Legislature(2011 - 2012)HOUSE FINANCE 519
03/02/2012 01:30 PM House FINANCE
| Audio | Topic |
|---|---|
| Start | |
| HB307 | |
| HJR4 | |
| HB78 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HJR 4 | TELECONFERENCED | |
| += | HB 78 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 307 | TELECONFERENCED | |
HOUSE BILL NO. 78
"An Act establishing a loan repayment program and
employment incentive program for certain health care
professionals employed in the state; and providing for
an effective date."
3:03:49 PM
Co-Chair Thomas MOVED to ADOPT proposed committee
substitute for HB 78, Work Draft 27-LS0147\O (Mischel,
3/1/12).
Co-Chair Stoltze OBJECTED for discussion.
JOE MICHEL, STAFF, REPRESENTATIVE BILL STOLTZE, discussed
the changes in the CS. He stated that each of the three
changes involved the addition of the term "advanced nurse
practitioner" to the legislation. He explained that the
insertion of the term was made on page 7, Section 2, page
7, Section 3 and finally page 8, Section 5.
Co-Chair Stoltze explained that the legislation did not
increase the pool of money, but instead increased the pool
of eligible people.
3:07:08 PM
Mr. Michel stated that the fiscal note had not changed
along with the CS.
Co-Chair Stoltze WITHDREW his objection. There being NO
further OBJECTION, Work Draft 27-LS0147\O was ADOPTED.
3:07:29 PM
REPRESENTATIVE BOB HERRON, SPONSOR, thanked the committee
for hearing the bill. He spoke about the limited access to
healthcare providers in rural Alaska. He explained that
both rural and urban Alaskans suffered as a result of the
shortage of health care providers. The legislation created
a loan repayment and direct cash incentive program to
attract and retain providers in ten different direct care
professions. He explained that the intent of the
legislation was to capture new graduates as well as
established professionals. He acknowledged the federally
funded programs, but noted their inadequacy. He proposed HB
78, which was designed by Alaskans, for Alaskans. He
pointed out that 47 other states had similar incentive
programs. The legislation allowed for competition with
those other states. He mentioned the abundance of support
received in the form of letters from his constituents and
others around the state.
3:10:23 PM
Representative Neuman talked about creating competitive
opportunities to incentivize an increase in health care
professionals in Alaska. He wondered if the incentive might
lower medical costs paid by Alaskans.
Representative Herron appreciated the question. He admitted
that he did not have the answer to that very large
question.
Representative Neuman expressed his goal of understanding
the investment for Alaska. He pointed out page 2, line 17,
which stated a lifetime maximum period of 12 years for
participation in the program. He asked how the 12-year time
period was selected.
LIZ CLEMENT, STAFF, REPRESENTATIVE BOB HERRON, pointed out
page 3, line 13 stating "the department may approve loaner
payment and direct incentive programs for an initial period
of 3 years," which would allow an applicant to participate
in the program for six years. The number was derived
following conversations with health care providers faced
with recruiting professionals as well as professionals
faced with the repayment of loans. The maximum was six
years, except for very few select individuals who may
return to school for further certification may be eligible
for an additional six years. She provided an example of a
nurse who was eligible for the six-year limit, and then
chose to attend medical school, would be then eligible for
an additional six years.
Representative Neuman asked about page 4, lines 17 through
23, which discussed the amounts of annual payments for
professionals. He assumed that the amount provided
recordable income for the professionals.
Representative Herron replied in the affirmative.
Representative Neuman asked about an opportunity for one
health professional to qualify for more than one section
since some were specialized.
Ms. Clement responded that a professional may chose only
one section at a time. She noted that the bill allowed the
Department of Health and Social Services (DHSS) the
latitude to develop regulations that specified procedures
and eligibility details for the program.
3:16:49 PM
Vice-chair Fairclough asked about the dollar amounts for
loan repayments and how they were constructed. She wondered
how the plan compared to other states offering similar
incentive programs.
Ms. Clement replied that the workgroup responsible for
providing the concept proposal for the legislation
considered factors such as educational cost standards and
pay scale ranges across the nation. She provided examples
of lengthy and expensive educational routes for physicians,
dentists, and pharmacists. She stated that each state's
program was different and tailored to its own needs. The
dollar amounts listed in HB 78 tended to land in the middle
upon comparison to the other states with similar incentive
programs.
Co-Chair Stoltze recalled that the bill nearly passed in
2010, but questions regarding cost retained it in the
finance committee.
Representative Wilson asked about cost of living
adjustments to the amounts listed in the bill.
Represented Herron replied that the amounts were set and
not available for adjustment.
Representative Wilson queried the difference between an
advanced nurse practitioner and a nurse practitioner.
Co-Chair Stoltze asked to defer the question to the nursing
representative scheduled to testify later in the meeting.
Representative Neuman understood the issue regarding
difficulty recruiting medical professionals in Alaska. He
wondered about other state programs addressing the
recruitment of medical professionals. He wondered about
total state spending for the medical field in Alaska.
Ms. Clement responded that the Washington, Alaska, Montana,
and Idaho Medical Education Program (WAMI) and Western
Interstate Commission for Higher Education (WICHE) were two
additional state programs. She noted that a couple of
federally funded programs like the National Health Service
Corps (NHSC) and Indian Health Service (IHS) also existed.
She offered to provide additional information upon further
research. She noted that federal funding included federal
requirements regarding the use of the money.
3:22:04 PM
Representative Gara understood that Alaska required
additional family practice physicians and internists. He
wondered if any aspect of the legislation granted a
priority to those high need professions.
Representative Herron replied that the board would address
the greatest needs.
Representative Gara opined that WAMI was a great program,
although it did not differentiate between high-need
professionals compared to lower-need medical professionals.
He appreciated HB 78 and its focus on the needs of the
state.
Co-Chair Stoltze remarked that the program proposed in HB
78 addressed criteria pertaining to the greatest needs for
service in Alaska.
Representative Herron agreed with Co-Chair Stoltze.
Representative Guttenberg appreciated that WAMI helped
attain tuition for medical school, while HB 78 would
recruit those professionals to Alaska.
3:25:46 PM
Representative Doogan pointed to language on page 5, line
27 "may not exceed 90 participants annually." He requested
further information about the limit.
Representative Herron replied that the limit related to
cost control. The program would face review in 2019.
Co-Chair Stoltze opined that the money proposed in the
fiscal note would not stretch far enough.
3:27:40 PM
CHRISTINE POTTER, PRESIDENT, ALASKA NURSE PRACTITIONER
ASSOCIATION (via teleconference), spoke in support of the
legislation. She explained that there were over 500
licensed nurse practitioners in the state. She pointed out
that 40 percent of Alaskan nurse practitioners work in
medically underserved communities. She added that 70
percent of nurse practitioners accept Medicare for
reimbursement and 88 percent accept Medicaid. She added
that 39 percent of nurse practitioners practice in rural
areas with 8 percent practicing as the sole licensed
providers in their communities. She spoke to the question
regarding differentiation between advanced nurse
practitioners and nurse practitioners. She remarked that
there was very little difference between the two in Alaska.
The two terms tend to be used interchangeably.
Co-Chair Stoltze remarked that ANP sounded better than NP.
Ms. Potter agreed.
DEBBIE THOMPSON, EXECUTIVE DIRECTOR, ALASKA NURSES
ASSOCIATION (via teleconference), spoke in favor of the
legislation. She thanked the committee members for their
time.
MARY SULLIVAN, ALASKA PRIMARY CARE ASSOCIATION (via
teleconference), vocalized support for the legislation.
Co-Chair Stoltze appreciated his meeting with the Alaska
Primary Care Association.
Ms. Sullivan thanked Co-Chair Stoltze.
3:31:11 PM
MARIE DARLIN, AMERICAN ASSOCIATION OF RETIRED PERSONS-
ALASKA, supported the legislation. She reminded the
committee that the estimated economic value of the seniors
was $1.7 billion. She believed that retention of retired
citizens in Alaska would benefit the state.
Co-Chair Stoltze welcomed staff from the Soldotna hospital.
Co-Chair Stoltze CLOSED public testimony.
Vice-chair Fairclough asked whether the bill required a
participant to be an Alaskan resident.
Representative Herron replied no.
Vice-chair Fairclough wondered whether the bill required a
participant to become an Alaskan resident.
Representative Herron did not know.
Vice-chair Fairclough believed that the people benefiting
from the program should be Alaskan residents as opposed to
commuters.
Co-Chair Stoltze wondered if DHSS might have included a
vetting requirement in its proposition.
Representative Guttenberg pointed to page 4, line 2(g)
related to loan repayments, "the department shall prorate
loan repayments and direct incentives under the program
based upon a number of hours of a qualified employment
worked in a quarter." He understood the statement to read
that if a person commuted, their payments might be reduced.
Vice-chair Fairclough remarked that the state was working
to attract qualified health care providers. It was
important that the individuals were residents if the bill
paid $35,000 per year to retire student loans. She queried
the intent of the legislation.
Co-Chair Stoltze requested testimony from the department.
PATRICIA CARR, DIRECTOR, HEALTH PLANNING AND SYSTEMS
DEVELOPMENT, DEPARTMENT OF HEALTH AND SOCIAL SERVICES,
replied that the bill stipulated that the applicant must be
licensed or exempt from state licensing, which might relate
to residency requirements as they relate to licensing.
Vice-chair Fairclough countered that practitioners could be
licensed in multiple states.
3:38:24 PM
Ms. Carr replied in the affirmative. She thought that the
issue could be addressed under the program guidelines.
Co-Chair Stoltze sensed Vice-chair Fairclough's hesitation
and asked if she had further questions.
Vice-chair Fairclough replied that she did not wish to hold
the bill in the finance committee. She referred to concern
by current employers to have medical professionals remain
in a community. She understood that the cash incentives
provided that opportunity for medical professionals as
stated in HB 78. She hoped that the professionals
interested in the program would remain in Alaska. She spoke
in favor of an eligibility requirement within the program
ensuring Alaskan citizenship.
Representative Edgmon wondered about the practical
implications of a physician residing in more than one
state.
Ms. Carr replied that the issue would be considered in
terms of the application process. She imagined that the
issue would be vetted in the program guidelines.
3:42:29 PM
Vice-chair Fairclough knew about dentists that commuted
back and forth to rural Alaska. She did not know how
prevalent the occurrence was. She wondered whether the
criteria existed in other states.
Representative Doogan clarified that a considerable amount
of his medical treatment was performed by medical
professionals called "travelers." He thought that the state
may not be in a position to impose a residency requirement
and to attract as many physicians as desired.
Representative Herron elaborated that a technical amendment
could be crafted to represent the effort to have physicians
become residents but not to require it. He agreed that the
intent of the legislation was to incentivize a long-term
commitment from medical professionals. He believed that
continuity of care was an important contribution in medical
care.
3:46:50 PM
Vice-chair Fairclough expressed her interest in working
with Representative Herron on the issue. She respected the
need for additional medical personnel in rural Alaska.
Co-Chair Thomas had grown up in rural Alaska and had seen
IHS doctors that traveled and worked to have their loans
paid off. He expressed concern about the potential for a
provider to receive dual payments from federal and state
sources. He added that newcomers either appreciate the
state and its lifestyle or they choose to leave.
Representative Herron responded that a provider could not
receive dual payments; the practice was prohibited.
3:50:12 PM
Representative Neuman discussed the competitive nature of
the legislation that was limited to 90 people. He opined
that the program intention was sound. He hoped to see the
benefit to the state regarding the potential savings
resulting from the ability for patients to receive medical
care in-state.
Representative Herron replied that a time period of two
years should determine the interest in, and success of the
program. The fiscal note was nearly $2.9 million, with $2.1
million from the general fund. The remainder of the money
would be contributed by providers. The participants seek
out certain candidates and they also contribute funds,
making the bill an unusual vehicle intended to stabilize
the work force in Alaska.
Co-Chair Stoltze preferred to work further on the bill in
committee. He proposed additional efforts to refine the
bill while in house finance, including a well-constructed
amendment.
3:54:30 PM
Representative Edgmon responded to a question by
Representative Neuman related to missions and measures. He
reminded the committee that seniors were the fastest
growing segment of the population. He stressed that caring
for the needs of the seniors was in the state's best
interest.
Representative Doogan recommended that the highest value be
placed on attracting qualified doctors and nurses. He
opined that the value of retaining the qualified
practitioners was secondary.
Co-Chair Stoltze intended to schedule the bill at the
earliest possible time.
3:56:57 PM
Representative Gara had one concern related to the bill. He
discussed a shortage of knee and heart doctors. He
suggested language stating that a rarity of physicians or
nurses with a certain specialty be considered a priority.
Representative Herron looked forward to working with
members on amendments.
HB 78 was HEARD and HELD in Committee for further
consideration.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Support Letter HJR4.doc |
HFIN 3/2/2012 1:30:00 PM |
HJR 4 |
| CS HJR4 WORKDRAFT FIN 27-LS0197-T-3.1.12.pdf |
HFIN 3/2/2012 1:30:00 PM |
HJR 4 |
| HJR004CS(TRA)-NEW FN-DOR-TRS-02-28-12.pdf |
HFIN 3/2/2012 1:30:00 PM |
HJR 4 |
| HB307 CS WORKDRAFT B version SUPPLEMENTAL.pdf |
HFIN 3/2/2012 1:30:00 PM |
HB 307 |
| HB307 Repot 3.2.12 Statewide Totals.pdf |
HFIN 3/2/2012 1:30:00 PM |
HB 307 |
| HB 307 SUPPLEMENTAL CS Backup.pdf |
HFIN 3/2/2012 1:30:00 PM |
HB 307 |
| Supplemental_Spreadsheet_1-31-12.pdf |
HFIN 3/2/2012 1:30:00 PM |
HB 307 |
| HB78 CS WORKDRAFT 27-LS0147-O.pdf |
HFIN 3/2/2012 1:30:00 PM |
HB 78 |