Legislature(2019 - 2020)ADAMS ROOM 519

04/22/2019 01:30 PM House FINANCE

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

Document Name Date/Time Subjects
HB114 SHARP-2 Final Report to Legislature 04.08.19.pdf HFIN 4/22/2019 1:30:00 PM
HB 114
HB114 DHSS Presentation 04.08.19.pdf HFIN 4/22/2019 1:30:00 PM
HB 114
HB114 Sectional Analysis 04.08.19.pdf HFIN 4/22/2019 1:30:00 PM
HB 114
HB114 Sponsor Statement 04.08.19.pdf HFIN 4/22/2019 1:30:00 PM
HB 114
HB114 Support Letters 04.08.19.pdf HFIN 4/22/2019 1:30:00 PM
HB 114
HB 41 CS WORKDRAFT v.U.pdf HFIN 4/22/2019 1:30:00 PM
HB 41
HB 87 CS WORKDRAFT v.M.pdf HFIN 4/22/2019 1:30:00 PM
HB 87
HB 114 Supporting Document Table - SHARP - Agency - List - 2019 - 03-20-19.pdf HFIN 4/22/2019 1:30:00 PM
HB 114
HB 87 NEW FN DOR Tax Division.pdf HFIN 4/22/2019 1:30:00 PM
HB 87