Alaska put a price on crisis beds the Legislature created in 2022

Alaska has finally put a price on the mental health crisis facilities its Legislature created four years ago: $1,833.33 a day for an adult, $2,197.15 for an adolescent.

The state health department opened the proposed Medicaid rates for public comment Thursday. They are the highest daily rates on the state's behavioral health chart, above what Medicaid pays for medically managed inpatient treatment.

They are also far above what the state pays now for comparable care. Crisis residential and stabilization services currently draw $982.82 a day. The adult rate is 87 percent higher and the adolescent rate 124 percent higher. Across the seven days a patient can stay without prior authorization, that comes to $12,833 for an adult and $15,380 for an adolescent.

Shorter stays would pay less than they do today. The proposal sets $81.16 an hour for stabilization capped just under 24 hours, about 36 percent below the $126.89 the state pays now for 23-hour crisis observation.

The facilities themselves date to a 2022 law. Gov. Mike Dunleavy signed it in July of that year, creating two categories: a crisis stabilization center where someone can stay just under 24 hours, and a crisis residential center where an involuntary admission can run seven days.

The state was supposed to write these rules two years ago. The department's own fiscal note on the bill said it would adopt regulations "as soon as possible, on or before 7/1/2024." That note also explained why the bill existed at all: it was required to satisfy a settlement with the Disability Law Center, entered Sept. 3, 2020, six years to the day before this notice went out.

The department says the rates cost nothing. Its notice lists zero in compliance costs and zero in state and federal spending, on the reasoning that projected use of these facilities was already built into the Medicaid budget.

Whether any facility currently qualifies is unclear. Nothing on the department's June list of 190 licensed facilities is identified as a crisis stabilization or crisis residential center, though the list does not describe scope and some may operate under older licenses. Separately, the Alaska Mental Health Trust Authority awarded Southcentral Foundation nearly $3 million this year to launch a crisis stabilization center in Anchorage, its largest grant of the quarter. That project is still in development.

Written comments are due Oct. 21. An online hearing is set for Oct. 6.