Legislature(2019 - 2020)CAPITOL 106
04/04/2019 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB84 | |
| HB89 | |
| HB92 | |
| HB114 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 84 | TELECONFERENCED | |
| *+ | HB 89 | TELECONFERENCED | |
| *+ | HB 92 | TELECONFERENCED | |
| *+ | HB 114 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 114-MEDICAL PROVIDER INCENTIVES/LOAN REPAYM'T
4:50:11 PM
CO-CHAIR ZULKOSKY announced that the final order of business
would be 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."
4:50:55 PM
CO-CHAIR SPOHNHOLZ paraphrased from the Sponsor Statement for HB
114 [Included in members' packets], which read:
Health care is one of the largest and most dynamic
industries in Alaska, yet many citizens, especially in
rural areas, continue to experience challenges with
accessing care. The availability of health care
services is important for maintaining health,
preventing and managing disease, and reducing costs
from unnecessary emergency room visits, and hospital
readmissions and temporary staffing. One reason access
to care is limited, particularly in rural Alaska, is
due to shortages of healthcare professionals. Health
care sites struggle with recruiting and retaining
health care professionals. Further, health care
professionals have challenges with large student loan
debt and high cost of living in rural and remote
locations.
To meet the ongoing demand, Alaska must continue to
address the shortage of health care professionals. HB
114 (SHARP-3) does this by establishing the Health
Care Professionals Workforce Enhancement Program, a
public-private partnership that will increase the
number of providers while minimizing the use of state
funds. Health care professionals agree to work for
minimum of three years in Alaska in underserved areas
in exchange for repayment of student loans or direct
incentives. Employers will fully fund the program,
taking advantage of a federal tax exemption available
only to a state-run program.
The success of healthcare loan repayment and incentive
programs in increasing the healthcare workforce in
Alaska was demonstrated in SHARP-2. Between 2013 and
2015, SHARP-2 was successful in recruiting and/or
retaining 83 clinicians statewide, with most
clinicians placed in locations off the road system and
emphasizing care for rural and underserved
populations. With the sunset of SHARP-2 on June 30,
2019, other healthcare practitioner incentive programs
are needed to reduce healthcare workforce shortages
throughout Alaska.
SHARP-3 builds on the success of SHARP-2 with new
practice settings, new occupations, new employers, new
locations, and new roles. Employers can hire much-
needed staff, providers get assistance with their loan
payments which makes it more affordable to work in a
rural community, and Alaskans living in rural
communities have improved access to health care--all
without the use of state general funds.
4:54:22 PM
JILL LEWIS, Deputy Director - Juneau, Central Office, Division
of Public Health, Department of Health and Social Services,
presented a PowerPoint titled "HB 114 Medical Provider
Incentives/Loan Repayment." She directed attention to slide 2,
"HB 114," which read:
Establishes a Health Care Professionals Workforce
Enhancement Program to address shortage of health care
workforce.
Health care professionals agree to work for three
years in underserved areas in exchange for repayment
of student loans or direct incentives.
Employers fully fund the program. No unrestricted
general funds are involved.
Replaces the existing program in AS 18.29 scheduled
for sunset June 30, 2019.
4:55:38 PM
MS. LEWIS noted that Representative Spohnholz had already
reviewed the challenges listed on slide 3, "Challenges in health
care access," and she directed attention to slide 4, "SHARP -
2," which read:
Operated 2013 2018
No new contracts after 2015 due to GF budget
reductions
83 contracts: 39 Tier 1 and 44 Tier 2
47-53% positions very hard-to-fill
$25,560 average payment per contract per year
10-30% employer match
31 employers distributed across 25 communities
Primarily non-profit and hospital associated
Similar numbers of tribal and non-tribal affiliated
organizations
MS. LEWIS moved on to paraphrase slide 5, "An innovative
solution," which read:
A public-private partnership that ensures access to
health care by expanding the distribution of health
care professionals all Alaskans at no cost to the
state.
SHARP-3 builds on the success of SHARP-1 and SHARP-2
with new practice settings, new occupations, new
employers, new locations, and new roles.
Benefit will not be limited to rural areas or primary
care; there is also room for specialists and urban
health care professionals.
Takes advantage of a federal law that exempts loan
repayment from federal income tax if awarded through a
state-run program.
Public-private partnerships increases the number of
providers while minimizing the use of state funds.
4:56:56 PM
MS. LEWIS shared slide 6, "Benefits," which read:
Health care sites can hire much needed staff
Health care professionals get assistance with their
student loans
Alaskans have improved access to health care
Access to health care is important for maintain health
and reducing costs
All without the use of undesignated general funds
4:57:21 PM
MS. LEWIS explained slide 7, "SHARP - 3," which read:
Health care professionals receive student loan
repayment and/or direct incentives for working in
underserved areas.
Employer sites provide health care services in
underserved or health care professional shortage
areas.
3 year contract with renewals; 12 year lifetime limit.
Employer payments fully cover cost of the
professional's program payment and an administrative
fee.
An advisory council recommends eligibility criteria,
prioritization of sites and professionals for
participation, and contract awards.
4:58:36 PM
REPRESENTATIVE CLAMAN asked whether the 3-year contract with the
12-year lifetime limit was intended to pay the entirety of a
loan or only the amount due each year of that contract time. He
offered an example of a 20-year loan, asking if a 3-year
contract would allow payment for 3 years of the 20-year loan.
MS. LEWIS replied that a provision only allowed up to one-third
repayment of a loan in each of the 3 years if a person was using
the loan repayment option and not a direct incentive.
4:59:31 PM
MS. LEWIS directed attention to slide 8, "SHARP - 3," adding
that this could further address the question posed by
Representative Claman, which read:
Tier 1: dentist, pharmacist, physician
$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
$20,000/year regular or $27,000 very hard-to-fill
Tier 3: not otherwise eligible under Tier 1 or Tier 2
$15,000/year regular or $20,250 very hard-to-fill
MS. LEWIS stated that, although these were the current amounts
currently set in statute for SHARP 1 and SHARP 2, the amounts
could be set by the commissioner. She pointed out that Tier 3
was new with the proposed bill, stating that each tier addressed
different levels of educational attainment and practice.
5:01:49 PM
MS. LEWIS moved on to the diagram on slide 9, which described
the process for the program. She explained that health care
professionals who have applied and were accepted would work at
an eligible site for a calendar quarter. At the end of that
quarter, the site would report back to the SHARP program on that
professional's hours worked and the amount of care given. She
noted that SHARP could adjust the maximum payments based on the
actual hours worked, and that individuals had an option for full
or half time. She noted that the service was provided before
the employer made any payments. SHARP would invoice the sites
for the professional's payment and the administrative fee. The
sites would send payment back to the SHARP program with that
money being used to make loan payment to the lender, or a direct
incentive payment to the professional. She reported that SHARP
routinely provided data back to the Advisory Council to
prioritize and establish criteria.
5:04:07 PM
MS. LEWIS presented slide 10, "In closing..." which read:
HB 114
Keeps health care professionals in rural
communities
Promotes health and economic community stability
Ensuring a healthier future for all Alaskans
At the lowest possible cost.
5:04:35 PM
CO-CHAIR ZULKOSKY referenced slide 4 and noted that the SHARP
program offered opportunities to all communities throughout
Alaska.
5:05:01 PM
REPRESENTATIVE DRUMMOND, directing attention to slide 4, asked
if SHARP - 2 was paying an average of $25,500 per year for 83
different contracts. She stated that this was about $2.1
million per year from the general fund and asked if this was
before or after the employer match.
MS. LEWIS reported that the program had ramped up in 2013 and
2014 and was fully operating in 2015 with more than 40 contracts
added each year. After that, as there were no additional
general funds, no new contracts were extended. She added that
there had been significant state match, with the employers
paying between 10 and 30 percent for each of the contracts.
REPRESENTATIVE DRUMMOND asked if the $2.1 million was before or
after the employer match.
MS. LEWIS stated that this was the total cost and included the
employer's share.
5:06:53 PM
CO-CHAIR SPOHNHOLZ pointed out that there was a "Final Report to
the Legislature," dated December 2018, [Included in members'
packets] and she directed attention to page 9, which listed the
range of health care providers and contract expenses listed
under SHARP 2. She emphasized that the proposed current
legislation for SHARP 3 was all privately funded. She reported
that under SHARP 2 the general fund expense had been $4,909,038
and the employer match was $1,455,438.
REPRESENTATIVE DRUMMOND asked where the money was coming from to
pay for proposed HB 114.
CO-CHAIR SPOHNHOLZ explained that the SHARP 3 program would be
entirely funded by the employer community, as there was an
interest in recruiting health care providers and providing
incentives. She noted that there was a tax benefit to both the
employer and the employee. She offered her belief that there
was still a state interest to ensure that health care was
provided, both in Rural Alaska and underserved populations in
urban Alaska. She noted that it was necessary to use "all of
the tools in our tool kit to recruit and retain providers in
those underserved areas of health care."
REPRESENTATIVE DRUMMOND asked what would happen to the health
care providers currently covered by the loan repayment program
if proposed HB 114 did not pass.
5:09:50 PM
MS. LEWIS explained that there would be no new contracts for the
SHARP 2 program, and that all the existing contracts have been
paid. She reported that SHARP 1, the federal option, was an on-
going grant that was not affected by either SHARP 2 or proposed
HB 114.
5:10:44 PM
RACHEL GEARHART, Co-Chair, SHARP Council, reported on the status
of health care professionals in each committee member's district
and noted that the proposed bill provided a benefit to all their
constituents. She acknowledged how valuable the proposed bill
would be for recruiting and retaining quality health care
professionals with no additional expenditure to the state. She
noted that she had been a SHARP 2 recipient, which had allowed
her to be free of student loan, and that she was still working
for the same agency as when she had received her benefit. She
pointed to the letters of support from SHARP recipients. She
shared that the SHARP data from the quarterly work reports
offered tracking for important demographics to further
recruitment and retention efforts, noting the retention of
permanent workers in substance use capacity. She noted that
proposed HB 114 would allow the biggest community mental health
centers to be eligible sites without also having to be a
federally qualified health center. SHARP 3 would expand
eligible sites and eligible professions, including respiratory
therapists, occupational therapists, case managers, chemical
dependency councilors, and training coordinators. She noted
that, in mental health work, the therapeutic alliance with a
client was considered one of the most important factors for
working together. She explained that, when those with high ACEs
scores started to connect with a mental health professional,
progress was made. She pointed to disruption to service
delivery due to staff turnover, which SHARP 3 could help
alleviate.
5:16:00 PM
NANCY MERRIMAN, Executive Director, Alaska Primary Care
Association, stated support for proposed HB 114 to establish the
SHARP 3 program and help Health Centers better serve Alaskans.
She declared that there was a shortage of health care
professionals of all types in Alaska, and that Health Center
leaders constantly grappled with vacant health care clinician
positions. Although health care jobs remained the fastest
growing sector in the Alaska labor force, the demands outpaced
the availability and, as Alaskans grew older, there was an
increased need for health care with an increased incidence of
chronic disease requiring more constant care. She pointed out
that health care professionals were not distributed evenly
across the state.
MS. MERRIMAN declared that the SHARP programs were critical for
community health centers, reporting that the SHARP 1 program had
issued 172 contracts to health centers since its inception in
2010; the SHARP 2 program had issued 47 contracts with health
care providers. She shared that APCA surveys revealed that the
most important work force issues were for recruitment and
retention, with noted appreciation for SHARP. She relayed that
SHARP had also addressed some of the disparity for the
distribution of providers. She added that Alaska community
health centers had benefited from the SHARP program, sharing
that 80 of the 105 candidates awarded into the SHARP 1 program
were practicing in community health centers.
MS. MERRIMAN stated that SHARP 3 was innovative and did not
require any state general fund dollars, while offering a
valuable state infrastructure. It would provide the ability to
expand the benefits of SHARP to many areas not currently
designated as health professional shortage areas. The proposed
bill would also expand the provider types eligible for loan
repayment.
REPRESENTATIVE CLAMAN asked if the increase of funding by
employers to 100 percent for the proposed SHARP 3 program would
be an issue.
MS. MERRIMAN explained that the program funding would not be 100
percent by the employers, as there would be a request to other
bodies for a cost share to help support the additional necessary
funding.
REPRESENTATIVE CLAMAN asked for information as to the other
bodies.
MS. MERRIMAN suggested that these could be philanthropic
organizations, labor unions, or associations.
5:21:56 PM
JANE ERICKSON, President, Alaska Nurses Association, stated
support of proposed HB 114. She stated that the Alaska Nurses
Association strongly believed in the value of the SHARPS
program, which improved access to high quality health care by
providing incentives to health care professionals to create a
more equitable distribution of health professionals throughout
Alaska. She reported that Alaska faced continual difficulties
in recruitment and retention for a health care workforce,
especially in rural and remote communities. She declared that
SHARP 3 was a critical need for this recruitment and retention
of health care professionals. She declared that the SHARP
program had made a tremendous positive difference and was the
main state program to support placement of a range of providers.
She added that the program was a smart financial move for the
state. She pointed out that private funds would be used instead
of state dollars and would expand the eligibility beyond the
strictures of the previous SHARP programs. This would greatly
impact the health and welfare of communities statewide.
5:24:57 PM
CONNIE BEEMER, Vice President, Alaska State Hospital and Nursing
Home Association (ASHNHA), stated support for proposed HB 114.
She paraphrased from a prepared statement [Included in members'
packets] which read:
The Alaska State Hospital and Nursing Home Association
(ASHNHA) is offering this letter of support for SHARP
- 3. As a member of the SHARP Council we have been
involved with the program since its inception and
believe in the value of the program to support high
quality care through an equitable distribution of
health professionals throughout Alaska.
The SHARP program has helped Alaska's hospitals ensure
an adequate supply of healthcare providers and is an
important tool to help with recruitment and retention.
We support the addition of a third component through
SHARP - 3 legislation.
SHARP - 3 will support a variety of practice settings,
locations (especially those not eligible as a HPSA or
other federal programs for SHARP - 1) and provider
types. We need to use whatever tools are available to
support healthcare organizations to recruit and retain
employees. SHARP - 3 would expand the use of federal
tax exemption for education loan repayment and enhance
the number and variety of financial contributors.
There is a need to give local control to allow
communities to designate funds to support recruitment
of providers. SHARP - 3 utilizes the existing SHARP
infrastructure while maximizing contributions from
local communities or foundations. Money could be
contributed from different local sources such as a
business, private foundation, trade association,
government entity, foundations or employers.
SHARP 3 provides valuable state infrastructure,
without additional state general funds, and will
provide us the ability to expand the benefits of SHARP
to areas that are not Health Professional Shortage
Areas (HPSAs), a require for SHARP 1.
ASHNHA is prepared to support our members in efforts
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 in this way.
5:27:56 PM
CO-CHAIR ZULKOSKY opened public testimony.
5:28:15 PM
CO-CHAIR ZULKOSKY closed public testimony.
[HB 114 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB084 Sectional Analysis 4.3.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM HL&C 2/26/2020 3:15:00 PM |
HB 84 |
| HB084 Sponsor Statement 3.28.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM HL&C 2/26/2020 3:15:00 PM |
HB 84 |
| HB084 Supporting Document- Breast Cancer in Women Firefighters.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM HL&C 2/26/2020 3:15:00 PM |
HB 84 |
| HB084 Supporting Document- Letter of Support ACAT 4.3.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM HL&C 2/26/2020 3:15:00 PM |
HB 84 |
| HB084 Supporting Document- Asbestos 03.28.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM HL&C 2/26/2020 3:15:00 PM |
HB 84 |
| HB084 Supporting Document- RADS in Police from Chemical Spill 3.28.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM HL&C 2/26/2020 3:15:00 PM |
HB 84 |
| HB084 Fiscal Note DLWD WC 04.03.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM HL&C 2/26/2020 3:15:00 PM |
HB 84 |
| HB084 Letter of Support- APOA 3.28.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM HL&C 2/26/2020 3:15:00 PM |
HB 84 |
| HB084 Opposition Document- AML Joint Insurance Association 3.29.2019.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM HL&C 2/26/2020 3:15:00 PM |
HB 84 |
| HB084 Presentation 4.3.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/25/2019 3:00:00 PM |
HB 84 |
| HB0089 Supporting Document-DHSS Handout 03.27.2019.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 89 |
| HB0089 Supporting Document-Support Letter 04.03.2019.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 89 |
| HB0089 Supporting Document-Support Letters 1.27.2019.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 89 |
| HB0089-Opposing Document-Opposition Letter 04.03.2019.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 89 |
| HB0089 Draft Proposed Blank CS ver U 04.03.2019.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 89 |
| HB0089 Explanation of Changes ver U 04.03.2019.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 89 |
| HB0089 Sectional Analysis ver A 03.27.2019.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 89 |
| HB0089 Sponsor Statement 03.27.2019.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 89 |
| HB092 ver U 3.27.19.PDF |
HHSS 4/4/2019 3:00:00 PM |
HB 92 |
| HB92 Fiscal Note DCCED-IO 3.31.2019.pdf |
HHSS 4/4/2019 3:00:00 PM |
HB 92 |
| HB92 Fiscal Note DHSS-MS 3.31.2019.pdf |
HHSS 4/4/2019 3:00:00 PM |
HB 92 |
| HB92 Sponsor Statement 3.31.19.pdf |
HHSS 4/4/2019 3:00:00 PM |
HB 92 |
| HB092 Sectional Analysis ver U 3.27.19.pdf |
HHSS 4/4/2019 3:00:00 PM |
HB 92 |
| HB114 Letters of Support 04.03.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 114 |
| HB114 Sectional Analysis 04.03.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 114 |
| HB114 SHARP-2 Final Report to Legislature 04.01.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 114 |
| HB114 Sponsor Statement 04.03.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 114 |
| HB114 DHSS Presentation 04.01.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 114 |
| HB114 Fiscal Note DCCED CBPL 04.01.19.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 114 |
| HB089 ver U Presentation.pdf |
HHSS 4/4/2019 3:00:00 PM HHSS 4/9/2019 3:00:00 PM |
HB 89 |