Legislature(2009 - 2010)BUTROVICH 205
03/25/2009 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SB139 | |
| SB12 | |
| SB101 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 101 | TELECONFERENCED | |
| *+ | SB 139 | TELECONFERENCED | |
| += | SB 12 | TELECONFERENCED | |
SB 139-INCENTIVES FOR CERTAIN MEDICAL PROVIDERS
1:31:34 PM
CHAIR DAVIS announced consideration of SB 139.
1:31:57 PM
SENATOR OLSON, sponsor of SB 139, said it establishes a loan
repayment and incentive program that is essential to induce
people to come to Alaska to serve as health care professionals.
Two years ago the Health Commission estimated that over 400 more
medical doctors are needed to provide the same level of care as
is available elsewhere in the country. SB 139 will play an
important role in the overall solution by establishing this
program now. Forty-four states already have a similar loan
program, so competition is fierce. Alaska offers unique
lifestyle opportunities, but a program such as this will make us
competitive with other areas. Rural Alaska faces an acute
shortage of doctors.
1:34:28 PM
KENDRI CESAR, staff to Senator Olson, said SB 139 establishes
the Health Care Profession's Loan Repayment and Incentive
Program to make health care employment more attractive to
practitioners who both originate from Alaska, but who are also
from the Outside. Particularly in hard-to-fill localities,
people face obstacles such as limited financial resources,
cultural barriers and geographical hindrances to health care
access. This program would mirror similar loan repayment
incentives in the Lower 48 that have been substantially
successful as cost effective strategies in addressing workforce
shortages both for health care and other professions.
The program would be overseen by the Department of Health and
Social Services (DHSS) and the commissioner would appoint an
advisory council to communicate between program administrators
and providers and would make recommendations back to the
commissioner regarding program administration. The commissioner
would use the data and input of the advisory council to annually
prioritize 10 eligible practitioner-types according to relative
need in Alaska. These 10 practitioner types would be further
prioritized into two categories - Tier 1 and Tier 2. The Tier 1
category would include pharmacists, dentists and physicians with
either an M.D. or a D.O., the types of practitioners that are in
highest demand in Alaska. These types of practitioners often
come out of medical school with the highest amount of loans.
Tier 2 practitioners would initially include dental hygienists,
nurse practitioners, registered nurses, physical therapists,
physician assistants, clinical psychologists, and clinical
social workers. These practitioners are also in high demand in
Alaska, but to a lesser extent than the Tier 1 practitioners.
MS. CESAR explained that each of the 10 practitioner types would
be allocated 8-9 slots in the program, so the total number of
program participants each year would be 90. She said 60 program
slots would be allocated to regular site positions and the other
30 slots will go to the very hard-to-fill slots in areas that
are labeled so by the commissioner.
Current federally defined health care shortage areas are
referred to as health profession shortage areas (HPSA) and these
would help to guide the commissioner in defining very hard-to-
fill slots, but he would not be confined to those and preference
would be given to sites that serve individuals who have
difficulty paying.
She explained that eligible program participants must commit to
three years, no more and no less, in exchange for either loan
repayment support; or if they have no student loans owing, they
could participate in the incentive payment component of the
program.
A Tier 1 practitioner serving in a regular site could receive up
to $35,000/yr.; or if they choose to serve in a very hard-to-
fill site, they could receive $47,000/yr. A Tier 2 practitioner
serving in a regular site could receive up to $20,000/yr. or up
to $27,000/yr. for a very hard-to-fill site. These figures are
the same regardless of whether they are participating in the
loan repayment component or the incentive payment.
A participant in the loan repayment component who completes
their three years of service can opt to work for up to a total
of six years. Employers might be required to pay a matching
amount at the commissioner's discretion, but that would be based
on the employer's ability to pay. The Alaska Commission on
Postsecondary Education would serve as payment agent for the
loan payments.
1:41:01 PM
She said that a $7.4 million price tag might seem high, but
because 44 other states already offer such programs, Alaska is
at a distinct disadvantage in hiring health care professionals.
1:42:03 PM
SENATOR OLSON urged that if they are going to take advantage of
existing residency programs, they end in July. Maybe those first
graduates can come up here.
1:43:28 PM
PAT CARR, Health Program Manager, Department of Health and
Social Services (DHSS), said she was available to answer
questions and that the administration does not support this bill
due to the price tag.
CHAIR DAVIS asked if she agreed that this program should be
within the Department of Health and Social Services and if they
have problems with anything other than the money.
MS. CARR replied that they have been monitoring the healthcare
work force for some time, and it is in the purview of
responsibilities of the department. The concerns about the price
tag and needing to add staff to manage the program are of
concern.
1:44:33 PM
CHAIR DAVIS said she didn't have a fiscal note from the
department, and asked where it was.
MS. CARR replied that the fiscal note went to the Governor's
office.
CHAIR DAVIS stated that they did not have it even though the
administration knew this bill was up today. She asked if she had
already told Senator Olson that the department didn't support
this bill.
MS. CARR replied that information should have reached him
yesterday.
1:45:30 PM
SENATOR DYSON pointed out a zero fiscal note from the Department
of Education.
1:46:06 PM
DIANE BERHENDS, Executive Director, Alaska Commission on
Postsecondary Education, Department of Education, explained the
reason they were asked to participate in the discussion around
this program was their familiarity with education loans, and
they agreed they were equipped to play the part of a disbursing
agent on the loan repayment piece.
1:46:39 PM
SENATOR DYSON said he was not aware of a shortage of physical
therapists in this state, and asked where that information came
from.
MS. BEHRENDS said their packets contain the 2007 Alaska Health
Workforce Vacancy Study, which gives that information. Physical
therapists were chosen in consultation with the working group
that helped to outline the proposed program.
1:48:18 PM
SENATOR DYSON said he was particularly concerned that the state
has had a long standing turf war between various levels of
counselors and he sees that social workers are included here but
other counselors are not, particularly counselors who deal with
sexually abused children. He wanted to know why they are not
listed and social workers are. He has heard it is because social
workers have the best lobbyists.
1:49:50 PM
CHAIR DAVIS recognized that Senator Ellis arrived at the meeting
some time ago.
1:50:09 PM
SUZANNA TRICK, WWAMI, said she was available to answer
questions.
1:51:00 PM
DELISSA CULPEPPER, CEO, Alaska Mental Health Trust Authority,
said she has been working on health care workforce issues for
some years and helped produce the Vacancy Study. All workforce
areas that serve their beneficiaries have shortages across
Alaska, both rural and urban. So three years ago, they began
putting money into a larger workforce development issue. Loan
repayment rose to the top as one strategy that could be used.
So, for the last two years they have crafted a small
demonstration project around master's level or higher behavioral
health positions across the state to help with loan repayment
and recruiting. Therefore, they have been involved as part of
the coalition that crafted the details of this bill believing
that incentives will help them compete with other states. She
urged the committee to pass SB 139.
1:53:02 PM
CHAIR DAVIS advised that they just received the fiscal note from
the department.
1:53:51 PM
SENATOR DYSON said he had the Health Workforce Vacancy Summary
before him and on page 2, Table 1 showed a 17.7 percent vacancy
rate of professions and therapists and a 13.9 percent vacancy
rate for behavioral health professionals. Those are the highest
rates of vacancy next to physician assistants. He said he
thought they "missed it" by not including those mental health
professionals and therapists and that someone "bluffed you" into
putting the social workers in there instead.
1:56:14 PM
MARIE DARLIN, Capital City Task Force, AARP, supported SB 139.
She said that Alaska is going to have to do something like this
if it is going to compete in recruitment and retention of
providers. The cost of our inability to provide care to our
people is greater than the cost of the program.
1:57:20 PM
BETH SIRLES, Director, School of Social Work, University of
Alaska Anchorage (UAA), said she is also co-chair of the Mental
Health Trust Authority Workforce Development Focus Area
Education and Training Committee, and supported SB 139. The
Committee has been working for years to identify key workforce
shortage areas in the state, and health care workers are at the
top of the list. Their providers tell them regularly that their
top priority is the recruitment and retention of health care
providers. Several workforce studies show there is no question
that Alaska has serious shortages of health providers, both Tier
1 and Tier 2.
1:59:03 PM
TRACY TURLEY, full-time nurse practitioner student, said she
when she gets out of school she will have over $95,000 in
student loans, and that makes it very hard to pay for a mortgage
at the same time.
1:59:51 PM
MARY LOEB, Family Physician, Sunshine Community Health Center,
said she has experienced the distress of unmet medical and
dental needs in her community. One and a half years ago their
community was down from five to two providers to staff two
clinics. At that time she interviewed a lot of providers and
administrators and she often heard that they would have to give
up so much financially to work for the Center.
2:02:24 PM
ROD BETIT, Alaska State Hospital and Nursing Home Association
(ASHNHA), supported SB 139, because it addresses this critical
hole in the health care workforce in Alaska. He hears stories
first hand every day from Alaskans who can't obtain health care
services. The investments made in the WWAMI program are great,
but the fruits from that program won't be seen for many years;
SB 139 will address the short term need.
2:04:45 PM
MR. BETIT continued that he sees this as a rural bill primarily,
but the problem exists in some urban areas, as well. "If we
don't go after these work-ready health care professionals more
aggressively, more competitively, with the limited number
available, we're going to look worse rather than better five
years from now." To do that they need funding and this bill
wasn't premised on the notion that there would be any
diminishment of funding by those who are going after health care
professional.
He said that urban hospitals and big clinics will continue to
hire the available professionals, because they have the
financial capacity to do so. This bill is aimed at the "safety
net providers" who are willing to serve Medicaid/Medicare and
uninsured patients, but don't have the discretionary income or
the balance sheet to get professionals to their area.
ASHNHA conducted a statewide survey in 2007 about health care
attitudes. It clearly showed that the public feels that
hospitals are in a position to make the workforce needs known
and to champion some solutions to address those needs, even if
the most pressing needs aren't hospital-based. This area has
been selected by his board as a way to give back to the
community in terms of trying to get that message out and develop
some strategies for putting the solutions together.
2:07:34 PM
He said that ASHNHA has been working with the Alaska Primary
Care Association, the Alaska Native Health Board, the Alaska
State Medical Association, the Alaska Dental Society, the Alaska
Nurses Association, the Alaska Mental Health Trust Authority,
the Alaska Commission on Postsecondary Education, the Alaska
Pharmacists Association, and the Alaska Native Tribal Health
Consortium. The Department of Health and Social Services (DHSS)
has provided some staff support and he is sorry it can't support
the bill due to its financial requirements.
Even so, Mr. Betit said, he wants to put this before them as a
good solution. The bill does not mandate a funding level each
year. The fiscal note for $7 million provides a half million to
the department to run the program annually, but the idea for the
rest is to fund 90 health care professionals to come work in the
state. If only half the money is available, then they could fund
45. It seems to be an excellent way to put something in place
that can be used when funds are available.
2:09:15 PM
MR. BETIT said he doesn't have all the details pinned down even
though they've worked on this for 10 months. This legislation
leaves a lot of discretion to the department, but the bill says
that the Advisory Committee, once it makes a recommendation to
the commissioner, wants it to be honored. Having been a state
official, he has seen a lot of advisory committee's input not
used. If the commissioner doesn't use the input, he needs to put
in writing why not. He is very supportive of this legislation
and he feels if this issue isn't dealt with now, it will be an
even bigger problem in the future.
2:11:07 PM
SENATOR DYSON asked if ASHNHA had input on which professionals
would be included.
MR. BETIT replied yes; they wrestled with this question at many
meetings, and the reason they went with the master's level
social worker is that those professionals could fill in other
areas as well. However, they are open to discussion on this
issue.
SENATOR DYSON said the supporting documentation doesn't talk
about a shortage of social workers, but does mention behavioral
and mental health workers.
MR. BETIT responded that it was felt that the social worker
would be the stronger health profession to put in that package,
but that was open to discussion.
2:13:44 PM
CHAIR DAVIS said she supported this bill; it requires some money
up front, but it would save in the long run, and it is not an
unusual amount of money to put forward on something like this.
2:14:33 PM
SENATOR PASKVAN asked if the department recognizes that it needs
to attract health care workers or do they reject that need. Does
the administration want to reject certain fields under the bill
or limit the number, or is it a situation where, regardless of
need they don't want to spend the money?
MS. CARR replied that she would have to go back to the
administration for answers.
CHAIR DAVIS said she would appreciate that.
MS. CARR said her department knows there are workforce
shortages. On the other questions, she would get prepared
responses for the committee.
2:18:13 PM
SHELLEY HUGHES, Alaska Primary Care Association, said she worked
with Mr. Betit and a number of others to craft this bill. They
started by looking at what other states were doing and found
that loan repayment and incentive programs were most effective.
They found that only 2 percent of medical students are currently
going into primary care. They hear from the 141 clinics in the
state that are part of the Association, that they will have a
candidate lined up and when they learn Alaska doesn't have an
incentive program, and the candidate moves on.
She clarified that the $7.5 million fiscal note is the
encumbrance for 3 years and 90 participants. She also wanted to
mention that, as they looked at the workforce study data, they
found that recruiting physical therapists has been very hard. As
for behavioral health, both psychologists and licensed clinical
social workers are included. She explained that in order to keep
a clinic's doors open you have to have providers who can bill to
Medicaid and both psychologists and licensed clinical social
workers are reimbursable through Medicaid. She didn't think that
some of the other positions were billable like RNs.
2:22:12 PM
CHAIR DAVIS closed public testimony and held SB 139 in
committee.
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