Legislature(2019 - 2020)CAPITOL 106
04/04/2019 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB84 | |
| HB89 | |
| HB92 | |
| HB114 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 84 | TELECONFERENCED | |
| *+ | HB 89 | TELECONFERENCED | |
| *+ | HB 92 | TELECONFERENCED | |
| *+ | HB 114 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 4, 2019
3:09 p.m.
MEMBERS PRESENT
Representative Ivy Spohnholz, Co-Chair
Representative Tiffany Zulkosky, Co-Chair
Representative Matt Claman
Representative Harriet Drummond
Representative Geran Tarr
Representative Sharon Jackson
MEMBERS ABSENT
Representative Lance Pruitt
COMMITTEE CALENDAR
HOUSE BILL NO. 84
"An Act relating to the presumption of compensability for a
disability resulting from certain diseases for firefighters,
emergency medical technicians, paramedics, and peace officers."
- HEARD & HELD
HOUSE BILL NO. 89
"An Act relating to the prescription of opioids; relating to the
practice of dentistry; relating to the practice of medicine;
relating to the practice of podiatry; relating to the practice
of osteopathy; relating to the practice of nursing; relating to
the practice of optometry; and relating to the practice of
pharmacy."
- HEARD & HELD
HOUSE BILL NO. 92
"An Act exempting direct health care agreements from regulation
as insurance; establishing a direct care payment program for
medical assistance recipients; and providing for an effective
date."
- HEARD & HELD
HOUSE BILL NO. 114
"An Act relating to a workforce enhancement program for health
care professionals employed in the state; and providing for an
effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 84
SHORT TITLE: WORKERS' COMP: POLICE, FIRE, EMT, PARAMED
SPONSOR(s): REPRESENTATIVE(s) JOSEPHSON
03/06/19 (H) READ THE FIRST TIME - REFERRALS
03/06/19 (H) HSS, L&C
04/04/19 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 89
SHORT TITLE: OPIOID PRESCRIPTION INFORMATION
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ
03/11/19 (H) READ THE FIRST TIME - REFERRALS
03/11/19 (H) HSS, FIN
04/04/19 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 92
SHORT TITLE: DIRECT HEALTH: NOT INSUR; ADD TO MEDICAID
SPONSOR(s): REPRESENTATIVE(s) JOHNSTON
03/13/19 (H) READ THE FIRST TIME - REFERRALS
03/13/19 (H) HSS, FIN
04/04/19 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 114
SHORT TITLE: MEDICAL PROVIDER INCENTIVES/LOAN REPAYM'T
SPONSOR(s): REPRESENTATIVE(s) SPOHNHOLZ
03/27/19 (H) READ THE FIRST TIME - REFERRALS
03/27/19 (H) HSS, FIN
04/04/19 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
ELISE SORUM-BIRK, Staff
Representative Andy Josephson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 84 on behalf of the bill
sponsor, Representative Josephson.
PAMELA MILLER, Executive Director
Alaska Community Action on Toxics
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 84.
DARCEY PERRY, Vice President
Public Safety Employees Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 84.
MIRANDA DORDAN, Intern
Representative Ivy Spohnholz
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the Sectional Analysis for HB 89
on behalf of the bill sponsor, Representative Spohnholz.
ERIN SHINE, Staff
Representative Jennifer Johnston
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 92 on behalf of the bill
sponsor, Representative Johnston.
LEE GROSS, MD
Epiphany Health
North Port, Florida
POSITION STATEMENT: Testified and answered questions in support
of HB 92.
ANNA LATHAM, Deputy Director
Juneau Office
Division of Insurance
Department of Commerce, Community & Economic Development
Juneau, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
92.
BERNICE NISBETT, Staff
Representative Ivy Spohnholz
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 114 on behalf of the bill
sponsor, Representative Spohnholz.
JILL LEWIS, Deputy Director - Juneau
Central Office
Division of Public Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Presented a PowerPoint titled "HB 114
Medical Provider Incentives/Loan Repayment."
RACHEL GEARHART, Co-Chair
SHARP Council
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of HB 114.
NANCY MERRIMAN, Executive Director
Alaska Primary Care Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 114.
JANE ERICKSON, President
Alaska Nurses Association
Palmer, Alaska
POSITION STATEMENT: Testified in support of HB 114.
CONNIE BEEMER, Vice President
Alaska State Hospital and Nursing Home Association (ASHNHA)
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 114.
ACTION NARRATIVE
3:09:53 PM
CO-CHAIR TIFFANY ZULKOSKY called the House Health and Social
Services Standing Committee meeting to order at 3:09 p.m.
Representatives Zulkosky, Spohnholz, Claman, Tarr, Drummond, and
Jackson were present at the call to order.
HB 84-WORKERS' COMP: POLICE, FIRE, EMT, PARAMED
3:10:36 PM
CO-CHAIR ZULKOSKY announced that the first order of business
would be HOUSE BILL NO. 84, "An Act relating to the presumption
of compensability for a disability resulting from certain
diseases for firefighters, emergency medical technicians,
paramedics, and peace officers."
3:11:02 PM
ELISE SORUM-BIRK, Staff, Representative Andy Josephson, Alaska
State Legislature, presented a PowerPoint titled "HB 84, An Act
relating to the presumption of compensability for a disability
resulting from certain diseases for firefighters, emergency
medical technicians, and peace officers." She directed
attention to slide 1, "Purpose of the bill," and paraphrased the
slide, which read:
Firefighters are already covered in current law
To extend "presumption of compensability" for certain
diseases to three more professions:
Emergency Medical Technicians
Peace Officers
Paramedic
These first responder professions often are exposed to
the same dangerous situations and toxins that
firefighters are
MS. SORUM-BIRK pointed out that, although firefighters were
already covered under a statute passed in the 25th Alaska State
Legislature with bi-partisan support and an effective date of
August 19, 2008, this proposed bill would expand presumptive
coverage for three professions left out of that legislation.
3:12:56 PM
MS. SORUM-BIRK paraphrased slide 2, "What is "presumptive"
legislation?" which read:
With work-related illness or injury-
Typically worker must prove their ailment is a result
of occupational exposures
With presumptive legislation-
Line-of-duty claim, and subsequent benefits, can be
automatically approved as long as the specific
criteria are met under the state's regulations
Some states choose broad language and some choose to
be much more specific
MS. SORUM-BIRK explained that Alaska had used very specific
language in the 2008 legislation, although many states used much
broader language.
3:13:26 PM
MS. SORUM-BIRK paraphrased slide 3, "Alaska's Criteria," which
read:
Narrowly defined and limited in AS 23.30.121
Presumption of coverage may be rebutted based on
tobacco use, physical fitness, weight, lifestyle,
hereditary factors, exposure from other employment or
non-employment activities
May not extend for more than 3 months for each year
of service or 60 months following last date of
employment
Only to those who have served for a minimum of seven
years
Only to individuals who have undergone qualifying
medical exam and requisite annual exams with no
evidence of disease
Only if the individual with cancer was exposed to
known carcinogens in the course of employment
3:14:22 PM
MS. SORUM-BIRK shared slide 4, "Sectional Analysis," which read:
Section 1:
Amends AS 23.30.121(b) throughout to add emergency
medical technician, paramedic and peace officer to
professions presumed covered for disability or
disease.
Creates a new section to include breast cancer
under diseases for which a covered professional can
claim compensation.
Extends coverage to certain professionals who
entered active service prior to August 19, 2008.
Section 2, Section 3, Section 4:
Includes emergency medical technician, paramedic
and peace officer among presumptively covered
professions
Section 5:
Provides definitions of "emergency medical
technician," "firefighter,""paramedic," and "peace
officer."
Section 6:
Clarifies that AS 23.30.121 as amended applies to
claims made on or after the effective date of this
Act.
Section 7:
Encourages revisors to update catch line of AS
23.30.121 to reflect changes made by this Act.
3:15:39 PM
MS. SORUM-BIRK moved on to paraphrase slide 5, "Diseases covered
in Alaska," [original punctuation provided] which read:
Currently covered: respiratory disease, certain
cardiovascular events related to toxin exposure,
primary brain cancer, malignant melanoma, leukemia,
non-Hodgkin's lymphoma, bladder cancer, ureter cancer,
kidney cancer, prostrate cancer
Added by HB 84: breast cancer
Emerging literature suggests a higher rate of breast
cancer among women firefighters
MS. SORUM-BIRK directed attention to an article [Included in
members' packets] regarding research regarding higher rates of
breast cancer with earlier onset for women firefighters.
3:16:35 PM
MS. SORUM-BIRK explained slide 6, "First responders who entered
service prior to August 19, 2008," which read:
AS 23.30.121(b)(4)-Allows these individuals to be
covered if a firefighter, emergency medical
technician, paramedic, or peace officer
received "all medical examination provided by the
department"
no evidence of the disease during the first seven
years of employment
August 19, 2008 is date of original enactment of
"presumptive" legislation in Alaska
MS. SORUM-BIRK stated that this would set up parameters for
individuals who entered service prior to this August date. She
reported that the one case dealing with this issue which had
gone to the Supreme Court had referred to this presumptive date.
3:18:29 PM
MS. SORUM-BIRK referred to slide 7, "Expands definition of
firefighters," which read:
Adds firefighters who are state employees to the
definition of firefighter
MS. SORUM-BIRK paraphrased slide 8, "Conclusions," which read:
A question of providing similar protections to
professional and volunteers who take comparable risk
Protecting those who protect our state and communities
3:19:30 PM
CO-CHAIR SPOHNHOLZ asked how the rate of breast cancer in female
firefighters and other first responders compared to those rates
in the general population.
MS. SORUM-BIRK replied that, although research was still on-
going, it was suggesting that these rates were "quite a bit
higher."
CO-CHAIR SPOHNHOLZ shared that a concern for the proposed bill
was for the costs related to the inclusion of breast cancer, and
that these facts would be important in consideration for the
proposed bill.
3:21:24 PM
PAMELA MILLER, Executive Director, Alaska Community Action on
Toxics (ACAT), stated that ACAT was an environmental health,
research, and advocacy organization that assisted worker
concerns with chemical exposure. She paraphrased from a letter
of support for the proposed bill dated March 21, [Included in
members' packets] [original punctuation provided] which read:
Thank you for your leadership in introducing and
serving as prime sponsor for HB No. 84, "An Act
relating to the presumption of compensability for a
disability resulting from certain diseases for
firefighters, emergency medical technicians,
paramedics, and police officers. We also thank
Representatives Tuck and Hopkins for co-sponsoring
this bill.
We strongly support HB No. 84 because it is inclusive
of emergency medical technicians, paramedics, and
peace officers in addition to firefighters who are
employed by a state or municipal fire department and
volunteer firefighters who are registered with the
state fire marshall. It is critical to include all
first responders under the provisions of this bill so
that they and their families are eligible for
compensation in the tragic event of disability
resulting from the performance of their duties.
First responders risk their lives every day to protect
the communities they live in. However, the risk of
injury responding to fires is not the only aspect that
makes their service a dangerous occupation. First
responders face significant chemical exposures on the
job due to the vast quantity of chemicals added to
building materials, consumer products and the
equipment they use every day. Many of these chemicals
have been linked to cancer and other negative health
concerns. Firefighters dying from occupational-related
cancers now account for 65 percent of the line-of-duty
deaths each year as reported to the International
Association of Firefighters. This is the largest
health-related issue facing the profession. Other first
responders are similarly at risk.
In 2010, a NIOSH (National Institute for Occupational
Safety and Health) study examined cancer incidence and
cancer deaths in approximately 30,000 firefighters
from San Francisco, Chicago, and Philadelphia fire
departments between 1950 and 2009. The results showed
that firefighters have higher rates of the digestive,
oral, respiratory, and urinary systems cancers than
the general U.S. population. A meta-analysis of 32
studies found an association between firefighting and
increased incidence of cancers such as 2 multiple
myeloma, non-Hodgkin's lymphoma, prostate cancer, and
testicular cancer, compared to the general population.
We support the inclusion of breast cancer among the
diseases for presumptive compensability because of
increasing evidence of the association with higher
rates among women firefighters. A study conducted in
the San Francisco Fire Department found the rate of
breast cancer among female firefighters aged 40-50 is
six times the national average. Studies also show that
firefighters are at greater risk of contracting the
following cancers: testicular cancer (102% greater
risk); multiple myeloma (53% greater risk); non-
Hodgkin lymphoma (51% greater risk); skin cancer (39%
greater risk); prostate cancer (28% greater risk);
malignant melanoma (32% greater risk); brain cancer
(32% greater risk); rectum (29% greater risk; stomach
(22% greater risk); colon cancer (21% greater risk).
Testicular cancer should be included in the provisions
of this bill for presumptive compensability because of
the high occupational risk and the fact that PFAS
exposure (used in industrial firefighting foams), for
example, is closely associated with testicular cancer.
We urge support and passage of HB 84 and additional
measures to protect the health and safety of our first
responders.
3:25:10 PM
CO-CHAIR SPOHNHOLZ asked how the rates of cancer for
firefighters compared to the population at large.
MS. MILLER offered to provide the information.
3:26:20 PM
DARCEY PERRY, Vice President, Public Safety Employees
Association, said that she had been a firefighter at Anchorage
International Airport since 2005 and was shocked to find out in
2008 that she was not covered by the legislation. She explained
the oversights in that legislation and offered her belief that
it had not been intended "to leave our own off." She stated her
support of the proposed legislation, pointing out that all first
responders should be covered as they were often entering unknown
situations.
3:29:11 PM
CO-CHAIR ZULKOSKY opened public testimony.
3:29:49 PM
REPRESENTATIVE JACKSON asked if the firefighters were covered by
an insurance policy.
MS. SORUM-BIRK replied that there was some insurance for
firefighters, dependent on their employers. She clarified that
the proposed bill was directed toward workers compensation.
3:30:57 PM
CO-CHAIR ZULKOSKY closed public testimony.
[HB 84 was held over.]
HB 89-OPIOID PRESCRIPTION INFORMATION
3:31:03 PM
CO-CHAIR ZULKOSKY announced that the next order of business
would be HOUSE BILL NO. 89, "An Act relating to the prescription
of opioids; relating to the practice of dentistry; relating to
the practice of medicine; relating to the practice of podiatry;
relating to the practice of osteopathy; relating to the practice
of nursing; relating to the practice of optometry; and relating
to the practice of pharmacy."
3:31:35 PM
The committee took a brief at-ease.
3:32:09 PM
REPRESENTATIVE TARR moved to adopt the proposed committee
substitute (CS) for HB 89, labeled 31-LS0421\U, Fisher,4/3/19,
as the working draft.
CO-CHAIR ZULKOSKY objected for discussion.
3:32:25 PM
CO-CHAIR SPOHNHOLZ introduced HB 89, explaining that this was
re-visiting a bill that had previously been introduced by
Representation Gara in 2018. She stated that the purpose of the
proposed bill was to ensure that Alaska did everything possible
to reduce access to opioids and the associated unnecessary
risks. She introduced a PowerPoint titled "House Bill 89:
Opioid Addiction Risk Disclosure." She reported that there had
been 100 overdoses from opioids in 2017, and although there had
been progress through a prescription drug monitoring program,
easier disposal of opioids, and a reduction of use, it was still
a problem as 80 percent of addiction to street level heroin
began with legally prescribed opioids, whether or not it was
their legal prescription. She suggested that it was best to
flip the conversation and begin with an introduction to the
risks associated with opioids before they were taken. She
stated that the proposed bill offered "a couple of opportunities
for a patient to be educated about the risks of addiction and
dependence on opioids before they can consume it." She allowed
that there would be exclusions for emergencies and other times
when it was not possible for an informed consent. She offered
her belief that education should take place at multiple points
as research had indicated that it takes multiple times for an
individual to hear a message before the information is
internalized. She paraphrased slide 3, "Research and
Statistics," which read:
A recent meta-analysis of research (Schmidt & Eisend,
2015) published in the Journal of Advertising found
that it takes an average of 8-10 exposures for a
person to remember a concept.
The more often a patient hears a message about
the inherent risks of opioids, the more likely they
are to have an increased awareness of the potential
dangers of physical dependence and addiction.
Statistics on Opioid Misuse and Opioid Related Deaths:
Drug overdose was Alaska's leading cause of
accidental death in 2016 (Alaska Department of Health
and Social Services).
More than 3 out of 5 drug overdoses involve an
opioid (Centers for Disease Control and Prevention, AK
DHSS).
4 out of 5 heroin users started out misusing
prescription opioids (American Society of Addiction
Medicine).
New research (Weinheimer, Michelotti, Silver, Taylor,
& Payatakes, 2018) on effective pain management:
A combination of Ibuprofen 200 mg and
Acetaminophen 500 mg is approximately 3 times more
effective than 15 mg of Oxycodone. (Dr. Don Teater,
Teater Health Solutions).
CO-CHAIR SPOHNHOLZ moved on and paraphrased slide 4, "Goals of
House Bill 89, which read:
Reduce the use of opioids for pain management and
increase use of non-opiate pain management tools and
medications.
Increase communication about the dangers and risks of
opioids.
Decrease opioid misuse and opioid-related deaths in
Alaska.
Mitigate the opioid related public health crisis
Alaska is currently facing.
Provide a positive example to other states in the US
that are facing similar public health crises.
3:36:45 PM
MIRANDA DORDAN, Intern, Representative Ivy Spohnholz, Alaska
State Legislature, paraphrased slide 5, "Section 1: Legislative
Findings" which read:
Legislative findings hold that the state has a moral,
financial, and public health interest in reducing
opioid and heroin addiction in Alaska.
Medically documented evidence finds that opioid
prescription drugs can lead to physical dependence and
potential addiction.
Studies have shown that a significant amount of heroin
users started as opioid drug users.
The Opioid Epidemic increases crime in the state, and
the presence of heroin dealers in the state poses a
public safety threat.
Opioid addictions tear families apart, destroy a
person's ability to hold a job, and decimate lives.
Addiction treatment is costly and hard on families,
affecting quality of life.
Addiction treatment and additional public safety costs
are also expensive for consumers and the state.
3:38:08 PM
MS. DORDAN paraphrased slide 6, "Section 2: Dentists," which
read:
Requires dentists to inform patients of the potential
addictive dangers of opioids and any reasonable
treatment alternatives using oral and written
information before prescribing an opioid.
The State Board of Dental Examiners will craft and
enforce regulations that satisfy requirements of HB
89.
MS. DORDAN directed attention to a handout on the Department of
Health and Social Services website as a visual aide with great
information for opioid statistics specific to Alaska.
3:40:02 PM
CO-CHAIR SPOHNHOLZ pointed out that the bill sponsors did not
want to over prescribe the way this should be implemented at the
Board level, but to instead, allow each of the Boards to
identify for themselves the best way to regulate and manage the
information. She emphasized that the sponsors only wanted to
ensure that providers in Alaska offered oral and written
communication about the risks and alternatives.
3:40:40 PM
MS. DORDAN moved on to paraphrase slide 7, "Section 3: Medical,
Osteopathy, and Podiatry Providers," which read:
Requires Medical, Osteopathy, and Podiatry Providers
to inform patients of the potential addictive dangers
of opioids and any reasonable treatment alternatives
using oral and written information before prescribing
an opioid.
The State Medical Board will craft and enforce
regulations that satisfy requirements of HB 89.
3:41:51 PM
MS. DORDAN directed attention to slide 8, "Section 4: Registered
Nurses," which read:
Requires registered nurses to inform patients of the
potential addictive dangers of opioids and any
reasonable treatment alternatives using oral and
written information before prescribing an opioid.
The Alaska Board of Nursing will craft and enforce
regulations that satisfy requirements of HB 89.
3:42:24 PM
MS. DORDAN shared slide 9 "Section 5: Optometrists," which read:
Requires optometrists to inform patients of the
potential addictive dangers of opioids and any
reasonable treatment alternatives using oral and
written information before prescribing an opioid.
The State Board of Examiners in Optometry will craft
and enforce regulations that satisfy requirements of
HB 89.
3:42:56 PM
MS. DORDAN indicated slide 10 "Section 6: Pharmacists," which
included the changes in the proposed committee substitute,
Version U, which read:
Requires pharmacists to inform patients of the
potential addictive dangers of opioids using oral and
written information before dispensing an opioid.
The Alaska Board of Pharmacy will craft and enforce
regulations that satisfy requirements of HB 89.
3:44:57 PM
MS. DORDAN directed attention to slide 11 "Section: Visual Aid,"
which read in part:
DHSS must create a visual aid that providers can hand
out to patients when they are being prescribed
opioids.
MS. DORDAN reiterated that the handout had already been created
and was on the Department of Health and Social Services website.
3:46:16 PM
MS. DORDAN shared the references and letters of support on slide
12, "Letters of Support:" which included the Alaska Dental
Society and Fallen Up Ministries.
3:46:37 PM
REPRESENTATIVE JACKSON offered her belief that doctors had taken
an oath to do everything within their power to keep their
patients healthy and that there was a federal requirement for
doctors to explain each drug and its side effects. She asked if
the proposed bill was requiring the state to manage doctors for
how they inform and educate their patients.
3:47:37 PM
CO-CHAIR SPOHNHOLZ explained that the proposed bill was designed
to add another layer of education for patients. She shared a
personal experience with opioids and noted that the bill
proposed to begin the conversation in the health care provider's
office. She offered her belief that more conversation would
reduce the number of opioids prescribed, consumed, and
distributed into our communities.
3:49:34 PM
REPRESENTATIVE JACKSON acknowledged awareness for the opioid
crisis, with a variety of organizations enforcing education on
opioids. She asked for clarification that Co-Chair Spohnholz
had been offered medications without any education.
CO-CHAIR SPOHNHOLZ replied that she had been offered opioids by
a full range of medical professionals.
REPRESENTATIVE JACKSON asked if the proposed bill would ensure
monitoring through the various Boards that doctors were offering
this education.
CO-CHAIR SPOHNHOLZ replied that the intent of the proposed bill
was to require medical personnel to educate patients about the
risks associated and give them printed materials to take home.
The proposed bill would give the power to the Boards for
enforcement. She emphasized that it was not intended to define
in law specific steps that should be taken. She offered her
belief that a way to build consensus was to allow the
professionals to determine the best way to regulate and enforce.
3:51:51 PM
REPRESENTATIVE JACKSON acknowledged that "the idea and the
intention is fabulous" but asked if there had been discussions
with the various boards for a timeframe. She suggested that
enforcement legislation may be necessary if the boards did not
comply.
CO-CHAIR SPOHNHOLZ shared the history of a prior compromise to
allow Department of Health and Social Services to create and
distribute information. However, it had been decided that it
was time to introduce legislation, as the boards had a limited
scope of responsibility and needed a law in order to take on new
regulations. She stated that she had been talking with
providers to craft a bill that was practical while achieving the
public health goal for reduction of opioid dependence.
3:53:49 PM
REPRESENTATIVE DRUMMOND directed attention to slide 2 and
expressed her surprise regarding the combination of ibuprofen
and acetaminophen as three times more effective than 15 mg of
oxycodone. She asked if this was a prescription combination or
was it available over the counter.
CO-CHAIR SPOHNHOLZ explained that the combination was a legal
over the counter level for each of those medications. She
acknowledged that this combination was so much more effective
than opioids.
3:55:44 PM
REPRESENTATIVE DRUMMOND directed attention to slide 3 and
expressed that she was impressed with the 36 percent decrease in
opioid overdoses and a 67 percent decrease in fentanyl
overdoses. She asked if each overdose resulted in death.
CO-CHAIR SPOHNHOLZ clarified that these were overdose related
deaths and not just overdoses. She reported that overdose death
had decreased with the broad distribution of naloxone as it
allowed emergency responders to reverse an overdose.
3:57:28 PM
REPRESENTATIVE DRUMMOND referred to slide 7 and asked about
exemptions for palliative and hospice care.
MS. DORDAN explained that these exemptions could be offered
although ultimately the Board would decide who was exempt.
CO-CHAIR SPOHNHOLZ added that, as the delivery of health care
was very complex, it was the intention not to define in law
exactly where the education should take place and that, instead,
the medical professionals make that decision. She noted that
the implementation could be addressed later if there were
concerns.
3:59:12 PM
REPRESENTATIVE DRUMMOND pointed to slide 9 and asked about
treatments performed by optometrists which required an opioid.
CO-CHAIR SPOHNHOLZ explained that, although it was not routine
care, optometrists could perform some minor procedures which
could create some pain and necessitate the prescription of pain
medication.
4:00:34 PM
CO-CHAIR ZULKOSKY removed her objection. There being no further
objection, the proposed committee substitute (CS) for HB 89,
labeled 31-LS0421\U, Fisher,4/3/19, was adopted as the working
draft.
4:01:05 PM
CO-CHAIR ZULKOSKY opened public testimony.
4:01:22 PM
CO-CHAIR ZULKOSKY said she would keep public testimony open.
[HB 89 was held over.]
HB 92-DIRECT HEALTH: NOT INSUR; ADD TO MEDICAID
4:01:30 PM
CO-CHAIR ZULKOSKY announced that the next order of business
would be HOUSE BILL NO. 92, "An Act exempting direct health care
agreements from regulation as insurance; establishing a direct
care payment program for medical assistance recipients; and
providing for an effective date."
4:01:44 PM
ERIN SHINE, Staff, Representative Jennifer Johnston, Alaska
State Legislature, paraphrased the Sponsor Statement [Included
in members' packets], which read:
HB 92 amends the state insurance code by exempting
direct care agreements from the definition of
insurance. It also, includes conditional language for
the Department of Health and Social Services to apply
for a State Plan Amendment with the Centers for
Medicare & Medicaid Services to allow for direct care
agreements for and, if approved, requires that
providers accept Medicare and Medicaid patients up to
20 percent of their patient population. This bill does
not mandate that direct care practices be formed; it
only exempts them from regulation by the division of
insurance.
Direct care agreements consist of a practitioner or
group of physicians who contract with individual
patients to provide care outlined in a contract for a
monthly, quarterly or semiannual fee. The relationship
between physician and patient is contractual and the
contractual relationship can be altered or amended by
the same means that already govern existing
contractual relationships. Through this arrangement
patients gain access to as much care as they need.
Under existing care models, a patient sees a doctor
and then the doctor bills the patient's insurance. In
a direct care practice, no bill is submitted to a
third-party payer. The only money exchanged is the
patient's monthly, quarterly or semi-annual membership
payments. This arrangement liberates the physician
from all involvement with insurance and are relieved
from paperwork required by payers. Physicians have
more time to spend on direct patient care.
The American Academy of Family Physicians "Principles
for Reform of the U.S. Health Care System" holds that:
"Less complicated administrative systems are essential
to reduce costs, create a more efficient health care
system, and maximize funding for health care
services."
HB 92 creates an environment where a new market for
the delivery of health care can exist and grow by
allowing direct care agreements to create a less
complicated administrative system.
4:04:20 PM
REPRESENTATIVE DRUMMOND asked if the requirement that doctors
accept Medicare and Medicaid patients for up to 20 percent of
their patient population would increase the availability of
primary care providers to those patients.
MS. SHINE offered her belief that this would create an avenue to
access care and that a provider with a direct care agreement
practice would be one more provider accepting Medicare and
Medicaid patients.
4:05:14 PM
REPRESENTATIVE JACKSON asked if this offered practitioners and
physicians the opportunity to set up a co-op for affordable care
between the physician and the patient.
MS. SHINE replied that it allowed patients to pay a revolving
fee to a provider or a group of providers for access to care as
outlined in a contract. She pointed out that this was not
insurance and that the proposed bill exempted them from the
definition of insurance.
REPRESENTATIVE JACKSON stated her support for legislation that
would allow physicians to have direct payment from patients as
an alternative for those without insurance. She asked about
making this mandatory for physicians to accept Medicaid and
Medicare patients.
MS. SHINE said that providers who accepted Medicare and Medicaid
patients could continue as status quo, whereas the proposed bill
would allow a provider to set up a different form of health care
delivery. This would allow a contract directly with the patient
and not with a third party. The proposed bill stated that a
physician who chose to set up this type of practice must accept
Medicare and Medicaid patients.
4:08:01 PM
REPRESENTATIVE CLAMAN expressed concern that the proposed bill
would provide access to middle class whereas those with "much
tighter financial situations really would never be able to take
advantage of this kind of situation." He asked how this would
work with medical savings accounts.
MS. SHINE offered her belief that this was an affordable way for
the patients in 25 states to access primary care. She opined
that Alaska would be the first state to open-up for other forms
of care, and not direct that this be primary care. She said
that the use of medical savings accounts was a grey area and
that there were testifiers who could more adequately answer the
question.
REPRESENTATIVE CLAMAN asked what areas beyond traditional
primary care did the bill propose to offer.
MS. SHINE explained that this had been left broad to determine
whether this was a good model for access to care in a more
efficient manner. She offered her assumption that most
providers would set up an agreement practice for primary care as
most general surgery could not charge enough on a monthly basis.
REPRESENTATIVE CLAMAN asked if there were specialties more
likely to be interested in this beyond primary care.
MS. SHINE offered her belief that some states were currently
trying to expand the scope beyond primary care.
4:12:18 PM
REPRESENTATIVE DRUMMOND asked about statistics, history in the
states where the program is allowed, and the cost to consumers
for the direct care agreements. She asked if those other states
with direct care agreements contained the Medicare and Medicaid
percentage requirement.
MS. SHINE offered her belief that about 25 states had direct
primary care agreements, although she did not know anything
about the cost of care. In response, she opined that, although
no other states included the proposed Medicare and Medicaid
percentage requirement, that was not to say that Medicare and
Medicaid patients did not access this form of care.
REPRESENTATIVE DRUMMOND offered her belief that it was difficult
to find primary care physicians that accepted Medicare in
Alaska, even as Medicare accepting physicians were much more
available in other states while being reimbursed at a better
rate. She opined that this could also be true for Medicaid.
4:14:35 PM
LEE GROSS, MD, Epiphany Health, reported that he was a full-time
practicing family doctor. He stated that this model could
simplify health care delivery, reduce the cost of care, lower
barriers to access, reduce physician burn-out, and restore the
central focus of the health care system to the patient. He
shared the history of his practice, noting that the name,
Epiphany Health, evolved from the question for why to insure
primary care as this created far too many barriers between the
doctor and the patient. He stated that health insurance was
being used incorrectly. He declared that routine health care
should be made affordable for everyone, with predictable, price
transparency, that insurance should be a hedge against
catastrophic loss, and not to pay for basic, essential care. He
reported that, in 2010, his practice had created a membership
based primary care program for patients aged five years and
older with a flat monthly fee of $60 per month for an adult,
which covered all the services his practice provided. He added
that a child was $25 per month, with each additional child in
the family for $10 per month. He pointed out that there were
not any co-pays for any services which could be done in the
office. He explained that, in order to practice outside a
traditional third-party payment system, he had reached out to
independent labs, image services, and others to secure wholesale
prices. He compared the prices of these services to those
through a traditional office visit. He reported that,
currently, there were about 1,000 of these practices with a
direct primary care model. He added that some of these
practices also offered wholesale dispensing of medications to
allow affordable access. He reiterated that there were 25
states with legislation to protect this practice model, pointing
out that no states had regulated against the provision of direct
primary care services. He noted that he did oppose provisions
in the proposed bill that set quotas for Medicare and Medicaid,
pointing out that no other states set these quotas, and that
portion of the proposed bill would be the first in the nation to
mandate participation in Medicare and Medicaid. He stated his
enthusiastic support for the rest of the proposed bill.
4:20:04 PM
CO-CHAIR SPOHNHOLZ asked how the rates were developed.
DR. GROSS replied that, as the cost for routine care was cheaper
than a cell phone plan, they had determined that this was a
reasonable price. He added that this had also stabilized the
finances for his practice. He noted that prior to shifting his
practice model, his office was not a Medicaid provider, but with
his new primary care model, he did have Medicaid patients as
they could afford the services provided.
CO-CHAIR SPOHNHOLZ asked about the risks to the consumers if a
patient became too expensive to care for.
DR. GROSS replied that, under existing law, a doctor could drop
a patient for any reason, adding that the provision in the
proposed bill which allowed for cancellation by either party
with two months' notice was longer than the notice which existed
in current law. He pointed out that the model was designed to
attract people with chronic diseases, heavier utilizers,
although it was not always the same utilizer each month. He
stated that these were the people a practice should keep.
CO-CHAIR SPOHNHOLZ asked how many patients he had let go in the
last year.
DR. GROSS replied that he had not terminated anyone, and that he
had a three month wait list for new patients to his practice.
CO-CHAIR SPOHNHOLZ asked how this practice model made money
without culling the expensive patients.
DR. GROSS explained that this practice was not financially
viable as a fee for service insurance-based practice because of
all the expenses necessary to provide medical care through the
insurance companies, which included proprietary software,
staffing, and the other 60 percent of overhead necessary to bill
the insurance companies. He noted that his overhead was now
some of the lowest in the country, between 20 - 30 percent. He
shared some of the costs, noting that there was little incentive
to cull the high utilizers.
4:25:20 PM
DR. GROSS, in response to Representative Claman, said that the
main office for his practice was in North Fork, Florida, with an
expansion office in rural Florida where there was a 50 percent
uninsured rate with a median income of $25,000 per year. He
added that they had integrated with the critical access rural
hospital an employee benefit into their health plan as an option
to a traditional health plan. He reported that 80 percent of
the hospital employees signed up for membership with his
practice, a projected savings of more than $1 million in the
first year for the hospital while also reducing employee
premiums 20 percent and eliminating their network restrictions,
co-pays, and deductibles for routine care.
REPRESENTATIVE CLAMAN asked how many physicians were in his main
clinic.
DR. GROSS replied that there were two doctors and a nurse
practitioner. In response to Representative Claman, he
acknowledged that he was one of the doctors.
REPRESENTATIVE CLAMAN asked about Medicaid payments.
DR. GROSS explained that his practice did not take any money
directly from Medicaid as the Medicaid patients paid his
practice directly. He reported that, because the State of
Florida had a Medicaid share of cost with a high patient
deductible which reset every month, the patients could not
afford access to chronic care management.
REPRESENTATIVE CLAMAN asked if the State of Florida offered any
reimbursement to Medicaid recipients for payment to his
practice.
DR. GROSS replied that it was most likely easier for Medicaid
recipients to pay his monthly fee out of pocket instead of
trying to work through the Medicaid system for routine primary
medical services. He declared that it was difficult to find a
doctor in Florida who took Medicaid.
REPRESENTATIVE CLAMAN asked if the monthly fee included
prescription medications.
DR. GROSS said that his practice encouraged patients to have
insurance for non-routine and catastrophic expenses. He
reiterated that the monthly fee only included services provided
in his office. He reported that some practices did offer
medications as a path through cost directly to the patient, and
he shared the prices of some generic drugs used to manage
chronic conditions. He noted that often it was more expensive
for a patient to use their insurance to pay for the medications
instead of paying cash.
REPRESENTATIVE CLAMAN asked if medication services as a pass-
through cost did not add to the base monthly fee and was only
reimbursed to his office.
DR. GROSS agreed that there would be a pass-through cost for the
wholesale cost for the medication.
REPRESENTATIVE CLAMAN asked how many providers similar to his
clinic were in Florida.
DR. GROSS offered that there were about 60 providers, and that
the legislation had only just passed about one year prior. He
added that the Florida legislature was already looking to expand
this.
4:31:21 PM
REPRESENTATIVE JACKSON stated that she thought this was a great
idea and asked if the current laws under the Patient Protection
and Affordable Care Act (PPACA) recognized this process.
DR. GROSS said that Section 1301 of the PPACA did contain a
provision that specifically allowed direct primary care with a
wrap around catastrophic plan to qualify as minimal coverage in
order to avoid the tax penalty.
4:32:58 PM
REPRESENTATIVE DRUMMOND asked if the prescriptions for a Type II
diabetic counted as a heavy utilizer in his practice.
DR. GROSS said that the Type I and Type II diabetics were the
ideal patients in his practice because they came in for visits
"five, six, seven times a year." He noted that, as the A1C test
for the three-month average blood sugar monitoring, was
administered in his office there was no charge for the point of
care testing. He explained that these patients could be managed
over the phone, by text, or by e-mail. He reported that one
diabetic patient could no longer afford to see the
endocrinologist because of the $600 per visit.
REPRESENTATIVE DRUMMOND asked about the cost of the insulin, as
it had skyrocketed in the last few years even though the
medication had not changed.
DR. GROSS expressed his agreement that the new pricing for
insulin was a national problem. He said they did the best they
could given the available resources and would often work
directly with the manufacturers. He noted that sometimes, given
the income level of his patients, they did not have to pay
anything for medications.
REPRESENTATIVE DRUMMOND asked how diabetic patients could afford
the best insulins. She asked if these prescriptions were
covered by insurance.
DR. GROSS said that patients who did have insurance would use it
to pay for the prescriptions, although his practice would work
with the manufacturers for patients without insurance. He
reported that Type II diabetics required more time to teach them
lifestyle changes and wean them away from the medications. He
declared that it took 3 minutes to prescribe a medication but 30
minutes to not prescribe a medication.
REPRESENTATIVE DRUMMOND asked if the manufacturers supplied free
insulin forever to a Type I diabetic who could not live without
insulin.
DR. GROSS replied, "at the moment, they do. Forever, I can't
certainly tell you that." He explained that, if a patient was
not eligible for a government program such as Medicare,
Medicaid, or benefits, and they were not presently getting
health insurance, then, in most cases they would qualify for
free insulin based on income. He expressed his desire to see
federal changes to the pharmacy benefits management as it could
not be fixed at the direct primary care level.
4:40:34 PM
CO-CHAIR ZULKOSKY shared concern that an exemption for direct
care agreements from insurance regulations would remove consumer
protections, and ultimately limit patients to contractual items
contained in the care agreements. She asked about the
regulation of rates and the guaranteed coverage allowed through
the various care agreements ensuring that clients who may get
sick outside the contracts were able to receive coverage.
DR. GROSS explained that they were not asking for physicians to
not be regulated, but that physicians should not be regulated as
insurance companies. He declared that physicians were very
heavily regulated and that would not change for direct primary
care.
CO-CHAIR ZULKOSKY asked if regulations of these direct care
agreements were managed through contractual law in the State of
Florida.
DR. GROSS replied that this law managed the actual agreement;
whereas, the conduct of the practice, the practitioner, and the
delivery of care was monitored through the State Medical Board.
CO-CHAIR ZULKOSKY asked if the Division of Insurance had
conducted an analysis for the impact on consumer protections in
Alaska with the exemption of direct care agreements from
insurance regulations.
4:43:06 PM
ANNA LATHAM, Deputy Director, Juneau Office, Division of
Insurance, Department of Commerce, Community & Economic
Development, said that the division had not analyzed any impact
to consumers should these agreements occur. She directed
attention to a report by the Office of the Insurance
Commissioner in the State of Washington. She said that
Washington had been groundbreaking in direct care practices,
with 41 direct care practices currently exempted from the
insurance code. She noted that direct care and concierge
medicine had been prevalent in Washington since the early 2000s
and were exempted in 2007. She reported that part of the
regulation required an extensive report to the Office of the
Insurance Commissioner. She suggested that this report could
have some analysis for the consumer impact. She pointed out
that these agreements were very transparent for what services
were provided.
CO-CHAIR ZULKOSKY asked for the history to the management and
regulation of rates and coverages within the direct care
agreements. She suggested that they were managed largely by the
provider groups and not through regulation by the Division of
Insurance.
MS. LATHAM explained that the rates were set by the practices.
She offered some information to the variance of the rates in the
past two years. From 2016 - 2018, 11 practices increased fees,
6 decreased fees, and 5 offered no changes in fees. According
to the Direct Primary Care coalition, the median fee was about
$70 per person per month, or $165 per month for a family of
four.
CO-CHAIR ZULKOSKY asked about the percentage of average
increase.
MS. LATHAM said that she could provide the Office of the
Insurance Commissioner report.
REPRESENTATIVE CLAMAN asked if Health Savings Accounts could be
used to pay the fees.
MS. LATHAM offered her belief that the use of Health Savings
Accounts was not allowed for these plans. She noted that there
had been some federal effort in 2017 to allow for this but the
bill did not pass.
DR. GROSS expressed his agreement that Health Savings Accounts
could not be used to pay for direct care contracts, as they were
not eligible under federal code.
DR. GROSS, in response to Representative Jackson, said that the
Health Savings Accounts had to be used with a qualifying high
deductible health plan. He pointed out that these high
deductible health plans could not cover direct primary care as
it was first dollar coverage. He offered his belief that most
people believed that direct primary care membership should
qualify under the Internal Revenue code.
4:49:34 PM
CO-CHAIR ZULKOSKY opened public testimony.
4:49:58 PM
CO-CHAIR ZULKOSKY closed public testimony.
[HB 92 was held over.]
HB 114-MEDICAL PROVIDER INCENTIVES/LOAN REPAYM'T
4:50:11 PM
CO-CHAIR ZULKOSKY announced that the final order of business
would be HOUSE BILL NO. 114, "An Act relating to a workforce
enhancement program for health care professionals employed in
the state; and providing for an effective date."
4:50:55 PM
CO-CHAIR SPOHNHOLZ paraphrased from the Sponsor Statement for HB
114 [Included in members' packets], which read:
Health care is one of the largest and most dynamic
industries in Alaska, yet many citizens, especially in
rural areas, continue to experience challenges with
accessing care. The availability of health care
services is important for maintaining health,
preventing and managing disease, and reducing costs
from unnecessary emergency room visits, and hospital
readmissions and temporary staffing. One reason access
to care is limited, particularly in rural Alaska, is
due to shortages of healthcare professionals. Health
care sites struggle with recruiting and retaining
health care professionals. Further, health care
professionals have challenges with large student loan
debt and high cost of living in rural and remote
locations.
To meet the ongoing demand, Alaska must continue to
address the shortage of health care professionals. HB
114 (SHARP-3) does this by establishing the Health
Care Professionals Workforce Enhancement Program, a
public-private partnership that will increase the
number of providers while minimizing the use of state
funds. Health care professionals agree to work for
minimum of three years in Alaska in underserved areas
in exchange for repayment of student loans or direct
incentives. Employers will fully fund the program,
taking advantage of a federal tax exemption available
only to a state-run program.
The success of healthcare loan repayment and incentive
programs in increasing the healthcare workforce in
Alaska was demonstrated in SHARP-2. Between 2013 and
2015, SHARP-2 was successful in recruiting and/or
retaining 83 clinicians statewide, with most
clinicians placed in locations off the road system and
emphasizing care for rural and underserved
populations. With the sunset of SHARP-2 on June 30,
2019, other healthcare practitioner incentive programs
are needed to reduce healthcare workforce shortages
throughout Alaska.
SHARP-3 builds on the success of SHARP-2 with new
practice settings, new occupations, new employers, new
locations, and new roles. Employers can hire much-
needed staff, providers get assistance with their loan
payments which makes it more affordable to work in a
rural community, and Alaskans living in rural
communities have improved access to health care--all
without the use of state general funds.
4:54:22 PM
JILL LEWIS, Deputy Director - Juneau, Central Office, Division
of Public Health, Department of Health and Social Services,
presented a PowerPoint titled "HB 114 Medical Provider
Incentives/Loan Repayment." She directed attention to slide 2,
"HB 114," which read:
Establishes a Health Care Professionals Workforce
Enhancement Program to address shortage of health care
workforce.
Health care professionals agree to work for three
years in underserved areas in exchange for repayment
of student loans or direct incentives.
Employers fully fund the program. No unrestricted
general funds are involved.
Replaces the existing program in AS 18.29 scheduled
for sunset June 30, 2019.
4:55:38 PM
MS. LEWIS noted that Representative Spohnholz had already
reviewed the challenges listed on slide 3, "Challenges in health
care access," and she directed attention to slide 4, "SHARP -
2," which read:
Operated 2013 2018
No new contracts after 2015 due to GF budget
reductions
83 contracts: 39 Tier 1 and 44 Tier 2
47-53% positions very hard-to-fill
$25,560 average payment per contract per year
10-30% employer match
31 employers distributed across 25 communities
Primarily non-profit and hospital associated
Similar numbers of tribal and non-tribal affiliated
organizations
MS. LEWIS moved on to paraphrase slide 5, "An innovative
solution," which read:
A public-private partnership that ensures access to
health care by expanding the distribution of health
care professionals all Alaskans at no cost to the
state.
SHARP-3 builds on the success of SHARP-1 and SHARP-2
with new practice settings, new occupations, new
employers, new locations, and new roles.
Benefit will not be limited to rural areas or primary
care; there is also room for specialists and urban
health care professionals.
Takes advantage of a federal law that exempts loan
repayment from federal income tax if awarded through a
state-run program.
Public-private partnerships increases the number of
providers while minimizing the use of state funds.
4:56:56 PM
MS. LEWIS shared slide 6, "Benefits," which read:
Health care sites can hire much needed staff
Health care professionals get assistance with their
student loans
Alaskans have improved access to health care
Access to health care is important for maintain health
and reducing costs
All without the use of undesignated general funds
4:57:21 PM
MS. LEWIS explained slide 7, "SHARP - 3," which read:
Health care professionals receive student loan
repayment and/or direct incentives for working in
underserved areas.
Employer sites provide health care services in
underserved or health care professional shortage
areas.
3 year contract with renewals; 12 year lifetime limit.
Employer payments fully cover cost of the
professional's program payment and an administrative
fee.
An advisory council recommends eligibility criteria,
prioritization of sites and professionals for
participation, and contract awards.
4:58:36 PM
REPRESENTATIVE CLAMAN asked whether the 3-year contract with the
12-year lifetime limit was intended to pay the entirety of a
loan or only the amount due each year of that contract time. He
offered an example of a 20-year loan, asking if a 3-year
contract would allow payment for 3 years of the 20-year loan.
MS. LEWIS replied that a provision only allowed up to one-third
repayment of a loan in each of the 3 years if a person was using
the loan repayment option and not a direct incentive.
4:59:31 PM
MS. LEWIS directed attention to slide 8, "SHARP - 3," adding
that this could further address the question posed by
Representative Claman, which read:
Tier 1: dentist, pharmacist, physician
$35,000/year regular or $47,250 very hard-to-fill
Tier 2: dental hygienist, registered nurse, advanced
practice registered nurse, physician assistant,
physical therapist, clinical psychologist, counseling
psychologist, professional counselor, board certified
behavior analyst, marital and family therapist, or
clinical social worker
$20,000/year regular or $27,000 very hard-to-fill
Tier 3: not otherwise eligible under Tier 1 or Tier 2
$15,000/year regular or $20,250 very hard-to-fill
MS. LEWIS stated that, although these were the current amounts
currently set in statute for SHARP 1 and SHARP 2, the amounts
could be set by the commissioner. She pointed out that Tier 3
was new with the proposed bill, stating that each tier addressed
different levels of educational attainment and practice.
5:01:49 PM
MS. LEWIS moved on to the diagram on slide 9, which described
the process for the program. She explained that health care
professionals who have applied and were accepted would work at
an eligible site for a calendar quarter. At the end of that
quarter, the site would report back to the SHARP program on that
professional's hours worked and the amount of care given. She
noted that SHARP could adjust the maximum payments based on the
actual hours worked, and that individuals had an option for full
or half time. She noted that the service was provided before
the employer made any payments. SHARP would invoice the sites
for the professional's payment and the administrative fee. The
sites would send payment back to the SHARP program with that
money being used to make loan payment to the lender, or a direct
incentive payment to the professional. She reported that SHARP
routinely provided data back to the Advisory Council to
prioritize and establish criteria.
5:04:07 PM
MS. LEWIS presented slide 10, "In closing..." which read:
HB 114
Keeps health care professionals in rural
communities
Promotes health and economic community stability
Ensuring a healthier future for all Alaskans
At the lowest possible cost.
5:04:35 PM
CO-CHAIR ZULKOSKY referenced slide 4 and noted that the SHARP
program offered opportunities to all communities throughout
Alaska.
5:05:01 PM
REPRESENTATIVE DRUMMOND, directing attention to slide 4, asked
if SHARP - 2 was paying an average of $25,500 per year for 83
different contracts. She stated that this was about $2.1
million per year from the general fund and asked if this was
before or after the employer match.
MS. LEWIS reported that the program had ramped up in 2013 and
2014 and was fully operating in 2015 with more than 40 contracts
added each year. After that, as there were no additional
general funds, no new contracts were extended. She added that
there had been significant state match, with the employers
paying between 10 and 30 percent for each of the contracts.
REPRESENTATIVE DRUMMOND asked if the $2.1 million was before or
after the employer match.
MS. LEWIS stated that this was the total cost and included the
employer's share.
5:06:53 PM
CO-CHAIR SPOHNHOLZ pointed out that there was a "Final Report to
the Legislature," dated December 2018, [Included in members'
packets] and she directed attention to page 9, which listed the
range of health care providers and contract expenses listed
under SHARP 2. She emphasized that the proposed current
legislation for SHARP 3 was all privately funded. She reported
that under SHARP 2 the general fund expense had been $4,909,038
and the employer match was $1,455,438.
REPRESENTATIVE DRUMMOND asked where the money was coming from to
pay for proposed HB 114.
CO-CHAIR SPOHNHOLZ explained that the SHARP 3 program would be
entirely funded by the employer community, as there was an
interest in recruiting health care providers and providing
incentives. She noted that there was a tax benefit to both the
employer and the employee. She offered her belief that there
was still a state interest to ensure that health care was
provided, both in Rural Alaska and underserved populations in
urban Alaska. She noted that it was necessary to use "all of
the tools in our tool kit to recruit and retain providers in
those underserved areas of health care."
REPRESENTATIVE DRUMMOND asked what would happen to the health
care providers currently covered by the loan repayment program
if proposed HB 114 did not pass.
5:09:50 PM
MS. LEWIS explained that there would be no new contracts for the
SHARP 2 program, and that all the existing contracts have been
paid. She reported that SHARP 1, the federal option, was an on-
going grant that was not affected by either SHARP 2 or proposed
HB 114.
5:10:44 PM
RACHEL GEARHART, Co-Chair, SHARP Council, reported on the status
of health care professionals in each committee member's district
and noted that the proposed bill provided a benefit to all their
constituents. She acknowledged how valuable the proposed bill
would be for recruiting and retaining quality health care
professionals with no additional expenditure to the state. She
noted that she had been a SHARP 2 recipient, which had allowed
her to be free of student loan, and that she was still working
for the same agency as when she had received her benefit. She
pointed to the letters of support from SHARP recipients. She
shared that the SHARP data from the quarterly work reports
offered tracking for important demographics to further
recruitment and retention efforts, noting the retention of
permanent workers in substance use capacity. She noted that
proposed HB 114 would allow the biggest community mental health
centers to be eligible sites without also having to be a
federally qualified health center. SHARP 3 would expand
eligible sites and eligible professions, including respiratory
therapists, occupational therapists, case managers, chemical
dependency councilors, and training coordinators. She noted
that, in mental health work, the therapeutic alliance with a
client was considered one of the most important factors for
working together. She explained that, when those with high ACEs
scores started to connect with a mental health professional,
progress was made. She pointed to disruption to service
delivery due to staff turnover, which SHARP 3 could help
alleviate.
5:16:00 PM
NANCY MERRIMAN, Executive Director, Alaska Primary Care
Association, stated support for proposed HB 114 to establish the
SHARP 3 program and help Health Centers better serve Alaskans.
She declared that there was a shortage of health care
professionals of all types in Alaska, and that Health Center
leaders constantly grappled with vacant health care clinician
positions. Although health care jobs remained the fastest
growing sector in the Alaska labor force, the demands outpaced
the availability and, as Alaskans grew older, there was an
increased need for health care with an increased incidence of
chronic disease requiring more constant care. She pointed out
that health care professionals were not distributed evenly
across the state.
MS. MERRIMAN declared that the SHARP programs were critical for
community health centers, reporting that the SHARP 1 program had
issued 172 contracts to health centers since its inception in
2010; the SHARP 2 program had issued 47 contracts with health
care providers. She shared that APCA surveys revealed that the
most important work force issues were for recruitment and
retention, with noted appreciation for SHARP. She relayed that
SHARP had also addressed some of the disparity for the
distribution of providers. She added that Alaska community
health centers had benefited from the SHARP program, sharing
that 80 of the 105 candidates awarded into the SHARP 1 program
were practicing in community health centers.
MS. MERRIMAN stated that SHARP 3 was innovative and did not
require any state general fund dollars, while offering a
valuable state infrastructure. It would provide the ability to
expand the benefits of SHARP to many areas not currently
designated as health professional shortage areas. The proposed
bill would also expand the provider types eligible for loan
repayment.
REPRESENTATIVE CLAMAN asked if the increase of funding by
employers to 100 percent for the proposed SHARP 3 program would
be an issue.
MS. MERRIMAN explained that the program funding would not be 100
percent by the employers, as there would be a request to other
bodies for a cost share to help support the additional necessary
funding.
REPRESENTATIVE CLAMAN asked for information as to the other
bodies.
MS. MERRIMAN suggested that these could be philanthropic
organizations, labor unions, or associations.
5:21:56 PM
JANE ERICKSON, President, Alaska Nurses Association, stated
support of proposed HB 114. She stated that the Alaska Nurses
Association strongly believed in the value of the SHARPS
program, which improved access to high quality health care by
providing incentives to health care professionals to create a
more equitable distribution of health professionals throughout
Alaska. She reported that Alaska faced continual difficulties
in recruitment and retention for a health care workforce,
especially in rural and remote communities. She declared that
SHARP 3 was a critical need for this recruitment and retention
of health care professionals. She declared that the SHARP
program had made a tremendous positive difference and was the
main state program to support placement of a range of providers.
She added that the program was a smart financial move for the
state. She pointed out that private funds would be used instead
of state dollars and would expand the eligibility beyond the
strictures of the previous SHARP programs. This would greatly
impact the health and welfare of communities statewide.
5:24:57 PM
CONNIE BEEMER, Vice President, Alaska State Hospital and Nursing
Home Association (ASHNHA), stated support for proposed HB 114.
She paraphrased from a prepared statement [Included in members'
packets] which read:
The Alaska State Hospital and Nursing Home Association
(ASHNHA) is offering this letter of support for SHARP
- 3. As a member of the SHARP Council we have been
involved with the program since its inception and
believe in the value of the program to support high
quality care through an equitable distribution of
health professionals throughout Alaska.
The SHARP program has helped Alaska's hospitals ensure
an adequate supply of healthcare providers and is an
important tool to help with recruitment and retention.
We support the addition of a third component through
SHARP - 3 legislation.
SHARP - 3 will support a variety of practice settings,
locations (especially those not eligible as a HPSA or
other federal programs for SHARP - 1) and provider
types. We need to use whatever tools are available to
support healthcare organizations to recruit and retain
employees. SHARP - 3 would expand the use of federal
tax exemption for education loan repayment and enhance
the number and variety of financial contributors.
There is a need to give local control to allow
communities to designate funds to support recruitment
of providers. SHARP - 3 utilizes the existing SHARP
infrastructure while maximizing contributions from
local communities or foundations. Money could be
contributed from different local sources such as a
business, private foundation, trade association,
government entity, foundations or employers.
SHARP 3 provides valuable state infrastructure,
without additional state general funds, and will
provide us the ability to expand the benefits of SHARP
to areas that are not Health Professional Shortage
Areas (HPSAs), a require for SHARP 1.
ASHNHA is prepared to support our members in efforts
to utilize SHARP 3 as soon as it is available. We're
eager to continue the momentum of SHARP and to support
workforce development efforts in Alaska in this way.
5:27:56 PM
CO-CHAIR ZULKOSKY opened public testimony.
5:28:15 PM
CO-CHAIR ZULKOSKY closed public testimony.
[HB 114 was held over.]
5:29:16 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:29 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB084 Sectional Analysis 4.3.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM HL&C 2/26/2020 3:15:00 PM |
HB 84 |
| HB084 Sponsor Statement 3.28.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM HL&C 2/26/2020 3:15:00 PM |
HB 84 |
| HB084 Supporting Document- Breast Cancer in Women Firefighters.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM HL&C 2/26/2020 3:15:00 PM |
HB 84 |
| HB084 Supporting Document- Letter of Support ACAT 4.3.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM HL&C 2/26/2020 3:15:00 PM |
HB 84 |
| HB084 Supporting Document- Asbestos 03.28.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM HL&C 2/26/2020 3:15:00 PM |
HB 84 |
| HB084 Supporting Document- RADS in Police from Chemical Spill 3.28.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM HL&C 2/26/2020 3:15:00 PM |
HB 84 |
| HB084 Fiscal Note DLWD WC 04.03.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM HL&C 2/26/2020 3:15:00 PM |
HB 84 |
| HB084 Letter of Support- APOA 3.28.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM HL&C 2/26/2020 3:15:00 PM |
HB 84 |
| HB084 Opposition Document- AML Joint Insurance Association 3.29.2019.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM HL&C 2/26/2020 3:15:00 PM |
HB 84 |
| HB084 Presentation 4.3.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM |
HB 84 |
| HB0089 Supporting Document-DHSS Handout 03.27.2019.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 89 |
| HB0089 Supporting Document-Support Letter 04.03.2019.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 89 |
| HB0089 Supporting Document-Support Letters 1.27.2019.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 89 |
| HB0089-Opposing Document-Opposition Letter 04.03.2019.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 89 |
| HB0089 Draft Proposed Blank CS ver U 04.03.2019.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 89 |
| HB0089 Explanation of Changes ver U 04.03.2019.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 89 |
| HB0089 Sectional Analysis ver A 03.27.2019.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 89 |
| HB0089 Sponsor Statement 03.27.2019.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 89 |
| HB092 ver U 3.27.19.PDF |
HHSS 4/4/2019 3:00:00 PM |
HB 92 |
| HB92 Fiscal Note DCCED-IO 3.31.2019.pdf |
HHSS 4/4/2019 3:00:00 PM |
HB 92 |
| HB92 Fiscal Note DHSS-MS 3.31.2019.pdf |
HHSS 4/4/2019 3:00:00 PM |
HB 92 |
| HB92 Sponsor Statement 3.31.19.pdf |
HHSS 4/4/2019 3:00:00 PM |
HB 92 |
| HB092 Sectional Analysis ver U 3.27.19.pdf |
HHSS 4/4/2019 3:00:00 PM |
HB 92 |
| HB114 Letters of Support 04.03.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 114 |
| HB114 Sectional Analysis 04.03.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 114 |
| HB114 SHARP-2 Final Report to Legislature 04.01.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 114 |
| HB114 Sponsor Statement 04.03.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 114 |
| HB114 DHSS Presentation 04.01.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 114 |
| HB114 Fiscal Note DCCED CBPL 04.01.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 114 |
| HB089 ver U Presentation.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 89 |