Legislature(2009 - 2010)CAPITOL 106
03/23/2010 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB260 | |
| HB188 | |
| HB392 | |
| HB270 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 188 | TELECONFERENCED | |
| *+ | HB 270 | TELECONFERENCED | |
| += | HB 260 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 392 | TELECONFERENCED | |
HB 392-INCENTIVES FOR CERTAIN MEDICAL PROVIDERS
3:36:15 PM
CO-CHAIR HERRON announced that the next order of business HOUSE
BILL NO. 392, "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."
3:36:27 PM
NIKOOSH CARLO, Staff to Representative Bob Herron, Alaska State
Legislature, paraphrased the "Talking Points HB 392: Loan
Repayment and Direct Incentives for Certain Medical Providers."
[Included in the committee packets.] She explained that HB 392
created a support-for-service program within DHSS. She pointed
out that support-for-service programs had been successful "in 44
states to recruit and retain a competent and sustainable health
care work force." She explained that it would provide loan
repayments and cash incentives for medical providers in 10
different health care categories. She stated that HB 392 would
help to remedy the shortage of health care professionals in
Alaska.
3:38:42 PM
REPRESENTATIVE SEATON asked for an explanation of the direct
incentives.
DR. CARLO, in response, explained that the incentive was a cash
payment, and could be combined with a loan repayment program.
She detailed that the amount for these programs varied by
location and by occupation, and that the maximum award was
$47,000 per year.
3:40:00 PM
REPRESENTATIVE SEATON asked for definitions to "regular
position" and "very hard to fill position."
DR. CARLO replied that the commissioner reviewed the needs
assessment and employment history for a location, and then would
annually rank the eligibility of sites, especially to determine
if any had a "shortage priority."
3:41:03 PM
REPRESENTATIVE SEATON asked if this was an annual ranking for
the preceding or the upcoming year. He asked if this was a new
procedure.
DR. CARLO replied that she did not know.
3:41:45 PM
REPRESENTATIVE T. WILSON asked if the incentive would still be
available, even if you had completed payment on your loans.
DR. CARLO replied that a loan was not necessary in order to
receive a direct incentive.
3:42:06 PM
REPRESENTATIVE HOLMES asked for the difference between Tier 1
and Tier 2 health care professionals.
DR. CARLO offered her belief that the recommendations for these
tiers came from a 2008 workgroup which evaluated work force
shortages across Alaska. She said that these tier categories
each had shortages.
3:43:24 PM
REPRESENTATIVE SEATON asked if there was a loan repayment plan
for any of these categories.
DR. CARLO replied that she did not know if there was a current
program.
3:44:02 PM
CO-CHAIR HERRON shared that Dr. Carlo had a doctorate in Neuro
Science and was helping formulate health care policy.
3:44:48 PM
REPRESENTATIVE HOLMES asked if this program was to be used as a
bonus to attract applicants, or would it be offered after the
hiring.
DR. CARLO offered her belief that there would be a DHSS
application process, which was yet to be determined, and each
individual would need apply.
3:46:06 PM
REPRESENTATIVE HOLMES asked to clarify that the applicant
already needed to be working and could then apply.
DR. CARLO said that the applicant did not have to be working at
the location when they applied for the benefit.
REPRESENTATIVE HOLMES asked to clarify that this could be both a
recruiting and a retention mechanism.
DR. CARLO agreed.
3:46:50 PM
REPRESENTATIVE SEATON asked for more information about the
current loan repayment programs for doctors, nurses, and
dentists.
DIANE BARRANS, Executive Director, Alaska Commission on Post
Secondary Education (ACPE), explained that the only similar
state program was the Washington, Wyoming, Alaska, Montana, and
Idaho (WWAMI) graduate medical education program. She pointed
out that this was slightly different, as Alaskan resident
participants had agreed to serve in Alaska as licensed
professionals. She noted that the loan obligations were
discharged after that service was completed.
3:48:20 PM
REPRESENTATIVE SEATON asked if both the proposed program and
WWAMI could work in coordination.
MS. BARRANS offered her belief that it was possible, as WWAMI
participants often had other education related debt. She did
not believe it was possible to use the new program to
concurrently pay the WWAMI debt.
3:49:30 PM
REPRESENTATIVE SEATON asked about the annual WWAMI reduction of
debt.
MS. BARRANS explained that for work in a rural area, one third
of the debt was reduced each year and that for work completed in
an urban area, one quarter of the debt was reduced each year.
3:50:01 PM
JIM L. LYNCH, Chief Finance Officer, Fairbanks Memorial Hospital
& Denali Center, said that he was the Chair of the [Alaska] Work
Force Investment Board and a member of the Steering Committee
for the [Alaska] Health Care Workforce Coalition. He pointed
out that Alaska will soon face challenging and significant
workforce shortages. He noted that the aging Alaskan population
would demand more access to health care. He offered his support
for the financial incentives in HB 392. He reported that the
private sector found these incentives to be cost effective and
result bearing when managed properly. He shared that 44 other
states had similar programs. He opined that national
competition would increase and financial tools such as HB 392
would be necessary to ensure a strong health force. He directed
attention to the Alaska Health Care Workforce Coalition
strategic plan for the development of the future Alaskan health
care workforce, and stated that it would include financial
incentives similar to HB 392.
3:53:01 PM
LANETTA LUNDBERG, Director of Human Resources, Ketchikan General
Hospital, expressed support for HB 392. She reported that there
were long standing vacancies for primary care health care
positions. She pointed out that applicants often accepted
positions with better loan repayment and incentive packages.
She stated that "a state loan repayment program and incentives
would enhance, incentivize, and draw a larger pool of health
care professionals to Alaska." She emphasized that a health
care loan repayment program was an investment in Alaska's
future.
3:55:08 PM
RICHARD PECK, Board President, Iliuliuk Family & Health
Services, declared that HB 392 was good public policy. He
emphasized that it was necessary for attraction and retention of
health care providers in rural Alaska.
3:56:21 PM
JERRY GROWER said that he was a graduate student in social work
at University of Alaska Anchorage (UAA). He shared that he had
accumulated over $70,000 in student loan debt. He pointed out
that his undergraduate work had been completed outside Alaska,
but that he came back to Alaska for the opportunity to bring his
services home to Alaskans. He spoke about many of the social
health issues in Alaska. He stated that the financial
incentives of HB 392 would motivate workers to stay in Alaska.
He offered his support for HB 392.
3:58:39 PM
ELIZABETH RIPLEY, Executive Director, Mat-Su Health Foundation,
stated that the Mat-Su Health Foundation's mission was to
improve the health and wellness of Alaskans living in Mat-Su
with a goal to be the healthiest borough in the state. She
shared some of its strategies which included increasing the
number of health care professionals in Alaska. She noted that
the Mat-Su Regional Medical Center had spent $6,238,438 on
temporary health professionals from outside Alaska during the
past five years, which she determined to be a low amount
compared to most hospitals in Alaska. She noted that the health
foundation currently had a $100,000 scholarship for local
students pursuing a career in health care. She stressed that
repayment and incentive programs were very effective. She said
that the health foundation was studying ways to encourage and
incentivize people to move to Alaska to work in health care, as
national studies had determined that loan repayment and
incentive programs were the two most effective strategies for
recruitment and retention. She stated support for HB 392 and
noted that this was an investment with a "phenomenal return."
4:04:09 PM
REPRESENTATIVE T. WILSON asked if there were similar incentive
packages in North Carolina.
4:04:29 PM
DON PATHMAN, Professor, University of North Carolina Rural
Health Research and Policy Analysis Center, replied that he had
been the recipient of an incentive program 25 years ago. He
shared that for the past 20 years he had studied the outcomes of
these programs for health care professionals. He noted that he
had coordinated his efforts with the Alaskan work group to write
the proposals in HB 392.
4:05:14 PM
SONIA HANFORTH-KOME, Executive Director, Iliuliuk Family &
Health Services Clinic; President, Alaska Primary Care
Association, said that she was in support of HB 392. She listed
the numerous position openings that the clinic experienced. She
shared that health care providers stayed longer with loan
repayment incentives. She noted that when interviewing
prospective candidates, one of their first questions was about
loan repayment incentives and retention bonuses.
4:07:53 PM
DAVID MORGAN, Alaska Primary Care Association, shared that the
Indian Health Services (IHS) already had a similar program. He
described the formula system for loan repayment which included
points for populations and demographics. He noted that the
programs were for individuals ready to start work, and finished
with school. He pointed out that the scholarship program
targeted professionals with high debt, and that it was necessary
to draw health care professionals away from the high density
areas. He noted that expenses were higher for medevacs and
Medicaid travel costs when these positions were left unfilled.
4:14:16 PM
CO-CHAIR KELLER asked for a definition to Tier 1 and Tier 2.
MR. MORGAN, in response to Co-Chair Keller, stated that the
difference of the tiers was for the amount of time in training,
and licensing. He said that Alaska did not score well enough on
the federal funding model to draw applicants, whereas the
formula for funding in HB 392 was designed specifically for
Alaska.
4:17:15 PM
CO-CHAIR KELLER asked if there were any "holes" in the bill.
MR. MORGAN replied that it was a good bill.
4:17:52 PM
REPRESENTATIVE T. WILSON asked for the annual costs to bring in
temporary health care professionals.
MR. MORGAN said that he would supply that for each of the 139
community health centers in Alaska.
REPRESENTATIVE T. WILSON asked if the community health centers
had any incentive programs.
MR. MORGAN replied that community health center funding was
highly regulated and would need to use the federal funding
formula. He pointed out that the community health center
program was designed for care delivery.
4:19:51 PM
NATALIE HALE, medical student, shared that she was a student in
the WWAMI program and she listed the other students from the
program who were also in support. She read some of their
statements of support, which included:
Alaska has many barriers preventing people from
receiving health care. Our state has made advances in
regard to this problem; however, we still face the
problem of physician and health care worker shortages.
As a medical student, I have spoken with several
physicians about the difficulties of practicing in
Alaska including the financial difficulties of
offering health care to those without insurance or on
government programs that don't adequately reimburse
physicians for their time with patients. I am fully
intending to return to Alaska to practice medicine;
however I am trepidatious about my ability to support
a practice and family and still see the patients most
in need of care. This bill will give me the
opportunity to do so without sacrificing my family as
well as attract more qualified health care workers to
the areas of the state that need it most. I am in
support of the bill.
4:23:39 PM
ANGEL DOTOMAIN, President & CEO, Alaska Native Health Board,
reported that the Alaska Native Health Board served over 130,000
Alaska Natives, and employed over 7,000 health professionals and
support staff. She noted that its health provider vacancy rates
exceeded the statewide vacancy rates by 150-200 percent. She
pointed out that it takes 14 months to fill a physician vacancy,
and about 6 months to fill a mid level vacancy. She stated that
HB 392 would provide an opportunity for recruitment and
retention of providers. The average tribal health care cost for
recruitment of a primary care provider was $31,000. The cost
for locums, or temporary, coverage was 150-200 percent more than
for a direct hire. She offered her belief that HB 392 offered a
solution to the health care workforce shortage. She shared that
90 percent of the individuals interviewed for Alaska positions
asked if there was a loan repayment or incentive program.
4:27:53 PM
MARIE DARLIN, Capital City Task Force AARP, stated support for
HB 392 and pointed out that it was another tool to secure a
health care work force.
4:29:26 PM
SAM TRIVETTE stated the need for more medical practitioners in
Alaska. He emphasized that HB 392 would make it possible for
Alaska to attract new health care professionals. He pointed out
that Alaska had the fastest growing senior population in the
U.S. and that retired seniors spend $1.7 billion in Alaska. He
noted the difficulty to find primary health care providers in
Anchorage and Fairbanks who would see new Medicare patients. He
emphasized that if care was not available, then seniors would
move out of the state. He stated support for HB 392.
4:31:53 PM
SHELLEY HUGHES, Government Affairs Director, Alaska Primary Care
Association (APCA), reported on a 2008 convention of
stakeholders to look at recruiting and retention. The group
reviewed what had worked for other states, and included tribal,
private, community health, urban and rural health centers. She
directed attention to HB 392 and stated that it was well thought
out. She stated that Alaska was not competitive, as candidates
were lost to other states. She predicted that there would be a
statewide shortage of 125,000 doctors in the next 15 years, and
that currently, Alaska had a 14 percent deficit of physicians to
the national norm. She stressed that only three other states
did not have programs, Hawaii, South Carolina, and Idaho. She
reported on the length of vacancies and the expense to hire
temporary physicians. She observed that the first question
posed to recruiters was about state loan repayment plans and
incentives. She pointed out that the use of loan repayment as a
strategy targeted about 60,000 ready to work professionals. She
advised that the addition of incentives to this strategy
increased the target pool to 800,000 professionals. She stated
that the Alaska Health Care Commission included a loan repayment
and incentive program in its recommendations. She emphasized
that the cost of doing nothing would include ongoing recruitment
and temporary hiring costs, increased emergency room use,
increased medevac use, increased Medicaid travel cost, and
increased costs for chronic disease, as there would not be
enough local physicians.
4:39:47 PM
REPRESENTATIVE T. WILSON asked the reason for a three year
repayment plan.
MS. HUGHES deferred the question to Dr. Pathman.
4:41:59 PM
REPRESENTATIVE HOLMES expressed confusion of whether the bill
was for three years or six years of qualified employment.
MS. HUGHES replied that the initial application would be for
three years, with an option to reapply after the end of the
contract.
REPRESENTATIVE HOLMES asked to clarify that this was a three
year repayment contract, and not a year by year contract.
MS. HUGHES said that the funding was guaranteed for the first
year, but that the legislature would need to approve the
appropriation annually. It would be a three year determination,
pending the funding.
4:43:15 PM
REPRESENTATIVE HOLMES asked for an explanation as to how the
program would work.
4:44:09 PM
MS. HUGHES explained that each medical facility could apply to
become an eligible site, so that this could be used as a
recruitment tool. She declared that this would be an ongoing
process for the department to rank the sites for eligibility.
4:45:04 PM
REPRESENTATIVE HOLMES, referring to the cap for the number of
annually eligible, asked if these would all be filled in the
first year.
MS. HUGHES offered her belief that it gave the department
flexibility, though it could not exceed 90 recipients in any
given year.
4:46:14 PM
CO-CHAIR HERRON asked why it was necessary to hire another
administrator for this program.
BILL STREUR, Deputy Commissioner, Director's Office, Division of
Health Care Services, Department of Health and Social Services
(DHSS), agreed that he was not sure of the necessity. He read
the necessary program start up requirements and expressed that
he did not know if there was a current employee who could
fulfill these. He stated that the position would need to be
ratified by the commissioner.
4:49:59 PM
REPRESENTATIVE SEATON asked about the pending federal loan pilot
program.
PAT CARR, Chief, Health Planning and Infrastructure, Division of
Health Care Services, Department of Health and Social Services
(DHSS), said that Alaska had applied for the state loan
repayment program. She explained that this funding included
$600,000 of federal funding which was matched by $200,000 from
the Alaska Mental Health Trust Authority and $400,000 funding
from three community health centers. She said this funding
would allow for 23 health care providers. She explained the
parameters of the requirements.
4:51:40 PM
CO-CHAIR KELLER opined that this need for health care providers
was connected to the federal health care reform.
4:52:41 PM
[HB 392 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB270 sponsor statement.pdf |
HHSS 3/23/2010 3:00:00 PM |
HB 270 |
| HB 270 support letter - AARP 03.22.2010.pdf |
HHSS 3/23/2010 3:00:00 PM |
HB 270 |
| HB 270 support letter - ACOA 01.30.2010.pdf |
HHSS 3/23/2010 3:00:00 PM |
HB 270 |
| HB 270 support letter - AGENET 02.18.2010.pdf |
HHSS 3/23/2010 3:00:00 PM |
HB 270 |
| HB 270 backup - Questions and Answers.pdf |
HHSS 3/23/2010 3:00:00 PM |
HB 270 |
| HB 270 backup - 2002 and 2003 Alaska statutes showing change from percentage to fixed dollar amount.pdf |
HHSS 3/23/2010 3:00:00 PM |
HB 270 |
| HB 270 backup - medicaid waiver info.pdf |
HHSS 3/23/2010 3:00:00 PM |
HB 270 |
| HB 260 support - AARP letter 03.23.2010.pdf |
HHSS 3/23/2010 3:00:00 PM |
HB 260 |