Legislature(2009 - 2010)CAPITOL 106

03/23/2010 03:00 PM HEALTH & SOCIAL SERVICES

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

Document Name Date/Time Subjects
HB270 sponsor statement.pdf HHSS 3/23/2010 3:00:00 PM
HB 270
HB 270 support letter - AARP 03.22.2010.pdf HHSS 3/23/2010 3:00:00 PM
HB 270
HB 270 support letter - ACOA 01.30.2010.pdf HHSS 3/23/2010 3:00:00 PM
HB 270
HB 270 support letter - AGENET 02.18.2010.pdf HHSS 3/23/2010 3:00:00 PM
HB 270
HB 270 backup - Questions and Answers.pdf HHSS 3/23/2010 3:00:00 PM
HB 270
HB 270 backup - 2002 and 2003 Alaska statutes showing change from percentage to fixed dollar amount.pdf HHSS 3/23/2010 3:00:00 PM
HB 270
HB 270 backup - medicaid waiver info.pdf HHSS 3/23/2010 3:00:00 PM
HB 270
HB 260 support - AARP letter 03.23.2010.pdf HHSS 3/23/2010 3:00:00 PM
HB 260