Legislature(2009 - 2010)CAPITOL 106

04/01/2009 08:00 AM EDUCATION

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08:00:57 AM Start
08:01:39 AM Confirmation Hearing(s)|| Professional Teaching Practices Commission
08:13:57 AM HB197
09:34:41 AM HB204
10:04:21 AM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
+ Confirmation Hearings: TELECONFERENCED
Board of Education, Professional Teaching
Practices Commission
+ Bills Previously Heard/Scheduled TELECONFERENCED
Heard & Held
HB 204-POSTSECONDARY MEDICAL EDUC. PROG.                                                                                      
9:34:41 AM                                                                                                                    
CHAIR SEATON announced that the  final order of business would be                                                               
HOUSE BILL  NO. 204,  "An Act increasing  the number  of students                                                               
pursuing  a  medical  education who  are  provided  postsecondary                                                               
educational  services   and  programs;   and  providing   for  an                                                               
effective date."                                                                                                                
9:35:22 AM                                                                                                                    
REPRESENTATIVE  WILSON  moved  to  adopt CSHB  204,  Version  26-                                                               
LS0778\R, Mischel, 3/31/09, as the working document.                                                                            
CHAIR SEATON objected for discussion purposes.                                                                                  
9:35:51 AM                                                                                                                    
SAM  DIX, Staff,  Representative  Nancy  Dahlstrom, Alaska  State                                                               
Legislature, explained  that Version R continues  to increase the                                                               
number of students  pursuing a medical education  to 24, although                                                               
the language  now specifies  "24" not "up  to and  including 24".                                                       
The legislation,  Version R, now  includes provisions  that would                                                               
allow   student  loan   forgiveness  to   Alaska  residents   who                                                               
participate in  the Washington,  Wyoming, Alaska,  Montana, Idaho                                                               
Medical Education  Program (WWAMI),  receive a  medical education                                                               
degree, and  provide qualified practice  in the state.   The loan                                                               
forgiveness is detailed in Section 2  of Version R.  Section 3 of                                                               
Version R states that those who  received a degree from the WWAMI                                                               
program  must be  a  full-time employee  or  practitioner for  at                                                               
least six  months in order  to qualify for the  loan forgiveness.                                                               
He  highlighted   that  Section   3  specifies   that  "full-time                                                               
employee"  doesn't  include  seasonal  or  temporary  employment.                                                               
Section 4 defines  a "qualified practice" to be  a facility where                                                               
medical  services  are  provided  by  a  physician  who  received                                                               
medical education  under the WWAMI  program, where  a significant                                                               
percentage  of the  patients  of the  practice  are uninsured  or                                                               
covered  under  Medicare  or other  medical  assistance,  and  is                                                               
located in a medically underserved area  of the state.  Section 4                                                               
also  specifies the  definition of  "rural".   Section 5  relates                                                               
that  Department  of  Health  and   Social  Services  (DHSS)  may                                                               
establish  standards  for  a qualified  practice  in  regulation,                                                               
including  the definition  of  "medically  underserved area"  and                                                               
"significant percent" in  terms of patients that  would qualify a                                                               
practice for loan  forgiveness.  Section 6 is  the effective date                                                               
of July 1, 2010.                                                                                                                
9:40:37 AM                                                                                                                    
REPRESENTATIVE  GARDNER directed  attention to  Section 3,  which                                                               
specifies  that in  order to  qualify for  [loan] forgiveness,  a                                                               
person must be a full-time  employee or practitioner for a period                                                               
of at least  six months.  She  asked, "Does it mean  they have to                                                               
be a  doctor for six  months before  the clock starts  ticking on                                                               
their employment under which loans will be forgiven?"                                                                           
MR.  DIX  answered  that  Section  3  means  that  they  must  be                                                               
considered  a  full-time employee  within  the  first year  after                                                               
graduating from the WWAMI program.                                                                                              
REPRESENTATIVE   GARDNER  surmised   then  an   individual  can't                                                               
graduate from the  WWAMI program, take a job elsewhere  for a few                                                               
years,  and  then  return  to  Alaska to  work  and  obtain  loan                                                               
MR. DIX stated his agreement.                                                                                                   
9:42:13 AM                                                                                                                    
CHAIR SEATON  asked then  whether a  WWAMI graduate  seeking loan                                                               
forgiveness  would have  to return  directly to  Alaska or  could                                                               
they return to Alaska with an outstanding WWAMI loan.                                                                           
MR. DIX clarified that if a  WWAMI graduate practices or takes up                                                               
employment  outside  of  the  medical   practice,  they  will  be                                                               
considered  under  the five  years  employment,  20 percent  loan                                                               
forgiveness program.                                                                                                            
9:43:05 AM                                                                                                                    
CHAIR SEATON related his understanding  that Section 3 means that                                                               
an individual  who takes a job  for one month can't  receive loan                                                               
forgiveness.  However, the language  doesn't specify that a WWAMI                                                               
graduate who  takes a  job elsewhere and  then returns  to Alaska                                                               
and is  employed for six  months can't receive  loan forgiveness.                                                               
He expressed the need to clarify this point.                                                                                    
MR. DIX deferred to departmental representatives.                                                                               
9:44:54 AM                                                                                                                    
ALICE  RARIG,  Planner  IV,  Department   of  Health  and  Social                                                               
Services,  related her  belief  that Section  3  doesn't seem  to                                                               
imply  that  service couldn't  be  interrupted.   Therefore,  she                                                               
suggested that the  sponsor may need to  provide clarification on                                                               
this  point.   She opined  that  the clock  for loan  forgiveness                                                               
would start once the individual  begins full-time employment in a                                                               
qualified  practice   and  after  six  months   could  apply  for                                                               
9:45:59 AM                                                                                                                    
REPRESENTATIVE   NANCY  DAHLSTROM,   Alaska  State   Legislature,                                                               
speaking as the  sponsor of HB 204, related that  the intent with                                                               
HB 204  is to provide  more efficient and better  quality medical                                                               
care  for  all  Alaskans.    She  said  she  shared  Ms.  Rarig's                                                               
understanding  that there  wouldn't be  a break  in the  service.                                                               
She  offered  to  request  an opinion  from  Legal  and  Research                                                               
9:47:01 AM                                                                                                                    
CHAIR SEATON opined  that the language seems  straight forward in                                                               
that  this  would  require  employment six  months  in  order  to                                                               
qualify  for  loan  forgiveness.    However,  Section  3  doesn't                                                               
stipulate that  a WWAMI graduate  couldn't take a job  in another                                                               
state  prior to  working six  months in  Alaska and  applying for                                                               
loan forgiveness or  return to Alaska and have  a six-month delay                                                               
prior to  taking a job.   The language simply says  that a [WWAMI                                                               
graduate] would  have to be employed  in Alaska for at  least six                                                               
9:47:49 AM                                                                                                                    
REPRESENTATIVE  GARDNER  said  that  she  has  received  adequate                                                               
clarification on the  language and pointed out that  the only new                                                               
language in Section 3 is the addition of "or practitioner".                                                                 
9:48:14 AM                                                                                                                    
REPRESENTATIVE  EDGMON asked  if  the language  "or for  services                                                           
provided in  a qualified practice  in" and "or practice"  on page                                                       
2, lines 13-16, is defined elsewhere  or is supportive of a full-                                                               
time employee.                                                                                                                  
CHAIR SEATON  pointed out  that page  3, subsection  (i) provides                                                               
the definition of "qualified practice".                                                                                     
9:49:28 AM                                                                                                                    
REPRESENTATIVE  EDGMON  then  asked  if  there  is  a  difference                                                               
between a medically underserved area and a rural area.                                                                          
MR. DIX answered that DHSS will define those terms.                                                                             
MR. RARIG  pointed out that  the term  "rural" is defined  in the                                                               
legislation  on  page  3,  lines  11-13.    The  term  "medically                                                               
underserved area"  is federal language  with a  specific meeting.                                                               
However, "medically  underserved area" has  yet to be  defined in                                                               
state statute.   She noted  that DHSS has developed  criteria for                                                               
the Denali  Commission funding priority  systems and  proposed an                                                               
Alaska-based  definition  of  medically underserved  area.    The                                                               
aforementioned  definition   has  been  submitted  to   the  U.S.                                                               
Department of Health and Human Services.   She said that DHSS has                                                               
no  qualms with  developing a  definition for  the term  for this                                                               
program.   There  are  non rural  areas that  may  be defined  as                                                               
medically underserved.                                                                                                          
9:52:02 AM                                                                                                                    
CHAIR SEATON  posed a  scenario in which  a portion  of Anchorage                                                               
has a lot of people who  qualify for Medicare, but there aren't a                                                               
lot of physicians who want to  take Medicare patients.  In such a                                                               
situation, Anchorage could be defined  as a medically underserved                                                               
area because of  the definition of "uninsured."  He  asked if the                                                               
aforementioned would  result in those in  Anchorage receiving the                                                               
same benefit  as [those in  rural Alaska], and thereby  take away                                                               
the incentive of the higher  reimbursement rate for rural Alaska.                                                               
Furthermore, does  such a situation  create a conundrum  in which                                                               
the  higher reimbursement  rate being  given in  rural Alaska  to                                                               
stimulate people  to go to rural  Alaska is given to  those in an                                                               
area with a significant number of Medicare patients.                                                                            
MS. RARIG related her understanding  that the regulations for the                                                               
medically  underserved  area  would  only  apply  to  the  census                                                               
designated level  and Anchorage would  be considered as  a whole.                                                               
An  area  that  would  likely  fall under  the  definition  of  a                                                               
medically  underserved area  would be  Ketchikan, where  there is                                                               
difficulty for certain portions  of the population gaining access                                                               
to services, although  the area wouldn't qualify  under the rural                                                               
definition due  to the  population being over  7,500.   Ms. Rarig                                                               
said that  most qualifying practices  would fall under  the first                                                               
designation  in  which  the practice  can  demonstrate  that  the                                                               
practice serves a significant portion  of individuals who receive                                                               
Medicare or Medicaid, or are uninsured.                                                                                         
9:54:31 AM                                                                                                                    
CHAIR  SEATON surmised  that under  Section 4(i)(1)(A)  Anchorage                                                               
would  qualify  for  the  higher   reimbursement  if  the  [WWAMI                                                               
graduate joins]  a practice  for which  a significant  portion of                                                               
the patients are Medicare patients.   He asked if that would be a                                                               
correct assumption.                                                                                                             
MS.  RARIG answered  that she  believes that  would be  a correct                                                               
9:55:33 AM                                                                                                                    
CHAIR   SEATON   expressed   concern   with   having   a   higher                                                               
reimbursement rate for those living  in the lowest cost of living                                                               
areas  in  the  state  while   possibly  taking  away  the  rural                                                               
MS. RARIG  stated her  understanding that there  are a  number of                                                               
practices in  Anchorage and other  urban areas that are  taking a                                                               
disproportionate  number   of  [Medicare,   Medicaid,  uninsured]                                                               
patients.    These  practices  feel that  they're  in  an  unfair                                                               
situation  in   terms  of  reimbursement   and  threaten   to  be                                                               
overwhelmed when other practices  won't accept Medicare patients.                                                               
She  opined  that   this  legislation  is  meant   to  provide  a                                                               
recruitment  incentive for  those practices  to be  able to  hire                                                               
more physicians  and perhaps create  a more  balanced competition                                                               
[in the urban areas].                                                                                                           
REPRESENTATIVE  DAHLSTROM  stated  that  the  intent  is  not  to                                                               
identify any  particular population in  the state, but  rather to                                                               
provide better  medical service for  all Alaskans.   Furthermore,                                                               
many  rural residents  come to  Anchorage  for medical  services.                                                               
She  clarified   that  this  legislation  wouldn't   qualify  the                                                               
Anchorage area  as a whole,  only those practices that  treat the                                                               
underserved populations.                                                                                                        
9:58:01 AM                                                                                                                    
REPRESENTATIVE  WILSON  acknowledged   the  sponsor's  view,  and                                                               
questioned whether the intent is to include Anchorage.                                                                          
REPRESENTATIVE DAHLSTROM responded that  the intent is to include                                                               
Anchorage as well as the entire state.                                                                                          
9:59:06 AM                                                                                                                    
REPRESENTATIVE  WILSON  opined  then  that  more  of  [the  WWAMI                                                               
graduates] will return to Anchorage to receive loan forgiveness.                                                                
REPRESENTATIVE DAHLSTROM  offered that  there are those  who will                                                               
consciously choose  to teach  in rural settings.   She  said that                                                               
she  didn't   believe  all  [WWAMI  graduates]   will  return  to                                                               
10:00:45 AM                                                                                                                   
CHAIR SEATON directed  attention to the language on  page 2, line                                                               
8,  which  refers  to  "employment  in the  state  in  a  medical                                                               
residency  program".    The only  medical  residency  program  is                                                               
offered in  Anchorage.   If there  are a  number of  Medicare and                                                               
uninsured patients  served at the  hospital [providing  a medical                                                               
residency  program],  would the  language  mean  that any  [WWAMI                                                               
student] at such  an institution would be reimbursed  at the high                                                               
rate, as if they were serving in rural Alaska.                                                                                  
MR. DIX said that the medical  residency program would have to be                                                               
considered  by  DHSS  as  serving  a  significant  percentage  of                                                               
Medicare and uninsured patients.                                                                                                
10:02:05 AM                                                                                                                   
CHAIR SEATON expressed the need  to answer the aforementioned and                                                               
how it works into this  legislation, although he said he wouldn't                                                               
hold the  legislation based on that  matter.  If the  hospital at                                                               
which a  physician is  serving has a  high incidence  of Medicare                                                               
and/or uninsured  patients, then  this legislation seems  to open                                                               
the  possibility of  everyone in  their  residency program  being                                                               
reimbursed  as if  they're serving  in rural  Alaska.   He opined                                                               
that that's not  the intent, and therefore he  suggested that the                                                               
sponsor work on that matter.                                                                                                    
10:03:00 AM                                                                                                                   
REPRESENTATIVE  BUCH  expressed  concern  with the  [lack  of  a]                                                               
definition  for  the  terms   "medically  underserved  area"  and                                                               
"significant percentage" and the lack of a fiscal note.                                                                         
10:03:44 AM                                                                                                                   
CHAIR SEATON stated that HB 204  would be held over.  [The motion                                                               
to  adopt CSHB  204, Version  26-LS0778\R, Mischel,  3/31/09, was                                                               
left pending per Chair Seaton's objection.]                                                                                     

Document Name Date/Time Subjects
Carol J. Schaeffer and Lou Pondolfino.pdf HEDC 4/1/2009 8:00:00 AM
cshb204 WORKDRAFT.pdf HEDC 4/1/2009 8:00:00 AM
HEDC 4/3/2009 8:00:00 AM
HB 204
HB 204 information.pdf HEDC 3/30/2009 8:00:00 AM
HEDC 4/1/2009 8:00:00 AM
HEDC 4/3/2009 8:00:00 AM
HB 204
HB 197.pdf HEDC 4/1/2009 8:00:00 AM
HB 197
Linda Lee Gillam Black.pdf HEDC 4/1/2009 8:00:00 AM