Legislature(2019 - 2020)BUTROVICH 205

04/03/2019 01:30 PM HEALTH & SOCIAL SERVICES

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Audio Topic
01:30:41 PM Start
01:30:57 PM SB93
01:47:46 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Bills Previously Heard/Scheduled: TELECONFERENCED
Moved CSSB 93(HSS) Out of Committee
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         April 3, 2019                                                                                          
                           1:30 p.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Senator David Wilson, Chair                                                                                                     
Senator John Coghill, Vice Chair                                                                                                
Senator Gary Stevens                                                                                                            
Senator Cathy Giessel                                                                                                           
Senator Tom Begich                                                                                                              
MEMBERS ABSENT                                                                                                                
All members present                                                                                                             
COMMITTEE CALENDAR                                                                                                            
SENATE BILL NO. 93                                                                                                              
"An Act relating to a workforce enhancement program for health                                                                  
care professionals employed in the state; and providing for an                                                                  
effective date."                                                                                                                
     - MOVED CSSB 93(HSS) OUT OF COMMITTEE                                                                                      
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: SB 93                                                                                                                   
SHORT TITLE: MEDICAL PROVIDER INCENTIVES/LOAN REPAYM'T                                                                          
SPONSOR(s): SENATOR(s) WILSON                                                                                                   
03/18/19       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/18/19       (S)       HSS, FIN                                                                                               
03/25/19       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/25/19       (S)       Heard & Held                                                                                           
03/25/19       (S)       MINUTE(HSS)                                                                                            
03/29/19       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/29/19       (S)       -- MEETING CANCELED --                                                                                 
04/01/19       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
04/01/19       (S)       <Bill Hearing Canceled>                                                                                
04/03/19       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
WITNESS REGISTER                                                                                                              
JILL LEWIS, Deputy Director                                                                                                     
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Reviewed the CSSB 93 fiscal note.                                                                         
ACTION NARRATIVE                                                                                                              
1:30:41 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:30 p.m.  Present at the                                                               
call to  order were Senators  Giessel, Coghill,  Stevens, Begich,                                                               
and Chair Wilson.                                                                                                               
        SB 93-MEDICAL PROVIDER INCENTIVES/LOAN REPAYM'T                                                                     
1:30:57 PM                                                                                                                    
CHAIR WILSON announced  that the only order of  business would be                                                               
SENATE BILL NO.  93, "An Act relating to  a workforce enhancement                                                               
program for health care professionals  employed in the state; and                                                               
providing for an effective date."                                                                                               
CHAIR WILSON recapped  that the sponsor presented  an overview of                                                               
SB  93  during  the  March   25,  2019,  meeting.  The  committee                                                               
discussed some  potential amendments. His office  worked with the                                                               
Department  of  Health  and  Social  Services  (DHSS)  and  SHARP                                                               
[Supporting  Health  Access  Repayment   Program]  to  produce  a                                                               
committee substitute.                                                                                                           
1:31:20 PM                                                                                                                    
CHAIR WILSON solicited  a motion to adopt  the proposed committee                                                               
substitute (CS).                                                                                                                
1:31:24 PM                                                                                                                    
SENATOR COGHILL moved to adopt  the committee substitute (CS) for                                                               
SB 93, work order 31-LS0598\U, as the working document.                                                                         
1:31:37 PM                                                                                                                    
SENATOR GIESSEL objected for purposes of discussion.                                                                            
1:31:40 PM                                                                                                                    
CHAIR  WILSON  reviewed  the  explanation   of  changes  for  the                                                               
committee substitute (CS) SB 93 from Version A to Version U:                                                                    
     Section 18.29.100 Legislative Intent:                                                                                      
     Version  U  clarifies  the  Legislative  Intent  is  to                                                                    
     increase  the  availability  of  health  care  services                                                                    
     throughout   the  state,   especially  to   underserved                                                                    
     individuals  and  health   care  professional  shortage                                                                    
     areas.  References  to  "underserved" were  changed  to                                                                    
     "underserved individuals" throughout the bill.                                                                             
     Section 18.29.105, Advisory Council:                                                                                       
     Version   U   clarifies    department   employees   can                                                                    
     participate as  non-voting members,  but may  not serve                                                                    
     in  a  leadership  role,  and  establishes  that  civil                                                                    
     penalties, not  to exceed $1,000, per  violation, apply                                                                    
     to  both   participating  employers  and   health  care                                                                    
1:33:08 PM                                                                                                                    
1:33:36 PM                                                                                                                    
CHAIR WILSON referred to pages 3-5 to Section 18.29.110:                                                                        
     Section 18.29.110, Employer Payments:                                                                                      
     New  language  sets  out  the  annual  maximum  payment                                                                    
     amounts for direct incentives per tier:                                                                                    
   • Tier I: $35,000 for regular positions and $47,250 for                                                                      
     very hard-to-fill positions                                                                                                
   • Tier II: $20,000 for regular positions and $27,000 for                                                                     
     very hard-to-fill positions                                                                                                
   • Tier III: $15,000 for regular positions and $20,250                                                                        
     for very hard-to-fill positions                                                                                            
CHAIR WILSON said the $15,000 was selected by the                                                                               
department after input from the stakeholders.                                                                                   
     Section 18.29.125, Student Loan Repayment:                                                                                 
     Clarifies  eligibility  requirements for  repayment  of                                                                    
     student loans.                                                                                                             
CHAIR WILSON referred to the next change on page 6, line                                                                        
25, which added  the department, in case  the commission was                                                                    
dismantled, as the entity who can verify student loan debt.                                                                     
     Section 18.29.130, Eligibility:                                                                                            
     Clarifies  verification of  student  loan  debt may  be                                                                    
     conducted  by the  Alaska  Commission on  PostSecondary                                                                    
        Education or the Department of Health and Human                                                                         
CHAIR WILSON referred to pages 6-8.                                                                                             
     Section 18.29.190, Definitions:                                                                                            
    Adds   a   definition   for   the   term   "underserved                                                                     
     Additionally, Version  U deletes Sections 7,  9, and 10                                                                    
     in  the original  bill, thereby  removing all  language                                                                    
     pertaining to  a requirement of  a doctoral  degree for                                                                    
     advance practice registered nurses.                                                                                        
    Lastly,   the   sections   throughout   the   Committee                                                                     
     Substitute were re-numbered accordingly.                                                                                   
CHAIR  WILSON said  that several  testifiers suggested  that                                                                    
the  program benefits  should  be  available to  underserved                                                                    
individuals,  so a  definition  was added  in AS  18.19.190.                                                                    
Carryover language from House Bill  78 and language in SB 93                                                                    
allow the commissioner to add  other health care professions                                                                    
to  Tier I  and Tier  II. It  does not  change the  existing                                                                    
educational   requirements   so   if  the   minimum   degree                                                                    
requirements for  an advance practice registered  nurse were                                                                    
to change in the future,  this bill allows the occupation to                                                                    
move to the appropriate tier.                                                                                                   
1:37:33 PM                                                                                                                    
SENATOR COGHILL asked for further clarification on the language                                                                 
in Section 2, which shows [AS 18.29.]035 and [AS 18.29.]099 are                                                                 
effective in July but also lists the same statues as repealed.                                                                  
SENATOR WILSON replied that SB 93 would go into effect in July,                                                                 
thus repealing it at the same time that the new provisions in SB
93 would be enacted.                                                                                                            
SENATOR COGHILL asked if SHARP 2 was primarily being repealed.                                                                  
CHAIR WILSON answered yes.                                                                                                      
SENATOR COGHILL asked if the bill was being repealed and                                                                        
CHAIR WILSON answered yes.                                                                                                      
1:38:51 PM                                                                                                                    
SENATOR  BEGICH asked  whether  the little  typos  in the  fiscal                                                               
notes had been corrected.                                                                                                       
CHAIR WILSON answered yes.                                                                                                      
1:39:11 PM                                                                                                                    
SENATOR STEVENS said  that Version M removed  the requirement for                                                               
a  doctoral degree  for advance  practice  registered nurses.  He                                                               
asked whether doctoral degrees were required for some positions.                                                                
1:39:36 PM                                                                                                                    
SENATOR GIESSEL  said that an  advance practice  registered nurse                                                               
in  the state  is not  required to  have a  doctoral degree.  The                                                               
profession  is moving  in that  direction and  it may  become the                                                               
level of  entry in the future,  but at this time  the requirement                                                               
for the position is a master's degree.                                                                                          
SENATOR  STEVENS clarified  that there  is no  requirement for  a                                                               
doctorate for any advance practice registered nurse.                                                                            
SENATOR GIESSEL replied that is  correct. She reiterated that the                                                               
practice requirement for an advance  practice registered nurse in                                                               
Alaska is a master's degree.                                                                                                    
CHAIR WILSON reiterated  that the bill included  language that if                                                               
that  requirement or  any requirement  for a  professional degree                                                               
changes, the  department can  move them  to the  appropriate tier                                                               
1:40:50 PM                                                                                                                    
SENATOR GIESSEL removed her objection.                                                                                          
1:41:01 PM                                                                                                                    
CHAIR  WILSON found  no further  objection.  Therefore, CSSB  93,                                                               
work order 31-LS0589\U, was adopted.                                                                                            
1:41:41 PM                                                                                                                    
JILL  LEWIS, Deputy  Director, Department  of  Health and  Social                                                               
Services (DHSS), Juneau,  reviewed the CSSB 93  fiscal notes. She                                                               
said  the   Department  of   Commerce,  Community   and  Economic                                                               
Development (DCCED)  submitted a zero  fiscal note for  Version A                                                               
because it referenced an action  concerning the Board of Nursing.                                                               
However, those sections have been deleted in Version U.                                                                         
The  fiscal note  for Department  of Health  and Social  Services                                                               
(DHSS),  Public Health,  Emergency  Programs, is  a large  fiscal                                                               
note. It increases from $814,300 in  FY 2020 to $5.043 million in                                                               
FY 2025.  This provides  the authority to  collect and  spend the                                                               
designated program  receipts for  the employers'  contribution to                                                               
the DHSS and does not have any UGF [unrestricted general funds].                                                                
She said  the funding  has a small  amount for  personal services                                                               
derived from  the administrative fee that  employers include with                                                               
their payments.  The remainder of  the operating  expenditures is                                                               
in   services,   which  is   for   the   actual  contracts   with                                                               
practitioners. As  previously mentioned,  the revenue  listed for                                                               
$814,300 in  FY 2020  to $5.043.0  million shows  that it  is new                                                               
revenue for the program. The net amount is zero.                                                                                
MS. LEWIS  indicated that in  the third  year, a new  position is                                                               
listed, which anticipates  the volume growing to  the extent that                                                               
it cannot be handled by existing  staff. It also provides a small                                                               
amount  to pay  for  a contractor  in year  five  if the  program                                                               
continues to grow to provide additional staff support.                                                                          
1:44:08 PM                                                                                                                    
SENATOR  BEGICH asked  for clarification  that personal  services                                                               
increased from  153.3 in  FY 2023  to 238.9 in  FY 2024,  but the                                                               
program remains at one position.                                                                                                
MS. LEWIS replied that as  the program grows, the department will                                                               
collect  additional receipts  in the  administrative fee  because                                                               
the fees  are a percent  of the  loan values that  the department                                                               
collects. As the program grows,  so will the administrative fees.                                                               
Those fees will  initially support the existing  staff person who                                                               
currently administers  the program.  Eventually the  program will                                                               
receive  enough fees  to fully  fund the  staff person  with fees                                                               
from [Supporting  Health Access  Repayment Program] SHARP  3. The                                                               
division will also  impose a fee for SHARP 1,  so other resources                                                               
will be available.                                                                                                              
1:45:18 PM                                                                                                                    
CHAIR WILSON solicited a motion.                                                                                                
1:45:26 PM                                                                                                                    
SENATOR COGHILL  moved to  report the  CS for  SB 93,  Version U,                                                               
from committee  with individual recommendations  and accompanying                                                               
fiscal notes. There being no  further objection, the CSSB 93(HSS)                                                               
was reported from the Senate  Health and Social Services Standing                                                               
CHAIR WILSON  said that Legislative Legal  Services is authorized                                                               
to make any necessary technical or conforming adjustments.                                                                      
1:45:48 PM                                                                                                                    
At ease.                                                                                                                        
1:47:06 PM                                                                                                                    
CHAIR WILSON reconvened the meeting. He remarked that Senator                                                                   
Stevens was present for the discussion but was absent for the                                                                   
vote to move CSSB 93(HSS) from committee.                                                                                       
1:47:46 PM                                                                                                                    
There being no further business to come before the committee,                                                                   
Chair Wilson adjourned the Senate Health and Social Services                                                                    
Standing Committee at 1:47 p.m.                                                                                                 

Document Name Date/Time Subjects
SB 93 Work Draft version U.pdf SHSS 4/3/2019 1:30:00 PM
SB 93
SB 93 LoS 4.2.19.pdf SHSS 4/3/2019 1:30:00 PM
SB 93
SB 93 Explanation of Changes A to U.pdf SHSS 4/3/2019 1:30:00 PM
SB 93