Legislature(2019 - 2020)ADAMS ROOM 519
04/22/2019 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB41 | |
| HB87 | |
| HB114 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 114 | TELECONFERENCED | |
| += | HB 41 | TELECONFERENCED | |
| += | HB 87 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE BILL NO. 114
"An Act relating to a workforce enhancement program
for health care professionals employed in the state;
and providing for an effective date."
1:52:33 PM
REPRESENTATIVE IVY SPOHNHOLZ, BILL SPONSOR, was before the
committee to discuss HB 114, the SHARP-3 bill. She asserted
that healthcare was one of Alaska's largest and dynamic
industries. Yet, many Alaskans continued to have challenges
accessing care because of the shortage of healthcare
providers, particularly in rural Alaska. It was difficult
to recruit and retain healthcare professionals in rural
Alaska because of large student debt and high costs of
living.
Representative Spohnholz continued that HB 114 sought to
address the issue by establishing the Healthcare
Professionals' Workforce Enhancement Program which was more
commonly known as SHARP-3 in which healthcare professionals
agreed to work for a provider for a minimum of 3 years in
exchange for a loan repayment for student loans or direct
incentives. Employers could use the program up to 4 times
with an individual healthcare practitioner for a total of
12 years. Employers would fully fund the program taking
advantage of a federal tax exemption available only to a
state-run program. She had looked at other alternatives
such as going to the community foundation or elsewhere. She
was aware it had to run through the State of Alaska in
order for the program to be tax sheltered.
Representative Spohnholz continued that the healthcare loan
repayment and incentive programs had demonstrated success
in increasing the healthcare workforce in Alaska. She
reported that the SHARP-2 Program, the Department of Health
and Social Services' existing state loan repayment
incentive program, was a combination of private and state
funding and was scheduled to sunset on June 30, 2019.
Therefore, the passage of the bill was time sensitive. She
reported that between 2013 and 2015 SHARP-2 was successful
in recruiting and retaining 83 clinicians statewide, a
majority of whom were placed off the road system with an
emphasis in care for rural and underserved populations. The
program was also used for underserved populations eligible
for Medicaid. She conveyed that Anchorage Community Health
and Fairbanks Community Health were eligible to use the
program. The new program was built on the success of
SHARP-2 introducing new practices, new occupations, new
employers, new locations, and new roles. However, the
newest program, SHARP-3, would be entirely privately
funded.
Vice-Chair Ortiz inquired whether there was an increasing
problem, even though SHARP-2 had been in practice. He
wondered if SHARP-2 had effectively addressed the need for
healthcare professionals throughout Alaska. Representative
Spohnholz explained that although Sharp-2 had been
successful, Alaska had a growing need, especially in the
area of Behavioral Health. She noted the problems in Alaska
of opioid and alcohol addiction. There was a healthcare gap
in Alaska. She reiterated that the SHARP-2 Program had been
effective in helping to address some of Alaska's healthcare
needs, but there were behavioral healthcare problems that
the state was becoming more aware of 10 years prior. In the
current version of the bill, additional mental health
providers were added for eligibility. She thought it was an
important update to the SHARP program.
BERNICE NISBETT, STAFF, REPRESENTATIVE IVY SPOHNHOLZ,
explained that someone from the department would review the
historical presentation for HB 114. She would be reviewing
the sectional analysis.
Co-Chair Wilson indicated she would not have the sectional
analysis presented in the current meeting, as the companion
bill would be coming over to the House.
1:57:30 PM
JILL LEWIS, DEPUTY DIRECTOR, DIVISION OF PUBLIC HEALTH,
DEPARTMENT OF HEALTH AND SOCIAL SERVICES, introduced the
PowerPoint presentation: "HB 114 Medical Provider
Incentives/Loan Repayment." She began with slide 2
reviewing the purpose of the bill which was to establish a
Healthcare Professionals Workforce Enhancement Program,
referred to as SHARP-3. The program addressed the shortage
of healthcare workers across the state. The program's basic
component was that a healthcare professional agreed to work
for 3 years in underserved areas in exchange for repayment
of either a student loan debt or a direct incentive.
Employers would fully fund the program and there were no
unrestricted general funds involved in SHARP-3. It was
replacing the existing program, SHARP-2, which sunsets June
30, 2019.
Representative Tilton asked Ms. Lewis to define
"underserved areas." Ms. Lewis responded that underserved
areas targeted what type of populations were being served.
She provided a list of examples including the uninsured,
Medicaid recipients, Medicare recipients, or people with
other public types of coverage. She noted Indian Health
Services and the Veterans Administration. She relayed that
the term "health shortage area" had to do with geography,
the type of employer, and the type of specialties.
Representative Tilton appreciated the information. She
clarified that the underserved had to do with the different
types of recipients rather than geography. Ms. Lewis
responded that the term "underserved" had to do with the
population being served. A "health shortage area" had to do
with specialties and the location in the state.
1:59:58 PM
Representative Knopp asked if employers would be fully
funding the program. Ms. Lewis responded in the
affirmative. State general funds would not be used to fund
SHARP-3. Employers would fully fund the program including
benefits to employees and administrative costs.
Representative Knopp asked if it would be mandatory for
employers to participate. He thought one of the
consequences of making the program mandatory for employers
was reduced payroll or a reluctancy to hire someone. Ms.
Lewis responded that the program was entirely voluntary.
The employee was not obligated to participate, nor was the
employer. The employer decided whether they wanted to
participate in the program and to submit their application
for eligibility. Employers were not allowed to reduce pay
to an employee for them to receive the benefit of the
program. Representative Spohnholz added that there was also
a SHARP Council made up of employers and providers that had
approached the legislature to initiate the legislation.
They wanted to be a part of a solution to the fiscal gap.
Ms. Lewis discussed slide 3: "Challenges in health care
access." There were challenges of access to healthcare
which the bill tried to address. The state had a shortage
and a mal-distribution of professionals across the state.
In other words, Alaska did not have all of the right type
of providers in the right places, which the bill attempted
to rectify. Healthcare sites struggled with recruiting and
retaining healthcare professions. It was costly for the
sites to do recruitment and, healthcare professionals were
challenged with large student debt. The bill would help
with both issues.
Representative Sullivan-Leonard asked about which
specialties were in short supply. She wondered if there was
a shortage of radiologists, general practitioners, physical
therapists, or others. Ms. Lewis responded that, depending
on the location, there were shortages in most occupations
including primary care, specialties, surgery, and many
other types. Not only did the bill have a list of 12
targeted occupations, it also allowed for the addition of
other occupations when demands changed.
2:04:36 PM
Representative Tilton asked about the success rate of the
SHARP-2 program in filling hard-to-fill positions in rural
areas of the state. Ms. Lewis responded that the SHARP-2
Program only operated for a few years. The department had
to stop the program early because it no longer had the
undesignated general funds (UGF) to apply to the program.
The program had 83 participants whose contracts were all
completed. About half of the participants were placed in
very difficult-to-fill positions. Positions were considered
difficult-to-fill after taking into account how long a
position had been vacant and how difficult the recruitment
had been. The employer had to provide evidence of how they
had recruited for the position. Retention had been pretty
good with positions. Most of the participants indicated
that, on average, they were looking at staying with their
employer for 8 years and 14 years in-state after they had
made a 3-year commitment to their employer. On average,
participants had indicated they would stay much longer once
they completed their contract.
Ms. Lewis explained the Supporting Health Access Repayment
Program II (SHARP-2) on slide 4: "SHARP-2." The program
operated from 2013 to 2018. However, they stopped signing
contracts after 2015. From 2013 to 2015, when the program
was most active, there were 83 contracts in place. All of
the contracts were completed and fully paid out. About half
of them were difficult-to-fill positions. She explained
there were 2 tiers in SHARP-2 and there will be 3 tiers in
SHARP-3. The average payment was just over $25,000 per year
across all of the tiers. Employers for SHARP-2 provided 10-
30 percent of the match. In the program they would provide
100 percent of the funding. SHARP-3 was broad-based with 83
contracts and 31 employers participating including non-
profits, hospitals, and tribal and non-tribal
organizations. She reported that there was participation
across the state. She added that participants were
voluntary which determined the location of participation.
2:07:41 PM
Co-Chair Wilson asked why only about 3 percent participated
from the Interior. Ms. Lewis thought it had to do with the
number of employers that applied from the region.
Vice-Chair Johnston asked for statistics around the number
of non-profit participants versus for-profit entities. Ms.
Lewis responded that a majority of the participants were
non-profits. She explained that for-profit entities were
also allowed to participate. She thought there was a final
report for SHARP-2 containing specific demographics.
Vice-Chair Johnston asked for the information because of
tax write-offs. Ms. Lewis responded that the tax incentive
was to the employee for their individual income tax. If the
employee had a student loan repayment, the loan was done
through a state-run program, and the program targeted the
underserved and health shortage areas, it would be exempt
from taxable income. If an employee received a direct
incentive it would be taxable. The employer benefited
because otherwise they would pay more doing it on their own
trying to hold the employee harmless for the tax. It would
cost the employer less by participating in the program.
Co-Chair Wilson relayed percentages from page 13 of the
SHARP-2 final report. She reported that of the 83
contracts, 68 (82 percent) were with non-profit
organizations, 13 (16 percent) were with government
agencies, and 2 percent were with for-profit entities.
2:11:01 PM
Ms. Lewis spoke to the benefits of the program on slide 5:
"An innovative solution." The SHARP-3 Program was an
innovative solution and a public-private partnership. She
indicated that SHARP-1 and SHARP-2 were limited in the
types of positions they could fund and the different type
of employers and geographical areas they could serve.
Sharp-3 allowed significantly more flexibility and would
respond to the demand of the industry as to where the
shortages were and what occupation. She thought that over
time SHARP-3 would be much more flexible. She reported that
10 years prior the state did not know how much of a demand
there was. There was not as high of a demand for behavioral
health positions as they were currently. She continued that
SHARP-1 and SHARP-2 had allowed some urban areas to
participate. However, the programs really targeted primary
care and rural areas. It had been difficult for some of the
urban areas who wanted to participate. The bill lifted the
restriction as long as the employer continued to have a
shortage and were still serving an under-served population.
Representative Spohnholz responded that primarily the
underserved population would be the uninsured, people who
were on Medicaid, and People who did not have their own
health insurance. They needed access to care. She suggested
she was talking about organizations in Urban Alaska such as
Anchorage Neighborhood Health or Fairbanks Community Health
Center.
Ms. Lewis continued to discuss the benefits of SHARP-3 on
slide 6. She elaborated that some of the state programs
broke down the types of occupations into 3 major
categories: medical, dental, and behavioral health. The
other programs often times might have a shortage in the
dental category but not in medical or behavioral health
categories. Therefore, the incentive might not be applied
to all of the occupations an entity might like. The bill
would open up the occupations in which the incentive could
be applied. There were a number of benefits the bill would
facilitate. She reported that healthcare sites would be
able to hire much needed staff. The professionals would
receive help with their student loan debt. Alaskans would
have access to improved access to healthcare because they
would have providers available in rural areas. If a site
was in more of a hub area that was serving a rural
population, patients would have access to more specialty
providers. She argued that access to healthcare was
important for maintaining good health which then reduced
costs to healthcare. The benefits would be provided without
any use of state UGF.
Representative Josephson suggested that SHARP-2 was covered
10-30 percent by employers and SHARP-3 would be covered 100
percent by employers. He wondered who covered the other
percentage of SHARP-2. Representative Spohnholz responded
that SHARP-1 was funded by the federal government and,
SHARP-2 was funded by the state and through private
funding. She reported that SHARP-3 would be funded entirely
by the private sector. No state general funds would be used
to fund the program; it would be fully self-supporting. She
noted hearing from the SHARP Council that communities were
prepared to help with funding. It would be up to
communities how to fund the program. She would be watching
to make sure the state was meeting its goal of increasing
access to healthcare. The private sector providers were
paying a fee to administer the program rather than the
state spending any UGF.
2:16:09 PM
Ms. Lewis addressed SHARP-3 on slide 7. She reported the
new program would operate such that healthcare
professionals would either receive student loan repayments
or direct incentives in exchange for working in under-
served areas and health shortage areas. The eligible
employer sites would provide the healthcare services.
Healthcare professionals would be required to make a 3-year
contractual commitment to work and could renew 3 additional
times up to 12 years for a lifetime. The renewals would
allow for someone who started with one loan to continue
their education and to advance. The employer payments would
fully cover the cost of the program payment and the
administrative fee. The advisory council had already been
mentioned.
Representative Sullivan-Leonard asked about direct
incentives for working in underserved areas. She asked Ms.
Lewis to give an example of a direct incentive. Ms. Lewis
responded that direct incentives were not often chosen.
More often professionals chose a loan or a combination of a
loan with a direct incentive. The direct incentive was a
payment made to the employee that was taxable income to
them. Direct incentives were included as an option was
because there were times a more experienced provider was
needed. The direct incentive was a way to get mid-career
providers into the rural areas.
Representative Sullivan-Leonard asked if they would also
look at other incentives such as housing and
transportation. Ms. Lewis responded that the participation
in SHARP-3 did not preclude an employer from offering any
other type of incentive. However, the program limited
employees from having a concurrent obligation for work -
they could have consecutive service obligations.
Representative Tilton asked about the make-up of the
advisory council. Ms. Lewis replied that council members
included members of the healthcare clinics and hospitals,
professional associations, and other entities that provided
important information to DHSS. She noted the Department of
Labor and Workforce Development and the Alaska Council on
Postsecondary Education. She indicated there were about 15
organizations that made up the council.
2:20:33 PM
Representative Carpenter asked how the advisory council
would determine an employer's ability to pay. Ms. Lewis
responded that when an employer decided they wanted to
participate, they filled out an application which included
information about where they would get their funding. She
explained that for SHARP-2 there was a waiver process for
part of the amount. The state would still look at an
employer's ability to pay.
Representative Carpenter thought he had heard a comment
about federal funding being available to help with the
program. He asked Ms. Lewis to elaborate. Ms. Lewis thought
he might have heard her talking about the SHARP-1 Program,
a federal grant program. The state would still have the
SHARP-1 Program available. However, the scope of
professionals that could participate was narrower.
Co-Chair Wilson reported that when she visited Unalaska
there was discussion about the difficulty of keeping a
provider in town. Once Unalaska hired a provider, they
immediately started looking for another provider to fill
the position at the end of the 3-year contract. Most
providers would only stay for the duration of their
contract. She asked about retention beyond the service
obligation period. Ms. Lewis responded that the state had
had pretty good success in retaining employees. She
reported that the SHARP-3 Program was a 3-year program,
whereas, the SHARP-1 program was a 2-year commitment. She
suggested that a period of 3-years made a difference
because of someone having a little more time to establish
themselves in a community. She thought the extra year of
obligation had paid off for the state. She reported that
participants had indicated they would stay 8 years at the
same location and 14 years in Alaska. Representative
Spohnholz added, "It works."
2:24:25 PM
Representative Knopp asked about the state's role in the
program. He asked if there were additional incentives for
the employer to participate. Representative Spohnholz
replied that the incentive for the employer to go through
the program was that it stretched their dollars farther.
She suggested that because the employees did not have to
pay taxes, the net impact of using the SHARP Program as
opposed to providing loan repayment directly to the
employee stretched farther. They did not have to pay taxes
on the loan repayment amount so, they received more net
benefit. They had to do slightly more paperwork; they had
to send a check through the State of Alaska. The recruiting
dollars would go farther.
Representative Knopp wondered if the checks had to be
funneled through the state. Representative Spohnholz had
explored whether it could be done entirely through the
private sector, but it could not. She further explained
that by running the payments through the state it shielded
the employee from the money becoming taxable income. Thus,
it maximized the value of the dollars.
Representative LeBon suggested that the program would help
with recruitment. In theory, the employer could build the
benefits of the program into an employee's compensation
package. He thought the program could be a win-win for the
provider and for the health center. Representative
Spohnholz reminded Representative LeBon that the SHARP
Program was designed to augment the compensation package by
allowing for loan repayment or a direct incentive. She
believed there was an incentive for a healthcare employer
to participate because it helped them with recruitment. In
terms of retaining employees for a long period, the SHARP
Program had a demonstrated track record of keeping
employees for 8 years - not a standard tenure in healthcare
careers presently. The field was very competitive, and
employees could shop around for the best package. If an
organization was able to keep an employee for 8 years on
average and potentially use the Sharp Program for up to 12
years, it was a significant incentive. An employer would
get better outcomes for their organization because there
was value in longevity within an organization.
Representative LeBon saw the advantage for a provider to
accept a proposal from a health center that built the
benefit of the program into the compensation package. He
thought it was a powerful incentive for an employee to have
their loan paid down. Representative Spohnholz agreed.
2:28:47 PM
Representative Josephson asked about Representative
Spohnholz's comment regarding the benefits package not
being able to be different. Representative Spohnholz
replied that the base compensation package had to be the
same for participants in the SHARP Program. The idea was
that employers would not be able to offer a lower salary
for someone participating in the SHARP Program because of
loan repayment. The employer would have to offer an
employee the same salary for similar employees. The SHARP
Program was designed to be an additive to the base
compensation.
Representative Carpenter asked if the fiscal note would be
addressed at a later time or whether he could ask about it
presently. Co-Chair Wilson suggested that Representative
Carpenter ask his question.
Representative Carpenter understood there was no cost to
the state for the program and that there was an
administrative fee. The administrative fee for years 1
through 4 equaled 5 percent of the contract value paid by
the employer. He asked about the new accounting position
and whether the position was for the life of the program or
for perpetuity. Ms. Lewis replied that the program ran very
lean. There was a single person who managed the program
currently. However, the department anticipated an increase
in volume with the SHARP-3 option and an additional
accounting technician would be needed. If the program were
to end, there would no longer be a need for the additional
position.
Representative Carpenter asked, if the funding source of
the employer dried up part way through the contract,
whether the contract would become null and void or whether
the state would become liable for finishing the contract.
Ms. Lewis responded that the state would not pick up the
liability.
2:31:54 PM
Representative Tilton referred to the administrative fee
which stated that in year 5 the fee would increase 1.5
percent to facilitate looking for a vendor to assist in the
administration of the program. She asked if it had to do
with contract collections. Ms. Lewis replied that
Representative Tilton was correct. The department
anticipated that as the program matured there would be more
work than the accounting technician could handle, at which
point, the state would look at hiring a private vendor to
help with collections rather than hiring another state
employee. The account technician would remain in place to
audit the providers and manage the contracts. The work
would shift for the accounting technician, but the position
would still be needed.
Ms. Lewis spoke on the different tiers within SHARP-3 on
slide 8. The slide showed 3 different tiers that addressed
different types of occupations. The department proposed
that each of the tiers paid a different amount. Tier 1 and
Tier 2 were aligned with what the department currently had
in terms of amounts in SHARP-1 and SHARP-2. Tier 3 was new.
She reviewed the tiers on the slide:
Tier 1: dentist, pharmacist, physician
â?¢ $35,000/year regular or $47,250 very hard-to-fill
Tier 2: dental hygienist, registered nurse, advanced
practice registered nurse, physician assistant,
physical therapist, clinical psychologist, counseling
psychologist, professional counselor, board certified
behavior analyst, marital and family therapist, or
clinical social worker
â?¢ $20,000/year regular or $27,000 very hard-to-fill
Tier 3: not otherwise eligible under Tier 1 or Tier 2
â?¢ $15,000/year regular or $20,250 very hard-to-fill
2:34:33 PM
Co-Chair Wilson asked if the tiers would be in statute.
Representative Spohnholz responded that she intended to
define Tier 1, Tier 2, and Tier 3 generally in statue but
allow the board flexibility to make changes over time. She
hoped the program could remain nimble over time to respond
to market forces and not be so rigid that it could not
respond without coming back to the legislature for a legal
change.
Representative Josephson referred to slide 7 and asked
about the administrative fee and whether it included the
accounting technician salary. Ms. Lewis responded that the
administrative fee would cover all of the costs to run the
program including the future accounting technician. The
department envisioned the fee being based on a percent of a
contract's value. As each contract came on or offline the
amount would change but, the department thought the amount
would be adequate to fund the position. She returned to
Representative Carpenter's question about whether employers
were paying the fee in perpetuity. She clarified that the
fee was for the duration of each contract between an
employee and employer.
Co-Chair Wilson asked Ms. Lewis to define, "very hard-to-
fill." Ms. Lewis responded that "very hard-to-fill" was
currently defined in regulations. It had to do with how
long a position had been vacant and how aggressively the
position had been recruited for. Employers provided
documentation when they asked for an employee and submitted
an employee's contract for consideration noting that the
particular contract was a very hard-to-fill position. A
very hard-to-fill position in regulations was a vacancy of
1 year or more.
Ms. Lewis reviewed the circular flow chart on slide 9. The
chart showed how the money flowed in and out and clarified
the state's role. She began at the top of the slide. First,
there were healthcare professionals who worked at an
eligible site for a calendar quarter. At the end of the
quarter the employer at the site would report on the
professional's hours worked to the SHARP Program to
indicate how much work was actually done. Employees had the
choice of either a full-time or part-time contract. Not all
employees worked the entire amount each quarter and, their
payments were adjusted accordingly. Once the payment amount
was adjusted based on the report, the SHARP Program would
invoice the employer for the quarter. In turn, the employer
sent the SHARP Program a check for the quarterly payment
which included the administrative fee for the contract.
Sharp would then make a payment to the lender if the
benefit was a loan repayment. If the benefit was a direct
incentive, the payment would be made to the employee.
Lastly, SHARP provided data to the advisory council which
helped the council to evaluate the program, plan ahead for
where the next shortages were, and to prioritize contracts
into the future.
2:39:21 PM
Vice-Chair Johnston asked if there was any liability to the
state regarding cash-flow. Ms. Lewis answered that the
state did not take on a liability if the employer failed to
pay. The terms were reflected in the contract between the
employee, employer, and the state.
Vice-Chair Johnston asked if a system would be in place, so
the employee was not burdened with a cash flow issue. Ms.
Lewis responded that Vice-Chair Johnston's statement was
true. She indicated that up to the present the state had
not had difficulties with employers making their payments.
She realized the state was going from a program with a
partial match to a 100 percent match on the part of the
employer. She reported that part of the screening process
was to look at the employer's ability to pay to ensure that
it was reasonable for the employer to sustain the contract.
Vice-Chair Ortiz asked how many states were following the
same path as Alaska in terms of helping employers to
recruit healthcare professionals. Ms. Lewis responded that
Alaska was on the cutting edge. There were several states
that participated in the federal program and some states
that had some sort of state-operated program. Alaska of the
programs were different. As far as she was aware, Alaska
was the first state to come up with a public/private
partnership that did not utilize any general funds to
support it. She suggested Alaska was quite innovative.
Representative LeBon referred to slide 8 using the Tier 1
provider. He asked if the repayment amount was determined
by a negotiation between the provider and the clinic. Ms.
Lewis responded that the state did not allow such a
negotiation. She explained that in order for it to be a
state-run program, there needed to be consistency in
criteria and amounts. She told of an employer wanting to
hire someone in Tier 1 but could not come up with the
entire $35,000. One option for the employer was to hire the
person half-time in order to keep in line with their
budget. The department encouraged the employer to seek
supporting funding such as philanthropy, fund raising, and
local government contributions. The department was agnostic
about where the funding would come from but encouraged them
to get more community involvement in their funding.
2:44:30 PM
Representative LeBon queried how the department verified
that the employer was treating the provider in accordance
of the SHARP-3 Program. Ms. Lewis replied that it was one
of the duties of the sole employee that ran the program for
the state. It was the state employee's role to check in
with both the employer and the employee. The state program
allowed for leave of absences. Therefore, if someone took a
leave of absence, the employee's service obligation date
would extend out.
Representative Carpenter was uncertain if the program was
needed. He wondered why the healthcare site needed to
involve the state. Ms. Lewis answered that the only way an
employee could avoid paying taxes on the benefit was
through a state-run program. The state had a benefit it
could provide to the private sector that they could not
access any other way. She reminded members that the program
was voluntary. Representative Spohnholz added that it
stretched out the dollars farther.
Co-Chair Wilson asked whether the state could contract out
the entire service. Ms. Lewis thought it might work the way
Co-Chair Wilson described. There was a minimal amount of
staffing the state would need to have to oversee the
contract, manage the program, and perform site visits.
There was a certain amount of work the state had to do to
be a state-run program. The department was keeping the
staffing at the bare minimum that the department thought it
could manage. She added that the department thought there
were some portions of the program that could be done as
well or better by a vendor, which was why the department
built it into its plan.
Co-Chair Wilson provided an example about filling the gap
if an employee were to take a leave of absence.
Representative Spohnholz argued that there was a case for
cross training which was part of doing business on a day-
to-day basis for any organization. Co-Chair Wilson agreed
but indicated some entities had not done cross training.
Ms. Lewis concluded her presentation with slide 10. HB 114
would keep healthcare professionals in rural communities,
promote health and economic community stability by allowing
healthcare to be delivered in the place closest to home,
and ensure a healthy future for all Alaskans at the lowest
possible cost.
Representative LeBon asked about the use of the word
"rural" and whether it would apply to downtown Fairbanks.
Ms. Lewis stated that that there was no one definition for
"rural" especially when talking about the healthcare
industry. She suspected that downtown Fairbanks would not
be considered rural. However, they might be doing work with
underserved populations or have health shortage areas.
SHARP-1 and SHARP-2 were more limited because of their
narrow focus in rural areas. Gaps were left in urban areas
- central hubs people went to in order to get specialty
care. She thought the bill would help to address the issue.
Representative LeBon thought the correct wordage could be
rural or eligible communities. In other words, a primary
healthcare facility in downtown Fairbanks could be eligible
for the SHARP-3 Program. Representative Spohnholz answered
that that was the reason the term "underserved" was added
to the bill. SHARP-3 was designed to meet the needs of both
rural and underserved areas.
2:51:58 PM
Representative Carpenter asked about the tax benefits that
applied with the bill. He wondered which entity would
benefit. Representative Spohnholz answered that it was the
federal income tax. She noted they would not be seeing a
reduced tax obligation or tax revenue. They would not be
receiving taxes on the loan repayment that otherwise the
provider would not likely get because of the SHARP-3
Program. It would be tax avoidance rather than reducing
taxes to the federal government.
2:52:55 PM
Co-Chair Wilson OPENED Public Testimony.
RACHEL GEARHART, SHARP COUNCIL CO-CHAIR, NATIONAL
ASSOCIATION OF SOCIAL WORKERS - ALASKA CHAPTER, read from a
prepared statement:
My name is Rachel Gearhart and I've been a licensed
clinical social worker in Alaska since 2008. I'm a
member of the National Association of Social Workers
Alaska Chapter and serve as the Southeast Region
Representative to the Board. It is through my
volunteer NASW service that I also volunteer to sit on
the SHARP Council; where NASW AK is a voting member
and where I serve as co-chair. I'm also a constituent
of Rep. Sara Hannan's District 33 - which is not
considered a federally designated geographic Health
Professional Shortage Area and unless you work for the
tribal health organization in town, would not eligible
for student loan repayment either through SHARP 1 or
National Health Services Corps.
Speaking of HPSAs; neither is Co-Chair Wilson's
district. Nor are the districts that Johnston,
Josephson, LeBon, or Merrick represent. Representative
Ortiz, Tilton, Sullivan-Leonard, Knopp, and
Carpenter's districts are considered geographic HPSAs
for mental health only, though upper Mat-Su is also
approved for primary care and dental. Of the
representatives on this committee, only Co-Chair
Foster's whole district qualifies as a HPSA for
primary care, dental care, and health care.
We dabbled in this arena before with SHARP 2 - this
time with no additional state expenditures and it's
time that we sign on for good. I was one of 83 lucky
recipients of SHARP-2. After paying on my student
loans for 7 years; and after a 3-year SHARP fee for
service contract, I am student debt-free 20 years
early still working at the same agency and have now
lived in Alaska nearly 13 years. Retention matters.
While we in this room cannot designate all of Alaska
as a HPSA, we can use SHARP 3 to recruit and retain
quality staff to serve our vulnerable and underserved
Alaskans. We can help well trained, compassionate
health professionals turn from cheechako to sourdough.
As the finance committee, you may be interested to
know that we get a fair amount of data from the
quarterly work reports completed by participants in
the SHARP programs. We are able to track who works in
primarily substance use capacities; and which
positions are full-time permanent position replacing
what was once filled by a costly locum tenens
position. We learn important demographics that can be
used for further recruitment and retention efforts in
Alaska's health professionals.
According to a study by the National Healthcare
Retention & RN Staffing Report, since 2013 the average
hospital has turned over 85.2 percent of its
workforce. The average cost of turnover across all
occupations in the healthcare industry is $60,000.
Some reports estimate replacing a physician as costing
at least $200,000 and as high as $1 million.
These two statistics are not Alaskan specific.
Considering that I think we can agree that Alaskan
hospitals & health care providers are anything but
average, this is concerning.
In Alaska there was a study done in 1998 of
developmental disability service providers who
contracted with the state (23 of 28 responded) about
how much they spent on advertising, overtime,
recruitment costs (like fingerprinting and background
checks), and training. The statewide average, more
than 20 years ago, PER worker, was $2341.
Healthcare is a growing field. As a social worker,
that's the field I know best. Social workers are the
largest group of mental health care providers in the
US and SW employment is projected to grow 16 percent
by 2026, faster than the average for all other
occupations.
So, it is important to note that SHARP 3 will not only
expand eligible sites; but will also expand eligible
professions. Occupational therapists, art therapists,
case managers, CNAs, training coordinators, chemical
dependency counselors, dental hygienists, health care
faculty members, phlebotomists and peer recovery
coaches would be examples of included professionals
working in health care settings that can be included
if they have qualified student loans and are working
at eligible sites.
In my line of work, the therapeutic alliance you have
with your client is considered the most important
factor in how well you'll work together. Not your age,
gender, where you were born, or whether you have
children. Once clients in primary care, dental care
and health care, with high ACEs scores, years of
trauma, and often co-morbid conditions and co-
occurring disorders start to connect; we see progress.
Disruptions in service delivery because of staff
turnover that may be due to high cost of living; is
unavoidable. SHARP 3 support for service helps all
Alaskans lives their own best lives. As a provider, a
SHARP alum, and SHARP Council co-chair, I'm happy to
answer any questions you might have.
Co-Chair Foster noted that Ms. Gearhart had mentioned that
his entire district was eligible but had referenced the
slide [slide 4] showing the Interior/Northern category at 3
percent. He assumed Nome was in that category. He wondered
why the numbers were so low since Nome was eligible.
Ms. Gearhart was referencing SHARP-2 numbers. She explained
that SHARP-2 expanded on SHARP-1. SHARP-1 was limited to a
geographic Health Professional Shortage Area (HPSA).
Representative Foster's entire district would be eligible
for SHARP-1 or National Health Service Core. Whereas, much
of the rest of the state and many of the constituents of
other representatives on the Finance Committee would not be
eligible. She guessed that there might be a low percentage
of applicants in the Interior and Northern areas of the
state because much of Representative Foster's constituents
were eligible for SHARP-1. He might have people in his
district that applied for SHARP-1 or other student loan
repayments. She reminded members that a person could only
apply for 1 program at a time.
Co-Chair Wilson asked if there was a list of recipients for
SHARP-1. Ms. Lewis could provide the list of employers who
have participated. Co-Chair Wilson would appreciate getting
the information. She thought it would provide a better
understanding whether people knew about the program.
Representative LeBon suggested that downtown Fairbanks was
somewhat rural. He referred to the Interior Community
Health Center. He asked if it had participated in SHARP-1
and SHARP-2. Ms. Lewis thought Representative LeBon was
correct.
Representative LeBon asked if it was likely that anyone who
had participated in SHARP-1 and SHARP-2 would be eligible
to participate in SHARP-3. Ms. Lewis confirmed that it was
certain that they would be eligible to participate in
SHARP-3. She elaborated that SHARP-1 was the most
restrictive, SHARP-2 was less restrictive, and SHARP-3 was
even less restrictive. Each program had expanded on the
other. SHARP-3 would be the most open-ended program the
department had to-date.
3:03:05 PM
JON ZASADA, POLICY INTEGRATION DIRECTOR, ALASKA PRIMARY
CARE ASSOCIATION (via teleconference), read from a prepared
statement:
Good Afternoon Co-Chairs Foster and Wilson and members
of the House Finance Committee. For the record my name
is Jon Zasada, and I am the Policy Integration
Director of the Alaska Primary Care Association.
The Alaska Primary Care Association (APCA) supports
the operations and development of Alaska's 27
Community Health Center organizations. Together with
the leaders of the Community Health Centers in this
state, we strongly support Senate Bill 93 to establish
the SHARP 3 program.
Today, I'd like to highlight three particular points
about how this legislation will help Health Centers
better serve Alaskans:
1: There is a shortage of health professionals of all
types in Alaska. Recruiting and retaining health
professionals is the number one area of concern for
Alaska Health Center leaders, who constantly grapple
with vacant healthcare clinician positions in their
clinics. Although Healthcare jobs remain the fastest
growing sector in the Alaska labor force, the demands
are outpacing the availability. Alaskans are growing
older, needing more healthcare; there is an increasing
incidence of chronic disease requiring more constant
care; and healthcare professionals are not distributed
evenly across the state.
2: SHARP and other loan repayment programs have been
critical for Community Health Centers. Since its
inception in 2010, the SHARP 1 program has issued 172
contracts to Health Centers and SHARP 2 has issued 47
contracts with healthcare providers 140 medical, 43
dental, and 36 behavioral health. And, SHARP has been
able to address some of the disparity in distribution
of providers placing them from Anchorage to Juneau,
to Norton Sound, Y-K, the Kenai Peninsula and out the
Chain to Dutch Harbor.
The SHARP support-for-service program, including loan
repayment and longevity payments, has made a
tremendously positive difference in Health Centers'
ability to attract and retain qualified healthcare
professionals in these critical positions. Over the
years Alaska's Community Health Centers have continued
to benefit from the SHARP program. In 2018 alone 80
out of the 105 candidates who were awarded into the
SHARP I program were practicing in Community Health
Centers. SHARP has been successful in serving as the
main state program to support placement of a range of
providers in many hard to place organizations and
communities, using the loan repayment incentive.
3: SHARP-3 is innovative and requires no State General
Fund dollars. SHARP-3 is a creative solution to
replace the State-funded program. SHARP 3 will offer a
valuable state infrastructure, without additional
state general funds, and will provide the ability to
expand the benefits of SHARP to areas that are not
Health Professional Shortage Areas (HPSAs), a
requirement for SHARP 1 as well as expand the provider
types that are eligible for loan repayment. Alaska's
Community Health Centers are prepared to utilize SHARP
3 as soon as it is available. We're eager to continue
the momentum of SHARP and to support workforce
development efforts in Alaska.
APCA and FQHCs appreciate the SHARP Council's
innovative thinking in contributing to the solutions
of the healthcare workforce shortage issues in Alaska.
The concept of SHARP 3 being privately funded (no
State of Alaska funds) means that loan repayment and
longevity incentives can be expanded to more
practitioner types and more clinical sites across
Alaska. This will greatly increase the number and
variety of health professionals and sites, like FQHCs,
who participate.
Thank you for the opportunity to speak today.
Co-Chair Wilson CLOSED Public Testimony.
HB 114 was HEARD and HELD in committee for further
consideration.
Co-Chair Wilson reviewed the agenda for the following
meeting at 4:00 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB114 SHARP-2 Final Report to Legislature 04.08.19.pdf |
HFIN 4/22/2019 1:30:00 PM |
HB 114 |
| HB114 DHSS Presentation 04.08.19.pdf |
HFIN 4/22/2019 1:30:00 PM |
HB 114 |
| HB114 Sectional Analysis 04.08.19.pdf |
HFIN 4/22/2019 1:30:00 PM |
HB 114 |
| HB114 Sponsor Statement 04.08.19.pdf |
HFIN 4/22/2019 1:30:00 PM |
HB 114 |
| HB114 Support Letters 04.08.19.pdf |
HFIN 4/22/2019 1:30:00 PM |
HB 114 |
| HB 41 CS WORKDRAFT v.U.pdf |
HFIN 4/22/2019 1:30:00 PM |
HB 41 |
| HB 87 CS WORKDRAFT v.M.pdf |
HFIN 4/22/2019 1:30:00 PM |
HB 87 |
| HB 114 Supporting Document Table - SHARP - Agency - List - 2019 - 03-20-19.pdf |
HFIN 4/22/2019 1:30:00 PM |
HB 114 |
| HB 87 NEW FN DOR Tax Division.pdf |
HFIN 4/22/2019 1:30:00 PM |
HB 87 |