total an additional $18.0 per
year.
Commodities: $19.0 for FY23 to purchase IT equipment and additional office supplies for the new position and then $4.0
for subsequent years.
(Revised 11/23/2021 OMB/LFD) Page 4 of 4
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Statutes affected:
HB0172A, AM HB 172, introduced 04/12/2021: 12.25.031, 47.32.900, 47.30.705, 47.30.700, 47.30.915, 47.30.725, 47.30.839, 47.30.851, 47.30.817, 47.30.865, 47.30.838, 47.30.710, 47.30.707, 47.30.715, 47.30.805, 47.30.685, 47.30.660, 47.32.010
HB0172B, AM CSHB 172(JUD), introduced 02/28/2022: 12.25.031, 47.30.705, 47.32.900, 18.65.530, 47.30.700, 47.30.708, 47.30.707, 47.30.730, 47.30.735, 47.30.709, 47.30.725, 47.30.817, 47.30.838, 47.30.840, 47.30.850, 47.30.855, 47.30.865, 47.30.815, 47.30.710, 47.30.915, 47.30.715, 47.30.805, 47.30.685, 47.30.660, 47.30.839, 01.10.060, 47.32.010
HB0172C, AM CSHB 172(HSS), introduced 04/04/2022: 12.25.031, 47.30.705, 47.32.900, 18.65.530, 47.30.700, 47.30.708, 47.30.707, 47.30.730, 47.30.735, 47.30.709, 47.30.725, 47.30.817, 47.30.838, 47.30.840, 47.30.850, 47.30.855, 47.30.865, 47.30.815, 47.30.710, 47.30.915, 47.30.715, 47.30.805, 47.30.685, 47.30.660, 47.30.839, 47.30.837, 01.10.060, 47.32.010
HB0172D, AM CSHB 172(FIN), introduced 04/29/2022: 12.25.031, 47.30.705, 47.32.900, 18.65.530, 18.85.100, 47.12.105, 18.15.355, 18.15.395, 47.30.700, 47.30.708, 47.30.707, 47.30.730, 47.30.735, 47.30.709, 47.30.725, 47.30.817, 47.30.838, 47.30.840, 47.30.850, 47.30.855, 47.30.865, 47.30.710, 47.30.915, 47.30.715, 47.30.805, 47.30.685, 47.30.660, 47.30.839, 47.30.837, 01.10.060, 47.32.010
HB0172E, AM CSHB 172(FIN) am, introduced 05/09/2022, passed House 05/10/2022: 12.25.031, 47.30.705, 47.32.900, 18.65.530, 18.85.100, 47.12.105, 18.15.355, 18.15.395, 47.30.700, 47.30.708, 47.30.707, 47.30.730, 47.30.735, 47.30.709, 47.30.725, 47.30.817, 47.30.838, 47.30.840, 47.30.850, 47.30.855, 47.30.865, 47.30.710, 47.30.915, 47.30.715, 47.30.805, 47.30.685, 47.30.660, 47.30.839, 47.30.837, 01.10.060, 47.32.010
HB0172F, AM SCS CSHB 172(FIN), introduced 05/15/2022, passed Senate 05/16/2022: 12.25.031, 47.30.705, 47.32.900, 18.65.530, 18.85.100, 47.12.105, 18.15.355, 18.15.395, 47.30.693, 47.30.700, 47.30.708, 47.30.707, 47.30.730, 47.30.735, 47.30.709, 47.30.725, 47.30.817, 47.30.865, 47.30.838, 47.30.710, 47.30.915, 47.30.715, 47.30.805, 47.30.685, 47.30.660, 47.30.836, 47.30.839, 47.30.837, 47.30.840, U.S.C, 01.10.060, 47.32.010
HB0172Z, AM Enrolled HB 172, introduced 05/17/2022: 12.25.031, 47.30.705, 47.32.900, 18.65.530, 18.85.100, 47.12.105, 18.15.355, 18.15.395, 47.30.693, 47.30.700, 47.30.708, 47.30.707, 47.30.730, 47.30.735, 47.30.709, 47.30.725, 47.30.817, 47.30.865, 47.30.838, 47.30.710, 47.30.915, 47.30.715, 47.30.805, 47.30.685, 47.30.660, 47.30.836, 47.30.839, 47.30.837, 47.30.840, U.S.C, 01.10.060, 47.32.010, 47.30.825
HB0172F, AM SCS CSHB 172(FIN), introduced 05/15/2022: 12.25.031, 47.30.705, 47.32.900, 18.65.530, 18.85.100, 47.12.105, 18.15.355, 18.15.395, 47.30.693, 47.30.700, 47.30.708, 47.30.707, 47.30.730, 47.30.735, 47.30.709, 47.30.725, 47.30.817, 47.30.865, 47.30.838, 47.30.710, 47.30.915, 47.30.715, 47.30.805, 47.30.685, 47.30.660, 47.30.836, 47.30.839, 47.30.837, 47.30.840, U.S.C, 01.10.060, 47.32.010, 47.30.825