ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 23, 2010
3:05 p.m.
MEMBERS PRESENT
Representative Bob Herron, Co-Chair
Representative Wes Keller, Co-Chair
Representative Tammie Wilson, Vice Chair
Representative Bob Lynn
Representative Paul Seaton
Representative Sharon Cissna
Representative Lindsey Holmes
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 260
"An Act relating to preventive care and disease management
services for medical assistance recipients; and providing for an
effective date."
- MOVED CSHB 260(HSS) OUT OF COMMITTEE
HOUSE BILL NO. 188
"An Act relating to the taxation of moist snuff tobacco, and
amending the definition of 'tobacco product' in provisions
levying an excise tax on those products."
- MOVED CSHB 188(HSS) OUT OF COMMITTEE
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."
- HEARD & HELD
HOUSE BILL NO. 270
"An Act amending the eligibility threshold for medical
assistance for persons in a medical or intermediate care
facility."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 260
SHORT TITLE: MEDICAID: PREVENTIVE CARE/DISEASE MGT.
SPONSOR(s): REPRESENTATIVE(s) KELLER
01/08/10 (H) PREFILE RELEASED 1/8/10
01/19/10 (H) READ THE FIRST TIME - REFERRALS
01/19/10 (H) HSS, FIN
02/11/10 (H) HSS AT 3:00 PM CAPITOL 106
02/11/10 (H) <Bill Hearing Canceled>
03/04/10 (H) HSS AT 3:00 PM CAPITOL 106
03/04/10 (H) -- MEETING CANCELED --
03/11/10 (H) HSS AT 3:00 PM CAPITOL 106
03/11/10 (H) Heard & Held
03/11/10 (H) MINUTE(HSS)
03/18/10 (H) HSS AT 3:00 PM CAPITOL 106
03/18/10 (H) Heard & Held
03/18/10 (H) MINUTE(HSS)
03/23/10 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 188
SHORT TITLE: TAX ON MOIST SNUFF
SPONSOR(s): REPRESENTATIVE(s) HERRON
03/12/09 (H) READ THE FIRST TIME - REFERRALS
03/12/09 (H) HSS, L&C, FIN
03/24/09 (H) HSS AT 3:00 PM CAPITOL 106
03/24/09 (H) <Bill Hearing Rescheduled to 03/26/09>
03/26/09 (H) HSS AT 3:00 PM CAPITOL 106
03/26/09 (H) Heard & Held
03/26/09 (H) MINUTE(HSS)
04/09/09 (H) HSS AT 3:00 PM CAPITOL 106
04/09/09 (H) Heard & Held
04/09/09 (H) MINUTE(HSS)
04/14/09 (H) HSS AT 3:00 PM CAPITOL 106
04/14/09 (H) Heard & Held
04/14/09 (H) MINUTE(HSS)
02/23/10 (H) HSS AT 3:00 PM CAPITOL 106
02/23/10 (H) Heard & Held
02/23/10 (H) MINUTE(HSS)
03/23/10 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 392
SHORT TITLE: INCENTIVES FOR CERTAIN MEDICAL PROVIDERS
SPONSOR(s): REPRESENTATIVE(s) HERRON
02/23/10 (H) READ THE FIRST TIME - REFERRALS
02/23/10 (H) HSS, FIN
03/18/10 (H) HSS AT 3:00 PM CAPITOL 106
03/18/10 (H) Heard & Held
03/18/10 (H) MINUTE(HSS)
03/23/10 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 270
SHORT TITLE: MEDICAID FOR MEDICAL & INTERMEDIATE CARE
SPONSOR(s): REPRESENTATIVE(s) MUNOZ, SEATON, HERRON, GRUENBERG
01/08/10 (H) PREFILE RELEASED 1/8/10
01/19/10 (H) READ THE FIRST TIME - REFERRALS
01/19/10 (H) HSS, FIN
03/23/10 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
PAT LUBY, Advocacy Director
AARP
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 260.
BILL STREUR, Deputy Commissioner
Office of the Commissioner
Department of Health and Social Services (DHSS)
POSITION STATEMENT: Testified during discussion of HB 260 and
during discussion of HB 392.
NIKOOSH CARLO, Staff
to Representative Bob Herron
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
392, on behalf of the prime sponsor, Representative Bob Herron.
DIANE BARRANS, Executive Director
Alaska Commission on Post Secondary Education (ACPE)
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of HB 392.
JIM L. LYNCH, Chief Finance Officer
Fairbanks Memorial Hospital & Denali Center
Fairbanks, Alaska
POSITION STATEMENT: Testified during discussion of Hb 392.
LANETTA LUNDBERG, Director of Human Resources
Ketchikan General Hospital
Ketchikan, Alaska
POSITION STATEMENT: Testified in support of HB 392.
RICHARD PECK, Board President
Iliuliuk Family & Health Services
Unalaska, Alaska
POSITION STATEMENT: Stated support of HB 392.
JERRY GROWER, Student
Wasilla, Alaska
POSITION STATEMENT: Testified in support of HB 392.
ELIZABETH RIPLEY, Executive Director
Mat-Su Health Foundation
Wasilla, Alaska
POSITION STATEMENT: Testified during discussion of HB 392.
DON PATHMAN, Professor
University of North Carolina Rural Health Research and Policy
Analysis Center
Durham, North Carolina
POSITION STATEMENT: Answered questions during discussion of HB
392.
SONIA HANFORTH-KOME, Executive Director
Iliuliuk Family & Health Services Clinic;
President, Alaska Primary Care Association
Unalaska, Alaska
POSITION STATEMENT: Stated support of HB 392.
DAVID MORGAN
Alaska Primary Care Association
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 392.
NATALIE HALE, Medical Student
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 392.
ANGEL DOTOMAIN, President & CEO
Alaska Native Health Board
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 392.
MARIE DARLIN
Capital City Task Force AARP
Juneau, Alaska
POSITION STATEMENT: Testified in support of HB 392.
SAM TRIVETTE
Juneau, Alaska
POSITION STATEMENT: Spoke in support of HB 392.
SHELLEY HUGHES, Government Affairs Director
Alaska Primary Care Association (APCA)
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 392.
PAT CARR, Chief
Health Planning and Infrastructure
Division of Health Care Services
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of HB 392.
KENDRA KLOSTER, Staff
to Representative Cathy Munoz
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HB 270 on behalf of the prime
sponsor, Representative Cathy Munoz.
ACTION NARRATIVE
3:05:33 PM
CO-CHAIR BOB HERRON called the House Health and Social Services
Standing Committee meeting to order at 3:05 p.m.
Representatives Herron, Keller, Lynn, T. Wilson, and Seaton were
present at the call to order. Representatives Cissna and Holmes
arrived as the meeting was in progress.
HB 260-MEDICAID: PREVENTIVE CARE/DISEASE MGT.
3:05:52 PM
CO-CHAIR HERRON announced that the first order of business would
be HOUSE BILL NO. 260, "An Act relating to preventive care and
disease management services for medical assistance recipients;
and providing for an effective date." [Before the committee,
adopted as the working draft on 3/11/10, was the proposed
committee substitute (CS) for HB 260, Version 26-LS1128\R,
Mischel, 2/4/10.]
3:06:42 PM
CO-CHAIR KELLER, as the prime sponsor of the bill, explained
that HB 260 was an authorization and encouragement for
Department of Health and Social Services (DHSS) to get a waiver
for preventative care services.
3:07:16 PM
REPRESENTATIVE SEATON moved to adopt Amendment 1, labeled 26-
LS1128\R.1, Mischel, 3/18/10, which read:
Page 2, following line 14:
Insert a new subsection to read:
"(e) The department shall establish measures
that include medical, social, and economic components
for the services provided under this section. The
measures shall be used in evaluating outcomes and
savings for purposes of reporting under (d) of this
section."
CO-CHAIR HERRON objected for discussion.
REPRESENTATIVE SEATON explained that the amendment would insert
a new subsection which he read.
3:07:54 PM
CO-CHAIR HERRON stated that the sponsor was in favor of
Amendment 1 and he asked if there were any questions.
3:08:05 PM
REPRESENTATIVE SEATON explained that the amendment built the
medical, economic, and social components into the program to
help evaluate success in a timelier manner.
3:08:59 PM
CO-CHAIR HERRON removed his objection.
There being no further objection, Amendment 1 was adopted.
3:09:16 PM
REPRESENTATIVE SEATON moved to adopt Amendment 2, labeled 26-
LS1128\R.2, Mischel, 3/18/10, which read:
Page 2, line 14, following "outcomes,":
Insert "costs,"
CO-CHAIR HERRON objected for discussion.
REPRESENTATIVE SEATON explained that the amendment inserted the
word "costs" on page 2, line 14 to allow for this analysis, as
well.
CO-CHAIR HERRON removed his objection.
There being no further objection, Amendment 2 was adopted.
3:10:19 PM
PAT LUBY, Advocacy Director, AARP, stated that AARP strongly
supported HB 260. He pointed out that Medicare had included
preventive health as a means for the program to save money. He
noted that HB 260 was a good health and fiscal policy.
3:11:13 PM
CO-CHAIR HERRON closed public testimony.
REPRESENTATIVE T. WILSON asked if there was any fiscal impact.
3:12:12 PM
The committee took an at-ease from 3:12 p.m. to 3:13 p.m.
3:13:51 PM
CO-CHAIR KELLER offered his belief that the federal health care
reform bill could have a fiscal impact on all health care
legislation and that each of these bills may need to be re-
addressed at some point in the future.
3:15:55 PM
REPRESENTATIVE CISSNA reiterated that the sponsor statement
focused on the importance of prevention. She stated that
studies show that "prevention pays." She shared that HB 260 was
"a great leadership role" and would get a start on the federal
health plan.
3:18:16 PM
REPRESENTATIVE T. WILSON asked if HB 260 could be implemented
without increasing the state payroll.
3:18:36 PM
BILL STREUR, Deputy Commissioner, Office of the Commissioner,
replied that the position was necessary for the set up of cost
containment issues to put the program in place, contracting, and
annual contract maintenance with the provider network.
3:19:31 PM
REPRESENTATIVE T. WILSON asked if the position was necessary
after the initial set up.
3:19:45 PM
MR. STREUR replied that it was necessary until the frequency of
contracts and the number of participating providers was known.
3:19:58 PM
REPRESENTATIVE T. WILSON asked for more information about the
impact and involvement with the private sector.
3:21:04 PM
CO-CHAIR KELLER moved to report the proposed committee
substitute (CS) for HB 260, Version 26-LS1128\R, Mischel,
2/4/10, as amended, out of committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, CSHB 260 (HSS) was reported from the House Health
and Social Services Standing Committee.
HB 188-TAX ON MOIST SNUFF
3:21:48 PM
CO-CHAIR HERRON announced that the next order of business would
be HOUSE BILL NO. 188, "An Act relating to the taxation of moist
snuff tobacco, and amending the definition of 'tobacco product'
in provisions levying an excise tax on those products." [Before
the committee, adopted as the working draft on 4/14/09, and
amended on 2/23/10, was the proposed committee substitute (CS)
for HB 188, Version 26-LS0714\N, Bullock, 4/9/09.]
3:22:40 PM
The committee took an at-ease from 3:22 p.m. to 3:26 p.m.
3:26:51 PM
REPRESENTATIVE SEATON moved to adopt the proposed committee
substitute (CS) for HB 188, Version 26-LS0714\K, Bullock,
2/24/10, as the working document.
3:27:04 PM
REPRESENTATIVE T. WILSON objected for discussion.
3:27:16 PM
REPRESENTATIVE SEATON explained the changes. He pointed to the
proposed CS, Version K, page 1, line 8, and said that the title
now included "relating to the offense of selling tobacco to a
minor;" page 3, line 30, moved the word "sold" from (b) to (1),
in front of "as loose tobacco."; and page 4, line 1, added the
wording after "sold only" in Sec 6 (b)(2) to now include "in
packages of not less than 10 units and." He also directed
attention to page 7, reported that Sec. 19 was repealed, and the
Applicability to the various sections was changed to conform.
3:28:15 PM
REPRESENTATIVE T. WILSON, directing attention to page 4, line 1,
asked if this referred to cigars.
REPRESENTATIVE SEATON agreed.
3:28:43 PM
REPRESENTATIVE T. WILSON asked why packages of five cigars would
be sold, especially to a person who only wanted to buy one.
REPRESENTATIVE SEATON replied that he had been referring to Sec
6 (b) about smokeless tobacco.
3:29:25 PM
REPRESENTATIVE T. WILSON asked for a definition to a unit.
REPRESENTATIVE SEATON replied that a unit was a dose.
3:30:01 PM
CO-CHAIR HERRON explained that these tobacco products must come
in packets.
REPRESENTATIVE T. WILSON withdrew her objection. [There being
no further objection, Version K was adopted as the working
document.] She stated that it was not possible through price
increase to stop people from bad behavior. She opined that
there was a bigger problem.
3:30:52 PM
REPRESENTATIVE LYNN expressed agreement with Representative T.
Wilson and opined that taxes were not intended to change
behavior.
3:31:46 PM
REPRESENTATIVE CISSNA agreed that taxation was a means to pay
for a provided service. She discussed the cost and tragedy of
tobacco use. She expressed the rationale for a disincentive
which would also fund the state expenses due to tobacco use.
3:33:52 PM
CO-CHAIR HERRON suggested that the tax revenue be put into
education funds for the cessation of tobacco use, especially for
youth.
3:34:33 PM
REPRESENTATIVE T. WILSON pointed out that 25 percent of the
moist snuff tobacco tax revenue was to be used for education,
and she suggested that the remaining 75 percent of the tax
revenue be used for health care.
3:35:43 PM
REPRESENTATIVE SEATON moved to report CSHB 188, Version 26-
LS0714\K, Bullock, 2/24/10, out of committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, CSHB 188 (HSS) was reported from the House Health
and Social Services Standing Committee.
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
Alaska.
3:38:42 PM
REPRESENTATIVE SEATON asked for an explanation of the direct
incentives.
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
procedure.
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
program.
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
hiring.
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
dentists.
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
debt.
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
future.
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
Alaska.
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
contract.
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
program.
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.]
HB 270-MEDICAID FOR MEDICAL & INTERMEDIATE CARE
4:53:04 PM
CO-CHAIR HERRON announced that the final order of business would
be HOUSE BILL NO. 270, "An Act amending the eligibility
threshold for medical assistance for persons in a medical or
intermediate care facility."
KENDRA KLOSTER, Staff to Representative Cathy Munoz, Alaska
State Legislature, explained HB 270 on behalf of the prime
sponsor, Representative Cathy Munoz. She stated that the bill
amended the eligibility threshold of medical assistance to
persons in a medical or intermediate care facility. She said
that, in 2003, the Alaska State Legislature had changed the
eligibility rate from 300 percent of the social security
Supplemental Security Income (SSI) to a fixed income rate of
$1656.00 per month. She explained that this did not allow for
any cost of living adjustments by social security, and that
these small increases could disqualify some people from the
program. She explained that SSI was a federal needs-based
disability program based on the ability to work, with the
disability expected to last at least a year. She explained the
difficulty and cost of obtaining a Medicaid qualifying income
trust. She stated that HB 270 would increase the Medicaid
income eligibility standards for individuals who reside in a
medical institution to 300 percent of the current SSI rate.
[HB 270 was held over.]
4:56:46 PM
CO-CHAIR KELLER asked to be put on the record about the
implications to Alaska of the federal health care reform bill.
He opined that the HHSS committee was unable to fully evaluate
the impact of the federal legislation on the state of Alaska,
and that the committee may need to reconsider its actions as
more information was forthcoming on the fiscal impacts.
REPRESENTATIVE SEATON clarified that this was not a
reconsideration to hold a bill in committee.
CO-CHAIR KELLER agreed that it was not.
5:00:14 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:00 p.m.