04/06/2009 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB2 | |
| SB139 | |
| SB27 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 2 | TELECONFERENCED | |
| += | SB 139 | TELECONFERENCED | |
| += | SB 27 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 6, 2009
1:32 p.m.
MEMBERS PRESENT
Senator Bettye Davis, Chair
Senator Joe Paskvan, Vice Chair
Senator Johnny Ellis
Senator Joe Thomas
Senator Fred Dyson
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 2(HSS)
"An Act relating to the issuance of a certificate of birth
resulting in a stillbirth."
MOVED CSHB 2(HSS) OUT OF COMMITTEE
SENATE BILL NO. 139
"An Act establishing a loan repayment program and employment
incentive program for certain health care professionals employed
in the state; and providing for an effective date."
MOVED CSSB 139(HSS) OUT OF COMMITTEE
SENATE BILL NO. 27
"An Act relating to tuition waivers for a child who was in
foster care; relating to eligibility for foster care and subsidy
payments for a hard-to-place child; and amending the definition
of 'child' in certain statutes."
MOVED CSSB 27(HSS) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 2
SHORT TITLE: BIRTH CERTIFICATE FOR STILLBIRTH
SPONSOR(s): REPRESENTATIVE(s) GATTO
01/20/09 (H) PREFILE RELEASED 1/9/09
01/20/09 (H) READ THE FIRST TIME - REFERRALS
01/20/09 (H) HSS, JUD
02/26/09 (H) HSS AT 3:00 PM CAPITOL 106
02/26/09 (H) Heard & Held
02/26/09 (H) MINUTE(HSS)
03/12/09 (H) HSS AT 3:00 PM CAPITOL 106
03/12/09 (H) Moved CSHB 2(HSS) Out of Committee
03/12/09 (H) MINUTE(HSS)
03/13/09 (H) HSS RPT CS(HSS) 4DP 2NR
03/13/09 (H) DP: LYNN, SEATON, COGHILL, KELLER
03/13/09 (H) NR: CISSNA, HERRON
03/16/09 (H) JUD RPT CS(HSS) 5DP
03/16/09 (H) DP: LYNN, COGHILL, GATTO, DAHLSTROM,
RAMRAS
03/16/09 (H) JUD AT 8:00 AM CAPITOL 120
03/16/09 (H) Moved CSHB 2(HSS) Out of Committee
03/16/09 (H) MINUTE(JUD)
03/23/09 (H) TRANSMITTED TO (S)
03/23/09 (H) VERSION: CSHB 2(HSS)
03/25/09 (S) READ THE FIRST TIME - REFERRALS
03/25/09 (S) HSS
04/06/09 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: SB 139
SHORT TITLE: INCENTIVES FOR CERTAIN MEDICAL PROVIDERS
SPONSOR(s): SENATOR(s) OLSON
03/09/09 (S) READ THE FIRST TIME - REFERRALS
03/09/09 (S) HSS, FIN
03/25/09 (S) HSS AT 1:30 PM BUTROVICH 205
03/25/09 (S) Heard & Held
03/25/09 (S) MINUTE(HSS)
04/06/09 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: SB 27
SHORT TITLE: FOSTER CARE AGE LIMIT/TUITION WAIVER
SPONSOR(s): SENATOR(s) DAVIS
01/21/09 (S) PREFILE RELEASED 1/9/09
01/21/09 (S) READ THE FIRST TIME - REFERRALS
01/21/09 (S) HSS, L&C, FIN
03/11/09 (S) HSS AT 1:30 PM BUTROVICH 205
03/11/09 (S) Heard & Held
03/11/09 (S) MINUTE(HSS)
03/18/09 (S) HSS AT 1:30 PM BUTROVICH 205
03/18/09 (S) Scheduled But Not Heard
03/27/09 (S) HSS AT 1:15 PM BUTROVICH 205
03/27/09 (S) Heard & Held
03/27/09 (S) MINUTE(HSS)
04/06/09 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
SANDRA WILSON
Aide to Representative Gatto
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Presented CSHB 2(HSS) for the sponsor.
MICHELLE WHITE, representing herself
POSITION STATEMENT: Supported HB 2.
SENATOR DONNY OLSON
State Capital
Juneau, AK
POSITION STATEMENT: Sponsor of SB 139.
KENDRI CEASAR
Staff to Senator Olson
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Commented on SB 139 for the sponsor.
DR. JAY BUTLER
Alaska Chief Medical Officer
Department of Health and Social Services (DHSS)
POSITION STATEMENT: Opposed SB 139 because of funding issues.
ROD BETIT, President/CEO
Alaska State Hospital and Nursing Home Association (ASHNHA
POSITION STATEMENT: Supported SB 139.
SHELLEY HUGHES, Director
Government Affairs
Alaska Primary Care Association
POSITION STATEMENT: Supported SB 139.
PAT LUBI, Advocacy Director
AARP Alaska
POSITION STATEMENT: Supported SB 139.
JEAN MISCHEL, Drafting Attorney
Legislative Legal Division
Legislative Affairs Agency
State Capital
Juneau AK
POSITION STATEMENT: Answered questions on SB 139.
TOM OBERMEYER, staff to Senator Davis
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Commented on SB 27 for the sponsor
MIKE LESSMAN, Manager
Community Relations and Legislative Contact
Office of Children's Services (OCS)
Department of Health and Social Services (DHSS)
POSITION STATEMENT: Neutral position on CSSB 27(HSS) because of
priority issues.
ACTION NARRATIVE
1:32:46 PM
CHAIR BETTYE DAVIS called the Senate Health and Social Services
Standing Committee meeting to order at 1:32 p.m. Present at the
call to order were Senators Paskvan, Ellis, Dyson, Thomas and
Davis.
HB 2-BIRTH CERTIFICATE FOR STILLBIRTH
1:33:17 PM
CHAIR DAVIS announced consideration of HB 2. [CSHB 2(HSS) was
before the committee.
SANDRA WILSON, aide to Representative Gatto, sponsor of HB 2,
presented the sponsor statement. It allows parents who had a
still born child to get a birth certificate for that child.
Currently, all they receive is a fetal death certificate.
Parents who have stillborn children go through the same labor as
parents whose child takes their first breath. Being able to get
a birth certificate for their child will validate that they had
a child; the certificate is completely optional and has to be
requested by the parent. Twenty-six other states have passed
similar legislation. This will bring some closure to parents who
are suffering through their loss.
1:35:12 PM
SENATOR DYSON asked how long a child may live outside the womb
before parents can claim a tax deduction or Permanent Fund
Dividend (PFD).
MS. WILSON said she was not sure, but this particular bill does
not provide any rights to claim a tax deduction or a PFD. The
birth certificate does not claim a live birth.
CHAIR DAVIS asked how the House voted on this.
MS. WILSON replied it passed the House by a vote of 29 to 1.
1:37:33 PM
MICHELLE WHITE, representing herself, supported HB 2. She said
her daughter was stillborn on March 30, 2004. She went through a
natural birth process, but was not able to get a birth
certificate. She had to go through the grieving process - the
depression, the going home with no child, the funeral
arrangements, along with the hospital bills of having a child.
This bill will bring closure to many grieving parents.
CHAIR DAVIS noted a zero fiscal note.
1:38:33 PM
SENATOR PASKVAN moved to report CSHB 2(HSS) from committee with
individual recommendations and attached fiscal note(s). There
being no objection, the motion carried.
SB 139-INCENTIVES FOR CERTAIN MEDICAL PROVIDERS
1:41:31 PM
CHAIR DAVIS announced consideration of SB 139.
SENATOR OLSON, sponsor of SB 139, said this is an incentive
program to recruit health care practitioners to underserved
areas of the state in areas that are hard to fill. Forty-four
other states already have loan repayment programs of some kind
and Alaska needs to do something as well.
He didn't think that many people fully understood the crisis the
state is in already and what it is heading for. The Nome
hospital had eight full-time staff several years ago, and is now
down to three. Because of that everybody is scrambling for the
temporary physicians and the competition is getting overwhelming
- not just from other hospitals throughout the state of Alaska,
but from hospitals throughout the whole United States. This
isn't an isolated case; there are shortages in all parts of the
state.
1:44:19 PM
SENATOR PASKVAN moved to adopt CSSB 139, labeled 26-LS0503\P as
the working document. There being no objection, version P was
before the committee.
1:44:56 PM
KENDRI CEASAR, staff to Senator Olson, said she went through a
lengthy description of the payment plan at the first meeting,
so, she would explain the changes in the committee substitute
(CS), most of which were just clarifying changes to more
accurately reflect the intent of the program. Language on page
1, line 14, says the Alaska Commission on Postsecondary
Education shall act as disbursing agent. The original bill said
the commission shall act as the fiscal agent. It was changed to
clarify that the intent is not for the commission to act as
appropriating entity and that the funds used for loan repayment
will not be falling to the commission's budget.
On page 2, lines 9-10, in reference to eligibility, "approved"
was changed to "verified" to clarify that the commission does
not provide the loans. Lines 12-14 in the original bill said in
first repayment year, and it now says in first year of program
participation. Page 3, line 28, had a simple technical
correction - AS 14.43.435 was changed to properly reference AS
14.33.430.
The last change was on page 5, lines 20-22, which says the
commissioner shall prioritize eligible sites based on the
percentage of patients treated at the site who (1) are uninsured
(2) have or are eligible for medical assistance or Medicare
coverage; or (3) have or are eligible for other federal health
program benefits. The original bill didn't include those who
have or are eligible for other federal health program benefits,
such as those covered under VA or tribal benefits.
The original bill also based the prioritization of sites on the
volume of these types of patients treated rather than the
percentage. This change was made so as not to give advantage to
larger urban clinics that because of their overall large numbers
of patients might treat a smaller percentage of these patients
than a smaller clinic that treats smaller numbers of patients to
begin with. All these changes were made in consultation with
Diane Barrans of the Alaska Commission on Postsecondary
Education and Tim Schuerch of the Alaska Native Health Board.
They do not change the overall purpose of the bill nor do they
address the issues that were brought up in the first committee
hearing.
She said that Senator Dyson had questions regarding how the
initial 10 practitioners in this program were chosen.
1:50:09 PM
SENATOR DYSON said he also want to know the definition of a
clinical psychologist.
MS. CESAR responded that Rod Betit, Alaska State Hospital and
Nursing Home Association, who played a key role in outlining the
proposed program in SB 139 could answer those questions as well
as summarize the bill for the committee.
1:50:48 PM
DR. JAY BUTLER, Alaska Chief Medical Officer, said he wanted to
address Senator Paskvan's question from the last hearing. He
said the administration is very conscious of the public health
challenge in maintaining a sufficient health care workforce. It
also recognized the work of the working group that developed the
plan to address the work force issues, but the administration
opposes the bill at this time because funding presents a
challenge.
He explained that other aspects of the budget are designed to
address the workforce challenges including the UAA money for the
family practice residency program - which is one of the most
powerful predictors for where a physician will ultimately set up
practice. A probity has been placed on providing funding to the
Alaska Student Loan Corporation to make sure loans are available
for students coming in at the undergraduate level.
1:53:21 PM
ROD BETIT, President/CEO, Alaska State Hospital and Nursing Home
Association (ASHNHA), responded to Senator Dyson's question
about how they came up with the 10 occupations. He said they
started with a vacancy study to see how severe the shortage was
in various parts of the state. They also looked at the Physician
Supply Task Force study from 2006, which he was a part of. At
that time they found Alaska was about 300 physicians short. Then
they took that information back to the work group, which
resolved it into the 10 occupations in the bill. Five of those
specifically address the behavior health area - the physician
category, which includes psychiatrists, nurse practitioner as
well as psychologist, the clinical social worker and the
physician assistant. Four of those have the ability to charge
and receive payment for the services that they deliver in their
own right. Particularly since this is focuses in rural areas,
they wanted to be sure to provide health care providers that
could generate revenue for those locations. The physician
assistant cannot do that except through a physician, but they
can provide services under the supervision of a physician who
can then bill for those services. That is how they got to the 10
categories, but they are open for discussion.
A very strong part of this legislation is that once the advisory
committee makes recommendations, they have to be accepted by the
department unless the commissioner puts in writing why not.
MR. BETIT said it is very important to move forward and at least
establish the program. He knows the department is in an awkward
position now, but he doesn't think the two things the
administration mentioned will help deal with the health care
crisis now, particularly in the rural and hard to fill areas.
1:58:24 PM
MR. BETIT said that a clinical psychologist has an advanced
degree and has to meet licensing requirements in this state. He
isn't completely clear on the required education level.
SENATOR DYSON said in-state licensed clinical counselors are as
well equipped to deal with behavioral issues as clinical
psychologists. So if this bill doesn't include those state-
licensed people, he has a problem with it.
2:00:08 PM
CHAIR DAVIS asked if anyone from legal was available to answer
that.
MS. CESAR replied no.
SENATOR THOMAS asked if ASHNHA is willing to participate in some
kind of a match for the grants or the repayment of loans.
MR. BETIT said he hadn't put that to his membership, but this is
not intended to help hospitals except in the smallest areas. The
small rural locations don't have the ability to attract
providers, and he didn't know if they were in a position to do
more than they are with the University's expanded nursing
program.
2:02:14 PM
SHELLEY HUGHES, Director, Government Affairs, Alaska Primary
Care Association, provided a chart entitled, "Why a Loan
Repayment and Incentive Program is Better Than Other Support-
for-Service Program Types." She remarked that a number of
proposals are "floating around" and they all have good
intentions in trying to meet the workforce shortage, but this
chart shows how this particular one is better for the state, as
far as being cost effective and result-producing. It doesn't put
the state at risk of loan default because it doesn't hold the
loan. It provides for less administration because there is no
need to track the person from their time as a student all the
way through to their time working in the field.
2:05:32 PM
PAT LUBI, Advocacy Director, AARP Alaska, expressed AARP's
strong support for SB 139. Without it, Alaska cannot compete
with other states for health care providers and workers.
2:08:04 PM
JEAN MISCHEL, Drafting Attorney, Legislative Legal Division,
Legislative Affairs, regarding a definition for clinical
psychologist, said the Board of Psychology doesn't license
psychologists specifically by type, but it does require certain
degrees before issuing one - and one of those is a degree in
clinical psychology. In her opinion, unless it is defined
otherwise, that would be the definition that would apply here.
MS. CESAR said the Division of Occupational Licensing requires a
PHD level degree for a statewide license in clinical psychology.
A Masters would qualify someone as only a professional counselor
or a psychologist associate.
SENATOR DYSON said he is disappointed that the CS doesn't
address his question. He pointed out that a Masters level
clinical psychology student here qualifies for a state license
and can bill for payment. To include them, but not including
social workers in the behavioral sciences seems to be unwise and
unjust.
SENATOR OLSON said he came up with the types of health care
providers with the help of the commission that Rod Betit was on.
MR. BETIT added that they are referring to the ad hoc workgroup
of interested parties, and this specific question never came up
in their discussions. This was their best effort initially, and
he had no problem with adding another occupation.
2:13:44 PM
SENATOR DYSON said he wasn't prepared with an amendment today,
but could have one by Wednesday. There are two other licensed
boards - one is marriage and family counseling and the other is
maybe behavioral counseling - who work in alcohol rehabilitation
programs and residential programs for children.
CHAIR DAVIS asked if there is a shortage in those areas that he
could verify.
SENATOR DYSON asked Mr. Betit the group did their research how
did they determine what jobs they were short in.
MR. BETIT replied that they worked with the organizations that
represent people who work in that area regularly - every tribal
organization, the Mental Health Trust, primary care level
organizations, the State Health Planning and Systems Development
people.
2:16:12 PM
SENATOR DYSON said he would try to get that information.
SENATOR OLSON said nothing else could act more immediately to
attract these health care providers to these hard-to-find areas.
He had no problem adding Senator Dyson's amendment to the bill,
but it may increase the fiscal note.
2:19:35 PM
SENATOR ELLIS said he appreciated Senator Olson bringing this
bill forward. Alaska is behind on this issue; it should have
tripled the WWAMI class three years ago, and this is the most
immediate thing they can do. He was very much in support of it.
CHAIR DAVIS said she would support adding a category if it is
needed.
SENATOR DYSON said if the sponsor would agree to support his
amendment in Finance he would agree to move the bill today.
SENATOR OLSON said as long as the other committee members agree
then he will do so.
2:23:21 PM
SENATOR PASKVAN moved to report CS for SB 139 from committee
with individual recommendations and attached fiscal note(s).
There being no objection, CSSB 139(HSS) moved from committee.
At ease from 2:23 p.m. to 2:25 p.m.
SB 27-FOSTER CARE AGE LIMIT/TUITION WAIVER
2:25:32 PM
CHAIR DAVIS announced consideration of SB 27. [CSSB 27, version
E was before the committee having been adopted at the 3/11/09
hearing.]
TOM OBERMEYER, staff to Senator Davis, said this bill provides
waivers of tuition and fees combined with other assistance to
help foster or out-of-home care children to enjoy the
opportunity and benefits of higher education afforded to others.
The University of Alaska (UA) has increased from 5 to 10
students statewide who were in foster care for tuition waivers,
but that isn't nearly enough. This bill attempts to provide many
more foster kids to go to college, it extends a court order age
to 21 for a child committed to the custody of the department, it
significantly changes "foster care" to "out-of-home care" for
purposes of a transition to an independent living program, and
adds a monetary stipend for children in the transition program
for a specified period of time up to one year. In the past these
youth who "aged out" of foster care were given financial
assistance for housing up to two months.
At ease from 2:27 p.m. to 2:30 p.m.
2:30:51 PM
MIKE LESSMAN, Manager, Community Relations and Legislative
Contact, Office of Children's Services (OCS), Department of
Health and Social Services (DHSS), said there are three fiscal
notes, because three components of the OCS budget would be
impacted. First, this extends the age a child can be in state
custody to 21; so the department would be paying for an
additional year for some youth. Another financial impact is
found in Section 12, the provision that provides for monetary
living expense stipend. And third, the state automated child
welfare system, ORCA, would require programming changes to
accommodate age changes.
CHAIR DAVIS said he might want to just run through the fiscal
notes.
2:34:46 PM
MR. LESSMAN explained that this is new territory for the OCS,
and these figures are basically their best guess.
SENATOR DYSON asked if he could say what the department's
position is.
MR. LESSMAN replied that the department is neutral.
SENATOR DYSON asked if he is correct that the cost would be
about $2.5 million per year.
MR. LESSMAN replied that in FY2010 the monetary stipend portion
alone is about $5 million. The foster care age increase to 21 is
about $725,000.
2:37:10 PM
CHAIR DAVIS said this is a positive way to spend the state's
money. The fiscal note represents all of the children who could
conceivably be served, but not all will take advantage of this
program. She noted that she heard no objections other than
monetary.
MR. LESSMAN explained that the premise behind the department's
neutral position is a simple matter of priorities. He said OCS
recently got its results of the federal review that said they
really need to concentrate on timeliness of investigations,
keeping children in their homes if it is safe to do so, and
doing more home visits. Families need to be reunified more
quickly and safely. So their priorities are on the front end of
the system.
2:40:02 PM
SENATOR DYSON said he'd like to see a copy of the audit results.
MR. LESSMAN said it is on the OCS web site.
SENATOR PASKVAN moved to report CS for SB 27 from committee with
individual recommendations and attached fiscal note(s). There
being no objection, CSSB 27(HSS) moved from committee.
2:42:03 PM
There being no further business to come before the committee,
Chair Davis adjourned the meeting at 2:42 p.m.
| Document Name | Date/Time | Subjects |
|---|