Legislature(2009 - 2010)HOUSE FINANCE 519
04/08/2010 01:30 PM House FINANCE
| Audio | Topic |
|---|---|
| Start | |
| HB392 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 392 | TELECONFERENCED | |
| + | TELECONFERENCED |
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."
1:41:25 PM
Co-Chair Stoltze took care of housekeeping and opened
public testimony.
REPRESENTATIVE BOB HERRON, explained that the intent of the
legislation was to provide the incentive to draw health
care professionals to the state. He furthered that the
state has a healthcare shortage in both rural and urban
areas.
NIKOOSH CARLO, STAFF, REPRESENTATIVE BOB HERRON, stated
that HB 392 would create a support for service program
within the Department of Health and Social Services (HESS)
that would be directed by the commissioner and an advisory
body. The program would provide a combination of cash
incentives and loan repayment for up to 90 applicants per
year, in 10 different health care occupations. The program
targeted experienced, mid-career level providers, and
monetary payments would be issued after the work was
performed. The payment would stop if the practitioner chose
to leave the state. Two different tiers of medical
providers were identified in the bill; dentists,
pharmacists, and physicians comprise Tier 1; Tier 2
included dental hygienists, registered nurses, certified
nurse practitioners, physician's assistants, physical
therapists, clinical psychologists, and clinical social
workers holding at least a masters degree in social work.
The amount of monetary incentive would depend on which tier
the applicant fell into, and the location in which they
would be serving.
Co-Chair Stoltze asked what role the social worker played
in the medical field. Ms. Carlo explained that a social
worker provided general assistance as a counselor to people
struggling with medical issues.
Representative Herron interjected that other testifiers
could further explain the infrastructure of the program. He
stated that medical occupations had a pyramidal system of
occupational support. Earlier discussions of the
legislation had highlighted the need to include social
workers in the second tier, it had been determined that
there was a shortage of social workers in the state, and
that they were instrumental in supporting the other
existing, limited occupations.
Representative Joule pointed out to the committee that the
bill read "clinical social worker". He felt this was an
important distinction. He relayed that patients who
suffered traumatic events would have needs specific to a
clinical social worker, particularly when addressing any
mental issues involved.
1:48:30 PM
Ms. Carlo continued. The program addressed a total of 90
practitioners per year in the ten categories. Each
practitioner type would have 9 slots, 3 would be reserved
for hard to fill areas. The remainder would be allocated
depending on need and the number of applications received.
Practitioners would be paid every quarter, following a
complete full quarter of service, with a lifetime cap of 6
years for participation.
Representative Gara relayed that medical professionals from
the state and the private sector had been complimentary of
the approach of the bill. He asked if there could be
assurances that the professions that were in the highest
demand in the state would benefit first from the
legislation. He gave the example of extending benefits to
primary care physicians over orthopedic surgeons.
1:51:08 PM
Ms. Carlo replied that the decision would be based on the
federal health care provided shortage criteria. She stated
that it would be unusual for orthopedic surgeons to end up
on the state's list of medical professionals needed in hard
to fill locations.
Rep Herron sincerely hoped that the understanding would be
that primary care was needed over exotic specialty care.
Representative Gara asked if the priority language on Page
3, Lines 22 and 23, set the parameters necessary to direct
the funding for the greatest need. Ms. Carlo replied yes.
She added that the criteria for allocation of the funds
would be determined in regulation by the commissioner and
the advisory body.
Rep Gara noted that heart surgeons made a lot of money, and
that there were not very many of them practicing in-state.
He wondered if assurances could be made that the funds
would not go to heart surgeons over primary care providers.
Ms. Carlo reiterated that the intent of the legislation was
to direct the funds toward primary care physicians, who
would then have the ability under regulation to use it to
fund heart surgeons.
1:54:58 PM
Representative Doogan expressed interest in the derivation
of the numbers in Section 18.29.020. Direct incentives. Ms.
Carlo responded that she was unable to answer the question.
She suggested referring the question to Senator Olsen's
office, which was carrying the companion bill in the other
body.
Rep Hawker asked about page 5, Lines 9-17. He understood
that Section A provided that the program was not to exceed
90 participants. He wondered what would happen if all the
slots were not filled each year. Ms. Carlo responded that
the intent of the language in the aforementioned lines was
to save 30 of the 90 positions for the very hard to fill
locations to ensure that the areas with the most need
received service. If there were not 30 individuals to fill
the positions, they would remain open.
Co-Chair Hawker suggested clarifying the language to more
clearly reflect the intent.
1:59:12 PM
Representative Joule wondered which commission was being
referred to in the legislation. Ms. Carlo said the
"commissioner" referred to the commissioner of HESS.
Representative Joule clarified. He noted Page 1, Line 7,
which referred to "the commission". Ms. Carlo believed it
referred to the commission on post secondary education.
Rep. Joule wondered how the passage of the legislation
would affect the mission of HB 50: Limit Overtime for
Registered Nurses. He thought there could be conflict
concerning recruitment and correct pay rates. Ms. Carlo
responded that she was not familiar with the bill.
2:01:58 PM
ROD BETIT, PRESIDENT/CEO, ALASKA STATE HOSPITAL AND NURSING
HOME ASSOCIATION (ASHNHA), testified in strong support of
the legislation. He noted the importance of the WAMMI
program and the continued funding to the University of
Alaska for health care professions. He thought that the
health care issue would be challenging over the next few
years, but that Alaska would catch up with other states in
providing readily available health care professionals. He
said that in the next five to seven years the state
expected a serious gap in a variety of medical fields. A
statewide survey performed by ASHNHA had revealed that the
public believed that the hospital should be taking an
active role to help address shortages in rural areas and
non-hospital settings. He thought that the bill was
effectively written to address the problem of primary care
physicians and other medical professional vacancy rates in
the state.
Co-Chair Hawker agreed the there was a shortage and need
for the positions mentioned, and that predicting the future
was difficult. He thought that it would make sense to add a
sunset date to the bill. Mr. Petit agreed.
Representative Joule revisited the issue of the nurse's
overtime bill. He thought that the bill highlighted the
underlying issue of a shortage of nurses in the state. He
requested more information as to how the legislation would
work with HB 50. Mr. Petit believed the legislation would
work to support HB 50. He said that HB 392 would allow
rural areas to seek additional resources without being
subject to repercussions.
2:08:08 PM
Vice-Chair Thomas commented that local students in Juneau
had been hired on at Bartlett Regional Hospital over
students from Haines. He added that Haines students were
scared to travel to Anchorage for opportunities because of
the violent urban environment. He relayed that SEARHC
required one year of work in a hospital setting before they
would hire students, forcing students to seek employment
out-of-state.
Mr. Betit stated that there were many moving parts to the
health workforce challenge. He said that over 200 nurses
graduated per year from state university programs, some of
which stay in-state to practice. He explained that the
challenge was getting the graduates the experience needed
to go out to the rural communities and immediately get to
work. There was the risk of placing a nurse without the
correct skill set on the front lines with patients. A
preceptor program that individual facilities could bring up
and run on their own had recently been established. Health
care providers wanted to hire local graduates, but those
graduates needed to have the proper training.
Vice-Chair Thomas said that students were not aware that
the year of work in a hospital was required before rural
clinics would hire them.
2:12:02 PM
Co-Chair Hawker solicited the department's position on the
bill.
DIANE BARRANS, EXECUTIVE DIRECTOR, POSTSECONDARY EDUCATION
COMMISSION, DEPARTMENT OF EDUCATION, replied that she was
not aware that administration had an opinion on the bill.
She shared that both her staff and staff from HESS had
provided technical input with respect to the loan repayment
elements.
Representative Gara asked if Ms. Barrans believed that the
incentives offered in the bill would encourage students to
stay in-state. Ms. Barrans responded that because the bill
provided the loan repayment and direct incentive, it was
considered to be a model approach.
2:14:05 PM
SAM TRIVETTE, SELF, testified that he had been working as a
volunteer with seniors and retirees for the last decade. He
stated that more medical providers were needed in Alaska as
many health care practitioners were approaching retirement
age. He believed that the bill would attract health care
professionals to the state. Alaska has the fastest growing
elderly population in the country, which contributed both
to generating money in-state, and job creation. He stated
that it had become difficult to find primary care providers
in Anchorage and Fairbanks who would see new Medicare
patients. In March of 2009, there were 25 providers in
Anchorage, but that number was down to 4 in 2010. If
seniors could not get medical care in-state they would be
forced to move outside Alaska. If retirees were to continue
to remain in Alaska and spend their savings, pensions, and
health care dollars in-state the state needed the medical
professionals to serve them.
2:16:56 PM
LANETTA LUNDBERG, KETCHIKAN GENERAL HOSPITAL (via
teleconference), testified in support of the legislation.
She stated that the hospital had experienced long standing
vacancies for physicians, pharmacists, physical therapists,
registered nurses, and clinical social workers. All of the
positions had been on the community recruitment program's
"most wanted" list for five years. Conversations with
persons of interest had revealed an interest in working and
living in Alaska, but also highlight the large loan debt
owed, and higher earning power out-of-state. She stated
that better loan repayment programs and incentive
components existed outside of Alaska, a state loan
repayment and incentive program would enhance, incentivize,
and draw a larger pool of health care professionals to
Alaska.
2:19:03 PM
JERRY GROWER, WASILLA (via teleconference), testified in
support of the legislation. He was currently a University
of Alaska graduate student in his final semester working
toward a master's degree in social work. He stated that
upon his graduation in May 2010, he would have a three
month deferment on his student loan payments. Between his
bachelor's and master's degrees he will have accumulated
over $70,000 in student loans. He thought that high burn
out rates in the healthcare field was a primary reason to
offer reimbursements and incentives to workers. He believed
that without a reimbursement program he would consider
moving out of state in order to have a better future in the
field of social work. He stated that the average licensed
clinical social worker earned approximately $40,000 per
year, much lower than other medical professionals. He urged
the state to remain competitive among states in the lower
48 to keep workers in Alaska.
Co-Chair Hawker expressed empathy for the large debt facing
current college graduates.
2:21:16 PM
DELISA CULPEPPER, CHIEF OPERATING OFFICER, ALASKA MENTAL
HEALTH TRUST AUTHORITY (via teleconference), testified in
support for HB 392. She felt that the legislation could
help with current needs and also those brought on by the
recently passed healthcare reform. She stated that the
state needed an expanded workforce in both urban and rural
areas. She pointed out to the committee that Alaska was one
of the few states in the nation that did not already have a
similar program in existence.
Co-Chair Hawker asked if the mental health trust would be
willing to split the fiscal note with the state. Ms.
Culpepper said no, but quickly added that he trust was
placing $200,000 per year in to match federal funds through
the federal loan repayment program.
2:24:17 PM
JULIE MCDONALD, PHARMACY, FLORIDA (via teleconference),
stated that in 2005, while in pharmacy school, she worked
at a pharmacy in Fairbanks. She testified that she fell in
love with the state and wanted to stay. She was currently
considering a job offer to work at an independent pharmacy
in Craig, Alaska; but due to her student loans the decision
was a difficult one. She shared that the passing of the
bill would directly affect her decision of whether or not
to move back to the state. She said that for the past three
years she had served on the board of directors for an
international pharmacy organization where her specific role
was to oversee student chapters and recent graduates. She
relayed that through her experience with the board, she
could give assurances that the passage of HB 392 would
attract young pharmacists to Alaska, especially in rural
areas.
Co-Chair Hawker pointed out to the testifier that the major
pharmacy outlets in Alaska were starved for pharmacists,
and were offering substantial incentives within the
corporate world.
RACHEL GREENBERG, PALMER SENIOR CENTER (via
teleconference), urged support of the bill. She believed
that the legislation would help to increase and secure the
workforce needed for the future of the state.
2:28:39 PM
PAT LUBY, DIRECTOR, AARP (via teleconference), testified in
strong support of the bill.
ANGEL DOTOMAIN, PRESIDENT/CEO, ALASKA NATIVE HEALTH BOARD
(via teleconference), urged support for the bill. She
relayed that tribal health provider vacancy rates exceeded
the statewide rates by over 200 percent, and in many cases
were the only providers of health services in rural areas.
As of 2009, the dental vacancy was upwards of 40%, and as
of November 2009, the tribal health system had over 80
physician vacancies. The board strongly believed that HB
392 would be an important part of the solution to Alaska's
healthcare workforce shortage.
2:32:17 PM
DORIS ROBBINS, SELF (via teleconference), testified in
support of the legislation. She stated that she was
Medicare age and had found it difficult to find a
healthcare provider in Fairbanks. She added that the
growing number of retired persons and the large number of
military dependents placed an extra burden on the Fairbanks
healthcare community.
DR. NIGHSWANDER, WAMMI MEDICAL SCHOOL (via teleconference),
strongly urged support for the bill. He stated that every
state west of the Mississippi had to import physicians, and
subsequently many of those states had incentive programs.
He reiterated that some groups in the state had developed
incentive packages but that the state was still behind in
offering incentive for providers to practice in Alaska. He
added that clinical social workers were very important to
the medical community as many patients had problems with
housing, employment, and food due to illness.
2:36:13 PM
Co-Chair Hawker stated that all the legislation pertaining
to enhancing, providing, and facilitating for students
entering the medical field in Alaska would be grouped
together and taken up in a timely manner.
Co-Chair Hawker closed public testimony.
Representative Doogan reiterated the desire for more
information on how the fee schedule was set up before
movement of the legislation.
Representative Gara asked if all of the 10 professions
identified in the bill were equally needed throughout the
state, or if there were some that were needed more urgently
than others. He wondered if more focus should be placed on
primary care.
Representative Herron believed that the state would benefit
from a surplus of healthcare providers in any field. He
added that the department would work with the committee on
issues pertaining to the fiscal note or any necessary
amendments.
2:39:59 PM
Mr. Betit replied to an earlier question by Representative
Doogan regarding tier payments. He relayed that the state
needed to be competitive with programs that were being
offered elsewhere in the country. In order to establish the
tier program the length of training time and vacancies were
weighed, as well as consideration for competitive
incentives.
Representative Doogan wondered if positions in rural Alaska
would be as easily filled as positions in urban areas, and
would the rural areas be advertized to entice out of state
professionals. Mr. Betit replied that human resource
professionals from around the state had been brought in to
assess the numbers. The professionals had determined that
the numbers establishing the tier breakdown were realistic
and would produce positive results.
PAT CARR, PROGRAM MANAGER, ALASKA DEPARTMENT OF HEALTH and
SOCIAL SERVICES, summarized the fiscal note explained the
funding source breakdown between program receipts and
general funds. She said that a 25 percent contributing
match from employing agencies was used, which resulted in
an expected general fund match of $2,036,300. The match
from the employing entities to develop the model for the
program was $678,700.
Co-Chair Hawker how the 25 percent employer match was
established.
2:46:24 PM
Ms. Carr replied that the percentage was an average of what
the estimated match would be for all employing entities.
Co-Chair Hawker requested further clarification on the
employer match provisions. Ms. Carlo replied Page 4, Lines
30-31 explained that the program allowed for an employee
match of up to 50 percent of the direct incentive allowed
per year, to be determined on a case by case basis by the
commissioner, which would result in some employing entities
having a zero match.
Co-Chair Hawker understood that the match could be left to
the commissioner's executive discretion.
Representative Gara said that the employing entities
incentives would not allow a medical professional to come
to the state and open their own office. Ms. Carlo said that
was correct. The program would not consider privately owned
practices as eligible.
2:48:08 PM
Representative Joule imagined that some medical providers
could use this bill in recruiting efforts.
HB 392 was HEARD and HELD in Committee for further
consideration.
| Document Name | Date/Time | Subjects |
|---|---|---|
| ADN_021610_article.pdf |
HFIN 4/8/2010 1:30:00 PM |
|
| HB392_changes_CS.pdf |
HFIN 4/8/2010 1:30:00 PM |
HB 392 |
| HB392_Data1_HPSA_MUA.pdf |
HFIN 4/8/2010 1:30:00 PM |
HB 392 |
| HB392_Data2_AHWV_Study.pdf |
HFIN 4/8/2010 1:30:00 PM |
HB 392 |
| HB392_Data3_UA_031409_RS14.pdf |
HFIN 4/8/2010 1:30:00 PM |
HB 392 |
| HB392_Data4_HCP_loan_proposal.pdf |
HFIN 4/8/2010 1:30:00 PM |
HB 392 |
| HB392_Data4_pathman2004.pdf |
HFIN 4/8/2010 1:30:00 PM |
HB 392 |
| HB392_letters_support.pdf |
HFIN 4/8/2010 1:30:00 PM |
HB 392 |
| HB392_sectional_analysis.pdf |
HFIN 4/8/2010 1:30:00 PM |
HB 392 |
| HB392_sponsor_statement.pdf |
HFIN 4/8/2010 1:30:00 PM |
HB 392 |
| HB 392 ASMA Letter.pdf |
HFIN 4/8/2010 1:30:00 PM |
HB 392 |
| HB 392 AARP Letter.pdf |
HFIN 4/8/2010 1:30:00 PM |
HB 392 |