03/25/2010 03:00 PM HEALTH & SOCIAL SERVICES
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ALASKA STATE LEGISLATURE HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE March 25, 2010 3:13 p.m. MEMBERS PRESENT Representative Bob Herron, Co-Chair Representative Wes Keller, Co-Chair Representative Tammie Wilson, Vice Chair Representative Bob Lynn Representative Paul Seaton Representative Lindsey Holmes MEMBERS ABSENT Representative Sharon Cissna COMMITTEE CALENDAR HOUSE BILL NO. 309 "An Act prohibiting health care insurers that provide dental care coverage from setting a minimum age for receiving dental care coverage, allowing those insurers to set a maximum age for receiving dental care coverage as a dependent, and prohibiting those insurers from setting fees that a dentist may charge for dental services not covered under the insurer's policy." - MOVED CSHB 309(HSS) OUT OF COMMITTEE HOUSE BILL NO. 361 "An Act requiring 911 dispatchers to be trained in cardiopulmonary resuscitation; and providing for an effective date." - HEARD & HELD 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." - MOVED CSHB 392(HSS) OUT OF COMMITTEE PREVIOUS COMMITTEE ACTION BILL: HB 309 SHORT TITLE: DENTAL CARE INSURANCE SPONSOR(s): REPRESENTATIVE(s) THOMAS 01/19/10 (H) READ THE FIRST TIME - REFERRALS
01/19/10 (H) HSS, FIN 02/11/10 (H) HSS AT 3:00 PM CAPITOL 106 02/11/10 (H) Scheduled But Not Heard 02/23/10 (H) HSS AT 3:00 PM CAPITOL 106 02/23/10 (H) Heard & Held 02/23/10 (H) MINUTE(HSS) 03/09/10 (H) HSS AT 3:00 PM CAPITOL 106 03/09/10 (H) <Bill Hearing Canceled> 03/25/10 (H) HSS AT 3:00 PM CAPITOL 106 BILL: HB 361 SHORT TITLE: CPR TRAINING FOR 911 DISPATCHERS SPONSOR(s): REPRESENTATIVE(s) FAIRCLOUGH 02/23/10 (H) READ THE FIRST TIME - REFERRALS 02/23/10 (H) CRA, HSS 03/09/10 (H) CRA AT 8:00 AM BARNES 124 03/09/10 (H) Moved Out of Committee 03/09/10 (H) MINUTE(CRA) 03/10/10 (H) CRA RPT 5NR 03/10/10 (H) NR: GARDNER, KELLER, HARRIS, MUNOZ, HERRON 03/10/10 (H) FIN REFERRAL ADDED AFTER HSS 03/25/10 (H) HSS AT 3:00 PM CAPITOL 106 BILL: HB 392 SHORT TITLE: INCENTIVES FOR CERTAIN MEDICAL PROVIDERS SPONSOR(s): REPRESENTATIVE(s) HERRON 02/23/10 (H) READ THE FIRST TIME - REFERRALS 02/23/10 (H) HSS, FIN 03/18/10 (H) HSS AT 3:00 PM CAPITOL 106 03/18/10 (H) Heard & Held 03/18/10 (H) MINUTE(HSS) 03/23/10 (H) HSS AT 3:00 PM CAPITOL 106 03/23/10 (H) Heard & Held 03/23/10 (H) MINUTE(HSS) 03/25/10 (H) HSS AT 3:00 PM CAPITOL 106 WITNESS REGISTER CECILE ELLIOTT, Staff to Representative Bill Thomas Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Introduced the proposed Committee Substitute (CS) for HB 309, Version C, for the prime sponsor of the bill, Representative Thomas. DAVID LOGAN, Dentist Alaska Dental Society Juneau, Alaska POSITION STATEMENT: Testified and answered questions about HB 309. REED STOOPS, Lobbyist Aetna Juneau, Alaska POSITION STATEMENT: Answered questions during discussion on HB 309. DENNIS BAILEY, Attorney Legislative Legal Counsel Legislative Legal and Research Services Legislative Affairs Agency Juneau, Alaska POSITION STATEMENT: Answered questions during discussion of HB 309. CHRIS HENRY, Treasurer Alaska Dental Society Fairbanks, Alaska POSITION STATEMENT: Offered to answer questions during discussion of HB 309. JIM TOWLE, Executive Director Alaska Dental Society Anchorage, Alaska POSITION STATEMENT: Offered to answer questions during discussion of HB 309. CRYSTAL KOENEMAN, Staff to Representative Anna Fairclough Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Introduced HB 361 for the prime sponsor, Representative Anna Fairclough. MICHAEL O'HARE, Deputy Director Division of Homeland Security/Emergency Management Department of Military & Veterans' Affairs (DMVA) Ft. Richardson, Alaska POSITION STATEMENT: Testified during discussion of HB 361. SUE STANCLIFF, Special Assistant Office of the Commissioner Department of Public Safety (DPS) Anchorage, Alaska POSITION STATEMENT: Testified and answered questions during discussion of HB 361. RODNEY DIAL, Lieutenant Alaska State Troopers Ketchikan, Alaska POSITION STATEMENT: Answered questions during discussion of HB 361. NIKOOSH CARLO, Staff to Representative Bob Herron Alaska State Legislature Juneau, Alaska POSITION STATEMENT: Introduced the CS for HB 392 for the prime sponsor, Representative Bob Herron. DIANE BARRANS, Executive Director Alaska Commission on Postsecondary Education (ACPE) Juneau, Alaska POSITION STATEMENT: Testified during discussion on HB 392. ACTION NARRATIVE 3:13:35 PM CO-CHAIR WES KELLER called the House Health and Social Services Standing Committee meeting to order at 3:13 p.m. Representatives Keller, Herron, Seaton, Lynn, and T. Wilson were present at the call to order. Representative Holmes arrived as the meeting was in progress. Representative Cissna was excused. HB 309-DENTAL CARE INSURANCE 3:13:52 PM CO-CHAIR KELLER announced that the first order of business would be HOUSE BILL NO. 309, "An Act prohibiting health care insurers that provide dental care coverage from setting a minimum age for receiving dental care coverage, allowing those insurers to set a maximum age for receiving dental care coverage as a dependent, and prohibiting those insurers from setting fees that a dentist may charge for dental services not covered under the insurer's policy." [In front of the committee was the proposed Committee Substitute (CS) for HB 309, 26-LS1315\C, Bailey, 3/24/10.] 3:14:38 PM CECILE ELLIOTT, Staff to Representative Bill Thomas, Alaska State Legislature, explained that Version C resulted as a compromise between the dental community, the insurance industry, and the small business community. She pointed out that the section regarding age limit had been removed, as it was covered elsewhere in statute; and the second section, prohibiting fee capping, was amended to reflect the compromise. She explained that dentists would now be offered the opportunity to sign contracts for covered and, if desired, non-covered services. 3:16:25 PM CO-CHAIR HERRON moved to adopt the proposed Committee Substitute (CS) for HB 309, 26-LS1315\C, Bailey, 3/24/10, as the working draft. There being no objection, Version C was before the committee. 3:16:54 PM REPRESENTATIVE T. WILSON asked if this affected self insured policies. 3:17:11 PM MS. ELLIOTT said that it did not. REPRESENTATIVE T. WILSON asked if this would only affect small businesses with policies similar to Blue Cross/ Blue Shield. MS. ELLIOTT explained that HB 309 referenced preferred provider contracts. In response to Representative T. Wilson, she explained that these were contracts negotiated between the insurance company and the dentist on a fee schedule. REPRESENTATIVE T. WILSON asked if there was a mechanism for the self insured to abide by the same rules. 3:18:33 PM DAVID LOGAN, Dentist, Alaska Dental Society, explained that the two broad categories of insurance were the traditional indemnity plans, where the provider billed the insurance company and the managed plans, which included Preferred Provider Organization (PPO) plans. He explained that with PPOs, the insurance company had contracted with dentists to provide services at a set fee schedule. In response to Representative T. Wilson, he pointed out that federal legislation regulated the Employee Retirement Income Security Act of 1974 (ERISA) plans. 3:20:15 PM REPRESENTATIVE SEATON asked how HB 309 would ensure that the insurance company notified the insured about the costs charged by each provider. MS. ELLIOTT offered her belief that the insurance company would provide that information to the consumer, but she did not know how it was provided. She pointed out that the insurance companies had provided the language for the CS. 3:22:23 PM REPRESENTATIVE SEATON pointed to the permissive language on page 2, line 15, and noted that this was a change from prior policy which had required notification to the insured. CO-CHAIR KELLER re opened public testimony. REPRESENTATIVE SEATON asked if the new uncapped plan had any requirement for the dentist to notify the PPO patient that some fees were no longer capped. MS. ELLIOTT deferred the question to Dr. David Logan. 3:25:32 PM DR. LOGAN said that the committee substitute did not stipulate this, and there was not any statutory requirement for notification to the insured. He opined that most medical offices attempted to inform patients about the fee structure for services. CO-CHAIR KELLER directed attention to page 2, lines 6 and 10, and asked for clarification of the phrase "take an action against the dentist." DR. LOGAN explained the intent to be that if a dentist signed a contract for either covered services, or covered and non-covered services, there would not be a differential in the fee schedule that would apply to the insured based on the contract. He reported that there was also language in Version C that the insurers may differentiate between the types of provider contract, but not fail to notify the insured that the dentist has signed a contract. 3:27:41 PM REED STOOPS, Lobbyist, Aetna, in response to Representative T. Wilson, said that Linda Hall could best respond to questions about ERISA. He said that a self insured plan would be exempt from mandated coverage, and he offered the minimum age requirement as an example of mandated coverage. 3:29:21 PM MR. STOOPS, in response to Co-Chair Keller, said that the employee handbook explains the benefits. Currently, there was no obligation from the insurer for prior notice. He said that Version C dictated a change of the current notification procedure. 3:31:27 PM REPRESENTATIVE T. WILSON asked about the rate change for small business. 3:31:49 PM MR. STOOPS said that the cost of insurance would not change, but that the cost to the consumer for non-covered service could change. He suggested asking the dentists if charges would increase. 3:32:24 PM REPRESENTATIVE SEATON asked if non-covered services might be offered at a lower cost than through the insurance fee schedule. MR. STOOPS replied that a dentist could charge less, but he opined those costs to be greater, or HB 309 would not be necessary. 3:33:33 PM REPRESENTATIVE SEATON directed attention to Version C, page 2, line 15, and asked if the insurance providers would object to a change from "may authorize the insurer to provide information to the insured" to "shall notify the insured." He pointed out that this notification would include both the list of all covered fees, and that there was no fee cap for the uncovered services from the provider. 3:34:18 PM MR. STOOPS replied that he would research this. REPRESENTATIVE SEATON opined that these were forward contracts, and the providers would be listed in the policy handbook. He asked when the provider list would be updated. MR. STOOPS said that existing contracts would be affected by HB 309, and that dentists would have the option to opt out of the non-covered service portions of the contracts, without a new contract being reissued. He said that it could be an extended period of time for contracts to be modified, and for new publications to be distributed. DR. LOGAN, in response to Mr. Stoops, stated that this did present a challenge for notification to the consumer, as the contracts were constantly changing. 3:39:49 PM CO-CHAIR KELLER asked why this was not occurring with primary care, as well. MR. STOOPS offered his belief that it was the dental providers who had introduced this legislation. DR. LOGAN, in response to Co-Chair Keller, said that dentists joined PPOs, which offered care at a discount rate, to fill otherwise unscheduled office time and to allow an opportunity for customary service rates to procedures not included under the insurance plans. 3:42:40 PM CO-CHAIR KELLER asked if HB 309 would affect current and future contracts with regard to information distribution to the consumer. DENNIS BAILEY, Attorney, Legislative Legal Counsel, Legislative Legal and Research Services, Legislative Affairs Agency, said that HB 309 would only apply to new contracts and that this would be an ongoing process. 3:44:44 PM REPRESENTATIVE SEATON asked for clarification that providers could opt out, without renewing the contract. MR. BAILEY replied that this was not specified in the bill, but would apply if it was in an existing contract. 3:45:44 PM REPRESENTATIVE SEATON expressed concern for notification to the insured that there would now be two types of PPO contracts. He directed attention to Version C, page 2, line 15, and asked if the language could change to ensure that the insured would understand the fees prior to the services. MR. BAILEY replied that Version C was currently permissive. He agreed that it was possible to describe the requested information and state that it was mandatory to provide the information. He opined that it may already exist in insurance statute. 3:47:49 PM REPRESENTATIVE SEATON asked if this could be changed with a conceptual amendment. MR. BAILEY agreed that a conceptual amendment for "may" to be changed to "shall" and to include both the insurer and the provider was acceptable. 3:49:11 PM CHRIS HENRY, Treasurer, Alaska Dental Society, said that he had been following the bill and that he was available to answer any questions. 3:49:45 PM JIM TOWLE, Executive Director, Alaska Dental Society, stated that he was also available to answer any questions. 3:50:27 PM CO-CHAIR KELLER closed public testimony. 3:50:46 PM REPRESENTATIVE T. WILSON offered her belief that although both the insurance industry and the dental providers had come to agreement, HB 309 was not fair to the self insurers. 3:51:16 PM CO-CHAIR HERRON moved to adopt Amendment 1, which read: Page 1, Line 14 After (2) Insert "not" REPRESENTATIVE T. WILSON objected for discussion. MS. ELLIOTT explained that during the changes to the bill, this was an oversight and the amendment would correct this. REPRESENTATIVE T. WILSON removed her objection. There being no objection, Amendment 1 was adopted. 3:52:30 PM REPRESENTATIVE SEATON moved to adopt Conceptual Amendment 2, as follows: Page 2, line 15, following (ii) Delete "may authorize" Insert "shall require both"; Following "insurer" Insert "and the dentist" REPRESENTATIVE T. WILSON objected for discussion. REPRESENTATIVE SEATON read the proposed line 15: (ii) shall require both the insurer and the dentist to provide information to the insured describing the dentist's choice of contract and fee schedules; 3:53:29 PM MS. ELLIOTT, in response to Representative T. Wilson, said that the sponsor was neutral on Conceptual Amendment 2 and would defer to the will of the committee. 3:53:51 PM REPRESENTATIVE HOLMES asked to clarify if the costs would be increased. MS. ELLIOTT said that she did not know. 3:54:46 PM CO-CHAIR KELLER opened public testimony. MS. ELLIOTT asked to clarify proposed Conceptual Amendment 2. REPRESENTATIVE SEATON restated proposed Conceptual Amendment 2, as follows: (ii) shall require both the insurer and the dentist to provide information to the insured describing the dentist's choice of contract and fee schedules; 3:55:45 PM DR. LOGAN, in response to Representative Holmes, said that Conceptual Amendment 2 would not increase dental rates. 3:56:28 PM DR. LOGAN, in response to Representative T. Wilson, offered his belief that Conceptual Amendment 2 would inform the insured whether the contract was for covered services only, or for covered and non-covered services. He noted that the fee schedule for non covered services would also be provided. REPRESENTATIVE T. WILSON asked if the entire fee schedule would need to be revealed. DR. LOGAN replied that the contract for the covered fee schedule was with the insurance company. He opined that the provider would show the fees not included in the negotiated fee schedule. 3:58:13 PM REPRESENTATIVE SEATON clarified that he had only modified the language from the dentists and the insured community. He stated his intention to be for the insured person to know the cost for service. 3:59:08 PM CO-CHAIR KELLER closed public testimony. 3:59:26 PM REPRESENTATIVE T. WILSON removed her objection to Conceptual Amendment 2. There being no further objection, Conceptual Amendment 2 was adopted. 4:00:04 PM REPRESENTATIVE SEATON relayed that he was uncomfortable with this as a procedure as it could raise costs for individuals. He stated that he did not want to have this procedure expanded to include other medical fields. 4:00:50 PM CO-CHAIR KELLER pointed out that new federal legislation may make some changes to this bill. 4:01:38 PM REPRESENTATIVE LYNN asked if dental service was covered under the federal health care bill. CHAIR KELLER said that he did not know. The committee took a brief at-ease. 4:02:44 PM REPRESENTATIVE T. WILSON moved to report CSHB 309, 26-LS1315\C, Bailey, 3/24/10, as amended, out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, CSHB 309 (HSS) was forwarded from the House Health and Social Services Standing Committee. 4:03:21 PM HB 361-CPR TRAINING FOR 911 DISPATCHERS 4:03:30 PM CO-CHAIR KELLER announced that the next order of business would be HOUSE BILL NO. 361, "An Act requiring 911 dispatchers to be trained in cardiopulmonary resuscitation; and providing for an effective date." [In front of the committee was the proposed committee substitute (CS) for HB 361, 26-LS1478\R, Luckhaupt/Mischel, 3/11/10.] CRYSTAL KOENEMAN, Staff to Representative Anna Fairclough, Alaska State Legislature, explained that HB 361 was an act requiring that 911 dispatchers be trained in cardiopulmonary resuscitation (CPR). She offered her belief that this was an important step as Alaska was one of only 18 states which did not mandate this. 4:04:49 PM CO-CHAIR HERRON moved to adopt the proposed committee substitute (CS) for HB 361, 26-LS1478\R, Luckhaupt/Mischel, 3/11/10, as the working document. There being no objection, Version R was before the committee. MS. KOENEMAN explained that the 911 coordinator was currently a position within the Department of Military & Veterans' Affairs (DMVA), and it was suggested the coordinator position should be moved to the Department of Public Safety (DPS). 4:06:01 PM REPRESENTATIVE T. WILSON asked if it would be necessary to have a person certified in CPR in each bush Alaska community. 4:06:21 PM MS. KOENEMAN replied that most municipalities had dispatchers trained as emergency medical dispatchers, which included CPR. She acknowledged that bush dispatchers would be required to receive CPR training and that CPR certification was available online. 4:07:43 PM REPRESENTATIVE T. WILSON questioned the value of an online CPR training and certification. MS. KOENEMAN said that the 911 coordinator would facilitate and monitor the CPR training. REPRESENTATIVE T. WILSON asked how many communities needed the CPR certification for its dispatchers. MS. KOENEMAN said that it was difficult to get the exact information. 4:09:15 PM REPRESENTATIVE SEATON reported that CPR no longer included airway breathing, and was now only "100 beats per minute." He asked if this CPR adaptation would affect the wording in the proposed bill and that the bill might be mandating something that was no longer recommended. 4:10:15 PM MS. KOENEMAN noted that she was aware of the new chest pump protocol and she suggested that DMVA or DPS might have more information. 4:10:52 PM REPRESENTATIVE T. WILSON asked if there was a fiscal note. MS. KOENEMAN replied that a new fiscal note was forthcoming from DPS. She pointed out that the bill did have a referral to the House Finance Committee. 4:11:33 PM CO-CHAIR KELLER suggested forwarding the bill to the House Finance Committee. 4:12:06 PM REPRESENTATIVE LYNN asked about the pros and cons for moving the 911 coordinator position within departments. 4:12:26 PM MS. KOENEMAN replied that neither department had objected. She opined that DMVA had initially received federal funding for the position. In response to Representative Lynn, she said the decision came through discussions with both the departments. 4:13:40 PM MICHAEL O'HARE, Deputy Director, Division of Homeland Security/Emergency Management, Department of Military & Veterans' Affairs (DMVA), explained that the position had been created at the end of 2004 for emergency communications as DMVA had responsibility for emergency communications during a catastrophic disaster. He explained that the day to day 911 system should belong in the Department of Public Safety (DPS), and as defined in statute, it was not appropriate within DMVA. 4:15:37 PM REPRESENTATIVE HOLMES asked if the position description in HB 361 was the same as currently in DMVA. MR. O'HARE agreed. In response to Representative Seaton, he said that CPR was still the current requirement, but that upon recertification, the protocol would be for chest pumps. REPRESENTATIVE SEATON expressed his concern for the use of the term CPR in statute, as it was no longer recommended. MR. O'HARE offered his belief that the term, CPR, reflected a current technique. He agreed that should the term be changed, then the statute would also have to change. 4:17:42 PM REPRESENTATIVE SEATON reflected on a need to use the correct term in statute. CO-CHAIR KELLER agreed, and shared an anecdote about an acquaintance who had recently trained with the chest pump technique although the certification was still for CPR. 4:18:23 PM SUE STANCLIFF, Special Assistant, Office of the Commissioner, Department of Public Safety, noted that there were two parts to the bill: CPR and the departmental transfer of the 911 coordinator. She said that a poll to the statewide agencies had revealed that the majority required CPR, while many offered even more extensive training. She reported that DPS left the determination for CPR with the dispatch commanders, but that HB 361 would now require CPR. She offered her support for CPR and additional training. Addressing the transfer of the 911 coordinator to DPS, she stated that as DPS did not currently have this position, it would require hiring a position within the Alaska State Troopers. She explained the additional duties for this position. She reflected that a fiscal note would be forthcoming. 4:23:12 PM REPRESENTATIVE T. WILSON asked how many communities did not require CPR. MS. STANCLIFF replied that no communities were required to have CPR certification. In response to Representative T. Wilson, she said that some communities, such as Anchorage and Fairbanks, had a municipal ordinance for CPR certification. REPRESENTATIVE T. WILSON asked if this was a problem in some communities and she asked if the coordinator would need to travel to the bush communities. She questioned whether this would be a burden to the rural communities. MS. STANCLIFF said that six police chiefs had responded to a DPS poll that they were already requiring CPR certification. REPRESENTATIVE T. WILSON asked if Alaska State Troopers and Village Public Safety Officers (VPSO) were required to have CPR certification. MS. STANCLIFF replied that this was part of the training. 4:25:57 PM CO-CHAIR HERRON asked why the 911 coordinator duties could not be assigned to an existing position. MS. STANCLIFF replied that DPS would not accept a statutory position without doing it correctly. She said that the search and rescue coordination, the emergency response, and the emergency calls in conjunction with DMVA all required training. She opined that the 911 coordinator would not be limited to CPR training. She pointed out that the job description would be based on the requirements listed in the statute. 4:27:30 PM CO-CHAIR HERRON expressed concern for an additional position to be created for the 911 coordinator. MS. STANCLIFF, in response, said that the DPS would not take the job responsibility lightly. CO-CHAIR HERRON asked if there was lateral funding from DMVA. 4:29:27 PM MR. O'HARE explained that, in 2004, this position was an unfunded mandate which DMVA had since been attempting to move to another department. He explained that the 911 coordinator position was in conjunction with the Alaska Land Mobile Radio system, which had since been moved to Department of Administration (DOA). He explained that, although the statute was with DMVA, the coordination was with DOA and the Network Security Officer. He said that HB 361 would add more responsibility, which would require the position to be full time. 4:31:44 PM REPRESENTATIVE T. WILSON asked for the current coordinator duties. MR. O'HARE explained that the 911 coordinator identified the statewide 911 dispatchers, and researched the technologies to enhance 911 statewide for approval by the legislature. The new job description would include coordination of the statewide 911 dispatchers for other required responsibilities. 4:32:40 PM REPRESENTATIVE T. WILSON asked which communities this would impact and if this was a positive impact. 4:34:35 PM RODNEY DIAL, Lieutenant, Alaska State Troopers, in response to Representative T. Wilson, said that there were very few small dispatch centers, and that this would not affect any of them. He reported that it would have more impact on hub facilities in bush communities, the majority of which were state trooper facilities. He said that the Alaska State Troopers did require CPR and it was also taught on a departmental level as time permitted. 4:35:31 PM REPRESENTATIVE T. WILSON asked what community this would impact. LT. DIAL replied that he could not think of a community that would be negatively impacted. He opined that most communities were offering emergency medical dispatch training to the dispatchers. He mentioned that providing CPR instructions over the phone was different than performing CPR, and he did not know if there would be a phone certification. He opined that it may be necessary for a CPR instructor certification, instead. 4:37:04 PM REPRESENTATIVE SEATON directed attention to page 2, line 5 which stated that "a municipality shall require that emergency dispatchers on the 911 system be trained and currently certified..." He asked if this applied to DPS. LT. DIAL said that he had not yet received a response from the Department of Law (DOL). REPRESENTATIVE SEATON pointed out that the bill language did not mention instruction, and he asked Lt. Dial if the language should be amended to include instruction. LT. DIAL replied that if dispatchers were only trained in basic CPR, they may not be qualified to give CPR instruction over the telephone. He referred to an earlier response by the American Heart Association. 4:39:35 PM MS. KOENEMAN, in response to Representative T. Wilson, clarified that municipalities were not required, but had chosen to train emergency medical dispatchers. She recognized the concern for CPR instruction over the phone versus the individual certification for CPR. She noted that this would be worked out with the DPS, the dispatchers, and the new 911 coordinator for the best direction. 4:41:39 PM CO-CHAIR KELLER closed public testimony. [HB 361 was held over.] HB 392-INCENTIVES FOR CERTAIN MEDICAL PROVIDERS 4:42:10 PM CO-CHAIR KELLER announced that the final order of business be 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." 4:42:28 PM CO-CHAIR HERRON moved to adopt proposed committee substitute (CS) for HB 392, 26-LS1528\S, Mischel, 3/17/10 as the working draft. 4:42:46 PM REPRESENTATIVE SEATON objected for discussion. 4:42:57 PM NIKOOSH CARLO, Staff to Representative Bob Herron, Alaska State Legislature, explained that the change to Version S was on page 5, line 15, and it inserted "to not fewer than three participants employed in very hard-to-fill positions." DR. CARLO explained that HB 392 created an incentive program and loan repayment program within Department of Health and Social Services. 4:46:19 PM DR. CARLO, in response to a questions about the earlier Version E, explained that on page 5, line 12, "continuing participant" had been inadvertently deleted. The committee took an at-ease from 4:46 p.m. to 4:47 p.m. 4:47:50 PM REPRESENTATIVE T. WILSON asked for a definition of "hard-to- fill." DR. CARLO replied that this definition would be worked out in regulations. 4:48:30 PM CO-CHAIR KELLER asked for the determination of "hard-to-fill." DIANE BARRANS, Executive Director, Alaska Commission on Postsecondary Education (ACPE), replied that this would be determined by Department of Health and Social Services. 4:49:02 PM REPRESENTATIVE SEATON asked about the duration for loan repayments to the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) graduate medical education program. He commented that HB 392 had a six year loan repayment program, and he asked if there were any other programs of that duration. 4:49:38 PM MS. BARRANS replied that the two WWAMI repayment terms were three years for underserved areas and five years for urban areas. She said that it was important to distinguish the fundamental structure of WWAMI. She explained that the agreement was entered into when students entered the first year of the graduate medical program, and the funds were paid directly to the University of Washington School of Medicine. She pointed out that if a graduate did not return to Alaska to practice, the service agreement would convert into a loan with active repayment. She said that there was not a similar, active program. She explained that there was a small teacher education loan with a similar structure to WWAMI. She pointed out that this proposed program could be paid off after three years of service, depending on the amount of debt. 4:52:01 PM REPRESENTATIVE SEATON questioned that if the proposed program was for any student loans, was it necessary to make direct payment to the loan holder, other than an Alaskan state loan, or just make the payment to the student. 4:53:05 PM MS. BARRANS said that this program had evolved over the years, and that it was only recently that the direct incentive of cash payment was included. She opined that the loan repayment language could be vestigial and that some groups believed the student loan payment to be duplicative. 4:54:04 PM REPRESENTATIVE SEATON asked if the reference could just be to the Alaska student loan program. MS. BARRANS offered her belief that this would be a different objective from the original program. She explained that the broad education loan eligibility was to allow recruitment from out of state. She said that a change might limit the participation. 4:55:22 PM REPRESENTATIVE SEATON offered his belief that this change would make it easier administratively, and he did not see "any downsides." 4:56:05 PM CO-CHAIR KELLER allowed that this would be the sponsor's decision. REPRESENTATIVE T. WILSON offered her support and stated that the doctor shortage was only going to worsen. 4:56:53 PM CO-CHAIR HERRON, as the prime sponsor of HB 392, expressed agreement with Representative Seaton. 4:58:04 PM REPRESENTATIVE SEATON suggested that a conceptual amendment would streamline the bill. CO-CHAIR HERRON asked if the conceptual agreement was for another means to administer the loan program. 4:59:30 PM REPRESENTATIVE SEATON moved to adopt Conceptual Amendment 1, which he explained would only limit the loan repayment be used for Alaska state issue loans, with the remainder of the same amount to now be paid by direct incentive. 5:00:02 PM REPRESENTATIVE T. WILSON objected for discussion. She expressed concern that this would limit the participation. REPRESENTATIVE HOLMES also objected for discussion. She stated her agreement with the intent to simplify the paperwork and lower the administrative cost. She expressed concern with any unforeseen consequences by somehow "skewing who is eligible to receive the money." 5:01:33 PM REPRESENTATIVE SEATON replied that the intent was for repayment to Alaska state loans, with the cap to remain the same. 5:02:09 PM REPRESENTATIVE T. WILSON removed her objection. REPRESENTATIVE HOLMES removed her objection. 5:02:24 PM DR. CARLO emphasized that an applicant was eligible for the program whether or not they had any loans. 5:02:40 PM There being no objection, Conceptual Amendment 1 was adopted. REPRESENTATIVE HOLMES expressed her support for HB 392. 5:03:29 PM CO-CHAIR KELLER stated his discomfort with the necessity to subsidize the salaries of these professionals, and he opined that government rate regulation had removed any incentives for practice. He reiterated that the current federal health care legislation could make it necessary to re-visit this bill. [Version S was adopted as the working draft.] 5:05:06 PM REPRESENTATIVE T. WILSON moved to report proposed committee substitute (CS) for HB 392, 26-LS1528\S, Mischel, 3/17/10, as amended, out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, CSHB 392 (HSS) was forwarded from the House Health and Social Services Standing Committee. 5:05:49 PM ADJOURNMENT There being no further business before the committee, the House Health and Social Services Standing Committee meeting was adjourned at 5:05 p.m.