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." 9:15:01 AM REPRESENTATIVE BOB HERRON remarked that during the last committee meeting a concern was addressed regarding state residency. He was instructed to craft a letter with the commissioner to address the issue. The letter is in the committee packet (copy on file.) The second issue concerned primary care physicians brought up by Representative Gara. The legislation creates an environment with all the occupations that support and enhance primary care throughout the state. The legislation would have the commissioner establish priorities for incentive loan programs for eligible sites to create a better environment for attracting primary care physicians to Alaska. Co-Chair Stoltze requested the department go on record to address the concerns. JILL LEWIS, DEPUTY DIRECTOR, DIVISION OF PUBLIC HEALTH, DEPARTMENT OF HEALTH and SOCIAL SERVICES, indicated that the administration agrees with Representative Herron's statement. Co-Chair Stoltze would like the department to say it for the record. Ms. Lewis remarked that in reference to the residency question, the current committee substitute gives the latitude and ability necessary to address residency in the regulatory process. 9:19:37 AM Representative Gara appreciated the statement of intent. He asked if the department agrees that the largest shortage is with primary care physicians. Ms. Lewis agreed. Vice-chair Fairclough pointed out in the fiscal note, component number 2765. The difference, on page 3, moves nurse practitioners from Tier 2 to Tier 1. It concerns a pending item before the Board of Nursing. The fiscal note would be implemented if the Board of Nursing adopts a regulation requiring Advanced Practice Registered Nurses (APRN) to complete a doctorate. Co-Chair Stoltze pointed out that the tier status is a categorization, not a retirement status. Vice-chair Fairclough agreed that was correct. The fiscal notes would come from payments for nurse practitioners that will be paid from the service line. Representative Wilson asked what a nurse practitioner with a doctorate can do that a nurse practitioner without one cannot. She also inquired about the difference in cost for education. LIZ CLEMENT, STAFF, REPRESENTATIVE HERRON, replied that by 2015 many states are requiring their advanced nurses to hold a Doctor of Nursing Practice. In the state of Alaska there are both Master and Doctor of Nursing Practice degrees. Currently the Board of Nursing is not planning on moving to the Doctor of Nurse Practice requirement by 2015, however they may in the future. The scope of practice is not that much different just the level of education that may be required to advance in the future. Co-Chair Stoltze questioned if a nurse practitioner must work under doctor. Ms. Clement referred the question to others available. Co-Chair Stoltze noted that Nurse Practitioners are less expensive, but can perform many of the same services of doctors. Vice-chair Fairclough disclosed in FY 13 the $2,842,900 is reduced in the commodities line by $7600 for future years which is reflected in the fiscal note. There will only be one full time person hired for loan reimbursements. She asked for a confirmation from the Department of Health and Social Services that only one person would be hired. Ms. Lewis confirmed that only one employee would be hired. 9:24:43 AM Representative Doogan referred to the fiscal note and asked how the 90 participant number in the first year was determined. Ms. Lewis answered the bill indicates that the maximum would be 90 participants. Representative Doogan remarked that the actual number could be lower. Ms. Lewis agreed the number of participants could be lower. Representative Doogan asked if there were a lower number of participants would the unspent money come directly back to the state. Ms. Lewis responded that if there were not 90 participants in first year, then the department would not need to spend all the money in the fiscal note, therefore the money would come back to the state. Vice-chair Fairclough followed up that when grants are issued from a non-profit; a lot of the spin-down occurs in the fourth quarter because the group does not want to lose the money for programs. She asked Ms. Lewis for her opinion on the difference in an operating budget item and a grant. She pointed out that a certain amount of money was being set aside without actually knowing how many people might be attracted. Ms. Lewis avowed that the department would not try to expand the regulations to encourage broader participation then the intent of the bill. The funds would be returned to the state if they are not used. 9:28:46 AM Vice-chair Fairclough MOVED to report CSHB 78(FIN) out of committee with individual recommendations and the accompanying fiscal notes. There being NO OBJECTION, it was so ordered. CSHB 78(FIN) was REPORTED out of committee with a "do pass" recommendation and with one new fiscal impact note from the Department of Health and Social Services and one new zero note from Department of Education and Early Development. 9:29:18 AM AT EASE 9:33:17 AM RECONVENED