03/16/2012 09:00 AM House FINANCE

HOUSE BILL NO. 78                                                                                                             
                                                                                                                                
     "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."                                                                                                        
                                                                                                                                
9:15:01 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  BOB HERRON  remarked  that  during the  last                                                                    
committee meeting  a concern  was addressed  regarding state                                                                    
residency.  He was  instructed to  craft a  letter with  the                                                                    
commissioner  to address  the issue.  The letter  is in  the                                                                    
committee packet (copy on file.)  The second issue concerned                                                                    
primary care  physicians brought up by  Representative Gara.                                                                    
The  legislation   creates  an  environment  with   all  the                                                                    
occupations   that   support   and  enhance   primary   care                                                                    
throughout  the  state.  The   legislation  would  have  the                                                                    
commissioner   establish  priorities   for  incentive   loan                                                                    
programs for  eligible sites to create  a better environment                                                                    
for attracting primary care physicians to Alaska.                                                                               
                                                                                                                                
Co-Chair Stoltze  requested the  department go on  record to                                                                    
address the concerns.                                                                                                           
                                                                                                                                
JILL  LEWIS, DEPUTY  DIRECTOR,  DIVISION  OF PUBLIC  HEALTH,                                                                    
DEPARTMENT  OF HEALTH  and SOCIAL  SERVICES, indicated  that                                                                    
the  administration  agrees   with  Representative  Herron's                                                                    
statement.  Co-Chair Stoltze  would like  the department  to                                                                    
say it for the record.  Ms. Lewis remarked that in reference                                                                    
to the residency question,  the current committee substitute                                                                    
gives  the   latitude  and  ability  necessary   to  address                                                                    
residency in the regulatory process.                                                                                            
                                                                                                                                
9:19:37 AM                                                                                                                    
                                                                                                                                
Representative Gara appreciated the  statement of intent. He                                                                    
asked if the department agrees  that the largest shortage is                                                                    
with primary care physicians. Ms. Lewis agreed.                                                                                 
                                                                                                                                
Vice-chair  Fairclough  pointed  out  in  the  fiscal  note,                                                                    
component  number 2765.  The difference,  on  page 3,  moves                                                                    
nurse practitioners  from Tier  2 to Tier  1. It  concerns a                                                                    
pending item  before the Board  of Nursing. The  fiscal note                                                                    
would  be  implemented if  the  Board  of Nursing  adopts  a                                                                    
regulation  requiring  Advanced Practice  Registered  Nurses                                                                    
(APRN)  to complete  a doctorate.  Co-Chair Stoltze  pointed                                                                    
out  that  the  tier  status  is  a  categorization,  not  a                                                                    
retirement  status. Vice-chair  Fairclough  agreed that  was                                                                    
correct.  The  fiscal notes  would  come  from payments  for                                                                    
nurse  practitioners  that will  be  paid  from the  service                                                                    
line.                                                                                                                           
                                                                                                                                
Representative Wilson  asked what a nurse  practitioner with                                                                    
a doctorate  can do  that a  nurse practitioner  without one                                                                    
cannot. She also  inquired about the difference  in cost for                                                                    
education.                                                                                                                      
                                                                                                                                
LIZ CLEMENT,  STAFF, REPRESENTATIVE HERRON, replied  that by                                                                    
2015  many states  are requiring  their  advanced nurses  to                                                                    
hold a  Doctor of Nursing  Practice. In the state  of Alaska                                                                    
there  are  both  Master  and  Doctor  of  Nursing  Practice                                                                    
degrees. Currently the  Board of Nursing is  not planning on                                                                    
moving to the Doctor of  Nurse Practice requirement by 2015,                                                                    
however they  may in  the future. The  scope of  practice is                                                                    
not that  much different  just the  level of  education that                                                                    
may be required to advance in the future.                                                                                       
                                                                                                                                
Co-Chair  Stoltze questioned  if a  nurse practitioner  must                                                                    
work  under doctor.  Ms. Clement  referred  the question  to                                                                    
others available.                                                                                                               
                                                                                                                                
Co-Chair  Stoltze noted  that Nurse  Practitioners are  less                                                                    
expensive,  but can  perform many  of the  same services  of                                                                    
doctors.                                                                                                                        
                                                                                                                                
Vice-chair Fairclough  disclosed in FY 13  the $2,842,900 is                                                                    
reduced in  the commodities line  by $7600 for  future years                                                                    
which is  reflected in the  fiscal note. There will  only be                                                                    
one  full time  person  hired for  loan reimbursements.  She                                                                    
asked for a  confirmation from the Department  of Health and                                                                    
Social Services  that only  one person  would be  hired. Ms.                                                                    
Lewis confirmed that only one employee would be hired.                                                                          
                                                                                                                                
9:24:43 AM                                                                                                                    
                                                                                                                                
Representative Doogan referred to  the fiscal note and asked                                                                    
how  the  90  participant  number  in  the  first  year  was                                                                    
determined. Ms.  Lewis answered the bill  indicates that the                                                                    
maximum  would  be  90 participants.  Representative  Doogan                                                                    
remarked that  the actual number  could be lower.  Ms. Lewis                                                                    
agreed   the  number   of  participants   could  be   lower.                                                                    
Representative Doogan asked if there  were a lower number of                                                                    
participants would  the unspent money come  directly back to                                                                    
the state.  Ms. Lewis  responded that if  there were  not 90                                                                    
participants in  first year, then  the department  would not                                                                    
need to  spend all the  money in the fiscal  note, therefore                                                                    
the money would come back to the state.                                                                                         
                                                                                                                                
Vice-chair  Fairclough  followed  up that  when  grants  are                                                                    
issued from a  non-profit; a lot of the  spin-down occurs in                                                                    
the fourth quarter  because the group does not  want to lose                                                                    
the money for programs. She  asked Ms. Lewis for her opinion                                                                    
on the difference  in an operating budget item  and a grant.                                                                    
She pointed  out that  a certain amount  of money  was being                                                                    
set aside without actually knowing  how many people might be                                                                    
attracted. Ms.  Lewis avowed that  the department  would not                                                                    
try  to   expand  the   regulations  to   encourage  broader                                                                    
participation then the  intent of the bill.  The funds would                                                                    
be returned to the state if they are not used.                                                                                  
                                                                                                                                
9:28:46 AM                                                                                                                    
                                                                                                                                
Vice-chair Fairclough  MOVED to  report CSHB 78(FIN)  out of                                                                    
committee   with   individual    recommendations   and   the                                                                    
accompanying fiscal notes. There  being NO OBJECTION, it was                                                                    
so ordered.                                                                                                                     
                                                                                                                                
CSHB 78(FIN) was REPORTED out  of committee with a "do pass"                                                                    
recommendation and with one new  fiscal impact note from the                                                                    
Department of  Health and Social  Services and one  new zero                                                                    
note from Department of Education and Early Development.                                                                        
                                                                                                                                
9:29:18 AM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
9:33:17 AM                                                                                                                    
RECONVENED