HOUSE BILL NO. 78 "An Act establishing a loan repayment program and employment incentive program for certain health care professionals employed in the state; and providing for an effective date." 1:38:16 PM REPRESENTATIVE BOB HERRON, SPONSOR, explained that HB 78 had been crafted to create a support for service program to attract medical professionals to Alaska. He stated that Alaska was one of only four states that did not offer incentives to keep healthcare providers in-state. Ideally, market forces would provide the state with access to quality care; this was not happening and was creating an ever expanding need. The legislation was based on a 2007 proposal, assembled by a workgroup of the Alaska Primary Care Council. He relayed that participating healthcare providers could choose from two options: loan repayment or a direct cash incentive. He believed that he the direct incentive option would give Alaska the necessary edge to lure well experienced, mid-career professionals to the state. Representative Herron shared that the federally funded workforce support programs that the state currently participated in did not support the needs unique to Alaska. The legislation would create a string program curtailed to Alaska and to Alaskans. He pointed out that the program could show high return with a low amount of investment and that similar programs, in over 46 states, had been found to be effective. Vice-chair Fairclough clarified that the committee was working with the "R" version of the bill. Representative Herron replied in the affirmative. Representative Wilson MOVED to ADOPT proposed committee substitute, work draft 27-LSO147\R. Representative Edgmon OBJECTED for the purpose of discussion. 1:42:12 PM Representative Gara offered support for the concept of the bill. He noted that the biggest physician shortage faced by the state was in primary care. He understood that other areas periodically faced shortages, but high wages maintained the pool of specialists within the state. He stated that if funds were limited, a priority for primary care providers should be written into the bill. Representative Herron agreed that the biggest shortage in the state was affordable primary care providers. He said he would work with the committee to improve the priority process. Representative Gara asked if the language prioritizing primary care already existed in the legislation. Representative Herron replied that prioritizing primary care providers was his intention when crafting the legislation. Representative Wilson asked whether similar legislation passed in other states had inspired the crafting of the bill. 1:46:26 PM LIZ CLEMENT, STAFF, REPRESENTATIVE BOB HERRON, referred the question to members of the work group that assembled the initial bill. Representative Guttenberg referenced page 5 of the bill. He wondered how the work group had established the 90 person cap for program participants. Vice-chair Fairclough requested clarification between the original legislation and the R version currently before the committee. Representative Herron highlighted the changes. A conforming change had been made on page 3, line 10: "lending institution or to the eligible health care", this allowed payment to the health care professional or the lending institution. Representative Edgmon REMOVED his OBJECTION. There being NO further OBJECTION, it was so ordered. 1:50:26 PM Vice-chair Fairclough opened public testimony MARGARET SODEN, PRESIDENT ALASKA PHARMACISTS ASSOCIATION (via teleconference), testified in strong support of the legislation. She stressed that there were currently no pharmacy schools located in Alaska, which forced students to seek schooling out-of-state for up to six years. She believed that providing the incentives would entice future pharmacists to return to the state to practice. RHONDA SCHNEIDER, NORTON SOUND HEALTH CORPORATION (via teleconference), testified in support of HB 78. She shared that her area of Nome, Alaska was particularly limited in transportation because it was not on a road system. She believed that the incentives written into the bill would help with retention of care providers in the Nome area. 1:52:51 PM NANCY DAVIS, EXECUTIVE DIRECTOR, ALASKA PHARMACISTS ASSOCIATION (via teleconference), voiced support for the legislation. She reiterated that there were no programs in the state to recruit and retain pharmacists. She highlighted that pharmacists were necessary for the responsible distribution and use of prescription drugs. IAN ERLICH, PRESIDENT AND CEO, MANIILAQ ASSOCIATION (via teleconference), testified in support of the legislation. He expressed curiosity concerning the employer match written into the legislation. Felt that the shortage of care providers was an issue that needed to be addressed to ensure the future of quality care in Alaska. 1:55:51 PM Representative Wilson asked how many doctors were working in Kotzebue and how many more would be required. Mr. Erlich responded that there were 15 full-time positions and currently 13 of those positions were filled. Representative Herron thought that the language referring to priority for those who served as primary care medical providers could appropriately be written into page 2 of the legislation. Vice-chair Fairclough noted that the committee had not intended to move the bill at this hearing. She stated that there would be further opportunity to entertain amendments about primary care providers and have a conversation concerning the employer match. Representative Gara if the shortage of care providers in Kotzebue were located primary care. Mr. Erlich replied yes. 1:58:25 PM EMILY HUGHES (via teleconference) shared that she was a pre-med student who would be applying to medical school in 2012. She voiced support for HB 78. She hoped to return to the state after completing medical school but worried about the financial debt. She stressed that a financial incentive to return to Alaska would be helpful when deciding where to practice in the future. SONIA HANDFORTH KOME, EXECUTIVE DIRECTOR, ILIULIUK FAMILY AND HEALTH SERVICES AND PRESIDENT, ALASKA PRIMARY CARE ASSOCIATION (via teleconference), testified in strong support of the bill. She expressed that 15 positions in Unalaska would be covered by the legislation; 5 of which were currently open. One registered nurse (RN) position had been open for over a year. She stressed that the legislation would be extremely helpful in providing services to the community. ELIZABETH RIPLEY, EXECUTIVE DIRECTOR, MATSU HEALTH FOUNDATION, WASILLA (via teleconference), spoke in support of HB 78. She testified that that recruitment of quality care providers in rural areas was a challenge. She stated that keeping people out of the hospital began with chronic disease management in the primary care setting. She stated the legislation would make significant improvements in reducing the rate in the growth of Medicate cost in the state. 2:03:12 PM MARY SULLIVAN, ALASKA PRIMARY CARE ASSOCIATION (via teleconference), spoke in support of HB 78. ELIZABETH SIRLES, DIRECTOR, UAA SCHOOL OF SOCIAL WORK, ANCHORAGE (via teleconference), testified in support of the legislation. She stressed that there were serious workforce shortages in all of the areas listed in HB 78. She specifically cited the possible increase in behavioral health providers that could result by passing the bill. KAREN PERDUE, EXECUTIVE DIRECTOR AND PRESIDENT, ALASKA STATE HOSPITAL & NURSING HOME ASSOCIATION, voiced support of HB 78. She stated that rural hospitals struggled to assist communities in recruiting providers of all kinds. She commented that there were severe shortages in the medical field across the board and not just for primary care providers. Representative Guttenberg asked about the urban hospital structure versus regional healthcare. He wondered if the bill was indifferent to the different needs throughout the state. 2:07:22 PM Ms. Perdue thought that the bill had evolved to try and target the greatest area of need. She believed that the bill was flexible to meeting the different strategic needs of the state. Representative Gara spoke to the draft amendment to the bill. He thought that the best way to move forward was to deal with the shortage in primary care first and use any leftover funds in the other recognized areas. Ms. Perdue responded that the medical sites were good at prioritizing what they needed. She was concerned there would not be funds left over for specialty services. SHELLEY HUGHES, ALASKA PRIMARY CARE ASSOCIATION, PALMER, testified in support of HB 78. She stated that as a healthcare consumer in Mat-Su it had taken her eight months to get an internal medicine physician through an application process. She stressed the importance of the legislation for the future of quality healthcare in the state. She said that clinics in Alaska were losing candidates to other states that offer incentives to providers. 2:11:47 PM PAT CARR, PROGRAM MANAGER, HEALTH PLANNING AND INFRASTRUCTURE, DIVISION OF HEALTH CARE SERVICES, DEPARTMENT OF HEALTH AND SOCIAL SERVICES testified in support of the legislation. Representative Wilson asked whether there was a model that the working group for the bill had used as a guide. Ms. Carr responded that the working group had done research across the country; information had been drawn from various states. Representative Wilson wondered if other states had chosen to make one care provider group a priority. Ms. Carr responded that some repayment programs set priority on particular types of providers, and the definition of "primary care" differed among the programs. Representative Guttenberg asked how many different categories of doctor fell under the term "primary care provider." Ms. Carr explained that the definition depended on who you asked, but most often the definition included categories of physicians, dentists, behavioral health providers, and certain types of clinical psychologists. She said that some states added others as needed. 2:15:43 PM Representative Gara reiterated the importance of retaining enough primary care providers. He repeated his query as to whether there was language in the bill to give priority to primary care providers, or would an amendment be needed. Ms. Carr responded that needs assessments would indicate that primary care should be a priority in the state. She thought the needs criteria allowed for analysis and priority setting. She believed that because a prioritization scheme had been used to draft the legislation, some priority language should be in the bill already. MARIE DARLIN, ALASKA ASSOCIATION OF RETIRED PERSONS, spoke in support of HB 78. She offered that most significant factor related to retaining the states retired population was availability of quality health care. 2:20:02 PM DELISA CULPEPPER, CHIEF OPERATING OFFICER, ALASKA MENTAL HEALTH TRUST AUTHORITY, testified in support of the bill. She explained that the trust had been involved in loan repayment programs for the last four years. She stressed that there were serious behavioral healthcare provider shortages in the state; close to half the applicants for loan repayment were for those positions, including clinical and social workers. She noted that the trust had many beneficiaries who were also in need of primary care. Representative Gara asked whether the loan repayment and financial assistance in the bill applied specifically to medical providers working for a non-profit clinic. Ms. Culpepper said she was not sure. She believed that the current program pertained to non-profit entities because it was tied to federal money that was designated for public and tribal clinics. Representative Gara requested further information concerning the question. He informed the committee that he had no present intention of offering an amendment. 2:23:29 PM KATE BURKHART, EXECUTIVE DIRECTOR, ALASKA MENTAL HEALTH BOARD AND ADVISORY BOARD ON ALCOHOL AND DRUG ABUSE, spoke in support of HB 78. She argued that the vacancy rate and workforce shortage for behavioral health providers was equally to that of primary care providers. She felt that an amendment that created a statutory priority for primary care providers would be unfair. She hoped that any amendment would embrace a broad definition of primary care to include behavioral healthcare providers. She pointed out that there was an advisory body referenced in the bill that would provide recommendations for oversight and evaluation of the program. The advisory body would be composed of individuals with expertise in hiring and retention of healthcare professionals; she believed this would keep priorities relevant without creating a statutory priority for one kind of provider. Representative Guttenberg asked if a subspecialty or additional training was necessary for a behavioral health specialist to practice using telemedicine. Ms. Burkhart understood that it would depend on the type of behavioral health provider. Alaska was more reliant on the telemedicine system than many others and the system was not a regular part of formal training. 2:27:09 PM DENISE DANIELLO, ALASKA COMMISSION ON AGING, voiced support of HB 78. She noted that Alaska was first in the nation in the growth of its elder population. She stated that the number of health care professional preparing to retire would contribute to the shortage of healthcare workers in the state. The commission had recently conducted a survey which had identified healthcare as the number one concern for seniors in the state. The survey had revealed that 31 percent of the seniors questioned had experienced problems finding a primary care provider in the community in which they lived. One part of the problem had been finding a provider that would accept Medicare reimbursement, but 10 percent had noted that they could not find a doctor because there were not enough in the community. Ms. Daniello continued that the issue was most common in Anchorage, where one out of four seniors had indicated a problem accessing primary care. She reported that many open ended comments from the seniors surveyed had warned that seniors were prepared to leave the state in order to find a primary care doctor. DAVID MORGAN, SOUTHCENTRAL FOUNDATION, testified in support of the bill. He believed that, in his 30 year experience with healthcare in Alaska, the legislation would be effective. He relayed that most states already had similar programs and that Alaska should become competitive in the field. He understood that the bill did not require a person to work for a non-profit to benefit from the incentives. 2:32:53 PM JOAN DIAMOND, SELF, ANCHORAGE (via teleconference) testified in support of HB 78. She shared that she had a daughter who was finishing her masters in the mental health field and who hoped to return to Alaska. JEFF LEPAGE, PRESIDENT OF THE ALASKA CHAPTER OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION testified in support of HB 78. He stated that physical therapists in Alaska were in support of the legislation. Vice-chair Fairclough closed public testimony. Representative Herron responded to an earlier question by Representative Gara. Any organization that provided healthcare services could benefit from the bill, however, the "underserved" of the state were to be considered first. Representative Gara felt that it would be unnecessary for the committee to amend the legislation. Representative Edgmon discussed the composition of the advisory board on page 2 of the bill. He suggested that rural Alaska should be specifically considered when creating the board. 2:37:18 PM Vice-chair Fairclough requested that the committee review the fiscal notes. HB 78 was HEARD and HELD in committee for further consideration.