03/15/2011 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic | 
|---|---|
| Start | |
| HB1 | |
| HCR5 | |
| HB78 | |
| Adjourn | 
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 1 | TELECONFERENCED | |
| += | HB 78 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HCR 5 | TELECONFERENCED | |
                    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 |