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SB 93: "An Act relating to a workforce enhancement program for health care professionals employed in the state; and providing for an effective date."

00                             SENATE BILL NO. 93                                                                          
01 "An Act relating to a workforce enhancement program for health care professionals                                       
02 employed in the state; and providing for an effective date."                                                            
03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:                                                                
04    * Section 1. AS 18.29 is amended by adding new sections to read:                                                   
05        Article 2. Health Care Professionals Workforce Enhancement Program.                                            
06 Sec. 18.29.100. Legislative intent. Student loan repayments and direct                                                
07 incentive payments provided under this chapter are intended to ensure that                                              
08 communities and individuals have equal access to health care by providing health care                                   
09       services in underserved or health care professional shortage areas.                                               
10 Sec. 18.29.105. Health care professionals workforce enhancement                                                       
11 program; purpose; advisory council. (a) The health care professionals workforce                                       
12 enhancement program is established in the department for the purpose of addressing                                      
13 the increasing shortage of certain health care professionals in the state by expanding                                  
14       the distribution of health care professionals.                                                                  
01            (b)  The program established under this section must include                                                 
02                 (1)  employer payments, as described in AS 18.29.110;                                                   
03                 (2)  direct incentives, as described in AS 18.29.120;                                                   
04                 (3)  student loan repayments, as described in AS 18.29.125;                                             
05                 (4)  procedures for the commissioner's designation and prioritization of                                
06       sites eligible for participation in the program;                                                                  
07                 (5)  an application process for participation in the program as                                         
08                      (A)  an eligible site; or                                                                          
09                      (B)  a tier I, tier II, or tier III health care professional;                                      
10 (6)  provision of public information and notices relating to the program;                                               
11 (7)  a 12-year lifetime maximum for participation in the program by a                                                   
12       tier I, tier II, or tier III health care professional.                                                            
13 (c)  The commissioner shall appoint an advisory council to advise the                                                   
14 department on the program. The advisory council consists of members with health                                         
15 care expertise, including expertise in economic issues affecting the hiring and                                         
16 retention of health care professionals in the state, but may not include an employee of                                 
17 the department. Members of the advisory council serve at the pleasure of the                                            
18 commissioner and without compensation but are entitled to per diem and travel                                           
19 allowances authorized for boards and commissions under AS 39.20.180. The advisory                                       
20 council shall provide oversight and evaluation of the program and make                                                  
21       recommendations, including recommendations relating to                                                            
22 (1)  identification and monitoring of underserved and health care                                                       
23       professional shortage areas;                                                                                      
24                 (2)  eligible sites;                                                                                    
25                 (3)  an employer's ability to pay;                                                                      
26 (4)  prioritization of sites and health care professionals eligible for                                                 
27       participation in the program;                                                                                     
28                 (5)  contract award priorities;                                                                         
29                 (6)  program capacities;                                                                                
30                 (7)  strategic plans; and                                                                               
31                 (8)  program data management.                                                                           
01            (d)  The commissioner shall, in consultation with the advisory council                                       
02       established under (c) of this section,                                                                            
03                 (1)  administer and implement the program;                                                              
04                 (2)  classify each eligible site as having either regular or very hard-to-                              
05       fill positions, or both;                                                                                          
06                 (3)  set the annual maximum program payment amount for each tier I,                                     
07       tier II, and tier III health care professional employed in a regular or very hard-to-fill                         
08       position;                                                                                                         
09                 (4)  establish                                                                                          
10                      (A)  procedures for allowable leaves of absence;                                                   
11 (B)  a civil penalty, not to exceed $1,000 for each violation, to                                                       
12 be imposed for a violation of a provision of this chapter, a regulation made                                            
13 under authority of this chapter, or a provision of a contract entered into under                                        
14            this chapter; and                                                                                            
15 (C)  a priority for participation in the program based on the                                                           
16            availability of funding.                                                                                     
17 (e)  The department shall, on or before July 1 of each year, prepare and submit                                         
18 to the advisory council a report that describes the participation rates, costs, and effect                              
19 on the availability of health care services in underserved or health care professional                                  
20       shortage areas for the previous calendar year.                                                                    
21            (f)  The department may                                                                                      
22 (1)  contract for payments under the program and for the services of a                                                  
23 consultant, expert, financial advisor, or other person the department considers                                         
24 necessary for the exercise of its powers and functions and to perform its duties under                                  
25       this chapter;                                                                                                     
26                 (2)  adopt regulations necessary to implement the program.                                              
27 Sec. 18.29.110. Employer payments. An employer approved for participation                                             
28 in the program shall make a nonrefundable quarterly payment to the department for                                       
29 the benefit of the employer's health care professional employee. The employer                                           
30 payment may come from any available source, including a philanthropic institution,                                      
31 health foundation, government agency, community organization, or private individual.                                    
01       The payment amount                                                                                                
02                 (1)  must be equal to the health care professional's program payment                                    
03       amount established by the commissioner;                                                                           
04                 (2)  may be adjusted based on the employer's ability to pay, as                                         
05       determined by the commissioner and in consultation with the advisory council; and                                 
06                 (3)  must include the fee established under AS 44.29.022 for services                                   
07       provided under this chapter.                                                                                      
08            Sec. 18.29.115. Initial and renewal payments. (a) The department may                                     
09       approve student loan repayment and direct incentive payments for a qualified                                      
10 applicant for an initial period of three years and may approve a maximum of three                                       
11       renewal periods of three years each if the applicant                                                              
12                 (1)  submits an application on a form approved by the department for                                    
13 (A)  student loan repayments and, for student loan repayment                                                            
14            renewal, demonstrates that the applicant has                                                                 
15 (i)  a continuing student loan obligation on the same                                                                   
16 student loan that was subject to repayment under the program during                                                     
17                 the initial three-year period; or                                                                       
18 (ii)  incurred additional student loan debt that qualifies                                                              
19                 for repayment;                                                                                          
20                      (B)  direct incentive payments; or                                                                 
21                      (C)  payments under both (A) and (B) of this paragraph;                                            
22                 (2)  is otherwise eligible under the program; and                                                       
23 (3)  does not exceed the 12-year lifetime maximum for participation in                                                  
24       the program.                                                                                                      
25 (b)  The department shall combine an eligible health care professional's direct                                         
26 incentives and pay the total amount to the eligible health care professional in the form                                
27 of one quarterly cash payment. The department shall combine an eligible health care                                     
28 professional's student loan repayments and pay the total amount to the lending                                          
29 institution or to the eligible health care professional in the form of one quarterly                                    
30       payment.                                                                                                          
31 (c)  The combined total amount of an eligible health care professional's direct                                         
01       incentives and student loan repayments may not exceed the annual maximum program                                  
02       payment amount established by the commissioner.                                                                   
03 (d)  The department shall prorate student loan repayments and direct incentive                                          
04 payments based on the number of qualified employment hours the health care                                              
05 professional worked in a calendar quarter. The department may not pay a student loan                                    
06 repayment or direct incentive before the completion of a calendar quarter in which the                                  
07       student loan repayment or incentive payment was earned.                                                           
08            (e)  The department shall deposit employer payments received and civil                                       
09       penalties collected under this chapter in the general fund.                                                       
10 (f)  The department shall pay student loan repayments and direct incentives                                             
11 with funds appropriated by the legislature for that purpose. The department may limit                                   
12 the number of program participants based on available funding. If insufficient money                                    
13 is appropriated to fully fund the program in a fiscal year, the department shall prorate                                
14       payments based on the number of approved participants in the program.                                             
15 Sec. 18.29.120. Direct incentives. The department shall provide a direct                                              
16 incentive in the form of quarterly cash payments to an eligible tier I, tier II, or tier III                            
17 health care professional engaged in qualified employment in an amount established by                                    
18       the commissioner and that is provided by employers approved under the program.                                    
19 Sec. 18.29.125. Student loan repayment. (a) The department shall repay a                                              
20 portion of eligible student loans held by or made to an eligible tier I, tier II, or tier III                           
21       health care professional.                                                                                         
22 (b)  A student loan is eligible for repayment if the student loan was issued by a                                       
23 government or commercial entity for qualified student loan debt of a participant                                        
24 eligible under AS 18.29.130 and resulted in a certificate, license, or degree required                                  
25       for employment as a tier I, tier II, or tier III health care professional.                                        
26 (c)  A student loan repayment under this section may not exceed 33.3 percent                                            
27 of the unpaid student loan balance existing in the first year of program participation                                  
28 multiplied by the percentage of full-time equivalent employment for each year of                                        
29       qualified employment, not to exceed three years.                                                                  
30 (d)  A student loan or interest on a student loan is not eligible for repayment                                         
31       under this section if the student loan or interest is                                                             
01                 (1)  to be repaid by another source, including another loan repayment or                                
02       forgiveness program or an employer-sponsored loan repayment program;                                              
03                 (2)  consolidated with a loan that is not eligible for repayment; or                                    
04                 (3)  refinanced as a loan that is not eligible for repayment.                                           
05            Sec. 18.29.130. Eligibility. (a) To be eligible for a direct incentive payment, an                         
06       individual must                                                                                                   
07                 (1)  submit an application that is approved by the commissioner;                                        
08                 (2)  be engaged in qualified employment at an eligible site with a                                      
09       participating employer or entity;                                                                                 
10 (3)  be licensed or exempt from licensure as a tier I, tier II, or tier III                                             
11       health care professional in the state;                                                                            
12                 (4)  meet a participation priority established by the commissioner; and                                 
13                 (5)  satisfy other criteria established by the commissioner.                                            
14            (b)  To be eligible for student loan repayment, an individual must                                           
15                 (1)  satisfy the requirements of (a) of this section; and                                               
16 (2)  have an unpaid balance on one or more eligible student loans                                                       
17       verified by the Alaska Commission on Postsecondary Education.                                                     
18            Sec. 18.29.190. Definitions. In AS 18.29.100 - 18.29.190,                                                  
19 (1)  "commissioner" means the commissioner of health and social                                                         
20       services;                                                                                                         
21 (2)  "department" means the Department of Health and Social Services;                                                   
22 (3)  "eligible site" means a service area or health care facility that                                                  
23 provides health care services in underserved or health care professional shortage areas                                 
24       and that satisfies the criteria for eligibility established by the commissioner;                                  
25 (4)  "employer payment" means the payment an employer makes to the                                                      
26       department for participation in the program;                                                                      
27 (5)  "program" means the health care professionals workforce                                                            
28       enhancement program;                                                                                              
29 (6)  "qualified employment" means employment of a tier I, tier II, or                                                   
30 tier III health care professional at an eligible site at which the health care professional                             
31       is hired or contracted and paid to work                                                                           
01                      (A)  in a full-time or not less than half-time position;                                           
02                      (B)  for a term that is not less than three years;                                                 
03 (7)  "tier I health care professional" means a person who spends not less                                               
04 than 50 percent of the person's time on direct patient health care services and who is                                  
05 licensed or exempt from licensure in the state as a dentist, pharmacist, physician, or                                  
06       other health care professional as determined by the commissioner;                                                 
07 (8)  "tier II health care professional" means a person who spends not                                                   
08 less than 50 percent of the person's time on direct patient health care services and who                                
09 is licensed or exempt from licensure in the state as a dental hygienist, registered nurse,                              
10 advanced practice registered nurse, physician assistant, physical therapist, clinical                                   
11 psychologist, counseling psychologist, professional counselor, board certified                                          
12 behavior analyst, marital and family therapist, clinical social worker, or other health                                 
13       care professional as determined by the commissioner;                                                              
14 (9)  "tier III health care professional" means a person who is employed                                                 
15 at an eligible site who is not otherwise eligible as a tier I or tier II health care                                    
16       professional.                                                                                                     
17    * Sec. 2. AS 18.29.190(7), enacted by sec. 1 of this Act, is amended to read:                                      
18 (7)  "tier I health care professional" means a person who spends not less                                               
19 than 50 percent of the person's time on direct patient health care services and who is                                  
20 licensed or exempt from licensure in the state as an advanced practice registered                                   
21 nurse, [A] dentist, pharmacist, physician, or other health care professional as                                     
22       determined by the commissioner;                                                                                   
23    * Sec. 3. AS 18.29.190(8), enacted by sec. 1 of this Act, is amended to read:                                      
24 (8)  "tier II health care professional" means a person who spends not                                                   
25 less than 50 percent of the person's time on direct patient health care services and who                                
26 is licensed or exempt from licensure in the state as a dental hygienist, registered nurse,                              
27 [ADVANCED PRACTICE REGISTERED NURSE,] physician assistant, physical                                                     
28 therapist, clinical psychologist, counseling psychologist, professional counselor, board                                
29 certified behavior analyst, marital and family therapist, clinical social worker, or other                              
30       health care professional as determined by the commissioner;                                                       
31    * Sec. 4. If AS 18.29.010, 18.29.015, 18.29.020, 18.29.025, 18.29.030, 18.29.035, and                              
01 18.29.099 are in effect on July 1, 2019, AS 18.29.010, 18.29.015, 18.29.020, 18.29.025,                                 
02 18.29.030, 18.29.035, and 18.29.099 are repealed.                                                                       
03    * Sec. 5. The uncodified law of the State of Alaska is amended by adding a new section to                          
04 read:                                                                                                                   
05       APPLICABILITY. This Act applies to an application or contract relating to a student                               
06 loan repayment or direct incentive under AS 18.29 submitted or entered into on or after                                 
07 July 1, 2019.                                                                                                           
08    * Sec. 6. The uncodified law of the State of Alaska is amended by adding a new section to                          
09 read:                                                                                                                   
10 TRANSITION. Notwithstanding AS 18.29.100 - 18.29.190, added by sec. 1 of this                                           
11 Act, the advisory body for the health care professions loan repayment and incentive program                             
12 shall act as a transition council. The transition council exists only until the initial health care                     
13 professionals workforce enhancement program advisory council is appointed by the                                        
14 commissioner.                                                                                                           
15    * Sec. 7. The uncodified law of the State of Alaska is amended by adding a new section to                          
16 read:                                                                                                                   
17 BOARD OF NURSING; NOTIFICATION OF REVISOR OF STATUTES. The                                                              
18 Board of Nursing shall, before July 1, 2024, notify the revisor of statutes of the adoption of a                        
19 regulation that requires completion of a degree of doctor of nursing practice to practice as an                         
20 advanced practice registered nurse in the state.                                                                        
21    * Sec. 8. The uncodified law of the State of Alaska is amended by adding a new section to                          
22 read:                                                                                                                   
23 RETROACTIVITY. If sec. 1 of this Act takes effect after July 1, 2019, sec. 1 of this                                    
24 Act is retroactive to July 1, 2019.                                                                                     
25    * Sec. 9. The uncodified law of the State of Alaska is amended by adding a new section to                          
26 read:                                                                                                                   
27 CONDITIONAL EFFECT. Sections 2 and 3 of this Act take effect only if the Board                                          
28 of Nursing notifies the revisor of statutes under sec. 7 of this Act, on or before July 1, 2024, of                     
29 the adoption of a regulation that requires completion of a degree of doctor of nursing practice                         
30 to practice as an advanced practice registered nurse in the state.                                                      
31    * Sec. 10. If secs. 2 and 3 of this Act take effect, they take effect 30 days after the Board of                   
01 Nursing notifies the revisor of statutes under sec. 7 of this Act of the adoption by the Board of                       
02 Nursing of a regulation that requires completion of a degree of doctor of nursing practice to                           
03 practice as an advanced practice registered nurse in the state.                                                         
04    * Sec. 11. Section 8 of this Act takes effect immediately under AS 01.10.070(c).                                   
05    * Sec. 12. Except as provided in secs. 10 and 11 of this Act, this Act takes effect July 1,                        
06 2019.