00 CS FOR HOUSE BILL NO. 78(HSS) 01 "An Act establishing a loan repayment program and employment incentive program for 02 certain health care professionals employed in the state; and providing for an effective 03 date." 04 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 05  * Section 1. AS 18 is amended by adding a new chapter to read: 06 Chapter 29. Health Care Professions Loan Repayment and Incentive Program.  07 Sec. 18.29.010. Legislative intent. The loan repayments and direct incentive 08 payments provided under this chapter are intended to ensure that residents throughout 09 the state, including recipients of medical assistance and Medicare, have access to 10 health care and that residents of rural areas of the state, in particular, experience 11 improved access to health care services. 12 Sec. 18.29.015. Health care professions loan repayment and incentive  13 program; purpose; advisory body. (a) The health care professions loan repayment 14 and incentive program is established in the department for the purpose of addressing 01 the worsening shortage of certain health care professionals in the state by increasing 02 the number and improving the distribution of health care professionals who provide 03 direct patient care. 04 (b) The program established under this section must include 05 (1) direct incentives paid under AS 18.29.020; 06 (2) loan repayments made under AS 18.29.025; 07 (3) procedures for the commissioner's designation and prioritization of 08 sites eligible for participation in the program; 09 (4) an application process for participation in the program as 10 (A) an eligible site; or 11 (B) a tier I or tier II health care professional; 12 (5) the dissemination of public information and notices pertinent to the 13 program; 14 (6) classification by the commissioner of each eligible site as having 15 either regular or very hard-to-fill positions, or both; 16 (7) matching payments, as provided under (d) of this section; 17 (8) a lifetime maximum period of 12 years for participation in the 18 program by a tier I or tier II health care professional, as described in (f) of this section; 19 (9) procedures for allowable leaves of absence; and 20 (10) annual program evaluations and reports. 21 (c) The program shall be administered by the commissioner in consultation 22 with an advisory body appointed by the commissioner. The advisory body is made up 23 of members with health care expertise, including expertise in economic issues 24 affecting the hiring and retention of health care professionals in the state. Members of 25 the advisory body serve at the pleasure of the commissioner to provide 26 recommendations for and oversight and evaluation of all aspects of the program. The 27 commissioner shall accept a recommendation of the advisory body on a matter 28 pertaining to the identification and monitoring of areas of shortages, eligible sites, 29 payment priorities, or evaluation of the program, unless the commissioner finds, in 30 writing, that the recommendation cannot be financially or otherwise supported by the 31 department. 01 (d) An employer or other entity approved for participation in the program shall 02 make nonrefundable quarterly matching payments to the department for deposit in the 03 general fund. The payments must be in an amount that is 04 (1) a portion of the combined annual incentive payment and the loan 05 repayment amounts paid under the program for the benefit of the employee, as 06 determined by the commissioner; and 07 (2) adjusted by the employer's or other entity's ability to pay, as 08 determined by the commissioner, in consultation with the program advisory body. 09 (e) A matching loan repayment or direct incentive payment made under (d) of 10 this section shall be paid as a combined amount to the professional by the department 11 from money appropriated for the purpose. 12 (f) The department may approve loan repayment and direct incentive 13 payments for a qualified applicant under the program for three-year periods, as 14 follows: 15 (1) an initial period of three years; 16 (2) a renewal period of three years if the applicant 17 (A) requests loan repayments and has a continuing loan 18 obligation on the same loan that was subject to repayment under the program 19 during the initial three-year period and is otherwise eligible under the program; 20 (B) continues to qualify for direct incentive payments under the 21 program; or 22 (C) is eligible under both (A) and (B) of this paragraph; 23 (3) a reapplication period of six years that is equivalent to (1) and (2) 24 of this subsection if the applicant is engaged in qualified employment and the 25 applicant 26 (A) requests additional loan repayments under the program and 27 has incurred additional loans that qualify for repayment under the program 28 during or after the first six years of the applicant's participation in the program; 29 (B) requests additional direct incentive payments under the 30 program; or 31 (C) is eligible under both (A) and (B) under this paragraph. 01 (g) The department shall prorate loan repayments and direct incentive 02 payments under the program based on the number of hours of qualified employment 03 worked in a calendar quarter. However, the department may not make a loan 04 repayment or direct incentive payment before the completion of a calendar quarter for 05 which the loan repayment or incentive payment is made. 06 (h) The department shall adopt regulations necessary to implement the 07 program. 08 (i) Direct incentive payments, loan repayments, and matching payments shall 09 be made with funds appropriated by the legislature for that purpose. 10 Sec. 18.29.020. Direct incentives. (a) The department shall provide direct 11 incentives in the form of quarterly cash payments to eligible tier I and tier II health 12 care professionals engaged in qualified employment. 13 (b) Payments made under this section, when combined with a matching 14 payment and a loan repayment amount paid under AS 18.29.025, if any, may not 15 exceed 16 (1) $35,000 annually for a tier I health care professional employed in a 17 regular position; 18 (2) $47,000 annually for a tier I health care professional employed in a 19 very hard-to-fill position; 20 (3) $20,000 annually for a tier II health care professional employed in 21 a regular position; or 22 (4) $27,000 annually for a tier II health care professional employed in 23 a very hard-to-fill position. 24 (c) The commissioner shall calculate the annual incentive payment amount by 25 multiplying the annual maximum payment under (b) of this section by the percentage 26 of full time equivalent employment for each of not more than three years of qualified 27 employment less a matching payment amount as determined under AS 18.29.015(d) of 28 this section and loan repayment amount, if any, under AS 18.29.025. 29 Sec. 18.29.025. Loan repayment. (a) The commissioner shall repay a portion 30 of eligible education loans described in this section that are held by or made to eligible 31 tier I and tier II health care professionals under the program according to the loan 01 repayment procedures established in this section. 02 (b) A loan is eligible for repayment under the program if the loan was issued 03 by a government or commercial entity for the payment of actual costs of tuition and 04 other reasonable educational and living expenses related to the undergraduate or 05 graduate education of a participant who is eligible under AS 18.29.035 and that 06 resulted in a degree required for employment as a tier I or tier II health care 07 professional under the program. 08 (c) A loan repayment under this section when combined with a matching 09 payment shall be in an amount not to exceed 33.3 percent of the unpaid loan balance 10 existing in the first year of program participation, multiplied by the percentage of full 11 time equivalent employment for each of up to three years of qualified employment less 12 a matching loan repayment or incentive amount from an employer or other entity as 13 determined under AS 18.29.015(d). 14 (d) The commissioner shall make a loan repayment under this section in 15 quarterly installments payable to the lending institution or to the eligible health care 16 professional. 17 (e) A loan or interest on a loan is not eligible for repayment under this section 18 if the loan or interest is 19 (1) to be repaid by another source, including another loan repayment or 20 forgiveness program or an employer-sponsored repayment program; 21 (2) consolidated with a loan that is not eligible for repayment; or 22 (3) refinanced. 23 Sec. 18.29.030. Number of participants. (a) The number of participants to 24 whom the commissioner may provide a direct incentive payment, loan repayment, or 25 both under the program established under AS 18.29.015 may not exceed 90 26 participants annually as described in (b) of this section, regardless of whether the 27 participants are new participants, continuing participants, or both. 28 (b) The commissioner shall reserve sufficient funding for not fewer than three 29 positions in each of the 10 tier I and tier II health care professions in very hard-to-fill 30 positions at eligible sites. 31 (c) If insufficient funds are appropriated in a fiscal year, the department shall 01 prorate payments based on the number of approved participants in the program. 02 Sec. 18.29.035. Eligibility and priority. (a) To be eligible for a direct 03 incentive payment under AS 18.29.020, an individual shall 04 (1) submit an application that is approved by the commissioner; 05 (2) be engaged in qualified employment at an eligible site with a 06 participating employer or entity; 07 (3) be licensed or exempt from licensure as a tier I or tier II health care 08 professional in the state; 09 (4) meet a priority for payment established under (c) of this section; 10 and 11 (5) meet other criteria established by the commissioner. 12 (b) To be eligible for loan repayment under AS 18.29.025, an individual shall 13 (1) meet eligibility and priority criteria established under (a) of this 14 section; and 15 (2) have an unpaid balance on one or more eligible education loans 16 described under AS 18.29.025 and verified by the Alaska Commission on 17 Postsecondary Education. 18 (c) The commissioner shall establish priorities for payment of incentives and 19 loan repayments under the program based on the recommendations of the program 20 advisory body and the availability of funding. The commissioner shall prioritize 21 eligible sites based on the needs assessment for the site, remoteness of the site, the 22 percentage of underserved patients treated at the site, or a combination of these 23 elements; in this subsection, an underserved patient 24 (1) is uninsured; 25 (2) receives or is eligible to receive medical assistance or Medicare 26 coverage; or 27 (3) receives or is eligible to receive other federal health program 28 benefits. 29 Sec. 18.29.099. Definitions. In AS 18.29.010 - 18.29.099, 30 (1) "commissioner" means the commissioner of health and social 31 services; 01 (2) "department" means the Department of Health and Social Services; 02 (3) "eligible site" means a service area or health care facility that the 03 commissioner has designated as located in a health care services shortage area based 04 on a needs assessment score and employment statistics for qualified tier I or tier II 05 health care professionals; 06 (4) "program" means the health care professions loan repayment and 07 incentive program; 08 (5) "qualified employment" means employment of a tier I or tier II 09 health care professional at an eligible site at which the health care professional is hired 10 and paid to work 11 (A) in a full-time or not less than half-time position; 12 (B) for a contract term that is not less than three years; and 13 (C) not less than 50 percent time on direct patient health care 14 services; 15 (6) "tier I health care professional" means a person licensed or exempt 16 from licensure in the state as a dentist, pharmacist, or physician; 17 (7) "tier II health care professional" means a person licensed or exempt 18 from licensure in the state as a dental hygienist, registered nurse, certified nurse 19 practitioner, physician assistant, physical therapist, clinical psychologist, or clinical 20 social worker holding at least a master's degree in social work. 21  * Sec. 2. The uncodified law of the State of Alaska is amended by adding a new section to 22 read: 23 HEALTH CARE INCENTIVE PROGRAM REPORT. On or before January 1, 2019, 24 the Department of Health and Social Services shall prepare and submit a report to the 25 legislature that describes the participation rates, costs, and effect on health care profession 26 shortage areas, as designated by the commissioner of health and social services, of the health 27 care profession incentive program established under AS 18.29.015. 28  * Sec. 3. AS 18.29.010, 18.29.015, 18.29.020, 18.29.025, 18.29.030, 18.29.035, and 29 18.29.099 are repealed June 30, 2019. 30  * Sec. 4. This Act takes effect immediately under AS 01.10.070(c).