00 Enrolled HB 78 01 Establishing a loan repayment program and employment incentive program for certain health 02 care professionals employed in the state; and providing for an effective date. 03 _______________ 04 * Section 1. AS 18 is amended by adding a new chapter to read: 05 Chapter 29. Health Care Professions Loan Repayment and Incentive Program. 06 Sec. 18.29.010. Legislative intent. The loan repayments and direct incentive 07 payments provided under this chapter are intended to ensure that residents throughout 08 the state, including recipients of medical assistance and Medicare, have access to 09 health care and that residents of rural areas of the state, in particular, experience 10 improved access to health care services. 11 Sec. 18.29.015. Health care professions loan repayment and incentive 12 program; purpose; advisory body. (a) The health care professions loan repayment 13 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 lending institution or to the 11 eligible health care professional by the department from money appropriated for the 12 purpose. 13 (f) The department may approve loan repayment and direct incentive 14 payments for a qualified applicant under the program for three-year periods, as 15 follows: 16 (1) an initial period of three years; 17 (2) a renewal period of three years if the applicant 18 (A) requests loan repayments and has a continuing loan 19 obligation on the same loan that was subject to repayment under the program 20 during the initial three-year period and is otherwise eligible under the program; 21 (B) continues to qualify for direct incentive payments under the 22 program; or 23 (C) is eligible under both (A) and (B) of this paragraph; 24 (3) a reapplication period of six years that is equivalent to (1) and (2) 25 of this subsection if the applicant is engaged in qualified employment and the 26 applicant 27 (A) requests additional loan repayments under the program and 28 has incurred additional loans that qualify for repayment under the program 29 during or after the first six years of the applicant's participation in the program; 30 (B) requests additional direct incentive payments under the 31 program; or 01 (C) is eligible under both (A) and (B) under this paragraph. 02 (g) The department shall prorate loan repayments and direct incentive 03 payments under the program based on the number of hours of qualified employment 04 worked in a calendar quarter. However, the department may not make a loan 05 repayment or direct incentive payment before the completion of a calendar quarter for 06 which the loan repayment or incentive payment is made. 07 (h) The department shall adopt regulations necessary to implement the 08 program. 09 (i) Direct incentive payments, loan repayments, and matching payments shall 10 be made with funds appropriated by the legislature for that purpose. 11 Sec. 18.29.020. Direct incentives. (a) The department shall provide direct 12 incentives in the form of quarterly cash payments to eligible tier I and tier II health 13 care professionals engaged in qualified employment. 14 (b) Payments made under this section, when combined with a matching 15 payment and a loan repayment amount paid under AS 18.29.025, if any, may not 16 exceed 17 (1) $35,000 annually for a tier I health care professional employed in a 18 regular position; 19 (2) $47,000 annually for a tier I health care professional employed in a 20 very hard-to-fill position; 21 (3) $20,000 annually for a tier II health care professional employed in 22 a regular position; or 23 (4) $27,000 annually for a tier II health care professional employed in 24 a very hard-to-fill position. 25 (c) The commissioner shall calculate the annual incentive payment amount by 26 multiplying the annual maximum payment under (b) of this section by the percentage 27 of full time equivalent employment for each of not more than three years of qualified 28 employment less a matching payment amount as determined under AS 18.29.015(d) 29 and loan repayment amount, if any, under AS 18.29.025. 30 Sec. 18.29.025. Loan repayment. (a) The commissioner shall repay a portion 31 of eligible education loans described in this section that are held by or made to eligible 01 tier I and tier II health care professionals under the program according to the loan 02 repayment procedures established in this section. 03 (b) A loan is eligible for repayment under the program if the loan was issued 04 by a government or commercial entity for the payment of actual costs of tuition and 05 other reasonable educational and living expenses related to the undergraduate or 06 graduate education of a participant who is eligible under AS 18.29.035 and that 07 resulted in a degree required for employment as a tier I or tier II health care 08 professional under the program. 09 (c) A loan repayment under this section when combined with a matching 10 payment shall be in an amount not to exceed 33.3 percent of the unpaid loan balance 11 existing in the first year of program participation, multiplied by the percentage of full 12 time equivalent employment for each of up to three years of qualified employment less 13 a matching loan repayment or incentive amount from an employer or other entity as 14 determined under AS 18.29.015(d). 15 (d) The commissioner shall make a loan repayment under this section in 16 quarterly installments payable to the lending institution or to the eligible health care 17 professional. 18 (e) A loan or interest on a loan is not eligible for repayment under this section 19 if the loan or interest is 20 (1) to be repaid by another source, including another loan repayment or 21 forgiveness program or an employer-sponsored repayment program; 22 (2) consolidated with a loan that is not eligible for repayment; or 23 (3) refinanced as a loan that is not eligible for repayment. 24 Sec. 18.29.030. Number of participants. (a) The number of participants to 25 whom the commissioner may provide a direct incentive payment, loan repayment, or 26 both under the program established under AS 18.29.015 may not exceed 90 27 participants annually as described in (b) of this section, regardless of whether the 28 participants are new participants, continuing participants, or both. 29 (b) The commissioner shall reserve sufficient funding for not fewer than three 30 positions in each of the 10 tier I and tier II health care professions in very hard-to-fill 31 positions at eligible sites. 01 (c) If insufficient funds are appropriated in a fiscal year, the department shall 02 prorate payments based on the number of approved participants in the program. 03 Sec. 18.29.035. Eligibility and priority. (a) To be eligible for a direct 04 incentive payment under AS 18.29.020, an individual shall 05 (1) submit an application that is approved by the commissioner; 06 (2) be engaged in qualified employment at an eligible site with a 07 participating employer or entity; 08 (3) be licensed or exempt from licensure as a tier I or tier II health care 09 professional in the state; 10 (4) meet a priority for payment established under (c) of this section; 11 and 12 (5) meet other criteria established by the commissioner. 13 (b) To be eligible for loan repayment under AS 18.29.025, an individual shall 14 (1) meet eligibility and priority criteria established under (a) of this 15 section; and 16 (2) have an unpaid balance on one or more eligible education loans 17 described under AS 18.29.025 and verified by the Alaska Commission on 18 Postsecondary Education. 19 (c) The commissioner shall establish priorities for payment of incentives and 20 loan repayments under the program based on the recommendations of the program 21 advisory body and the availability of funding. The commissioner shall prioritize 22 eligible sites based on the needs assessment score for the site, remoteness of the site, 23 the percentage of underserved patients treated at the site, or a combination of these 24 elements; in this subsection, an underserved patient 25 (1) is uninsured; 26 (2) receives or is eligible to receive medical assistance or Medicare 27 coverage; or 28 (3) receives or is eligible to receive other federal health program 29 benefits. 30 Sec. 18.29.099. Definitions. In AS 18.29.010 - 18.29.099, 31 (1) "commissioner" means the commissioner of health and social 01 services; 02 (2) "department" means the Department of Health and Social Services; 03 (3) "eligible site" means a service area or health care facility that the 04 commissioner has designated as located in a health care services shortage area based 05 on a needs assessment score and employment statistics for qualified tier I or tier II 06 health care professionals; 07 (4) "program" means the health care professions loan repayment and 08 incentive program; 09 (5) "qualified employment" means employment of a tier I or tier II 10 health care professional at an eligible site at which the health care professional is hired 11 and paid to work 12 (A) in a full-time or not less than half-time position; 13 (B) for a contract term that is not less than three years; and 14 (C) not less than 50 percent time on direct patient health care 15 services; 16 (6) "tier I health care professional" means a person licensed or exempt 17 from licensure in the state as a dentist, pharmacist, or physician; 18 (7) "tier II health care professional" means a person licensed or exempt 19 from licensure in the state as a dental hygienist, registered nurse, advanced nurse 20 practitioner, physician assistant, physical therapist, clinical psychologist, or clinical 21 social worker holding at least a master's degree in social work. 22 * Sec. 2. AS 18.29.099(6), as enacted by sec. 1 of this Act, is amended to read: 23 (6) "tier I health care professional" means a person licensed or exempt 24 from licensure in the state as an advanced nurse practitioner, [A] dentist, 25 pharmacist, or physician; 26 * Sec. 3. AS 18.29.099(7), as enacted by sec. 1 of this Act, is amended to read: 27 (7) "tier II health care professional" means a person licensed or exempt 28 from licensure in the state as a dental hygienist, registered nurse, [ADVANCED 29 NURSE PRACTITIONER,] physician assistant, physical therapist, clinical 30 psychologist, or clinical social worker holding at least a master's degree in social 31 work. 01 * Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to 02 read: 03 HEALTH CARE PROFESSIONS LOAN REPAYMENT AND INCENTIVE 04 PROGRAM REPORT. On or before January 1, 2019, the Department of Health and Social 05 Services shall prepare and submit a report to the legislature that describes the participation 06 rates, costs, and effect on health care profession shortage areas, as designated by the 07 commissioner of health and social services, of the health care professions loan repayment and 08 incentive program established under AS 18.29.015. 09 * Sec. 5. The uncodified law of the State of Alaska is amended by adding a new section to 10 read: 11 BOARD OF NURSING; NOTIFICATION OF REVISOR OF STATUTES. The 12 Board of Nursing shall notify the revisor of statutes of the adoption of a regulation that 13 requires completion of a degree of doctor of nursing practice in order to practice as an 14 advanced nurse practitioner in the state. 15 * Sec. 6. AS 18.29.010, 18.29.015, 18.29.020, 18.29.025, 18.29.030, 18.29.035, and 16 18.29.099 are repealed June 30, 2019. 17 * Sec. 7. Sections 2 and 3 of this Act take effect 30 days after the Board of Nursing notifies 18 the revisor of statutes of the adoption by the Board of Nursing of a regulation that requires 19 completion of a degree of doctor of nursing practice in order to practice as an advanced nurse 20 practitioner in the state. 21 * Sec. 8. Except as provided in sec. 7 of this Act, this Act takes effect immediately under 22 AS 01.10.070(c).