Legislature(2009 - 2010)BUTROVICH 205
04/06/2009 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB2 | |
| SB139 | |
| SB27 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 2 | TELECONFERENCED | |
| += | SB 139 | TELECONFERENCED | |
| += | SB 27 | TELECONFERENCED | |
SB 139-INCENTIVES FOR CERTAIN MEDICAL PROVIDERS
1:41:31 PM
CHAIR DAVIS announced consideration of SB 139.
SENATOR OLSON, sponsor of SB 139, said this is an incentive
program to recruit health care practitioners to underserved
areas of the state in areas that are hard to fill. Forty-four
other states already have loan repayment programs of some kind
and Alaska needs to do something as well.
He didn't think that many people fully understood the crisis the
state is in already and what it is heading for. The Nome
hospital had eight full-time staff several years ago, and is now
down to three. Because of that everybody is scrambling for the
temporary physicians and the competition is getting overwhelming
- not just from other hospitals throughout the state of Alaska,
but from hospitals throughout the whole United States. This
isn't an isolated case; there are shortages in all parts of the
state.
1:44:19 PM
SENATOR PASKVAN moved to adopt CSSB 139, labeled 26-LS0503\P as
the working document. There being no objection, version P was
before the committee.
1:44:56 PM
KENDRI CEASAR, staff to Senator Olson, said she went through a
lengthy description of the payment plan at the first meeting,
so, she would explain the changes in the committee substitute
(CS), most of which were just clarifying changes to more
accurately reflect the intent of the program. Language on page
1, line 14, says the Alaska Commission on Postsecondary
Education shall act as disbursing agent. The original bill said
the commission shall act as the fiscal agent. It was changed to
clarify that the intent is not for the commission to act as
appropriating entity and that the funds used for loan repayment
will not be falling to the commission's budget.
On page 2, lines 9-10, in reference to eligibility, "approved"
was changed to "verified" to clarify that the commission does
not provide the loans. Lines 12-14 in the original bill said in
first repayment year, and it now says in first year of program
participation. Page 3, line 28, had a simple technical
correction - AS 14.43.435 was changed to properly reference AS
14.33.430.
The last change was on page 5, lines 20-22, which says the
commissioner shall prioritize eligible sites based on the
percentage of patients treated at the site who (1) are uninsured
(2) have or are eligible for medical assistance or Medicare
coverage; or (3) have or are eligible for other federal health
program benefits. The original bill didn't include those who
have or are eligible for other federal health program benefits,
such as those covered under VA or tribal benefits.
The original bill also based the prioritization of sites on the
volume of these types of patients treated rather than the
percentage. This change was made so as not to give advantage to
larger urban clinics that because of their overall large numbers
of patients might treat a smaller percentage of these patients
than a smaller clinic that treats smaller numbers of patients to
begin with. All these changes were made in consultation with
Diane Barrans of the Alaska Commission on Postsecondary
Education and Tim Schuerch of the Alaska Native Health Board.
They do not change the overall purpose of the bill nor do they
address the issues that were brought up in the first committee
hearing.
She said that Senator Dyson had questions regarding how the
initial 10 practitioners in this program were chosen.
1:50:09 PM
SENATOR DYSON said he also want to know the definition of a
clinical psychologist.
MS. CESAR responded that Rod Betit, Alaska State Hospital and
Nursing Home Association, who played a key role in outlining the
proposed program in SB 139 could answer those questions as well
as summarize the bill for the committee.
1:50:48 PM
DR. JAY BUTLER, Alaska Chief Medical Officer, said he wanted to
address Senator Paskvan's question from the last hearing. He
said the administration is very conscious of the public health
challenge in maintaining a sufficient health care workforce. It
also recognized the work of the working group that developed the
plan to address the work force issues, but the administration
opposes the bill at this time because funding presents a
challenge.
He explained that other aspects of the budget are designed to
address the workforce challenges including the UAA money for the
family practice residency program - which is one of the most
powerful predictors for where a physician will ultimately set up
practice. A probity has been placed on providing funding to the
Alaska Student Loan Corporation to make sure loans are available
for students coming in at the undergraduate level.
1:53:21 PM
ROD BETIT, President/CEO, Alaska State Hospital and Nursing Home
Association (ASHNHA), responded to Senator Dyson's question
about how they came up with the 10 occupations. He said they
started with a vacancy study to see how severe the shortage was
in various parts of the state. They also looked at the Physician
Supply Task Force study from 2006, which he was a part of. At
that time they found Alaska was about 300 physicians short. Then
they took that information back to the work group, which
resolved it into the 10 occupations in the bill. Five of those
specifically address the behavior health area - the physician
category, which includes psychiatrists, nurse practitioner as
well as psychologist, the clinical social worker and the
physician assistant. Four of those have the ability to charge
and receive payment for the services that they deliver in their
own right. Particularly since this is focuses in rural areas,
they wanted to be sure to provide health care providers that
could generate revenue for those locations. The physician
assistant cannot do that except through a physician, but they
can provide services under the supervision of a physician who
can then bill for those services. That is how they got to the 10
categories, but they are open for discussion.
A very strong part of this legislation is that once the advisory
committee makes recommendations, they have to be accepted by the
department unless the commissioner puts in writing why not.
MR. BETIT said it is very important to move forward and at least
establish the program. He knows the department is in an awkward
position now, but he doesn't think the two things the
administration mentioned will help deal with the health care
crisis now, particularly in the rural and hard to fill areas.
1:58:24 PM
MR. BETIT said that a clinical psychologist has an advanced
degree and has to meet licensing requirements in this state. He
isn't completely clear on the required education level.
SENATOR DYSON said in-state licensed clinical counselors are as
well equipped to deal with behavioral issues as clinical
psychologists. So if this bill doesn't include those state-
licensed people, he has a problem with it.
2:00:08 PM
CHAIR DAVIS asked if anyone from legal was available to answer
that.
MS. CESAR replied no.
SENATOR THOMAS asked if ASHNHA is willing to participate in some
kind of a match for the grants or the repayment of loans.
MR. BETIT said he hadn't put that to his membership, but this is
not intended to help hospitals except in the smallest areas. The
small rural locations don't have the ability to attract
providers, and he didn't know if they were in a position to do
more than they are with the University's expanded nursing
program.
2:02:14 PM
SHELLEY HUGHES, Director, Government Affairs, Alaska Primary
Care Association, provided a chart entitled, "Why a Loan
Repayment and Incentive Program is Better Than Other Support-
for-Service Program Types." She remarked that a number of
proposals are "floating around" and they all have good
intentions in trying to meet the workforce shortage, but this
chart shows how this particular one is better for the state, as
far as being cost effective and result-producing. It doesn't put
the state at risk of loan default because it doesn't hold the
loan. It provides for less administration because there is no
need to track the person from their time as a student all the
way through to their time working in the field.
2:05:32 PM
PAT LUBI, Advocacy Director, AARP Alaska, expressed AARP's
strong support for SB 139. Without it, Alaska cannot compete
with other states for health care providers and workers.
2:08:04 PM
JEAN MISCHEL, Drafting Attorney, Legislative Legal Division,
Legislative Affairs, regarding a definition for clinical
psychologist, said the Board of Psychology doesn't license
psychologists specifically by type, but it does require certain
degrees before issuing one - and one of those is a degree in
clinical psychology. In her opinion, unless it is defined
otherwise, that would be the definition that would apply here.
MS. CESAR said the Division of Occupational Licensing requires a
PHD level degree for a statewide license in clinical psychology.
A Masters would qualify someone as only a professional counselor
or a psychologist associate.
SENATOR DYSON said he is disappointed that the CS doesn't
address his question. He pointed out that a Masters level
clinical psychology student here qualifies for a state license
and can bill for payment. To include them, but not including
social workers in the behavioral sciences seems to be unwise and
unjust.
SENATOR OLSON said he came up with the types of health care
providers with the help of the commission that Rod Betit was on.
MR. BETIT added that they are referring to the ad hoc workgroup
of interested parties, and this specific question never came up
in their discussions. This was their best effort initially, and
he had no problem with adding another occupation.
2:13:44 PM
SENATOR DYSON said he wasn't prepared with an amendment today,
but could have one by Wednesday. There are two other licensed
boards - one is marriage and family counseling and the other is
maybe behavioral counseling - who work in alcohol rehabilitation
programs and residential programs for children.
CHAIR DAVIS asked if there is a shortage in those areas that he
could verify.
SENATOR DYSON asked Mr. Betit the group did their research how
did they determine what jobs they were short in.
MR. BETIT replied that they worked with the organizations that
represent people who work in that area regularly - every tribal
organization, the Mental Health Trust, primary care level
organizations, the State Health Planning and Systems Development
people.
2:16:12 PM
SENATOR DYSON said he would try to get that information.
SENATOR OLSON said nothing else could act more immediately to
attract these health care providers to these hard-to-find areas.
He had no problem adding Senator Dyson's amendment to the bill,
but it may increase the fiscal note.
2:19:35 PM
SENATOR ELLIS said he appreciated Senator Olson bringing this
bill forward. Alaska is behind on this issue; it should have
tripled the WWAMI class three years ago, and this is the most
immediate thing they can do. He was very much in support of it.
CHAIR DAVIS said she would support adding a category if it is
needed.
SENATOR DYSON said if the sponsor would agree to support his
amendment in Finance he would agree to move the bill today.
SENATOR OLSON said as long as the other committee members agree
then he will do so.
2:23:21 PM
SENATOR PASKVAN moved to report CS for SB 139 from committee
with individual recommendations and attached fiscal note(s).
There being no objection, CSSB 139(HSS) moved from committee.
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