Legislature(2009 - 2010)HOUSE FINANCE 519

04/08/2010 01:30 PM FINANCE


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01:41:11 PM Start
01:41:20 PM HB392
02:48:08 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ HB 392 INCENTIVES FOR CERTAIN MEDICAL PROVIDERS TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
                  HOUSE FINANCE COMMITTEE                                                                                       
                       April 8, 2010                                                                                            
                         1:41 p.m.                                                                                              
                                                                                                                                
                                                                                                                                
1:41:11 PM                                                                                                                    
                                                                                                                                
CALL TO ORDER                                                                                                                 
                                                                                                                                
Co-Chair Stoltze called the  House Finance Committee meeting                                                                    
to order at 1:41 p.m.                                                                                                           
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Mike Hawker, Co-Chair                                                                                            
Representative Bill Stoltze, Co-Chair                                                                                           
Representative Bill Thomas Jr., Vice-Chair                                                                                      
Representative Mike Doogan                                                                                                      
Representative Neal Foster                                                                                                      
Representative Les Gara                                                                                                         
Representative Reggie Joule                                                                                                     
Representative Mike Kelly                                                                                                       
Representative Woodie Salmon                                                                                                    
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Anna Fairclough                                                                                                  
Representative Allan Austerman                                                                                                  
                                                                                                                                
ALSO PRESENT                                                                                                                  
                                                                                                                                
Representative   Bob    Herron;   Nikoosh    Carlo,   Staff,                                                                    
Representative  Bob  Herron;  Rod Betit,  President,  Alaska                                                                    
Hospital  Association;  Diane Barrans,  Executive  Director,                                                                    
Postsecondary    Education    Commission,   Department    of                                                                    
Education; Sam  Trivette, Self;  Pat Carr,  Program Manager,                                                                    
DHSS                                                                                                                            
                                                                                                                                
PRESENT VIA TELECONFERENCE                                                                                                    
                                                                                                                                
Lanetta Lundberg, Ketchikan  General Hospital; Jerry Grower,                                                                    
Wasilla; Delisa  Culpepper, Chief Operating  officer, Alaska                                                                    
Mental  Health Trust  Authority;  Julie McDonald,  Pharmacy,                                                                    
Florida; Rachel  Greenberg, Palmer Senior Center;  Pat Luby,                                                                    
Director,  AARP; Angel  Dotomain,  President, Alaska  Native                                                                    
Health Board;  Doris Robbins,  Self; Dr.  Nighswander, WAMMY                                                                    
Medical School                                                                                                                  
                                                                                                                                
SUMMARY                                                                                                                       
                                                                                                                                
HB 392         INCENTIVES FOR CERTAIN MEDICAL PROVIDERS                                                                         
                                                                                                                                
               CS HB 392(HSS) was HEARD and HELD in                                                                             
               Committee for further consideration.                                                                             
                                                                                                                                
1:41:20 PM                                                                                                                    
                                                                                                                                
HOUSE BILL NO. 392                                                                                                            
                                                                                                                                
     "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."                                                                                                        
                                                                                                                                
1:41:25 PM                                                                                                                    
                                                                                                                                
Co-Chair  Stoltze  took  care  of  housekeeping  and  opened                                                                    
public testimony.                                                                                                               
                                                                                                                                
REPRESENTATIVE BOB HERRON, explained  that the intent of the                                                                    
legislation  was to  provide the  incentive  to draw  health                                                                    
care  professionals  to the  state.  He  furthered that  the                                                                    
state  has a  healthcare shortage  in both  rural and  urban                                                                    
areas.                                                                                                                          
                                                                                                                                
NIKOOSH  CARLO,  STAFF,  REPRESENTATIVE BOB  HERRON,  stated                                                                    
that  HB 392  would  create a  support  for service  program                                                                    
within the  Department of Health and  Social Services (HESS)                                                                    
that would be  directed by the commissioner  and an advisory                                                                    
body.  The  program  would provide  a  combination  of  cash                                                                    
incentives and  loan repayment for  up to 90  applicants per                                                                    
year, in  10 different health care  occupations. The program                                                                    
targeted  experienced,   mid-career  level   providers,  and                                                                    
monetary  payments  would  be  issued  after  the  work  was                                                                    
performed. The payment would stop  if the practitioner chose                                                                    
to  leave   the  state.  Two  different   tiers  of  medical                                                                    
providers   were   identified   in   the   bill;   dentists,                                                                    
pharmacists,  and   physicians  comprise  Tier  1;   Tier  2                                                                    
included  dental  hygienists, registered  nurses,  certified                                                                    
nurse   practitioners,   physician's  assistants,   physical                                                                    
therapists,  clinical  psychologists,  and  clinical  social                                                                    
workers holding  at least a  masters degree in  social work.                                                                    
The amount of monetary incentive  would depend on which tier                                                                    
the  applicant fell  into, and  the location  in which  they                                                                    
would be serving.                                                                                                               
                                                                                                                                
Co-Chair Stoltze  asked what role  the social  worker played                                                                    
in  the medical  field. Ms.  Carlo explained  that a  social                                                                    
worker provided general assistance  as a counselor to people                                                                    
struggling with medical issues.                                                                                                 
                                                                                                                                
Representative  Herron  interjected  that  other  testifiers                                                                    
could further explain the infrastructure  of the program. He                                                                    
stated that  medical occupations  had a pyramidal  system of                                                                    
occupational   support.    Earlier   discussions    of   the                                                                    
legislation  had  highlighted  the need  to  include  social                                                                    
workers  in the  second tier,  it had  been determined  that                                                                    
there was  a shortage  of social workers  in the  state, and                                                                    
that  they   were  instrumental  in  supporting   the  other                                                                    
existing, limited occupations.                                                                                                  
                                                                                                                                
Representative Joule  pointed out to the  committee that the                                                                    
bill  read "clinical  social worker".  He felt  this was  an                                                                    
important   distinction.  He   relayed  that   patients  who                                                                    
suffered  traumatic events  would have  needs specific  to a                                                                    
clinical  social worker,  particularly  when addressing  any                                                                    
mental issues involved.                                                                                                         
                                                                                                                                
1:48:30 PM                                                                                                                    
                                                                                                                                
Ms. Carlo  continued. The  program addressed  a total  of 90                                                                    
practitioners  per   year  in   the  ten   categories.  Each                                                                    
practitioner type  would have 9  slots, 3 would  be reserved                                                                    
for hard  to fill  areas. The  remainder would  be allocated                                                                    
depending on  need and the number  of applications received.                                                                    
Practitioners  would  be  paid every  quarter,  following  a                                                                    
complete full quarter  of service, with a lifetime  cap of 6                                                                    
years for participation.                                                                                                        
                                                                                                                                
Representative Gara relayed  that medical professionals from                                                                    
the state and  the private sector had  been complimentary of                                                                    
the  approach  of the  bill.  He  asked  if there  could  be                                                                    
assurances  that the  professions that  were in  the highest                                                                    
demand   in  the   state  would   benefit  first   from  the                                                                    
legislation. He  gave the example  of extending  benefits to                                                                    
primary care physicians over orthopedic surgeons.                                                                               
                                                                                                                                
1:51:08 PM                                                                                                                    
                                                                                                                                
Ms. Carlo  replied that the  decision would be based  on the                                                                    
federal health  care provided shortage criteria.  She stated                                                                    
that it would  be unusual for orthopedic surgeons  to end up                                                                    
on the state's list of  medical professionals needed in hard                                                                    
to fill locations.                                                                                                              
                                                                                                                                
Rep Herron  sincerely hoped that the  understanding would be                                                                    
that primary care was needed over exotic specialty care.                                                                        
                                                                                                                                
Representative Gara  asked if the priority  language on Page                                                                    
3, Lines 22  and 23, set the parameters  necessary to direct                                                                    
the funding  for the greatest  need. Ms. Carlo  replied yes.                                                                    
She  added that  the criteria  for allocation  of the  funds                                                                    
would be  determined in regulation  by the  commissioner and                                                                    
the advisory body.                                                                                                              
                                                                                                                                
Rep Gara noted that heart surgeons  made a lot of money, and                                                                    
that there were  not very many of  them practicing in-state.                                                                    
He  wondered if  assurances  could be  made  that the  funds                                                                    
would not go to heart surgeons over primary care providers.                                                                     
Ms. Carlo reiterated that the  intent of the legislation was                                                                    
to  direct the  funds  toward primary  care physicians,  who                                                                    
would then  have the ability  under regulation to use  it to                                                                    
fund heart surgeons.                                                                                                            
                                                                                                                                
1:54:58 PM                                                                                                                    
                                                                                                                                
Representative Doogan  expressed interest in  the derivation                                                                    
of the numbers in  Section 18.29.020. Direct incentives. Ms.                                                                  
Carlo responded that she was  unable to answer the question.                                                                    
She  suggested referring  the  question  to Senator  Olsen's                                                                    
office, which was  carrying the companion bill  in the other                                                                    
body.                                                                                                                           
                                                                                                                                
Rep Hawker  asked about  page 5,  Lines 9-17.  He understood                                                                    
that Section A  provided that the program was  not to exceed                                                                    
90 participants.  He wondered what  would happen if  all the                                                                    
slots were  not filled each  year. Ms. Carlo  responded that                                                                    
the intent of  the language in the  aforementioned lines was                                                                    
to save  30 of the  90 positions for  the very hard  to fill                                                                    
locations  to  ensure that  the  areas  with the  most  need                                                                    
received service. If  there were not 30  individuals to fill                                                                    
the positions, they would remain open.                                                                                          
                                                                                                                                
Co-Chair Hawker  suggested clarifying  the language  to more                                                                    
clearly reflect the intent.                                                                                                     
                                                                                                                                
1:59:12 PM                                                                                                                    
                                                                                                                                
Representative  Joule wondered  which  commission was  being                                                                    
referred  to   in  the  legislation.  Ms.   Carlo  said  the                                                                    
"commissioner" referred to the commissioner of HESS.                                                                            
                                                                                                                                
Representative  Joule clarified.  He noted  Page 1,  Line 7,                                                                    
which referred  to "the commission".  Ms. Carlo  believed it                                                                    
referred to the commission on post secondary education.                                                                         
                                                                                                                                
Rep.  Joule  wondered how  the  passage  of the  legislation                                                                    
would  affect  the mission  of  HB  50: Limit  Overtime  for                                                                  
Registered  Nurses.  He  thought  there  could  be  conflict                                                                  
concerning  recruitment and  correct  pay  rates. Ms.  Carlo                                                                    
responded that she was not familiar with the bill.                                                                              
                                                                                                                                
2:01:58 PM                                                                                                                    
                                                                                                                                
ROD BETIT, PRESIDENT/CEO, ALASKA  STATE HOSPITAL AND NURSING                                                                    
HOME ASSOCIATION  (ASHNHA), testified  in strong  support of                                                                    
the  legislation.  He  noted the  importance  of  the  WAMMI                                                                    
program  and  the continued  funding  to  the University  of                                                                    
Alaska  for health  care professions.  He  thought that  the                                                                    
health care  issue would  be challenging  over the  next few                                                                    
years, but that  Alaska would catch up with  other states in                                                                    
providing  readily available  health care  professionals. He                                                                    
said  that  in  the  next  five to  seven  years  the  state                                                                    
expected a  serious gap  in a variety  of medical  fields. A                                                                    
statewide survey  performed by ASHNHA had  revealed that the                                                                    
public  believed  that  the hospital  should  be  taking  an                                                                    
active role  to help  address shortages  in rural  areas and                                                                    
non-hospital  settings.   He  thought  that  the   bill  was                                                                    
effectively written  to address the problem  of primary care                                                                    
physicians and  other medical professional vacancy  rates in                                                                    
the state.                                                                                                                      
                                                                                                                                
Co-Chair Hawker  agreed the  there was  a shortage  and need                                                                    
for the positions mentioned, and  that predicting the future                                                                    
was difficult. He thought that it  would make sense to add a                                                                    
sunset date to the bill. Mr. Petit agreed.                                                                                      
                                                                                                                                
Representative  Joule revisited  the  issue  of the  nurse's                                                                    
overtime  bill. He  thought that  the  bill highlighted  the                                                                    
underlying issue  of a shortage  of nurses in the  state. He                                                                    
requested more  information as to how  the legislation would                                                                    
work with  HB 50. Mr.  Petit believed the  legislation would                                                                    
work  to support  HB 50.  He said  that HB  392 would  allow                                                                    
rural  areas  to  seek additional  resources  without  being                                                                    
subject to repercussions.                                                                                                       
                                                                                                                                
2:08:08 PM                                                                                                                    
                                                                                                                                
Vice-Chair Thomas  commented that  local students  in Juneau                                                                    
had  been  hired  on  at  Bartlett  Regional  Hospital  over                                                                    
students  from Haines.  He added  that Haines  students were                                                                    
scared to  travel to Anchorage for  opportunities because of                                                                    
the  violent  urban  environment.  He  relayed  that  SEARHC                                                                    
required one year of work  in a hospital setting before they                                                                    
would  hire students,  forcing students  to seek  employment                                                                    
out-of-state.                                                                                                                   
                                                                                                                                
Mr. Betit  stated that there  were many moving parts  to the                                                                    
health  workforce challenge.  He said  that over  200 nurses                                                                    
graduated per  year from state university  programs, some of                                                                    
which  stay  in-state to  practice.  He  explained that  the                                                                    
challenge was  getting the  graduates the  experience needed                                                                    
to go  out to the  rural communities and immediately  get to                                                                    
work.  There was  the risk  of placing  a nurse  without the                                                                    
correct  skill  set on  the  front  lines with  patients.  A                                                                    
preceptor program that individual  facilities could bring up                                                                    
and run on  their own had recently  been established. Health                                                                    
care  providers wanted  to hire  local graduates,  but those                                                                    
graduates needed to have the proper training.                                                                                   
                                                                                                                                
Vice-Chair  Thomas said  that students  were not  aware that                                                                    
the year  of work  in a hospital  was required  before rural                                                                    
clinics would hire them.                                                                                                        
                                                                                                                                
2:12:02 PM                                                                                                                    
                                                                                                                                
Co-Chair Hawker  solicited the department's position  on the                                                                    
bill.                                                                                                                           
                                                                                                                                
DIANE BARRANS,  EXECUTIVE DIRECTOR,  POSTSECONDARY EDUCATION                                                                    
COMMISSION, DEPARTMENT  OF EDUCATION,  replied that  she was                                                                    
not aware  that administration had  an opinion on  the bill.                                                                    
She  shared that  both her  staff  and staff  from HESS  had                                                                    
provided technical input with  respect to the loan repayment                                                                    
elements.                                                                                                                       
                                                                                                                                
Representative Gara  asked if Ms. Barrans  believed that the                                                                    
incentives offered  in the bill would  encourage students to                                                                    
stay in-state.  Ms. Barrans responded that  because the bill                                                                    
provided  the loan  repayment and  direct incentive,  it was                                                                    
considered to be a model approach.                                                                                              
                                                                                                                                
2:14:05 PM                                                                                                                    
                                                                                                                                
SAM TRIVETTE, SELF, testified that  he had been working as a                                                                    
volunteer with seniors and retirees  for the last decade. He                                                                    
stated that more medical providers  were needed in Alaska as                                                                    
many health  care practitioners were  approaching retirement                                                                    
age. He  believed that  the bill  would attract  health care                                                                    
professionals to  the state. Alaska has  the fastest growing                                                                    
elderly population  in the  country, which  contributed both                                                                    
to generating  money in-state, and  job creation.  He stated                                                                    
that it had become difficult  to find primary care providers                                                                    
in  Anchorage  and  Fairbanks who  would  see  new  Medicare                                                                    
patients.  In March  of  2009, there  were  25 providers  in                                                                    
Anchorage,  but  that number  was  down  to  4 in  2010.  If                                                                    
seniors could  not get medical  care in-state they  would be                                                                    
forced to move outside Alaska.  If retirees were to continue                                                                    
to remain in  Alaska and spend their  savings, pensions, and                                                                    
health care  dollars in-state the  state needed  the medical                                                                    
professionals to serve them.                                                                                                    
                                                                                                                                
2:16:56 PM                                                                                                                    
                                                                                                                                
LANETTA   LUNDBERG,   KETCHIKAN    GENERAL   HOSPITAL   (via                                                                    
teleconference),  testified in  support of  the legislation.                                                                    
She stated  that the hospital had  experienced long standing                                                                    
vacancies for physicians,  pharmacists, physical therapists,                                                                    
registered nurses,  and clinical social workers.  All of the                                                                    
positions had  been on  the community  recruitment program's                                                                    
"most  wanted"  list  for  five  years.  Conversations  with                                                                    
persons of interest had revealed  an interest in working and                                                                    
living in  Alaska, but  also highlight  the large  loan debt                                                                    
owed,  and higher  earning  power  out-of-state. She  stated                                                                    
that   better   loan   repayment  programs   and   incentive                                                                    
components  existed   outside  of   Alaska,  a   state  loan                                                                    
repayment and incentive  program would enhance, incentivize,                                                                    
and  draw a  larger  pool of  health  care professionals  to                                                                    
Alaska.                                                                                                                         
                                                                                                                                
2:19:03 PM                                                                                                                    
                                                                                                                                
JERRY  GROWER, WASILLA  (via  teleconference), testified  in                                                                    
support of  the legislation.  He was currently  a University                                                                    
of  Alaska graduate  student in  his final  semester working                                                                    
toward  a master's  degree in  social work.  He stated  that                                                                    
upon  his graduation  in May  2010,  he would  have a  three                                                                    
month deferment  on his student  loan payments.  Between his                                                                    
bachelor's  and master's  degrees he  will have  accumulated                                                                    
over $70,000  in student  loans. He  thought that  high burn                                                                    
out rates  in the healthcare  field was a primary  reason to                                                                    
offer reimbursements and incentives  to workers. He believed                                                                    
that  without  a  reimbursement program  he  would  consider                                                                    
moving out of state in order  to have a better future in the                                                                    
field of  social work. He  stated that the  average licensed                                                                    
clinical  social  worker  earned approximately  $40,000  per                                                                    
year, much lower than other  medical professionals. He urged                                                                    
the state  to remain competitive  among states in  the lower                                                                    
48 to keep workers in Alaska.                                                                                                   
                                                                                                                                
Co-Chair Hawker expressed empathy  for the large debt facing                                                                    
current college graduates.                                                                                                      
                                                                                                                                
2:21:16 PM                                                                                                                    
                                                                                                                                
DELISA  CULPEPPER, CHIEF  OPERATING  OFFICER, ALASKA  MENTAL                                                                    
HEALTH  TRUST AUTHORITY  (via teleconference),  testified in                                                                    
support  for HB  392. She  felt that  the legislation  could                                                                    
help with  current needs  and also those  brought on  by the                                                                    
recently  passed  healthcare  reform. She  stated  that  the                                                                    
state needed an  expanded workforce in both  urban and rural                                                                    
areas. She pointed out to  the committee that Alaska was one                                                                    
of the few states in the  nation that did not already have a                                                                    
similar program in existence.                                                                                                   
                                                                                                                                
Co-Chair Hawker  asked if the  mental health trust  would be                                                                    
willing  to  split  the  fiscal note  with  the  state.  Ms.                                                                    
Culpepper  said no,  but  quickly added  that  he trust  was                                                                    
placing $200,000 per year in  to match federal funds through                                                                    
the federal loan repayment program.                                                                                             
                                                                                                                                
2:24:17 PM                                                                                                                    
                                                                                                                                
JULIE  MCDONALD,  PHARMACY,  FLORIDA  (via  teleconference),                                                                    
stated that  in 2005, while  in pharmacy school,  she worked                                                                    
at a pharmacy  in Fairbanks. She testified that  she fell in                                                                    
love with  the state and  wanted to stay. She  was currently                                                                    
considering a job  offer to work at  an independent pharmacy                                                                    
in Craig, Alaska; but due  to her student loans the decision                                                                    
was  a difficult  one. She  shared that  the passing  of the                                                                    
bill would  directly affect her  decision of whether  or not                                                                    
to move back to the state.  She said that for the past three                                                                    
years  she had  served  on  the board  of  directors for  an                                                                    
international pharmacy organization  where her specific role                                                                    
was to  oversee student  chapters and recent  graduates. She                                                                    
relayed  that through  her experience  with  the board,  she                                                                    
could  give assurances  that  the passage  of  HB 392  would                                                                    
attract  young pharmacists  to Alaska,  especially in  rural                                                                    
areas.                                                                                                                          
                                                                                                                                
Co-Chair Hawker pointed out to  the testifier that the major                                                                    
pharmacy  outlets in  Alaska were  starved for  pharmacists,                                                                    
and   were  offering   substantial  incentives   within  the                                                                    
corporate world.                                                                                                                
                                                                                                                                
RACHEL    GREENBERG,     PALMER    SENIOR     CENTER    (via                                                                    
teleconference),  urged support  of the  bill. She  believed                                                                    
that the legislation  would help to increase  and secure the                                                                    
workforce needed for the future of the state.                                                                                   
                                                                                                                                
2:28:39 PM                                                                                                                    
                                                                                                                                
PAT LUBY, DIRECTOR, AARP  (via teleconference), testified in                                                                    
strong support of the bill.                                                                                                     
                                                                                                                                
ANGEL  DOTOMAIN, PRESIDENT/CEO,  ALASKA NATIVE  HEALTH BOARD                                                                    
(via  teleconference),  urged  support  for  the  bill.  She                                                                    
relayed that  tribal health provider vacancy  rates exceeded                                                                    
the statewide rates  by over 200 percent, and  in many cases                                                                    
were the only  providers of health services  in rural areas.                                                                    
As of  2009, the dental vacancy  was upwards of 40%,  and as                                                                    
of  November 2009,  the  tribal health  system  had over  80                                                                    
physician  vacancies. The  board strongly  believed that  HB
392 would be  an important part of the  solution to Alaska's                                                                    
healthcare workforce shortage.                                                                                                  
                                                                                                                                
2:32:17 PM                                                                                                                    
                                                                                                                                
DORIS  ROBBINS,  SELF  (via  teleconference),  testified  in                                                                    
support  of  the  legislation.   She  stated  that  she  was                                                                    
Medicare  age  and   had  found  it  difficult   to  find  a                                                                    
healthcare  provider  in  Fairbanks.   She  added  that  the                                                                    
growing number  of retired persons  and the large  number of                                                                    
military dependents placed an  extra burden on the Fairbanks                                                                    
healthcare community.                                                                                                           
                                                                                                                                
DR. NIGHSWANDER, WAMMI  MEDICAL SCHOOL (via teleconference),                                                                    
strongly urged  support for the  bill. He stated  that every                                                                    
state west of the Mississippi  had to import physicians, and                                                                    
subsequently many  of those  states had  incentive programs.                                                                    
He reiterated  that some groups  in the state  had developed                                                                    
incentive packages  but that the  state was still  behind in                                                                    
offering incentive  for providers to practice  in Alaska. He                                                                    
added that  clinical social workers  were very  important to                                                                    
the  medical community  as many  patients had  problems with                                                                    
housing, employment, and food due to illness.                                                                                   
                                                                                                                                
2:36:13 PM                                                                                                                    
                                                                                                                                
Co-Chair Hawker  stated that all the  legislation pertaining                                                                    
to  enhancing,  providing,  and  facilitating  for  students                                                                    
entering  the  medical  field in  Alaska  would  be  grouped                                                                    
together and taken up in a timely manner.                                                                                       
                                                                                                                                
Co-Chair Hawker closed public testimony.                                                                                        
                                                                                                                                
Representative  Doogan   reiterated  the  desire   for  more                                                                    
information  on  how the  fee  schedule  was set  up  before                                                                    
movement of the legislation.                                                                                                    
                                                                                                                                
Representative  Gara  asked if  all  of  the 10  professions                                                                    
identified in  the bill were  equally needed  throughout the                                                                    
state, or if there were  some that were needed more urgently                                                                    
than others. He  wondered if more focus should  be placed on                                                                    
primary care.                                                                                                                   
                                                                                                                                
Representative Herron believed that  the state would benefit                                                                    
from  a surplus  of healthcare  providers in  any field.  He                                                                    
added that the  department would work with  the committee on                                                                    
issues  pertaining  to  the fiscal  note  or  any  necessary                                                                    
amendments.                                                                                                                     
                                                                                                                                
2:39:59 PM                                                                                                                    
                                                                                                                                
Mr. Betit  replied to an earlier  question by Representative                                                                    
Doogan regarding  tier payments.  He relayed that  the state                                                                    
needed  to  be competitive  with  programs  that were  being                                                                    
offered elsewhere in the country.  In order to establish the                                                                    
tier program the length of  training time and vacancies were                                                                    
weighed,   as   well   as  consideration   for   competitive                                                                    
incentives.                                                                                                                     
                                                                                                                                
Representative Doogan wondered if  positions in rural Alaska                                                                    
would be as  easily filled as positions in  urban areas, and                                                                    
would the rural  areas be advertized to entice  out of state                                                                    
professionals.  Mr.   Betit  replied  that   human  resource                                                                    
professionals from around  the state had been  brought in to                                                                    
assess the  numbers. The  professionals had  determined that                                                                    
the numbers  establishing the tier breakdown  were realistic                                                                    
and would produce positive results.                                                                                             
                                                                                                                                
PAT CARR,  PROGRAM MANAGER, ALASKA DEPARTMENT  OF HEALTH and                                                                    
SOCIAL SERVICES,  summarized the  fiscal note  explained the                                                                    
funding  source  breakdown   between  program  receipts  and                                                                    
general  funds.  She said  that  a  25 percent  contributing                                                                    
match from  employing agencies was  used, which  resulted in                                                                    
an  expected general  fund match  of  $2,036,300. The  match                                                                    
from the  employing entities  to develop  the model  for the                                                                    
program was $678,700.                                                                                                           
                                                                                                                                
Co-Chair  Hawker  how  the 25  percent  employer  match  was                                                                    
established.                                                                                                                    
                                                                                                                                
2:46:24 PM                                                                                                                    
                                                                                                                                
Ms. Carr replied that the  percentage was an average of what                                                                    
the estimated match would be for all employing entities.                                                                        
                                                                                                                                
Co-Chair  Hawker  requested  further  clarification  on  the                                                                    
employer match  provisions. Ms. Carlo replied  Page 4, Lines                                                                    
30-31  explained that  the program  allowed for  an employee                                                                    
match of  up to 50  percent of the direct  incentive allowed                                                                    
per year,  to be determined on  a case by case  basis by the                                                                    
commissioner, which would result  in some employing entities                                                                    
having a zero match.                                                                                                            
                                                                                                                                
Co-Chair Hawker understood  that the match could  be left to                                                                    
the commissioner's executive discretion.                                                                                        
                                                                                                                                
Representative  Gara   said  that  the   employing  entities                                                                    
incentives would  not allow a  medical professional  to come                                                                    
to the state and open their  own office. Ms. Carlo said that                                                                    
was correct. The program would  not consider privately owned                                                                    
practices as eligible.                                                                                                          
                                                                                                                                
2:48:08 PM                                                                                                                    
                                                                                                                                
Representative  Joule imagined  that some  medical providers                                                                    
could use this bill in recruiting efforts.                                                                                      
                                                                                                                                
HB  392  was  HEARD  and   HELD  in  Committee  for  further                                                                    
consideration.                                                                                                                  
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
The meeting was adjourned at 2:54 PM.                                                                                           

Document Name Date/Time Subjects
ADN_021610_article.pdf HFIN 4/8/2010 1:30:00 PM
HB392_changes_CS.pdf HFIN 4/8/2010 1:30:00 PM
HB 392
HB392_Data1_HPSA_MUA.pdf HFIN 4/8/2010 1:30:00 PM
HB 392
HB392_Data2_AHWV_Study.pdf HFIN 4/8/2010 1:30:00 PM
HB 392
HB392_Data3_UA_031409_RS14.pdf HFIN 4/8/2010 1:30:00 PM
HB 392
HB392_Data4_HCP_loan_proposal.pdf HFIN 4/8/2010 1:30:00 PM
HB 392
HB392_Data4_pathman2004.pdf HFIN 4/8/2010 1:30:00 PM
HB 392
HB392_letters_support.pdf HFIN 4/8/2010 1:30:00 PM
HB 392
HB392_sectional_analysis.pdf HFIN 4/8/2010 1:30:00 PM
HB 392
HB392_sponsor_statement.pdf HFIN 4/8/2010 1:30:00 PM
HB 392
HB 392 ASMA Letter.pdf HFIN 4/8/2010 1:30:00 PM
HB 392
HB 392 AARP Letter.pdf HFIN 4/8/2010 1:30:00 PM
HB 392