Legislature(2009 - 2010)CAPITOL 106
03/25/2010 03:00 PM House HEALTH & SOCIAL SERVICES
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HB 392-INCENTIVES FOR CERTAIN MEDICAL PROVIDERS 4:42:10 PM CO-CHAIR KELLER announced that the final order of business be 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." 4:42:28 PM CO-CHAIR HERRON moved to adopt proposed committee substitute (CS) for HB 392, 26-LS1528\S, Mischel, 3/17/10 as the working draft. 4:42:46 PM REPRESENTATIVE SEATON objected for discussion. 4:42:57 PM NIKOOSH CARLO, Staff to Representative Bob Herron, Alaska State Legislature, explained that the change to Version S was on page 5, line 15, and it inserted "to not fewer than three participants employed in very hard-to-fill positions." DR. CARLO explained that HB 392 created an incentive program and loan repayment program within Department of Health and Social Services. 4:46:19 PM DR. CARLO, in response to a questions about the earlier Version E, explained that on page 5, line 12, "continuing participant" had been inadvertently deleted. The committee took an at-ease from 4:46 p.m. to 4:47 p.m. 4:47:50 PM REPRESENTATIVE T. WILSON asked for a definition of "hard-to- fill." DR. CARLO replied that this definition would be worked out in regulations. 4:48:30 PM CO-CHAIR KELLER asked for the determination of "hard-to-fill." DIANE BARRANS, Executive Director, Alaska Commission on Postsecondary Education (ACPE), replied that this would be determined by Department of Health and Social Services. 4:49:02 PM REPRESENTATIVE SEATON asked about the duration for loan repayments to the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) graduate medical education program. He commented that HB 392 had a six year loan repayment program, and he asked if there were any other programs of that duration. 4:49:38 PM MS. BARRANS replied that the two WWAMI repayment terms were three years for underserved areas and five years for urban areas. She said that it was important to distinguish the fundamental structure of WWAMI. She explained that the agreement was entered into when students entered the first year of the graduate medical program, and the funds were paid directly to the University of Washington School of Medicine. She pointed out that if a graduate did not return to Alaska to practice, the service agreement would convert into a loan with active repayment. She said that there was not a similar, active program. She explained that there was a small teacher education loan with a similar structure to WWAMI. She pointed out that this proposed program could be paid off after three years of service, depending on the amount of debt. 4:52:01 PM REPRESENTATIVE SEATON questioned that if the proposed program was for any student loans, was it necessary to make direct payment to the loan holder, other than an Alaskan state loan, or just make the payment to the student. 4:53:05 PM MS. BARRANS said that this program had evolved over the years, and that it was only recently that the direct incentive of cash payment was included. She opined that the loan repayment language could be vestigial and that some groups believed the student loan payment to be duplicative. 4:54:04 PM REPRESENTATIVE SEATON asked if the reference could just be to the Alaska student loan program. MS. BARRANS offered her belief that this would be a different objective from the original program. She explained that the broad education loan eligibility was to allow recruitment from out of state. She said that a change might limit the participation. 4:55:22 PM REPRESENTATIVE SEATON offered his belief that this change would make it easier administratively, and he did not see "any downsides." 4:56:05 PM CO-CHAIR KELLER allowed that this would be the sponsor's decision. REPRESENTATIVE T. WILSON offered her support and stated that the doctor shortage was only going to worsen. 4:56:53 PM CO-CHAIR HERRON, as the prime sponsor of HB 392, expressed agreement with Representative Seaton. 4:58:04 PM REPRESENTATIVE SEATON suggested that a conceptual amendment would streamline the bill. CO-CHAIR HERRON asked if the conceptual agreement was for another means to administer the loan program. 4:59:30 PM REPRESENTATIVE SEATON moved to adopt Conceptual Amendment 1, which he explained would only limit the loan repayment be used for Alaska state issue loans, with the remainder of the same amount to now be paid by direct incentive. 5:00:02 PM REPRESENTATIVE T. WILSON objected for discussion. She expressed concern that this would limit the participation. REPRESENTATIVE HOLMES also objected for discussion. She stated her agreement with the intent to simplify the paperwork and lower the administrative cost. She expressed concern with any unforeseen consequences by somehow "skewing who is eligible to receive the money." 5:01:33 PM REPRESENTATIVE SEATON replied that the intent was for repayment to Alaska state loans, with the cap to remain the same. 5:02:09 PM REPRESENTATIVE T. WILSON removed her objection. REPRESENTATIVE HOLMES removed her objection. 5:02:24 PM DR. CARLO emphasized that an applicant was eligible for the program whether or not they had any loans. 5:02:40 PM There being no objection, Conceptual Amendment 1 was adopted. REPRESENTATIVE HOLMES expressed her support for HB 392. 5:03:29 PM CO-CHAIR KELLER stated his discomfort with the necessity to subsidize the salaries of these professionals, and he opined that government rate regulation had removed any incentives for practice. He reiterated that the current federal health care legislation could make it necessary to re-visit this bill. [Version S was adopted as the working draft.] 5:05:06 PM REPRESENTATIVE T. WILSON moved to report proposed committee substitute (CS) for HB 392, 26-LS1528\S, Mischel, 3/17/10, as amended, out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, CSHB 392 (HSS) was forwarded from the House Health and Social Services Standing Committee.