Legislature(2019 - 2020)SENATE FINANCE 532
04/09/2019 09:00 AM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB43 | |
| SB44 | |
| SB93 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 43 | TELECONFERENCED | |
| + | SB 44 | TELECONFERENCED | |
| + | SB 93 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE FINANCE COMMITTEE
April 9, 2019
9:01 a.m.
9:01:21 AM
CALL TO ORDER
Co-Chair von Imhof called the Senate Finance Committee
meeting to order at 9:01 a.m.
MEMBERS PRESENT
Senator Natasha von Imhof, Co-Chair
Senator Bert Stedman, Co-Chair
Senator Click Bishop
Senator Lyman Hoffman
Senator Peter Micciche
Senator Donny Olson
Senator Mike Shower
Senator Bill Wielechowski
Senator David Wilson
MEMBERS ABSENT
None
ALSO PRESENT
Juli Lucky, Staff, Senator Natasha von Imhof; Senator Cathy
Giessel, Sponsor; Jane Conway, Staff, Senator Cathy
Giessel; Jill Lewis, Deputy Director, Division of Public
Health, Department of Health and Social Services; Rachel
Gearhart, Co-Chair, SHARP Advisory Council.
PRESENT VIA TELECONFERENCE
Christopher Dietrich, Orion Behavioral Health Network,
Palmer; Debora Stovern, Executive Administrator, State
Medical Board, Anchorage; Eric Boyer, Alaska Mental Trust
Authority, Anchorage; Nancy Merriman, Executive Director,
Alaska Primary Care Association.
SUMMARY
SB 43 EXTEND BIG GAME COMMERCIAL SERVICES BOARD
CSSB 43(FIN) was REPORTED out of committee with a
"no recommendation" recommendation and with one
forthcoming fiscal impact note from the
Department of Commerce, Community and Economic
Development.
SB 44 TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS
SB 44 was HEARD and HELD in committee for further
consideration.
SB 93 MEDICAL PROVIDER INCENTIVES/LOAN REPAYM'T
SB 93 was HEARD and HELD in committee for further
consideration.
SENATE BILL NO. 43
"An Act extending the termination date of the Big Game
Commercial Services Board; and providing for an
effective date."
9:02:07 AM
Co-Chair von Imhof relayed that the committee first heard
the bill on March 13, 2019, with an additional hearing on
March 27, 2019 to further discuss the investigation process
and disciplinary actions by the board.
Senator Wielechowski MOVED to ADOPT proposed committee
substitute for SB 43, Work Draft 31-LS0442\M (Bullard,
4/5/19).
Co-Chair von Imhof OBJECTED for discussion.
JULI LUCKY, STAFF, SENATOR NATASHA VON IMHOF, addressed the
Explanation of Changes document (copy on file):
Amends section 1 to reduce the sunset extension to 5
years (June 30, 2024).
Adds section 2, which allows the board to immediately
suspend a license for violations that
already disqualify a person from receiving or renewing
that license.
Adds section 3, which increases the minimum
qualifications for a master-guide outfitter license,
including a requirement to have a clean record for 15
years.
Adds section 4, which allows the board to revoke a
master-guide outfitter license if a person's
privileges are revoked or if the person is convicted
of a violation. A person whose master-guide outfitter
license is revoked under this provision can still be
issued a registered guide-outfitter license if
qualified.
9:05:10 AM
Co-Chair von Imhof WITHDREW her objection. There being NO
further OBJECTION, it was so ordered.
Co-Chair von Imhof invited further discussion of the
legislation.
Senator Wielechowski MOVED to report CSSB 43(FIN) out of
Committee with individual recommendations and the
forthcoming fiscal note. There being NO OBJECTION, it was
so ordered.
CSSB 43(FIN) was REPORTED out of committee with a "no
recommendation" recommendation and with one forthcoming
fiscal impact note from the Department of Commerce,
Community and Economic Development.
Co-Chair von Imhof let the committee know that her office
was working with the Division of Legislative Budget and
Audit regarding investigations. More information would be
made available later.
SENATE BILL NO. 44
"An Act relating to the prescription of drugs by a
physician assistant without physical examination."
9:06:43 AM
SENATOR CATHY GIESSEL, SPONSOR, explained that the goal of
SB 44 was to increase access to medical and behavioral
health in the state. She shared that the 2016 Medicaid
Reform bill (SB 74) provided for the use of telehealth by
revising Alaska statutes to require the Alaska State
Medical Board to adopt regulations and guidelines for
physicians rendering a diagnosis, providing treatment, or
prescribing, dispensing, or administering a prescription
drug to a person without conducting a physical examination
under AS 08.64.364. She furthered that SB 74 only addressed
physicians, and the Board's interpretation was the bill's
provisions should not apply to physician assistants (PAs),
and issued guidelines outlining different requirements for
PAs and physicians. This has effectively barred PAs from
practicing telemedicine, requiring them to first conduct
in-person examinations. She offered a brief history of the
role of PAs. She spoke to a document in members packets
that outlined the education and experience required for Pas
(copy on file). She relayed that education included taking
medical histories, doing physical exams, lab testing, and
prescribing medications. She shared that, typically, the
education of a PA lasted 27 months, with usual medical
rotations: medical and surgical, family and internal
medicine, pediatrics, obstetrics, emergency medicine and
psychiatry. She said that PAs complete 2,000 hours of
supervised clinical practice. Nearly all PAs educational
programs were masters degrees and would be required to be
so by 2020.
9:10:11 AM
Senator Giessel noted the Alaska State Medical Board
guidelines for PAs (copy on file). She said that the
collaborative practice agreement must be maintained with
the PAs physician supervisor. The collaborating physician
authorized where the PA could practice and what medications
they could prescribe. The agreement also required monthly
contact with the supervision physician. She shared that, in
Alaska, PAs were authorized to prescribe certain controlled
substances. She said that SB 44 would allow the
approximately 700 PAs in the state the ability to provide
telemedicine in the same manner as physicians. She revealed
that prior to SB 74, PAs had been able to provide this
function, she lamented that this was a consequence of the
passage of that bill. She detailed the available backup
that could be found in member packets and online.
9:12:58 AM
Senator Shower thought the bill might drive down costs. He
asked whether there was potential to lower healthcare costs
by providing telemedicine rather than paying for travel.
Senator Giessel answered in the affirmative.
9:13:58 AM
JANE CONWAY, STAFF, SENATOR CATHY GIESSEL, discussed the
Sectional Analysis (copy on file):
Section 1:
Amends AS 08.64.101(a)(6) by requiring the board to
adopt regulations for a physician assistant practicing
telehealth under AS 08.64.364, and that the
regulations must use a recognized national model for
standards of telehealth care.
Section 2:
Amends AS 08.64.364(a) by saying that disciplinary
action cannot be directed toward a physician assistant
for prescribing drugs via telehealth if the drugs are
not controlled substances, if follow up care can be
provided from its medical group, and if consent has
been given by the patient for care and sharing of
records to the primary care provider.
Section 3:
Amends AS 08.64.364(b) by saying that a physician
assistant may administer botulinum toxin (Botox) if
they meet all the requirements set out in 08.64.363
and is supervised by an appropriate licensed health
care provider.
Section 4:
Amends AS 08.64.364(c) by renumbering and adds that a
physician or physician assistant may not prescribe,
dispense or administer a prescription drug via an
Internet questionnaire or email message without having
a prior patient/doctor relationship.
Section 5:
Adds an effective date of March 1, 2020
9:16:19 AM
Senator Wielechowski asked for the rationale for changing
patient to person in Sections 2 and 3.
Ms. Conway thought "patient" was medically terminology,
while "person" was legal terminology; the drafter chose to
use the legal terminology.
9:16:54 AM
Senator Shower was curious about Section 3 pertaining to
Botox. He asked why botulinum toxin had to be specifically
named.
Senator Giessel informed that there had been existing
statute and believed that because botulinum was a paralytic
agent, it had been specifically named.
9:17:56 AM
Co-Chair von Imhof addressed Section 5 and asked why the
effective date was chosen.
Ms. Conway relayed that the sponsor had conferred with Sara
Chambers from the Division of Corporations, Businesses and
Professional Licensing who had recommended the date.
9:18:40 AM
Co-Chair von Imhof OPENED public testimony.
CHRISTOPHER DIETRICH, ORION BEHAVIORAL HEALTH NETWORK,
PALMER (via teleconference), testified in support of the
bill. He provided an overview of his work in the state. He
believed that the bill would make it easier for patients to
receive adequate treatment, particularly rural patients.
9:20:35 AM
Co-Chair von Imhof CLOSED public testimony.
Co-Chair von Imhof asked if the committee had further
comments.
9:20:57 AM
Senator Wielechowski felt that he needed a better
understanding of Section 4, (c) (1), and the administration
of abortion-inducing drugs.
DEBORA STOVERN, EXECUTIVE ADMINISTRATOR, STATE MEDICAL
BOARD, ANCHORAGE (via teleconference), addressed Senator
Wielechowski's question pertaining to the change from or
to and under Section 4. She did not know the answer to
the question about changing "or" to "and," and mused that
there had been a decision by the bill drafter to assure
that both items (1) and (2) would be limited. She added
that the limitation already applied to physicians.
9:23:24 AM
Senator Wielechowski said that he would research the issue
further.
Co-Chair von Imhof relayed that her office would assist in
answering committee questions.
9:24:02 AM
Senator Micciche reviewed FN 1 from DCCED, OMB Component
2360:
SB044 adds Physician Assistants (PAs) as authorized
practitioners of telemedicine. When the telemedicine
bill was passed during a previous Legislature, it was
specific to physicians. This bill would expand that
authority to physician assistants.
If the bill passes the division will require $5.3 to
cover legal costs to amend regulations, printing, and
postage in the first year.
Professional licensing programs within the Division of
Corporations, Business and Professional Licensing are
funded by Receipt Supported Services, fund source 1156
Rcpt Svcs (DGF). Licensing fees for each occupation
are set per AS 08.01.065 so the total amount of
revenue collected approximately equals the
occupation's actual regulatory costs.
SB 44 was HEARD and HELD in committee for further
consideration.
9:25:36 AM
AT EASE
9:29:52 AM
RECONVENED
SENATE BILL NO. 93
"An Act relating to a workforce enhancement program
for health care professionals employed in the state;
and providing for an effective date."
9:29:56 AM
Senator Wilson gave a brief overview of the bill and read
from the Sponsor Statement (copy on file):
Urban and rural Alaskan communities face a serious
shortage of healthcare providers. If not immediately
addressed, this shortage will rapidly worsen.
Senate Bill 93 builds upon successes of the Alaska
Health Care Professions Loan Repayment and
Incentive Program, commonly referred to as the SHARP
Program. Established in 2012, SHARP is a loan
repayment and direct monetary incentive program that
helps reduce shortages by filling vacant healthcare
provider positions in some of the most underserved
areas across the state.
SHARP I and SHARP II leveraged federal, state, Alaska
Mental Health Trust Authority, and employer funding,
with a focus on rural, remote, and safety net
providers. To date, the program, which is administered
by the Department of Health and Social Services, has
supported more than 250 practitioners in nearly 60
sites across the state.
SHARP III fills the gap between the Federally funded
SHARP I program and the State-funded SHARP II program
by allowing private sponsorship in the form of local
government, philanthropic foundation or employer
support. SHARP III focuses on private-public
partnerships, recruitment, and retention, by offering
incentives to new and experienced professionals who
may have exhausted other loan repayment options or who
no longer carry educational loan debt. These
professionals must meet eligibility criteria and be
engaged in qualified employment. The program does not
require any state general funds; user fees cover the
cost of program administration.
SHARP III is a budget-neutral initiative that
addresses service shortages in our current healthcare
landscape, leverages community-level investment across
the state, and improves health outcomes of Alaskans. I
encourage your support of this legislation.
9:33:25 AM
JILL LEWIS, DEPUTY DIRECTOR, DIVISION OF PUBLIC HEALTH,
DEPARTMENT OF HEALTH AND SOCIAL SERVICES, addressed the
presentation "SB 93 Medical Provider Incentives/Loan
Repayment:
Ms. Lewis looked at Slide 2, "SB 93":
? 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.
Ms. Lewis stated that the Heath Care Professionals
Workforce Enhancement Program was referred to as SHARP III.
She said that under the program employers would be able to
take advantage of a federal tax exemption available only to
state-run programs. She said that the public/private
partnership would increase the number of providers, while
minimizing the use of state funds.
9:34:31 AM
Ms. Lewis informed the committee that health care was one
of the largest and dynamic industries in the state and the
availability of health care services was important for
miniating health, managing disease, reducing cost from
unnecessary emergency room visits, hospital readmissions,
and temporary staffing costs. To meet the ongoing demand
the state must continue to address the shortage of health
care professionals.
Ms. Lewis highlighted Slide 3, "Challenges in health care
access":
? Alaska needs a more optimal distribution of health
care professionals, across regions, across disciplines
and across populations served.
? Many citizens, especially in rural and frontier
areas, continue to experience challenges with
accessing health care.
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.
? Health care professionals have challenges with large
student loan debt, high cost of living in rural and
remote locations, and resulting financial pressures.
9:35:27 AM
Ms. Lewis showed slide 4, "SHARP-2":
? 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 informed that the SHARP II program was scheduled
to sunset June 20, 2019. The federally funded SHARP I
option would not be affected by sunsetting or SB 93; the
program will continue. She said that other health care
practitioner programs were needed to continue to reduce
workforce shortages throughout the state.
9:37:31 AM
Ms. Lewis discussed Slide 5, "An innovative solution":
A publicprivate 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.
9:38:22 AM
Ms. Lewis referenced Slide 6, "Benefits":
• 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
9:38:52 AM
Ms. Lewis reviewed Slide 7, "SHARP-3":
? 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.
Ms. Lewis explained that health care professionals applied
to join the program and chose whether they wanted to get
student loan repayment, a direct incentive, or a
combination of both. She reiterated that the program was of
no cost to the state.
9:40:48 AM
Ms. Lewis addressed Slide 8, "SHARP-3":
? Tier 1: dentist, pharmacist, physician
o $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
o $20,000/year regular or $27,000 very
hard-to-fill
? Tier 3: not otherwise eligible under Tier 1 or
Tier 2
o $15,000/year regular or $20,250 very
hard-to-fill
Ms. Lewis shared that the three different tiers offered
different payment maximums for health care professionals.
She noted that Tier 3 was new under SB 93.
9:41:44 AM
Senator Micciche asked whether there was clear-cut criteria
for "hard to fill" as listed on the slide.
Ms. Lewis noted that the term was documented in current
regulation and was part of the SHARP II program. She said
that very hard to fill required documentation by the
employer that the position had been vacant for at least a
year and employers had to demonstrate how actively they had
recruited for the position.
9:42:31 AM
Senator Olson asked about the percentages of hard to fill
positions between rural and urban clinics.
Ms. Lewis stated that the difficulty particularly effected
urban areas. She said that much of the health care in the
state was served in a hub and spoke model, which saw
concentrations of physicians in urban areas that also
served rural areas. She said that geographic limitations
existed but that the SHARP III program would be open to
urban areas, as well as rural, and would include
specialties the state was in dire need of but had never had
an incentive program before.
Senator Olson assumed that inner cities qualified for being
"underserved" as well.
Ms. Lewis explained that there were healthcare shortages
within individual occupations. She said that employers had
to provide care to underserved populations (uninsured or on
Medicaid).
9:44:38 AM
Senator Olson considered Slide 4 and asked what the
difference was between Gulf Coast versus Anchorage.
Ms. Lewis asked him to restate the question.
Senator Olson discussed the percentages listed at the
bottom of Slide 4.
Ms. Lewis stated that the Gulf Coast was part of the area
around Kodiak, Dillingham, and the Kenai.
9:45:57 AM
Senator Wilson stated that the final report to the
legislature on the SHARP II program released in December
2018, Anchorage only had 2 behavioral health; 4 dentists; 2
medical, while the Gulf Coast had 2 health; 4 dentists; 2
medical.
Co-Chair von Imhof asked if Senator Wilson was citing
vacancies.
Senator Wilson relayed that the numbers represented people
participating in the program.
9:47:02 AM
Senator Shower referenced the "hub and spoke" model
mentioned in the presentation. He lamented the cost of
travel for providers. He asked whether the model was
working. He wondered whether the program would truly be
covered by the employers and not the state.
Ms. Lewis stated that the hub and spoke model had been used
in the state for a great deal time, and telehealth expanded
the model. She stated that there were ways that technology
was helping keep costs down. She said that travel for
health care a burden on both patients and heath care
professionals.
Senator Shower requested assurances that the state would
not ever be burdened with the cost of staffing hard to fill
positions.
Ms. Lewis stated that SHARP-III used no state funds, and
100 percent of funding was provided by employers. She
reiterated that the program was voluntary. She shared that
the state funded program allowed for health care
practitioners' loan repayment to be exempt from federal
income tax, which was a boon to the professional and
reduced costs to the employer. She restated that employers
would pay all costs.
9:50:46 AM
Senator Wilson added that the hub and spoke model provided
different levels of service for small communities.
9:51:43 AM
Senator Shower thought the model was inefficient. He
wondered how the Washington, Wyoming, Alaska, Montana, and
Idaho (WWAMI) program could be ties into the SHARP III
program.
Ms. Lewis stated there was more than one underlying reason
why the state had healthcare shortages. One problem was
attracting professionals to rural areas and getting them
stay. Additionally, the state did not train and educate its
own heath care professionals in all necessary areas;
particularly physicians and dentists. She stated that
individuals that had gone through the WAMMI, and had
repayment, could qualify for the SHARP III program once
they were fully trained and in practice.
9:53:54 AM
Co-Chair von Imhof thought it was a positive direction that
the private sector was helping to fund programs that it
found important. She reminded the committee to speak to the
bill but appreciated Senator Showers comments. She stated
that the private sector would not step in across the board
to help with public services because it was not profitable
to do so. She thought that it was refreshing to see some
private sector efforts to help off-set some costs in high
need areas.
9:54:55 AM
Senator Micciche thought the bill was a clear example of
the use of designated general funds (DGF). He reiterated
that although it looked like the program was part of the
state budget, it was not, costs were covered by the private
sector.
9:55:43 AM
Ms. Lewis returned to Slide 8. She noted that Tier 3 was an
innovation that had been crafted using feedback from the
health care industry. Tier 3 allowed physicians that were
otherwise not eligible and would include drug and alcohol
counselors, pathologists, radiologic technologists,
infection prevention specialists, care coordinators, and
other. She said that Tier 3 was intentionally broad to
include professionals that were necessary to deliver
quality health care. She said that the council would set
the priorities to assure that the applicant addressed a
real shortage need in the state.
9:57:35 AM
Ms. Lewis turned to Slide 9, which showed a flow chart of
the program's process:
Health care professionals work at eligible site for a
calendar quarter
Sites report quarterly to SHARP on professionals'
hours worked
SHARP adjusts maximum payment amount for hours worked
SHARP adjusts maximum payment amount for hours worked
SHARP invoices sites for professional's program
payment and administrative fee
Sites send SHARP their quarterly payment
SHARP makes loan payments to lenders, and/or direct
incentives to professionals
SHARP provides data to the Advisory Council for
evaluation and planning
9:59:01 AM
Senator Micciche asked whether an employer had to register
in advance to be a member of the program.
Ms. Lewis stated that eligible sites had to provide care to
the underserved population in a state designated shortage
area, defined in regulation. Employers and professionals
could apply separately and seek each other out; a health
care professional who was looking for loan repayment would
seek out an eligible site when seeking employment.
Senator Micciche understood that the employer was not
charged unless they hired a program eligible employee.
Ms. Lewis confirmed that there was no cost to the employer
until after the professional had provided a quarter of
care.
10:00:24 AM
Ms. Lewis referenced Slide 10, "In closing?":
SB 93
? 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.
10:00:54 AM
Senator Olson considered the student loan repayment program
and asked how individuals could qualify for that program.
He wondered about students that had financed their own
education through bank loans.
Ms. Lewis affirmed that commercial loans were included in
the loans that could be repaid. She said that personal
loans were not eligible for repayment.
10:01:51 AM
Senator Shower asked whether the statute was needed to give
authority for providers to join the program. He wondered
why government was getting involved.
Senator Wilson saw the program as a public-private
partnership. He said that employers could do it on their
own but would not receive the federal tax benefits
available by going through the state. He reiterated that
the goal of the bill was to help the state with provider
shortages.
Senator Shower asked whether the legislation was required
to provide the tax benefits, of could private entities
receive the benefits on their own.
Senator Wilson explained that authority needed to be
established within stature to allow the department to
receive the funds for dispersal to private entities.
10:04:26 AM
Senator Micciche surmised that there was tax protection in
two directions. The statue made it a state loan repayment
program; a deduction for those contributing to the program
as an employer and not counted as income for the employee
as a loan repayment.
Ms. Lewis stated it was true that the loan repayment option
for health care professional in the state-run program would
be considered income. The direct incentive would be
considered taxable income. The tax benefit for the employer
was more of a cost-savings, rather than a tax benefit.
10:07:03 AM
Senator Olson asked what happened to medical professionals
that already had loans paid off. He wondered how the
program would be an incentive for those that did not have
loan debt.
Ms. Lewis stated that there were a great many mid-career
professionals, without loans, would benefit from the direct
incentive.
10:07:53 AM
Senator Wilson addressed the Sectional Analysis (copy on
file):
Section. 1. Adds a new Article 2, Health Care
Professionals Workforce Enhancement Program, to AS
18.29, Health Care Professions Loan Repayment and
Incentive Program.
Sec. 18.29.100. The legislative intent is to increase
the availability of health care services throughout
the state, especially to underserved individuals or in
health care professional shortage areas.
Sec. 18.29.105(a). The program's purpose is to address
the increasing shortage of health care professionals
in the state by expanding the distribution of health
care professionals.
Sec. 18.29.105(b). Outlines the structure of the
program, including application processes, public
notice requirements, and a 12-year lifetime maximum
for participation.
Sec. 18.29.105(c). Outlines the role and structure of
the advisory council.
Sec. 18.29.105(d). Outlines the responsibilities of
the commissioner and his or her relationship with the
advisory council.
Sec. 18.29.105(e). Outlines requirements for the
department's annual report to the advisory council.
Sec. 18.29.105(f). Specifies the department may
contract for services and adopt regulations.
10:10:11 AM
Senator Wielechowski asked whether designated funds would
be used if the the department were to contract for
services.
Senator Wilson answered in the affirmative.
10:10:29 AM
Senator Wilson continued to address the Sectional Analysis:
Sec. 18.29.110. Details the requirements for employer
payments.
Sec. 18.29.115. Establishes the structure for initial
and renewal payments and sets out annual maximum
limits for student loan repayments and direct
incentives for Tiers I, II, and III.
Sec. 18.29.120. States eligible professionals may
receive direct incentive quarterly cash payments.
Employers provide the payment amount.
Sec. 18.29.125. Pertains to student loan repayments.
Sec. 18.29.130. Details the eligibility requirements
for direct incentive payments and student loans.
Sec. 18.29.190 Contains the Definitions Section.
Section 2. Repeals the existing health care loan
repayment and incentive program in AS
18.29.010 18.29.099, which is scheduled to sunset
July 1, 2019.
Section 3. Applicability to applications or contracts
on or after July 1, 2019.
Section 4. Contains transition language stating the
existing advisory council will act as a transition
council until a new advisory council is appointed by
the commissioner.
Section 5. States if sec. 1 of this Act takes effect
after July 1, 2019, sec. 1 of this Act is retroactive
to July 1, 2019.
Section 6. States sec. 5 of this Act takes effect
immediately under AS 01.10.070(c).
Section 7. States that except for sec. 6, the
effective date is July 1, 2019.
10:13:26 AM
Senator Wielechowski asked about Page 7, lines 23-25 of the
bill. He asked whether the sponsor had a sense of what
percentage of people who received SHARP benefits were Tier
3 health care professionals.
Ms. Lewis stated there were currently no Tier 3 contracts
as the tier was new after the passage of SB 93. She
expected that the contracts would be mostly health care
professional jobs. She noted that if there was a shortage
of any position, that was not a direct care professional
but was necessary to provide healthcare, the council would
weigh the application and decide whether incentivization
was in the best interest of the state.
10:15:17 AM
Co-Chair von Imhof noted that there was invited testimony.
RACHEL GEARHART, CO-CHAIR, SHARP ADVISORY COUNCIL, offered
her credentials. She noted that her district, District Q,
was not considered a federally geographic healthcare
professional shortage area; unless you worked for a tribal
health organization you could not be eligible for student
loan repayment through SHARP I. She pointed out that the
certain members of the committee did not live in federally
geographic healthcare professional shortage. She felt that
those that did could appreciate the problem and support the
legislation. She had participated successfully in the SHARP
II program. She believed that the SHARP III program would
help to recruit and retain quality staff to serve
vulnerable and underserved Alaskans. She cited a study by
the National Health Care Retention and Registered Nurse
Staffing Report, since 2013 the average hospital had turned
over 85.2 percent of its workforce. She noted that turnover
was costly.
10:19:45 AM
Ms. Gearhart continued to discuss the myriad of ways in
which the program would enhance healthcare services within
the state. She offered that the therapeutic alliance that a
provider has with a client is considered the most important
factor in determining how well they will work together. She
said that connection between providers and clients resulted
in better health outcomes. She concluded that SHARP III
support for service helped all Alaskans live their own best
lives.
10:22:17 AM
Senator Wielechowski was curious whether the program was a
tax on every health care provider in the state.
Ms. Gearhart stated that the program was entirely
voluntary. She thought that the program leveled the playing
field for smaller agencies. There were large employers that
used sign-on bonuses and other incentives that not all
agencies had the ability to offer. She relayed that since
the program did not require state general funds, innovative
partnerships could be sought.
Senator Wielechowski wanted to see how the program was
administered.
Co-Chair von Imhof reiterated that the program was
voluntary. She asked Ms. Gearhart to provide information on
how the funding was sourced.
Ms. Gearhart noted that the there was a 5 percent
administrative fee that would help to fund the program.
10:24:34 AM
Senator Olson asked what percentage of the program was
effective, and what was the most effective part of the
program
Ms. Gearhart agreed to provide graphs demonstrating
retention. She shared that between SHARP 1 and SHARP 2, the
program had served 328 different contracts. She said that
data could be shared for each site or within the entire
state.
Senator Olson thought that the federally funded program
would be more restrictive.
Ms. Gearhart answered in the affirmative. Those people
would be required to work within a geographic health
professional shortage area.
10:25:35 AM
Senator Bishop appreciated the program and likened it to an
apprenticeship program.
10:26:33 AM
Co-Chair von Imhof OPENED public testimony.
ERIC BOYER, ALASKA MENTAL TRUST AUTHORITY, ANCHORAGE (via
teleconference), testified in support of the bill. He
relayed that the authority had invested in the SHARP I and
SHARP II programs, resulting in the recruitment and
retention of clinicians across the state. He asserted that
the bill would expand healthcare access for trust
beneficiaries. He stressed the importance of the program.
He relayed that the legislation would result in more trust
beneficiaries getting necessary care in their community of
residence.
10:28:28 AM
NANCY MERRIMAN, EXECUTIVE DIRECTOR, ALASKA PRIMARY CARE
ASSOCIATION (via teleconference), strongly supported the
bill. She highlighted three ways the bill would help serve
Alaskans. She discussed the shortage of healthcare
providers in the state. She detailed that SHARP and other
programs had been critical for community health centers.
The program had been able to address some disparity in
distribution of providers. She thought the program was
innovative and reminded that it was of no cost to the
state. She said that the program would offer a valuable
state infrastructure without the use of state general
funds. She expounded on her support of the legislation and
the SHARP III program.
10:32:19 AM
Co-Chair von Imhof CLOSED public testimony.
Senator Micciche understood that the SHARP III program used
no state funds. He noted that the contract fee for those
that chose to participate, which increased to 6.5 percent
in year 5, would cover the one position that would be
added.
Ms. Lewis answered in the affirmative. She reiterated that
the program was voluntary for employers and would be of no
cost to employers unless they chose to participate by
hiring someone and offering them the incentive. There was
no requirement that the incentive be offered.
10:34:00 AM
Co-Chair Stedman addressed FN 1 from DCCED, OMB Component
2360. The fiscal note was zero.
Co-Chair Stedman addressed FN 2 from DHSS, OMB Component
2877. The fiscal note had $814,300 in FY 20; and $2,060,000
in FY 21, increasing to $5,043.0 in FY 2025. He noted that
DGF did not have budgetary impact and used pass-through
funds. The bill did not reflect the growth in government
that the committee was trying to control.
10:36:13 AM
Senator Micciche thought the use of DGF was an important
point for the public to understand.
SB 93 was HEARD and HELD in committee for further
consideration.
Senator Wilson thanked the committee for hearing the bill.
10:37:51 AM
Senator Micciche thought the note was indeterminate, and
the fiscal impact reflected on the note was only for
illustrative purposes.
Ms. Lewis confirmed that the figure was an estimate.
Co-Chair von Imhof discussed housekeeping.
ADJOURNMENT
10:39:04 AM
The meeting was adjourned at 10:39 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB43 Bob Cassell Email 2.19.19.pdf |
SFIN 4/9/2019 9:00:00 AM SRES 2/20/2019 3:30:00 PM |
SB 43 |
| SB43 Alaska Professional Hunters Association Letter 2.15.19.pdf |
SFIN 4/9/2019 9:00:00 AM SRES 2/20/2019 3:30:00 PM |
SB 43 |
| SB43 Resident Hunters of Alaska Letter 2.18.19.pdf |
SFIN 4/9/2019 9:00:00 AM SRES 2/20/2019 3:30:00 PM |
SB 43 |
| SB43 Big Game Commercial Services Board Sunset Review Audit.pdf |
SFIN 4/9/2019 9:00:00 AM SRES 2/20/2019 3:30:00 PM |
SB 43 |
| SB43 Treasure Hunter Lodge Email 2.20.19.pdf |
SFIN 4/9/2019 9:00:00 AM SRES 2/20/2019 3:30:00 PM |
SB 43 |
| SB43 Paul Ferucci Email 2.20.19.pdf |
SFIN 4/9/2019 9:00:00 AM SRES 2/20/2019 3:30:00 PM |
SB 43 |
| SB43 Cole Kramer Email 2.20.19.pdf |
SFIN 4/9/2019 9:00:00 AM SRES 2/20/2019 3:30:00 PM |
SB 43 |
| SB43 Jacob Fletcher Email 2.19.19.pdf |
SFIN 4/9/2019 9:00:00 AM SRES 2/20/2019 3:30:00 PM |
SB 43 |
| SB43 Joe Klutsch Email 2.19.19.pdf |
SFIN 4/9/2019 9:00:00 AM SRES 2/20/2019 3:30:00 PM |
SB 43 |
| SB43 Mike McCrary Email 2.19.19.pdf |
SFIN 4/9/2019 9:00:00 AM SRES 2/20/2019 3:30:00 PM |
SB 43 |
| SB43 Jay Stanford Email 2.25.19.pdf |
SFIN 4/9/2019 9:00:00 AM SRES 2/27/2019 3:30:00 PM |
SB 43 |
| SB43 Jaff Pralle Email 2.22.19.pdf |
SFIN 4/9/2019 9:00:00 AM SRES 2/27/2019 3:30:00 PM |
SB 43 |
| SB43 Brad Dennison Email 2.18.19.pdf |
SFIN 4/9/2019 9:00:00 AM SRES 2/27/2019 3:30:00 PM |
SB 43 |
| SB43 Kodiak Outdoor Adventures Letter 2.25.19.pdf |
SFIN 4/9/2019 9:00:00 AM SRES 2/27/2019 3:30:00 PM |
SB 43 |
| SB43 Nate Turner Letter 2.25.19.pdf |
SFIN 4/9/2019 9:00:00 AM SRES 2/27/2019 3:30:00 PM |
SB 43 |
| SB43 Wayne Kubat Email 2.26.19.pdf |
SFIN 4/9/2019 9:00:00 AM SRES 2/27/2019 3:30:00 PM |
SB 43 |
| SB 43 Letters of Opposition.pdf |
HRES 5/3/2019 1:00:00 PM SFIN 3/13/2019 9:00:00 AM SFIN 4/9/2019 9:00:00 AM |
SB 43 |
| SB 43 Letters of Support.pdf |
SFIN 3/13/2019 9:00:00 AM SFIN 4/9/2019 9:00:00 AM |
SB 43 |
| SB 43 Senator von Imhof.docx |
SFIN 3/13/2019 9:00:00 AM SFIN 4/9/2019 9:00:00 AM |
SB 43 |
| SB 43 RHAK Letter Senate Finance - Extend Big Game Commercial Services Board.pdf |
SFIN 3/13/2019 9:00:00 AM SFIN 4/9/2019 9:00:00 AM |
SB 43 |
| SB 43 CBPL Timeline of Investigations.pdf |
SFIN 3/13/2019 9:00:00 AM SFIN 4/9/2019 9:00:00 AM |
SB 43 |
| SB 43 Bunch Testimony.pdf |
HRES 5/3/2019 1:00:00 PM SFIN 3/13/2019 9:00:00 AM SFIN 4/9/2019 9:00:00 AM |
SB 43 |
| SB 43 Additional Testimony Huttunen.pdf |
HRES 5/3/2019 1:00:00 PM SFIN 3/13/2019 9:00:00 AM SFIN 4/9/2019 9:00:00 AM |
SB 43 |
| SB 43 DCCED CBPL SB43 response to Sen von Imhof 3-23-19.pdf |
SFIN 3/29/2019 9:00:00 AM SFIN 4/9/2019 9:00:00 AM |
SB 43 |
| SB 43 BGCSB Support Letter 4-3-2019.pdf |
SFIN 4/9/2019 9:00:00 AM |
SB 43 |
| SB44 Sponsor Statement 2-17-19.pdf |
SFIN 4/9/2019 9:00:00 AM SL&C 3/14/2019 1:30:00 PM |
SB 44 |
| SB44 Sectional Analysis vsn U.pdf |
SFIN 4/9/2019 9:00:00 AM SL&C 3/14/2019 1:30:00 PM |
SB 44 |
| SB44 Letters of Support.pdf |
SFIN 4/9/2019 9:00:00 AM |
SB 44 |
| SB44 Letters of Support.pdf |
SFIN 4/9/2019 9:00:00 AM SL&C 3/14/2019 1:30:00 PM |
SB 44 |
| SB44 Supporting Document AK State Medical Bd Roster 3-13-19.pdf |
SFIN 4/9/2019 9:00:00 AM SL&C 3/14/2019 1:30:00 PM |
SB 44 |
| SB44 Supporting Document HRSA -HPSA Underserved Primary Care Areas.pdf |
SFIN 4/9/2019 9:00:00 AM SL&C 3/14/2019 1:30:00 PM |
SB 44 |
| SB44 Supporting Document Medically Underserved Areas HRSA 3-13-19.pdf |
SFIN 4/9/2019 9:00:00 AM SL&C 3/14/2019 1:30:00 PM |
SB 44 |
| HB097 Supporting Document Letters of Support for companion legislation SB44.pdf |
HHSS 3/26/2019 3:00:00 PM HHSS 3/28/2019 3:00:00 PM HL&C 4/15/2019 3:15:00 PM SFIN 4/9/2019 9:00:00 AM |
HB 97 SB 44 |
| CSSB44(L&C) Sectional Analysis vsn S.pdf |
SFIN 4/9/2019 9:00:00 AM |
SB 44 |
| SB44 Summary of Changes 4-3-19.pdf |
SFIN 4/9/2019 9:00:00 AM |
SB 44 |
| SB44 Letters of Support SFIN 4-3-19.pdf |
SFIN 4/9/2019 9:00:00 AM |
SB 44 |
| SB44 Sponsor Statement revised 4-2-19.pdf |
SFIN 4/9/2019 9:00:00 AM |
SB 44 |
| Final Report to Leg 2018 SHARP III.pdf |
SFIN 4/9/2019 9:00:00 AM SHSS 3/25/2019 1:30:00 PM SHSS 4/1/2019 1:30:00 PM |
SB 93 |
| SHARP-AKJournal-article.pdf |
SFIN 4/9/2019 9:00:00 AM SHSS 3/25/2019 1:30:00 PM SHSS 4/1/2019 1:30:00 PM |
SB 93 |
| ACoA Support SB 93, Workforce Enhancement Program, Senator Wilson.pdf |
SFIN 4/9/2019 9:00:00 AM |
SB 93 |
| Fed Tax Status SHARP III.pdf |
SFIN 4/9/2019 9:00:00 AM |
SB 93 |
| SB 93 DHSS Slides SFIN 4.9.19.pdf |
SFIN 4/9/2019 9:00:00 AM |
SB 93 |
| SB 93 Support Letters 1.pdf |
SFIN 4/9/2019 9:00:00 AM |
SB 93 |
| SB 93 Support Letters 2.pdf |
SFIN 4/9/2019 9:00:00 AM |
SB 93 |
| SB 93 v U Sectional Analysis (1).pdf |
SFIN 4/9/2019 9:00:00 AM |
SB 93 |
| SB 93 v U Sectional Analysis.pdf |
SFIN 4/9/2019 9:00:00 AM |
SB 93 |
| Senate Bill 93 Sponsor Statement v U.pdf |
SFIN 4/9/2019 9:00:00 AM |
SB 93 |
| SB 43 Work Draft Version M.pdf |
SFIN 4/9/2019 9:00:00 AM |
SB 43 |
| SB 43 Work Draft v. M - Explanation.pdf |
SFIN 4/9/2019 9:00:00 AM |
SB 43 |
| SB 43 RHAK Letter CS for SB 43 - Extend Big Game Commercial Services Board.pdf |
SFIN 4/9/2019 9:00:00 AM |
SB 43 |