SB 93-MEDICAL PROVIDER INCENTIVES/LOAN REPAYM'T  1:30:57 PM CHAIR WILSON announced that the only order of business would be 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." CHAIR WILSON recapped that the sponsor presented an overview of SB 93 during the March 25, 2019, meeting. The committee discussed some potential amendments. His office worked with the Department of Health and Social Services (DHSS) and SHARP [Supporting Health Access Repayment Program] to produce a committee substitute. 1:31:20 PM CHAIR WILSON solicited a motion to adopt the proposed committee substitute (CS). 1:31:24 PM SENATOR COGHILL moved to adopt the committee substitute (CS) for SB 93, 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 the explanation of changes for the committee substitute (CS) SB 93 from Version A to Version U: 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. 1:33:08 PM At-ease. 1:33:36 PM CHAIR WILSON referred to pages 3-5 to Section 18.29.110: 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 CHAIR WILSON said the $15,000 was selected by the department after input from the stakeholders. Section 18.29.125, Student Loan Repayment: Clarifies eligibility requirements for repayment of student loans. CHAIR WILSON referred to the next change on page 6, line 25, which added the department, in case the commission was dismantled, as the entity who can verify student loan debt. 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. CHAIR WILSON referred to pages 6-8. 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. CHAIR WILSON said that several testifiers suggested that the program benefits should be available to underserved individuals, so a definition was added in AS 18.19.190. Carryover language from House Bill 78 and language in SB 93 allow the commissioner to add other health care professions to Tier I and Tier II. It does not change the existing educational requirements so if the minimum degree requirements for an advance practice registered nurse were to change in the future, this bill allows the occupation to move to the appropriate tier. 1:37:33 PM SENATOR COGHILL asked for further clarification on the language in Section 2, which shows [AS 18.29.]035 and [AS 18.29.]099 are effective in July but also lists the same statues as repealed. SENATOR WILSON replied that SB 93 would go into effect in July, thus repealing it at the same time that the new provisions in SB 93 would be enacted. SENATOR COGHILL asked if SHARP 2 was primarily being repealed. CHAIR WILSON answered yes. SENATOR COGHILL asked if the bill was being repealed and replaced. 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 that Version M removed the requirement for a doctoral degree for advance practice registered nurses. He asked whether doctoral degrees were required for some positions. 1:39:36 PM SENATOR GIESSEL said that an advance practice registered nurse in the state is not required to have a doctoral degree. The profession is moving in that direction and it may become the level of entry in the future, but at this time the requirement for the position 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. She reiterated that the practice requirement for an advance practice registered nurse in Alaska is a master's degree. CHAIR WILSON reiterated that the bill included language that if that requirement or any requirement for a professional degree changes, the department can move them to the appropriate tier level. 1:40:50 PM SENATOR GIESSEL removed her objection. 1:41:01 PM CHAIR WILSON found no further objection. Therefore, CSSB 93, work order 31-LS0589\U, was adopted. 1:41:41 PM JILL LEWIS, Deputy Director, Department of Health and Social Services (DHSS), Juneau, reviewed the CSSB 93 fiscal notes. She said the Department of Commerce, Community and Economic Development (DCCED) submitted a zero fiscal note for Version A because it referenced an action concerning the Board of Nursing. However, those sections have been deleted in Version U. The fiscal note for Department of Health and Social Services (DHSS), Public Health, Emergency Programs, is a large fiscal note. It increases from $814,300 in FY 2020 to $5.043 million in FY 2025. This provides the authority to collect and spend the designated program receipts for the employers' contribution to the DHSS and does not have any UGF [unrestricted general funds]. She said the funding has a small amount for personal services derived from the administrative fee that employers include with their payments. The remainder of the operating expenditures is in services, which is for the actual contracts with practitioners. As previously mentioned, the revenue listed for $814,300 in FY 2020 to $5.043.0 million shows that it is new revenue for the program. The net amount is zero. MS. LEWIS indicated that in the third year, a new position is listed, which anticipates the volume growing to the extent that it cannot be handled by existing staff. It also provides a small amount to pay for a contractor in year five if the program continues to grow to provide additional staff support. 1:44:08 PM SENATOR BEGICH asked for clarification that personal services increased from 153.3 in FY 2023 to 238.9 in FY 2024, but the program remains at one position. MS. LEWIS replied that as the program grows, the department will collect additional receipts in the administrative fee because the fees are a percent of the loan values that the department collects. As the program grows, so will the administrative fees. Those fees will initially support the existing staff person who currently administers the program. Eventually the program will receive enough fees to fully fund the staff person with fees from [Supporting Health Access Repayment Program] SHARP 3. The division will also impose a fee for SHARP 1, so other resources will be available. 1:45:18 PM CHAIR WILSON solicited a motion. 1:45:26 PM SENATOR COGHILL moved to report the CS for SB 93, Version U, from committee with individual recommendations and accompanying fiscal notes. There being no further objection, the CSSB 93(HSS) was reported from the Senate Health and Social Services Standing Committee. CHAIR WILSON said that Legislative Legal Services is authorized to make any necessary technical or conforming adjustments. 1:45:48 PM At ease. 1:47:06 PM CHAIR WILSON reconvened the meeting. He remarked that Senator Stevens was present for the discussion but was absent for the vote to move CSSB 93(HSS) from committee.