Legislature(2019 - 2020)BUTROVICH 205

04/03/2019 01:30 PM HEALTH & SOCIAL SERVICES

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Audio Topic
01:30:41 PM Start
01:30:57 PM SB93
01:47:46 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Bills Previously Heard/Scheduled: TELECONFERENCED
+= SB 93 MEDICAL PROVIDER INCENTIVES/LOAN REPAYM'T TELECONFERENCED
Moved CSSB 93(HSS) Out of Committee
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         April 3, 2019                                                                                          
                           1:30 p.m.                                                                                            
                                                                                                                                
                             DRAFT                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator John Coghill, Vice Chair                                                                                                
Senator Gary Stevens                                                                                                            
Senator Cathy Giessel                                                                                                           
Senator Tom Begich                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
OTHER LEGISLATORS PRESENT                                                                                                     
                                                                                                                                
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
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."                                                                                                                
                                                                                                                                
     - MOVED CSSB 93(HSS) OUT OF COMMITTEE                                                                                      
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB  93                                                                                                                  
SHORT TITLE: MEDICAL PROVIDER INCENTIVES/LOAN REPAYM'T                                                                          
SPONSOR(s): SENATOR(s) WILSON                                                                                                   
                                                                                                                                
03/18/19       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/18/19       (S)       HSS, FIN                                                                                               
03/25/19       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/25/19       (S)       Heard & Held                                                                                           
03/25/19       (S)       MINUTE(HSS)                                                                                            
03/29/19       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/29/19       (S)       -- MEETING CANCELED --                                                                                 
04/01/19       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
04/01/19       (S)       <Bill Hearing Canceled>                                                                                
04/03/19       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
JILL LEWIS, Deputy Director                                                                                                     
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Reviewed the CSSB 93 fiscal note.                                                                         
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:30:41 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:30 p.m.  Present at the                                                               
call to  order were Senators  Giessel, Coghill,  Stevens, Begich,                                                               
and Chair Wilson.                                                                                                               
                                                                                                                                
                                                                                                                                
        SB  93-MEDICAL PROVIDER INCENTIVES/LOAN REPAYM'T                                                                    
                                                                                                                                
                                                                                                                                
1:30:57 PM                                                                                                                    
CHAIR WILSON announced the consideration  of SB 93. He noted that                                                               
the  committee  heard  an  overview  of the  bill  March  25  and                                                               
discussed some  potential amendments. His office  worked with the                                                               
Department of  Health and  Social Services  (DHSS) and  the SHARP                                                               
[Supporting  Health  Access  (through  loan)  Repayment  Program]                                                               
Council to  produce a committee substitute.  Before the committee                                                               
this afternoon is work draft 31-LS0598\U.                                                                                       
                                                                                                                                
1:31:20 PM                                                                                                                    
CHAIR WILSON solicited a motion.                                                                                                
                                                                                                                                
1:31:24 PM                                                                                                                    
SENATOR  COGHILL moved  to adopt  the Committee  Substitute (CS),                                                               
work order 31-LS0598\U, as the working document.                                                                                
                                                                                                                                
1:31:37 PM                                                                                                                    
SENATOR GIESSEL objected for purposes of discussion.                                                                            
                                                                                                                                
1:31:40 PM                                                                                                                    
CHAIR WILSON reviewed changes from Version  A to Version U for SB                                                               
93.                                                                                                                             
                                                                                                                                
     Section 18.29.100 Legislative Intent:                                                                                      
     Version U  clarifies the Legislative  Intent is  to increase                                                               
     the  availability of  health  care  services throughout  the                                                               
     state,  especially  to  underserved individuals  and  health                                                               
     care    professional   shortage    areas.   References    to                                                               
     "underserved"  were  changed  to  "underserved  individuals"                                                               
     throughout the bill.                                                                                                       
                                                                                                                                
     Section 18.29.105, Advisory Council:                                                                                       
     Version U clarifies department  employees can participate as                                                               
     non-voting members, but may not  serve in a leadership role,                                                               
     and establishes that civil penalties,  not to exceed $1,000,                                                               
     per  violation, apply  to both  participating employers  and                                                               
     health care professionals.                                                                                                 
                                                                                                                                
     Section 18.29.110, Employer Payments:                                                                                      
     New  language sets  out the  annual maximum  payment amounts                                                               
     for direct incentives per tier:                                                                                            
        • Tier I: $35,000 for regular positions and $47,250 for                                                                 
          very hard-to-fill positions                                                                                           
        • Tier II: $20,000 for regular positions and $27,000 for                                                                
          very hard-to-fill positions                                                                                           
        • Tier III: $15,000 for regular positions and $20,250                                                                   
          for very hard-to-fill positions                                                                                       
                                                                                                                                
     Section 18.29.125, Student Loan Repayment:                                                                                 
     Clarifies eligibility requirements  for repayment of student                                                               
     loans.                                                                                                                     
                                                                                                                                
     Section 18.29.130, Eligibility:                                                                                            
     Clarifies  verification   of  student   loan  debt   may  be                                                               
     conducted   by  the   Alaska  Commission   on  PostSecondary                                                               
     Education or the Department of Health and Human Services.                                                                  
                                                                                                                                
     Section 18.29.190, Definitions:                                                                                            
     Adds a definition for the term "underserved individuals."                                                                  
                                                                                                                                
     Additionally, Version  U deletes  Sections 7,  9, and  10 in                                                               
     the original bill, thereby  removing all language pertaining                                                               
     to a requirement  of a doctoral degree  for advance practice                                                               
     registered nurses.                                                                                                         
                                                                                                                                
     Lastly,  the sections  throughout  the Committee  Substitute                                                               
     were re-numbered accordingly.                                                                                              
                                                                                                                                
SENATOR COGHILL asked for an explanation that in the repeal                                                                     
section, [AS18.29.]035 and [AS18.29.]099 take effect in July,                                                                   
but the rest are repealed.                                                                                                      
                                                                                                                                
SENATOR WILSON  replied that  this bill would  go into  effect in                                                               
July, thus  repealing it  at the  same time that  this new  SB 93                                                               
would be enacted.                                                                                                               
                                                                                                                                
SENATOR COGHILL  clarified that  SHARP 2  is being  repealed, for                                                               
the most part.                                                                                                                  
                                                                                                                                
CHAIR WILSON answered yes.                                                                                                      
                                                                                                                                
SENATOR COGHILL clarified that they are repealing and replacing.                                                                
                                                                                                                                
CHAIR WILSON answered yes.                                                                                                      
                                                                                                                                
1:38:51 PM                                                                                                                    
SENATOR  BEGICH asked  whether  the little  typos  in the  fiscal                                                               
notes had been corrected.                                                                                                       
                                                                                                                                
CHAIR WILSON answered yes.                                                                                                      
                                                                                                                                
1:39:11 PM                                                                                                                    
SENATOR  STEVENS  said  they  took  out  the  requirement  for  a                                                               
doctoral degree for advance practice  registered nurses. He asked                                                               
whether that was required for some positions.                                                                                   
                                                                                                                                
1:39:36 PM                                                                                                                    
SENATOR GIESSEL  said that an  advance practice  registered nurse                                                               
in  the state  of  Alaska  is not  required  to  have a  doctoral                                                               
degree.  The  profession is  moving  in  that direction.  It  may                                                               
become the level of  entry in the future, but at  this time it is                                                               
a master's degree.                                                                                                              
                                                                                                                                
SENATOR  STEVENS clarified  that there  is no  requirement for  a                                                               
doctorate for any advance practice registered nurse.                                                                            
                                                                                                                                
SENATOR   GIESSEL  replied   that   is   correct.  The   practice                                                               
requirement  for  an advance  practice  registered  nurse in  the                                                               
state of Alaska is a master's degree.                                                                                           
                                                                                                                                
CHAIR WILSON  added that the bill  has the language that  if that                                                               
requirement  or   any  requirement  for  a   professional  degree                                                               
changes, the  department can  move them  to the  appropriate tier                                                               
level, so the  department will not have to go  to the legislature                                                               
for small tweaks to the legislation.                                                                                            
                                                                                                                                
1:40:50 PM                                                                                                                    
SENATOR GIESSEL removed her objection.                                                                                          
                                                                                                                                
1:41:01 PM                                                                                                                    
CHAIR  WILSON found  no objection  and  the motion  to adopt  the                                                               
proposed committee substitute as the working document carried.                                                                  
                                                                                                                                
1:41:15 PM                                                                                                                    
JILL  LEWIS, Deputy  Director, Department  of  Health and  Social                                                               
Services  (DHSS), Juneau,  Alaska,  Reviewed the  CSSB 93  fiscal                                                               
note.  said the  Department of  Commerce, Community  and Economic                                                               
Development (DCCED)  submitted a zero  fiscal note. This  was put                                                               
in for  Version A because it  referenced an action for  the Board                                                               
of Nursing, but  those sections have been deleted  in the current                                                               
version. The  public health fiscal  note is a large  fiscal note.                                                               
It goes from $800,000 to $5  million. All of that is authority to                                                               
collect the employers' contribution.  It is not UGF [unrestricted                                                               
general funds]. It is the authority  for DHSS to collect and then                                                               
spend  the designated  program receipts  for  the employers.  The                                                               
funding  is split.  A  small  amount that  is  used for  personal                                                               
services will come  out of the administrative  fee that employers                                                               
will  include  with  their  payments. The  remainder  is  on  the                                                               
services line.  Almost all  of that is  for the  actual contracts                                                               
with practitioners. A change in  revenue is showing. The $800,000                                                               
to $5 million  just shows that it is brand  new revenue that will                                                               
be  spent on  the program.  It is  a net  zero: money  coming in,                                                               
money coming out.  For the third year, a new  position is listed.                                                               
That is an anticipation of the  volume growing to the extent that                                                               
it cannot  be handled  by existing staff.  The fiscal  notes also                                                               
account for, in  the services line, a small amount  that would go                                                               
to a  contractor in year five  if they continue to  see growth in                                                               
the program and the additional  staff member would need even more                                                               
help.                                                                                                                           
                                                                                                                                
SENATOR BEGICH asked about the  personal services line increasing                                                               
but remaining at one position.                                                                                                  
                                                                                                                                
MS. LEWIS  replied that as  the program grows, they  will collect                                                               
additional receipts in  the administrative fee because  that is a                                                               
percent  of  the loan  values  they  collect.  As they  grow  the                                                               
program,  so  will  the  administrative  fees.  Those  fees  will                                                               
initially support an  existing staff person who  runs the program                                                               
now. Eventually  they will have  enough money to fully  fund that                                                               
person with fees from SHARP 3 and SHARP 1.                                                                                      
                                                                                                                                
1:45:18 PM                                                                                                                    
CHAIR WILSON solicited a motion.                                                                                                
                                                                                                                                
1:45:26 PM                                                                                                                    
SENATOR  COGHILL  moved  to  report  CSSB  93,  Version  U,  from                                                               
committee  with   individual  recommendations   and  accompanying                                                               
fiscal notes.                                                                                                                   
                                                                                                                                
1:45:36 PM                                                                                                                    
CHAIR WILSON  found no  objection and CSSB  93(HSS) moved  out of                                                               
committee.                                                                                                                      
                                                                                                                                
1:45:52 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
1:45:56 PM                                                                                                                    
CHAIR  WILSON  reconvened  the meeting.  He  noted  that  Senator                                                               
Stevens had  been present for  the discussion but was  absent for                                                               
the vote on SB 93.                                                                                                              
                                                                                                                                
1:47:46 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair  Wilson adjourned  the Senate  Health  and Social  Services                                                               
Standing Committee at 1:47 p.m.                                                                                                 
                                                                                                                                

Document Name Date/Time Subjects
SB 93 Work Draft version U.pdf SHSS 4/3/2019 1:30:00 PM
SB 93
SB 93 LoS 4.2.19.pdf SHSS 4/3/2019 1:30:00 PM
SB 93
SB 93 Explanation of Changes A to U.pdf SHSS 4/3/2019 1:30:00 PM
SB 93