Legislature(2019 - 2020)SENATE FINANCE 532

04/09/2019 09:00 AM FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= SB 43 EXTEND BIG GAME COMMERCIAL SERVICES BOARD TELECONFERENCED
Moved CSSB 43(FIN) Out of Committee
+ SB 44 TELEHEALTH: PHYSICIAN ASSISTANTS; DRUGS TELECONFERENCED
Heard & Held
-- Public Testimony <Time Limit May Be Set> --
+ SB 93 MEDICAL PROVIDER INCENTIVES/LOAN REPAYM'T TELECONFERENCED
Heard & Held
-- Public Testimony <Time Limit May Be Set> --
+ Bills Previously Heard/Scheduled 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