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1 FILED OCT BEFORE THE CORPORATION COMMISSION OF OKLAHOJRT CLERKS OFFICE - OKC CORPORATION COMMISSION IN THE MATTER OF A PERMANENT ) OF OKLAHOMA RULEMAKING OF THE OKLAHOMA CORPORATION COMMISSION AMENDING ) CAUSE NO. RM OAC 165:59, OKLAHOMA UNIVERSAL SERVICE COMMENTS OF THE OKLAHOMA DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) is responsible for providing services to Oklahomans who are living with mental illness, substance abuse and addiction. ODMHSAS also manages the statutory certification process set forth in Title 43A of the Oklahoma Statutes. ODMHSAS and facilities certified as a Community Mental Health Center, a Community-Based Structured Crisis Center or a Community Comprehensive Addiction Recovery Center are currently authorized to receive OUSF funding by virtue of (17) and (C)(2). In FY2013, 33,840 Oklahomans received mental health or substance abuse treatment services via the 0DM HSAS TeleHealth network. ODMHSAS submits the following comments in the above-captioned rule making proceedings: 165: Procedures for requesting funding from the OUSF (e) The Commission will utilize the following procedures when evaluating a request for OUSF funding: (1) Competitive bidding should be used for all services where OUSF funding will be sought. A copy of all bids for services must be provided by the end-user to the OUSF Administrator, along with a documented review of all service alternatives considered by the end-user. The end-user shall provide a written explanation detailing the underlying reason for the selection of a bid which does not represent the least cost alternative. Funding from the OUSF may be limited to recovery of the least cost option; provided the least cost option appears to be for reliable service that will meet the stated needs of the school, library or telemedicine recipient. In the event a competitive bid was not available,

2 documentation of pricing for similar services to non-ousf end-users of the carrier in similar geographic areas will be required to be provided. Such documentation will be used in determining reasonableness of rates. (7) The OUSF will not reimburse quality of service charges. 0DM HSAS Comments: This proposed provision fails to contemplate the statutory requirement for consideration by the Commission in 17 O.S (E) of public interest. Cost for bandwidth is clearly the primary determining factor for approval of recovering OUSF funding for telemedicine services. Consideration of cost of service for bandwidth alone fails to recognize other costs both tangible and intangible which contribute to the public interest. In the Technical Conference held on September 25, 2014, Corporation Commissioner Bob Anthony posed the question of what is to be considered when determining public interest. ODMHSAS submits that the statutory authority of 17 O.S (E) allowing the Corporation Commission to determine if granting a request for Special Universal Services is or is not in the public interest authorizes the Commission to consider the health of Oklahomans. Furthermore, the Commission is authorized to also consider the cost on the State as a whole when adequate healthcare is not available. The cost of untreated mental illness and addiction has grave impact on Oklahoma communities, hospitals in the form of uncompensated emergency department visits, businesses, families, and our criminal justice system. Oklahoma ranks second nationally in prevalence rates of both "serious" mental illness and "any" mental illness among adults over age eighteen.' Oklahoma workers dealing with depression and addiction will cost employers an extra $600 million annually in medical expenses.2 During FY2013, Oklahoma law enforcement officers spent 16,847 hours transporting individuals for an SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health, 2011 and 2012 (Revised October 2013). 2 Governor's and Attorney General's Blue Ribbon Task Force on Mental Health, Substance Abuse and Domestic Violence, Task Force Recommendation, February 2005

3 initial assessment. The purpose of the initial assessment is to determine whether or not the individual is a person requiring treatment and could be confined to an inpatient setting without his or her consent. The number of hours cited above is not inclusive of time law enforcement spends waiting for the licensed mental health provider to begin the assessment or the assessment itself. Reducing travel time for law enforcement through the use of telemedicine is in the public interest. Use of telemedicine in this manner promotes public safety as well as providing quality care for the individual, and bandwidth alone is not the sole contributing factor for making this system work. In its Order released December 21, 2012, the Federal Communications Commission (FCC) stated, "By high quality, we mean that HCPs often need a high degree of reliability, service quality, and redundancy for telehealth applications, in addition to bandwidth." 3 Limiting recovery to bandwidth alone is failing to recognize what health care providers need to ensure the delivery of quality telemedicine. Our federal funding partner, Healthcare Connect Fund, requires the health care provider certify they are selecting the most cost-effective method of providing a service. The "most cost-effective method of providing a service is defined as the method that costs the least after consideration of the features, quality of transmission, reliability, and other factors that the health care provider deems relevant to choosing a method of providing the required health care services." 4 These factors were also considered by the FCC and the National Broadband Plan. In the same FCC order as cited above, the Assessment of Broadband Needs of Health Care Providers stated that quality of service is critical to health IT utilization. "Applications that integrate real-time image manipulation and real-time two-way video will stimulate demand for more and better broadband because these applications have specific requirements for network speed, latency and jitter." 5 Having lines down during an initial assessment for determination if an individual should be hospitalized against FCC Order para C.F.R (b)(4) FCC Order , Appendix B, Assessment of Broadband Needs of Health Care Providers

4 their will poses risks and costs to the individual, law enforcement and potentially the community as a whole. If the delivery of services through telemedicine is to be effective, quality of service is an integral and necessary element. In conclusion, limiting OUSF recovery to the least cost option does not always serve the public interest which the Commission is statutorily able to consider. Providing that the least cost option presents the appearance to be a reliable service for the needs of the health care provider fails to consider the totality of the makeup of quality telemedicine service. Respectfully submitted, Robin its n, OBA #17520 Counsel for Public Policy Oklahoma Department of Mental Health and Substance Abuse Services P.O. Box Oklahoma City, OK Telephone: (405) Fax: (405)

5 CERTIFICATE OF MAILING On this 1*1day of October, 2014, a true and correct copy of the foregoing Comments of the Oklahoma Department of Mental Health and Substance Abuse Services was mailed electronically to: Jerry J. Sanger Tessa Hager Office of the Attorney General 112 State Capitol Building Tessa. Dominic Williams Assistant General Counsel Oklahoma City, OK Jack G. Clark, Jr. Clark, Stakem, Wood & Patten, P.C. 101 Park Avenue, Suite 400 David Jacobson Jacobson & Laasch 212 East Second Street Edmond, OK idi8788aol.com Jennifer H. Castillo 100 N. Broadway, Suite 2900 Kim Argenbright 2504 N.W. 68th Oklahoma City, OK Cody B. Waddell, Attorney 2212 N.W. 50th Suite 163 Oklahoma City, OK Nancy Thompson P.O. Box Oklahoma City, OK Ron Comingdeer Corn ingdeer, Lee & Gooch 6011 North Robinson Oklahoma City, OK Marc Edwards Corporate Tower, l3" Floor 101 North Robinson Howard Siegel VP of External & Regulatory Affairs Logix Communications 201 Barton Springs Road, Suite 100 Austin, TX Dallas E. Ferguson Williams Center Tower Il Two West 2nd St., Suite 700 Tulsa, OK dferusondsda.com Eric King One Leadership Square, 15th Floor 211 North Robinson Sandra B. Harrison Coordinator, Advocacy & Regulatory Affairs Oklahoma Hospital Association 4000 N. Lincoln Blvd

6 Brandy L. Wreath Director, Public Utility Division Maribeth Snapp Telecommunications Policy Director m.snappocc .com Kimberly Prigmore Assistant General Counsel Oklahoma City, Ok John W. Gray AT&T Services Inc. 405 N. Broadway, Room 203 Robin Wilson

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