Legislature(2011 - 2012)CAPITOL 106

03/15/2011 03:00 PM House HEALTH & SOCIAL SERVICES


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 1 POLICY FOR SECURING HEALTH CARE SERVICES TELECONFERENCED
Moved CSHB 1(HSS) Out of Committee
+= HB 78 INCENTIVES FOR CERTAIN MEDICAL PROVIDERS TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= HCR 5 VITAMIN D SUPPLEMENTS TELECONFERENCED
Moved CSHCR 5(HSS) Out of Committee
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         March 15, 2011                                                                                         
                           3:03 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Wes Keller, Chair                                                                                                
Representative Alan Dick, Vice Chair                                                                                            
Representative Bob Herron                                                                                                       
Representative Paul Seaton                                                                                                      
Representative Bob Miller                                                                                                       
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Beth Kerttula                                                                                                    
Representative Charisse Millett                                                                                                 
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 1                                                                                                                
"An Act stating a public policy that allows a person to choose                                                                  
or decline any mode of securing health care services."                                                                          
                                                                                                                                
     - MOVED CSHB   1(HSS) OUT OF COMMITTEE                                                                                     
                                                                                                                                
HOUSE CONCURRENT RESOLUTION NO. 5                                                                                               
Relating to prevention of disease and to vitamin D.                                                                             
                                                                                                                                
     - MOVED CSHCR  5(HSS) OUT OF COMMITTEE                                                                                     
                                                                                                                                
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."                                                                             
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 1                                                                                                                    
SHORT TITLE: POLICY FOR SECURING HEALTH CARE SERVICES                                                                           
SPONSOR(s): REPRESENTATIVE(s) GATTO, LYNN                                                                                       
                                                                                                                                
01/18/11       (H)       PREFILE RELEASED 1/7/11                                                                                

01/18/11 (H) READ THE FIRST TIME - REFERRALS

01/18/11 (H) HSS, JUD 03/01/11 (H) HSS AT 3:00 PM CAPITOL 106 03/01/11 (H) Scheduled But Not Heard 03/08/11 (H) HSS AT 3:00 PM CAPITOL 106 03/08/11 (H) Heard & Held 03/08/11 (H) MINUTE(HSS) 03/15/11 (H) HSS AT 3:00 PM CAPITOL 106 BILL: HCR 5 SHORT TITLE: VITAMIN D SUPPLEMENTS SPONSOR(s): REPRESENTATIVE(s) SEATON 02/11/11 (H) READ THE FIRST TIME - REFERRALS 02/11/11 (H) HSS 03/10/11 (H) HSS AT 3:00 PM CAPITOL 106 03/10/11 (H) Heard & Held 03/10/11 (H) MINUTE(HSS) 03/15/11 (H) HSS AT 3:00 PM CAPITOL 106 BILL: HB 78 SHORT TITLE: INCENTIVES FOR CERTAIN MEDICAL PROVIDERS SPONSOR(s): REPRESENTATIVE(s) HERRON

01/18/11 (H) PREFILE RELEASED 1/14/11

01/18/11 (H) READ THE FIRST TIME - REFERRALS

01/18/11 (H) HSS, FIN 03/08/11 (H) HSS AT 3:00 PM CAPITOL 106 03/08/11 (H) Heard & Held 03/08/11 (H) MINUTE(HSS) 03/15/11 (H) HSS AT 3:00 PM CAPITOL 106 WITNESS REGISTER REPRESENTATIVE CARL GATTO Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Presented HB 1 as a prime sponsor of the bill. DR. WARD HURLBURT, Chief Medical Officer/Director Division Of Public Health Central Office Department of Health and Social Services Anchorage, Alaska POSITION STATEMENT: Answered questions during the discussion of HCR 5. CAROL BAGGERLY, Director Grassroots Health Encinatas, California POSITION STATEMENT: Answered questions and testified in support during discussion of HCR 5. LIZ CLEMENT, Staff Representative Bob Herron Alaska State Legislature Juneau, Alaska POSITION STATEMENT: During discussion of HB 78, explained the changes in the proposed committee substitute, Version D. MARGARET SODEN, Pharmacist Alaska Pharmacist Association Fairbanks, Alaska POSITION STATEMENT: Testified in support of HB 78. DIANE BARRANS, Executive Director Alaska Commission on Postsecondary Education Juneau, Alaska POSITION STATEMENT: Answered questions during discussion of HB 78. PAT CARR, Chief Health Planning and Infrastructure Division of Health Care Services Department of Health and Social Services (DHSS) Juneau, Alaska POSITION STATEMENT: Answered questions during discussion of HB 78. ACTION NARRATIVE 3:03:47 PM CHAIR WES KELLER called the House Health and Social Services Standing Committee meeting to order at 3:03 p.m. Representatives Keller, Dick, Seaton, and Miller were present at the call to order. Representative Herron arrived as the meeting was in progress. HB 1-POLICY FOR SECURING HEALTH CARE SERVICES 3:04:07 PM CHAIR KELLER announced that the first order of business would be HOUSE BILL NO. 1, "An Act stating a public policy that allows a person to choose or decline any mode of securing health care services." REPRESENTATIVE CARL GATTO, Alaska State Legislature, stated that HB 1 was "a bill about liberty, as much as it's about health care. Health care is simply the vehicle to describe what liberties we may or may [not] be losing." He established that HB 1 declared that the government cannot force an individual to make a purchase without their consent. He opined that this was the first time in United States history that the federal government had attempted to place a tax on inactivity. He assessed that this was a question of the liberty to choose. He argued that the commerce clause [Article 1, Section 8, Clause 3 of the U.S. Constitution] should not be used to tax an individual for not doing something. He offered his belief that "citizens cannot be compelled by the government to purchase a product that they don't want to purchase." 3:07:20 PM REPRESENTATIVE MILLER asked to clarify that HB 1 would exempt Alaskans from a federal mandate, but that the State of Alaska could still mandate requirements for Alaskans. 3:08:10 PM REPRESENTATIVE GATTO replied that the gist of the bill was focused on a response to the federal government declaring states rights. He directed attention to page 1, lines 12-14, which read: (1) does not apply to health care services provided or required by the state, a political subdivision of the state, or a court of the state; and (2) may not impair a contract right that provides health care services. He asked if that answered Representative Miller's question. 3:09:16 PM REPRESENTATIVE DICK expressed his agreement with HB 1 and stated that this was a precedent for taxation on inactivity. He declared "if we aren't very loud and very firm, very clear on this, we're going to get steamrolled down the road on all concerns." 3:09:41 PM REPRESENTATIVE GATTO offered some examples that reflected his fear for a requirement to buy health care that you did not want. He announced that "this will send a message that will be collected with other messages that will ultimately, hopefully, go to the courts, because this is really the Supreme Court decision, more than anything else." 3:10:48 PM REPRESENTATIVE DICK addressed his concern for the deferred cost to future generations of payment for the uninsured by those with insurance. He declared: "I don't think this really has to do with health care at all. I think this has to do with just gathering information on U.S. citizens." REPRESENTATIVE GATTO cited that the health care system in the United States was the best, but that "we're just paying too much to have them treated." He assessed that health care problems could be fixed, but that the federal health care bill was not a fix. He stated his approval for the private sector to maintain control of the health care system. 3:13:08 PM REPRESENTATIVE SEATON moved to adopt Amendment 1, which read [original punctuation provided]: Page 2, Line 9: following "charge [.] Insert: ";however, liability for the cost of health services is not a penalty." 3:13:47 PM CHAIR KELLER objected for discussion. REPRESENTATIVE SEATON established the intent of proposed Amendment 1 to be a reminder that the liability for medical payments was not a penalty that could be declined because of proposed HB 1. 3:14:40 PM CHAIR KELLER opined that proposed Amendment 1 would create more problems. He offered his belief that the word "charge" on page 2, line 9 of the bill was understandable and intuited to be a fee for services rendered; therefore, proposed Amendment 1 was unnecessary. He expressed concern that proposed Amendment 1 would occasion that another section of law pertaining to payment could be subject to question unless it, too, contained this clarification. 3:15:31 PM REPRESENTATIVE SEATON indicated the need for clarification because of specific language on page 1 [line 9] of the bill that "a person has the right to choose or decline any mode of obtaining health care services without penalty..." He declared the need for clarity that this bill language did not include a release of liability for medical expenses. 3:16:43 PM CHAIR KELLER asked if proposed Amendment 1 had been reviewed by Legislative Legal and Research Services. REPRESENTATIVE SEATON replied that he had offered it to the bill sponsor as a conceptual amendment to be drafted by Legislative Legal and Research Services. 3:17:12 PM CHAIR KELLER removed his objection. There being no further objection, Amendment 1 was passed. 3:17:32 PM REPRESENTATIVE SEATON moved to report HB 1, as amended, out of committee with individual recommendations. There being no objection, CSHB 1(HSS) was reported from the House Health and Social Services Standing Committee. 3:18:06 PM The committee took an at-ease from 3:18 p.m. to 3:20 p.m. HCR 5-VITAMIN D SUPPLEMENTS 3:20:22 PM CHAIR KELLER brought the committee back to order. CHAIR KELLER announced that the next order of business would be HOUSE CONCURRENT RESOLUTION NO. 5, Relating to prevention of disease and to vitamin D. [In front of the committee was Version 27-LS0504\M.] 3:20:29 PM REPRESENTATIVE SEATON moved to adopt the proposed committee substitute (CS) for HCR 5, Version 27-LS0504\B, Mischel, 3/14/11, as the working document. There being no objection, Version B was before the committee. 3:20:43 PM REPRESENTATIVE SEATON explained that Version B included the addition of "potentially" and the substitution of "promote" for "provide" on page 5, line 26, and on page 6, lines 5, 10, and 16. He pointed to page 6, line 12-13, and noted the addition of "using the comparative treatment effectiveness analysis." He directed attention to the addition of "postmenopausal" on page 2, line 1, the addition of "blood" on page 6, line 5, and the correction to 1,200 IU on page 3, line 28. He reported the addition of a new "Whereas" on page 5, lines 28-29. He expressed his desire that these changes would eliminate any misconception that HCR 5 was a mandate. 3:24:05 PM DR. WARD HURLBURT, Chief Medical Officer/Director, Division Of Public Health, Central Office, Department of Health and Social Services, in response to Chair Keller, confirmed that he had read Version B. He allowed that he still had some concerns with the bill as a clinical statement, and he suggested more general language. He pointed to page 6, lines 11 and [12], which encouraged appropriate vitamin supplements, but he endorsed the dosage recommendations of the Centers for Disease Control and Prevention, the Advisory Committee on Immunization Practice, and the American Academy of Pediatrics for related immunizations. He observed that it was not in the State of Alaska's capacity to analyze and make different recommendations. He questioned the recommendation of Vitamin D for pregnant women as being too narrow, and he assured that prenatal vitamins for pregnant women were being promoted. He opined that proposed HCR 5 was still too clinical, and he suggested that the bill be more general. 3:27:44 PM CHAIR KELLER asked if a proposal to promote vitamin supplements including Vitamin D would sufficiently broaden proposed HCR 5. DR. HURLBURT replied that although this would still make a specific recommendation, he did not see it as unreasonable. 3:28:52 PM REPRESENTATIVE SEATON stated that he did not have data to support other supplements, but that he had clinical data and studies to show that many problems in pregnancy were "at greater risk if you are low in Vitamin D." He reflected on the vitamin fads not based on studies, and he indicated his lack of support for the use of supplements that were not backed up by studies. He emphasized that there was a lot of information which showed Alaskans to be deficient in Vitamin D, and that there were greater health risks associated with low Vitamin D. He urged the Department of Health and Social Services to investigate whether a lack of Vitamin D was detrimental to Alaskans specifically. He stated that softening the resolution to say "that the department should look after the health of the Alaskan population" would not urge a specific investigation on the evidence presented in the resolution. He expressed concern with basing studies on the overall population of the United States and not specifically on the Alaskan population. He declared the need for a prevention model for health care. 3:33:10 PM CHAIR KELLER agreed that the purpose of a resolution was to raise awareness in both the general populace and in the Department of Health and Social Services. He expressed his concern that over focus did not allow for other possibilities. 3:33:57 PM REPRESENTATIVE HERRON asked why Vitamin D3 was not referenced in proposed HCR 5. 3:35:01 PM REPRESENTATIVE SEATON, in response to Representative Herron, said that the level of Vitamin D in the blood was the significant factor. He confirmed that both Vitamin D2 and D3 increased the blood serum level, 25(OH)D. He affirmed that HCR 5 was attempting to avoid any specific reference to either Vitamin D2 or D3. 3:36:17 PM REPRESENTATIVE MILLER, noting that the language in proposed HCR 5 promoted Vitamin D supplements, asked if other sources of Vitamin D should also be included. He opined that the combination of Vitamin A with Vitamin D was better for an individual. 3:37:22 PM CAROL BAGGERLY, Director, Grassroots Health, affirmed that Grassroots Health was a public health outreach organization specifically focused on solving the Vitamin D deficiency epidemic. She reported that the optimal dosage of Vitamin D was not available from foods. She stated that the average person used about 4000 IU of Vitamin D each day, but that even a serving of Alaska salmon, the most substantial food source for Vitamin D, only accounted for 400 IU. She declared the best source of Vitamin D to be the sun; however, as most people were not getting enough sun, it was necessary to complement it with food and Vitamin D supplements. 3:38:48 PM REPRESENTATIVE DICK moved to report CSHCR 5, Version 27- LS0504\B, Mischel, 3/14/11, out of committee with individual recommendations. There being no objection, CSHCR 5(HSS) was reported from the House Health and Social Services Standing Committee. 3:39:19 PM The committee took a brief at-ease. HB 78-INCENTIVES FOR CERTAIN MEDICAL PROVIDERS 3:41:29 PM CHAIR KELLER announced that the final order of business would be 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." [In front of the committee was CSHB 78, Version I, which had been adopted as the working draft by House Health and Social Services Standing Committee on March 8, 2011.] REPRESENTATIVE HERRON moved to adopt the proposed Committee Substitute (CS) for HB 78, 27-LS0147\D, Mischel, 3/11/11, as the working document. There being no objection, Version D was before the committee. 3:42:26 PM LIZ CLEMENT, Staff, Representative Bob Herron, Alaska State Legislature, explained the changes from Version I to the proposed Version D. She pointed out that Section 1 of Version I had been deleted, as it was found to be unnecessary. She directed attention to Version D, page 1, line 7, and said that it had been reworded to clearly reflect the loan repayment plan. She moved on in Version D, to page 3, lines 1-8, and explained that this now consolidated criteria for the employers matching payment from two places in Version I. 3:45:10 PM MS. CLEMENT, referring to Version D, page 2, line 19, established that a new (b)(9) had been added to direct the Department of Health and Social Services (DHSS) to include procedures for allowable leaves of absence for the providers participating in the program. Continuing to discuss Version D, she pointed to page 3, lines 11-30, which elaborated on the 12 year lifetime maximum for a medical provider program participant. She said that this allowed, after the initial three year period, for an additional three year cycle of participation in the program should the provider like to continue, and if DHSS agreed with the eligibility. She clarified that even if a participant was in the program for all six years, and then returned to school for further training, that they could return upon completion of this training for an additional three year period, with the possibility of another three year renewal. 3:47:21 PM REPRESENTATIVE SEATON, referring to page 3, line 15, asked if there was a limitation to the three year renewal period. MS. CLEMENT replied that the intent was for one initial period and one renewal period, for a maximum of six years within the first participation span. REPRESENTATIVE SEATON asked if this was the only mention for the maximum six year participation. 3:48:42 PM REPRESENTATIVE HERRON, in response to Representative Seaton, directed attention to page 3, line 27. MS. CLEMENT, directing attention to page 3, line 31 through page 4, line 4, declared that new language ensured that DHSS will have the capability to prorate loan repayments and direct incentive payments to providers for the percentage of the calendar quarter which they worked. She opined that it would most likely be in effect during the first and the last quarter of work. She confirmed that allowing payment on a calendar quarterly basis would add efficiency. 3:50:23 PM MS. CLEMENT indicated page 4, line 27, Version D, which now read "education loans held by or made to eligible tier I and tier II health care professionals..." She explained that this increased the eligibility for the loan repayment portion of the program to include loans other than those from the State of Alaska. She announced that consultant remarks to this idea had ranged from neutral to supportive. 3:51:22 PM REPRESENTATIVE SEATON asked for a reason to include the complexity of a loan repayment program, as opposed to an incentive payment which would allow the participants to pay the loans themselves. MS. CLEMENT replied that other states with similar programs had found that participants in loan repayment programs were sometimes exempt from federal income tax on this repayment. 3:52:32 PM MS. CLEMENT explained page 4, line 25, Version D, which added "and loan repayment amount, if any, under AS 18.29.025." She stated that this would allow the loan repayment participant to complete a three year cycle, and if the loan repayment had been completed, then to continue work for an additional three year cycle, if eligible, under the direct incentive program. 3:53:44 PM MS. CLEMENT, moving on to page 5, line 23, Version D, clarified that eligibility was determined by the approval of the application by the commissioner. 3:54:32 PM REPRESENTATIVE SEATON asked if the intent was for an applicant to submit an application which, after meeting all the criteria, could then be approved by the commissioner. MS. CLEMENT concurred. 3:55:06 PM MS. CLEMENT directed attention to page 6, line 2, Version D, and explained that eligibility for the loan repayment program was contingent on the applicant having an unpaid balance on one or more eligible educational loans, as verified by the Alaska Commission on Postsecondary Education (ACPE). 3:55:55 PM REPRESENTATIVE SEATON asked to clarify that ACPE would gather data and verify it to be an eligible education loan, even if the loan did not originate from ACPE. MS. CLEMENT agreed, and shared that ACPE had suggested this process. REPRESENTATIVE SEATON referred to page 5, line 30, noted the definition of eligibility for loan repayment, and asked if there was a definition for an eligible education loan. 3:57:43 PM MS. CLEMENT replied that proposed HB 78 did not contain a written definition for an eligible education loan, and she offered to supply one. 3:59:36 PM MS. CLEMENT reviewed page 6, line 6, Version D, and stated that this would allow DHSS to prioritize sites, and the physicians at those sites, for eligibility of participation in the program based on remoteness and/or a percentage of federal health care, Medicaid, or Medicare program beneficiaries. 4:01:26 PM REPRESENTATIVE SEATON asked if the prioritization was in conflict with the definition for eligible site on page 6, line 18-20. CHAIR KELLER requested that the question be held for later response. 4:02:24 PM MS. CLEMENT directed attention to page 6, line 31 through page 7, line 5, Version D, and shared that the words "licensed or exempt from licensure in the state" had been added to both definitions. She said that this would ensure the program was open to qualified, trained health care providers. She noted that Indian Health Services health care providers were exempt from licensure in the state. 4:03:42 PM MS. CLEMENT pointed out that a few grammatical changes with no impact had also been changed in proposed HB 78. 4:03:53 PM MARGARET SODEN, Pharmacist, Alaska Pharmacist Association, offered her belief that proposed HB 78 would encourage medical professionals to come to Alaska to work. She expressed her support of proposed HB 78. CHAIR KELLER closed public testimony. 4:07:02 PM REPRESENTATIVE SEATON, pointing to page 6, asked about the prioritization criteria and the criteria for site eligibility. He asked if the needs assessment and the employment statistics required for site eligibility would also be considered in the prioritization criteria. 4:08:42 PM MS. CLEMENT replied that this was not intended and she offered to clarify this section. She opined that the needs assessment would be included in the consideration for remoteness of site and the percentage of underserved patients. 4:09:35 PM CHAIR KELLER, referring to page 6, line 29, asked if it would be more appropriate for qualified employment to include not less than 70 percent of time on direct patient health care services, as opposed to 50 percent as currently written. REPRESENTATIVE HERRON agreed that there was room for clarification, but that smaller clinics required that a medical professional do more than direct patient services. 4:11:10 PM REPRESENTATIVE SEATON reminded the Chair of his earlier request for further clarification on eligible education loans. He referred to page 2, line 19, and asked for an explanation on the procedures for allowable leaves of absence. 4:12:39 PM REPRESENTATIVE HERRON asked that the DHSS respond to this. 4:13:02 PM CHAIR KELLER, indicating page 3, line 4, asked why the employer would not pay more than 50 percent of the combined incentive. 4:13:32 PM MS. CLEMENT replied that the value of up to 50 percent was a carryover from previous versions of the bill. She suggested that the percentage could be increased to match the ability of a facility to pay. REPRESENTATIVE HERRON relayed that the range could be as broad as 0 percent to 100 percent. CHAIR KELLER reflected that this was aligned with the needs assessment by the Commissioner of DHSS. 4:15:16 PM CHAIR KELLER moved to adopt Amendment 1, labeled 27-LS0147\D.1, Mishcel, 3/15/11, which read: Page 3, line 2, following "department": Insert "for deposit in the general fund" Page 3, line 10, following "department": Insert "from money appropriated for the purpose" Page 4, following line 6: Insert a new subsection to read: "(i) Direct incentive payments, loan repayments, and matching payments shall be made with funds appropriated by the legislature for that purpose." Page 4, lines 30 - 31: Delete all material. Reletter the following subsections accordingly. Page 5, following line 20: Insert a new subsection to read: "(c) If insufficient funds are appropriated in a fiscal year, the department shall prorate payments based on the number of approved participants in the program." REPRESENTATIVE HERRON objected for discussion. CHAIR KELLER clarified that this was not the conceptual amendment [Included in members' packets.] CHAIR KELLER, explaining proposed Amendment 1 and referring to page 3, line 1, asked if the "nonrefundable quarterly matching payments to the department" could be construed as either a tax or a dedicated fund. He suggested that "for deposit in the general fund" be inserted on page 3, line 2. 4:18:18 PM REPRESENTATIVE SEATON asked that if the money were paid to the general fund, would the funds then not be available until the legislature appropriated the money. CHAIR KELLER asked to leave the question open. 4:18:57 PM CHAIR KELLER opined that adding "from money appropriated for the purpose" following "department" on page 3, line 10 would better clarify it. 4:19:07 PM CHAIR KELLER, continuing his discussion of proposed Amendment 1, moved on to page 4, line 6, where he proposed to add a new subsection (i). 4:19:32 PM CHAIR KELLER suggested deletion of all the material on page 4, line 30-31. 4:19:51 PM CHAIR KELLER endorsed that proposed Amendment 1 add a new subsection (c) on page 5, following line 20. He suggested that proposed Amendment 1 answered Representative Seaton's question. 4:20:48 PM REPRESENTATIVE SEATON asked for an explanation for the proposal to delete lines 30-31 on page 4, and he asked if that had been deleted elsewhere. CHAIR KELLER, in response, explained that proposed Amendment 1 inserted a new subsection (i), on page 4, following line 6, as well as a new subsection (c) on page 5, following line 20. He confirmed that the proposed deletion had been from the loan repayment section, but was now included in the description of the entire program. 4:22:51 PM REPRESENTATIVE HERRON asked if deleting it from AS 18.29.025 and inserting it into AS 18.29.015 accomplished the same thing. He opined that the drafter of the amendment would not do something which they should not do. CHAIR KELLER replied that Legislative Legal and Research Services would need to answer that. 4:23:29 PM CHAIR KELLER announced that proposed HB 78 and proposed Amendment 1 would be held over. He offered to work with the bill sponsor on the amendment, and he asked Representative Seaton to further investigate the questions regarding leave of absence. 4:24:28 PM DIANE BARRANS, Executive Director, Alaska Commission on Postsecondary Education, offered her belief that it would be beneficial to include a definition for "eligible loans." She confirmed that similar definitions were contained in related federal loan repayment programs. 4:25:09 PM MS. BARRANS, in response to Chair Keller, said that she did not know about leave of absence. 4:25:35 PM CHAIR KELLER suggested that Representative Herron, as the bill sponsor, work with Ms. Barrans and Representative Seaton to formulate a definition. 4:26:04 PM REPRESENTATIVE SEATON asked about the quarterly repayment of loans, especially in conjunction with leaves of absence. 4:26:53 PM PAT CARR, Chief, Health Planning and Infrastructure, Division of Health Care Services, Department of Health and Social Services, explained that quarterly payments were more efficient. She agreed that a mid quarter entrance or departure to the program allowed the department to pro rate that quarterly payment, which would be the same for any unpaid leave of absence. REPRESENTATIVE SEATON clarified that payments for the calendar quarter defined when the payments were to be made, and that they would be prorated to the actual time. He established that unpaid leaves of absence were allowed under special conditions, such as an emergency or a medically necessity. [HB 78 was held over.] 4:29:01 PM ADJOURNMENT There being no further business before the committee, the House Health and Social Services Standing Committee meeting was adjourned at 4:29 p.m.

Document Name Date/Time Subjects
CS HCR 5.pdf HHSS 3/15/2011 3:00:00 PM