03/31/2010 09:00 AM Senate FINANCE

SENATE BILL NO. 139                                                                                                           
                                                                                                                                
     "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."                                                                                                        
                                                                                                                                
9:49:01 AM                                                                                                                    
                                                                                                                                
Co-Chair Hoffman MOVED to ADOPT  CSSB 139 (FIN), labeled 26-                                                                    
LS0503\N, Mischel, 3/29/10.                                                                                                     
                                                                                                                                
Co-Chair Stedman OBJECTED.                                                                                                      
                                                                                                                                
Senator Olson, sponsor, related  that the bill establishes a                                                                    
loan  repayment  program  and employment  incentives  for  a                                                                    
number of health care  professionals employed throughout the                                                                    
state.   It   addresses   an  immediate   need.   The   bill                                                                    
distinguishes  itself   from  other  scholarship   bills  by                                                                    
providing immediate results when  filling vacancies. It does                                                                    
not  require  waiting  for students  to  "come  through  the                                                                    
pipeline"  before they  can begin  their  practice. It  also                                                                    
targets experienced providers  who are ready to  go to work.                                                                    
The funds will  be issued after the work  has been performed                                                                    
and payments will be stopped  if the practitioner leaves the                                                                    
state  or designated  area.  It is  not a  loan  and has  no                                                                    
defaults.  There  is  a preference  for  Alaskans;  however,                                                                    
graduates  from  elsewhere  can   come  to  Alaska  to  take                                                                    
advantage of the loan repayment program.                                                                                        
                                                                                                                                
Senator  Olson  stressed  that  one of  the  focuses  is  on                                                                    
recruiting physicians because of their expertise.                                                                               
                                                                                                                                
9:51:14 AM                                                                                                                    
                                                                                                                                
DENISE  LICCIOLI,   STAFF,  SENATOR  OLSON,   explained  the                                                                    
changes in the bill. The first  change is on page 1, line 8,                                                                    
and on  page 2, lines 9-10,  the words, "by the  state" were                                                                    
added in  order to  limit loan repayments  to loans  held by                                                                    
the  state. The  second  change  was made  by  adding a  new                                                                    
section  on  page  5,  beginning  on  line  9.  The  section                                                                    
provides clarification  to the department for  the intention                                                                    
of the  legislation to limit  the number of  participants to                                                                    
90 per  year, regardless  of whether  the participant  was a                                                                    
new participant  or a continuing participant.  It would also                                                                    
provide  guidance to  ensure  that at  least  three of  each                                                                    
practitioner type was reserved for filling in a very hard-                                                                      
to-fill location.  The intention  is to address  health care                                                                    
shortages in various areas of the state.                                                                                        
                                                                                                                                
9:53:58 AM                                                                                                                    
                                                                                                                                
Senator  Thomas wondered  if there  was an  hour requirement                                                                    
prior to  receiving a license for  certain participants. Ms.                                                                    
Liccioli said  the bill targets  those who are or  who would                                                                    
be  licensed  by  the  state  to  practice  their  preferred                                                                    
occupation.                                                                                                                     
                                                                                                                                
Co-Chair Stedman WITHDREW his OBJECTION. There being NO                                                                         
OBJECTION, Version N was adopted.                                                                                               
                                                                                                                                
Senator Olson said the bill addresses in a comprehensive                                                                        
manner, important health care issues.                                                                                           
                                                                                                                                
9:56:12 AM                                                                                                                    
                                                                                                                                
Ms. Liccioli provided information about the bill:                                                                               
                                                                                                                                
     Alaska  is  facing  a serious  shortage  of  healthcare                                                                    
     practitioners,  especially in  the rural  areas of  our                                                                    
     state, and  it is projected to  worsen significantly in                                                                    
     the next  few decades. Senate  Bill 139 is  intended to                                                                    
     address  this  issue  by   establishing  a  program  to                                                                    
     immediately   begin  filling   the  vacant   healthcare                                                                  
     practitioner positions throughout the state.                                                                               
                                                                                                                                
     This legislation will establish  a direct incentive and                                                                    
     loan repayment program, for loans  held by the State of                                                                    
     Alaska,  in   the  Department  of  Health   and  Social                                                                    
     Services.  The program  is designed  to be  competitive                                                                    
     with  incentives offered  by other  states and  attract                                                                    
     and retain healthcare practitioners.                                                                                       
                                                                                                                                
     SB  139   will  provide  direct  incentives   and  loan                                                                    
     repayments  for 10  different health  care occupations,                                                                    
     categorized   by   "Tier".   Tier   1   slots   include                                                                    
     physicians,  pharmacists  and  dentists. Tier  2  slots                                                                    
     include    dental   hygienists,    registered   nurses,                                                                    
     certified  nurse  practitioners, physician  assistants,                                                                    
     physical   therapists,   clinical  psychologists,   and                                                                    
     clinical  social workers  holding at  least a  master's                                                                    
     degree in social work.                                                                                                     
                                                                                                                                
     The slots are  also categorized by whether  they are in                                                                    
     a "regular" site, which can  be located anywhere in the                                                                    
     state;  or whether  they are  in a  "very-hard-to-fill"                                                                    
     site, which can be located  only in areas designated as                                                                    
     such  by   the  Commissioner   of  Health   and  Social                                                                    
     Services. The  sites would not  be exactly the  same as                                                                    
     the federal designations.                                                                                                  
                                                                                                                                
     The  amount  of  the  incentive for  each  slot  varies                                                                    
     according to  location and the category,  or "Tier", of                                                                    
     healthcare provided.  Tier 1  slots have  incentives of                                                                    
     up to  $35,000 per  year at  a regular  site, or  up to                                                                    
     $47,000 per  year at a  very-hard-to-fill site.  Tier 2                                                                    
     slots have  incentives of up  to $20,000 per year  at a                                                                    
     regular  site, or  up to  $27,000 per  year at  a very-                                                                    
     hard-to-fill site.                                                                                                         
                                                                                                                                
     The   bill   provides   direct  incentives   and   loan                                                                    
     repayments   for  9   slots  or   positions  for   each                                                                    
     occupation. The bill requires that  at least 3 of the 9                                                                    
     slots for each occupation  are reserved for "very-hard-                                                                    
     to-fill"  positions;  the   remaining  slots  for  each                                                                    
     occupation can  be anywhere  based on  applications and                                                                    
     need.    The  fiscal  note  allows  for  funding  of  6                                                                    
     positions  in  "very-hard-to-fill  locations.  Priority                                                                    
     will  be given  to sites  that treat  patients who  are                                                                    
     uninsured and  who have medical assistance  or Medicare                                                                    
     coverage.  The maximum slots  for which an incentive or                                                                    
     loan payment  is made  in any given  year is  capped at                                                                    
     90. She emphasized  that it is 90 per year  in order to                                                                    
     provide more flexibility.                                                                                                  
                                                                                                                                
9:59:28 AM                                                                                                                    
                                                                                                                                
                                                                                                                                
     Eligible  individuals  are   provided  their  incentive                                                                    
     and/or loan  repayment in quarterly  installments, only                                                                    
     after  working   the  previous  three  months,   for  a                                                                    
     contract term  of 3  years.  The  program allows  for a                                                                    
     possible  extension up  to an  additional 3  years, but                                                                    
     has a  lifetime maximum of  6 years for  any individual                                                                    
     to participate. Individuals would  have to apply for an                                                                    
     extension.   Payments    stop   immediately    if   the                                                                    
     practitioner leaves their position.                                                                                        
                                                                                                                                
     There is  no risk  of loan  default since  it is  not a                                                                    
     loan program and  funds are only issued  after the work                                                                    
     is performed.                                                                                                              
                                                                                                                                
     The  employer of  the participant  will be  required to                                                                    
     match the  amount provided to the  participant based on                                                                    
     the  employer's ability  to pay,  as determined  by the                                                                    
     Commissioner. The  match can range from  nothing to 50%                                                                    
     of the  total. For purposes  of the fiscal note,  a 25%                                                                    
     match is assumed, to allow for that range.                                                                                 
                                                                                                                                
     SB 139 is  an effective way to address  the shortage of                                                                    
     healthcare    practitioners    quickly   and    targets                                                                    
     experienced  practitioners  who   are  ready  to  work.                                                                    
     Although   preference  can   be   given  to   Alaskans,                                                                    
     practitioners can  be from anywhere  in the  nation. If                                                                    
     passed,  this   legislation  is  expected   to  attract                                                                    
     healthcare   practitioners  from   all  areas   of  the                                                                    
     country,  which   will  give   us  a  bigger   pool  of                                                                    
     qualified,  experienced  healthcare professionals  from                                                                    
     which  to choose;  and which  will help  to assure  our                                                                    
     ability to fill the available slots.                                                                                       
                                                                                                                                
     The  program  established  by  this  bill  will  be  an                                                                    
     effective complement  -- not a replacement  -- to other                                                                    
     programs such as WWAMI and  would fill the gap existing                                                                    
     while students are  going to school and  until they are                                                                    
     able  to practice  their chosen  field. In  other words                                                                    
     there will be immediate  results for filling vacancies;                                                                    
    no waiting for a student to become a practitioner.                                                                          
                                                                                                                                
     It  is  critical  that  we  promptly  address  Alaska's                                                                    
     healthcare  shortages  in  order  to  ensure  that  all                                                                    
     Alaskans have adequate access to  medical care.  SB 139                                                                    
     helps  us  to  save  and   improve  the  lives  of  our                                                                    
     constituents by  allowing us to  provide for  those who                                                                    
     cannot wait  until tomorrow to  get the care  that they                                                                    
     need today.                                                                                                                
                                                                                                                                
10:01:57 AM                                                                                                                   
                                                                                                                                
Senator Thomas  referred to page  5 and asked if  the person                                                                    
can receive  loan repayments if  they are not  yet licensed,                                                                    
but  are in  the program.  Ms. Liccioli  pointed to  page 5,                                                                    
line 21,  to show that  they must become licensed  within 90                                                                    
days of their first day of employment.                                                                                          
                                                                                                                                
10:03:00 AM                                                                                                                   
                                                                                                                                
Co-Chair Stedman noted two fiscal  notes; one zero note from                                                                    
the Department  of Education and Early  Development, and one                                                                    
fiscal  note  from  the  Department  of  Health  and  Social                                                                    
Services  for  $2,882,300  in general  funds  to  cover  the                                                                    
estimated  cost  of  incentive  payments  and  to  hire  one                                                                    
additional   full-time  staff   person  to   administer  the                                                                    
program.  Ms. Liccioli  believed the  two new  notes reflect                                                                    
the new CS.                                                                                                                     
10:04:15 AM                                                                                                                   
                                                                                                                                
LANETTA  LUNDBERG,  DIRECTOR,   HUMAN  RESOURCES,  KETCHIKAN                                                                    
GENERAL HOSPITAL (via teleconference),  spoke in favor of SB
. She highlighted the benefits of the legislation.                                                                           
                                                                                                                                
10:06:00 AM                                                                                                                   
                                                                                                                                
JERRY GRONEN,  WASILLA (via teleconference),  explained that                                                                    
he  is a  student  who will  accumulate  $70,000 in  student                                                                    
loans.   He  testified   in  favor   of  SB   139  and   the                                                                    
reimbursements and incentives it provides.                                                                                      
                                                                                                                                
JIM  LYNCH,   CHIEF  FINANCE  OFFICER,   FAIRBANKS  MEMORIAL                                                                    
HOSPITAL (via teleconference), spoke in  favor of SB 139. He                                                                    
brought up the  problem of retiring health  care workers and                                                                    
the difficulty  of trying to  fill positions,  especially in                                                                    
rural areas.                                                                                                                    
                                                                                                                                
JIM  JORDAN,   EXECUTIVE  DIRECTOR,  ALASKA   STATE  MEDICAL                                                                    
ASSOCIATION  (via teleconference),  spoke  in  favor of  the                                                                    
legislation. He  said the pool  of physicians  available for                                                                    
recruitment from  around the country  has been reduced  by a                                                                    
growing tendency  of a reduction  in patient care  hours. He                                                                    
highlighted   the  results   of   health   care  reform   in                                                                    
Massachusetts in 2006.                                                                                                          
                                                                                                                                
10:12:15 AM                                                                                                                   
                                                                                                                                
DR.  DON PATHMAN,  PHYSICIAN, UNIVERSITY  OF NORTH  CAROLINA                                                                    
(via teleconference),  spoke of his experience  studying the                                                                    
outcomes  of loan  repayment and  incentive programs  in the                                                                    
health profession.  He referred to handouts  provided to the                                                                    
committee. He  agreed with  SB 139  and testified  about the                                                                    
effectiveness of the loan repayment incentive.                                                                                  
                                                                                                                                
10:15:35 AM                                                                                                                   
                                                                                                                                
ELIZABETH    RIPLEY,    MATSU   HEALTH    FOUNDATION    (via                                                                    
teleconference), spoke  in favor of  SB 139. She  listed the                                                                    
benefits   of  her   program.  She   voiced  concern   about                                                                    
understaffing. She referred to  a resolution included in the                                                                    
members'  packets.  She   shared  statistics  about  medical                                                                    
providers.                                                                                                                      
                                                                                                                                
10:19:14 AM                                                                                                                   
                                                                                                                                
SAM TRIVETTE,  JUNEAU, spoke in  favor of SB 139  because it                                                                    
would  attract health  care workers  and  increase care  for                                                                    
retirees. He  spoke of  keeping retirees  in Alaska  and the                                                                    
necessity to providing health care for them.                                                                                    
                                                                                                                                
SHELLEY HUGHES, GOVERNMENT  AFFAIRS DIRECTOR, ALASKA PRIMARY                                                                    
CARE ASSOCIATION, testified  in favor of SB  139. She shared                                                                    
concerns  about  the  shortage in  Alaska  of  primary  care                                                                    
providers. She urged passage of the bill.                                                                                       
                                                                                                                                
10:24:09 AM                                                                                                                   
                                                                                                                                
NANCY  DAVIS,  RN,  PRESIDENT,  ALASKA  NURSES  ASSOCIATION,                                                                    
JUNEAU, added her organization's support for SB 139.                                                                            
                                                                                                                                
MARIE  DARLIN, AARP,  testified in  support of  SB 139.  She                                                                    
reminded  the committee  that Alaska  would lose  if seniors                                                                    
move away due to inadequate health care.                                                                                        
                                                                                                                                
10:26:48 AM                                                                                                                   
                                                                                                                                
NANCY   O.  DAVIS,   EXECUTIVE  DIRECTOR,   ALASKA  PHARMACY                                                                    
ASSOCIATION,  spoke in  favor of  the legislation.  She said                                                                    
the bill will allow health care workers to be recruited.                                                                        
                                                                                                                                
10:27:52 AM                                                                                                                   
                                                                                                                                
Senator Olson stressed  that Alaska is losing  the battle to                                                                    
keep up  with adequate health care  providers. He emphasized                                                                    
that large  school debt is forcing  medical professionals to                                                                    
work in  major metropolitan  areas. This  legislation allows                                                                    
the state  to have  an incentive program.  Alaska is  one of                                                                    
three states that  do not currently have such  a program. He                                                                    
requested the committee's support for the bill.                                                                                 
                                                                                                                                
10:28:54 AM                                                                                                                   
                                                                                                                                
Senator Huggins  agreed with Senator Olson  about not losing                                                                    
any  battles. He  thanked Senator  Olson for  sponsoring the                                                                    
legislation.                                                                                                                    
                                                                                                                                
SB  139  was  heard  and   HELD  in  Committee  for  further                                                                    
consideration.                                                                                                                  
                                                                                                                                
SENATE BILL NO. 174                                                                                                           
                                                                                                                                
     "An Act relating to professional student exchange                                                                          
     program   availability   and    conditions   for   loan                                                                    
     forgiveness."                                                                                                              
                                                                                                                                
SB 174 was SCHEDULED but not HEARD.                                                                                             
                                                                                                                                
SENATE BILL NO. 235                                                                                                           
                                                                                                                                
     "An Act relating to charter school approval and                                                                            
     funding."                                                                                                                  
                                                                                                                                
SB 235 was SCHEDULED but not HEARD.                                                                                             
                                                                                                                                
SENATE BILL NO. 236                                                                                                           
                                                                                                                                
     "An Act relating to tax credits for cash contributions                                                                     
     by taxpayers that are accepted for certain educational                                                                     
     purposes or for a college facility; and providing for                                                                      
     an effective date."                                                                                                        
                                                                                                                                
SB 236 was SCHEDULED but not HEARD.                                                                                             
                                                                                                                                
SENATE BILL NO. 224                                                                                                           
                                                                                                                                
     "An Act establishing the governor's performance                                                                            
     scholarship program and relating to the program;                                                                           
     establishing the governor's performance scholarship                                                                        
     fund and relating to the fund; relating to student                                                                         
     records; making conforming amendments; and providing                                                                       
     for an effective date."                                                                                                    
                                                                                                                                
SB 224 was SCHEDULED but not HEARD.