Legislature(2009 - 2010)CAPITOL 106

02/01/2010 08:00 AM EDUCATION

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
Heard & Held
Scheduled But Not Heard
+ Bills Previously Heard/Scheduled TELECONFERENCED
         HB 235-PROF STUDENT EXCHANGE LOAN FORGIVENESS                                                                      
8:55:12 AM                                                                                                                    
CHAIR  SEATON   announced  that   the  next  order  of  business                                                                
would   be   HOUSE   BILL  NO.   235,   "An   Act   relating   to                                                               
professional   student   exchange   program   availability    and                                                               
conditions for loan forgiveness."                                                                                               
8:55:23 AM                                                                                                                    
KENDRA   KLOSTER,   Staff,   to  Representative    Cathy   Munoz,                                                               
Alaska  State   Legislature,   presented   the  bill,  addressed                                                                
previous   questions  from  the  committee,   and  reviewed   the                                                               
fiscal  notes.   She  paraphrased   from a  prepared  statement,                                                                
which read as follows [original punctuation provided]:                                                                          
     As  discussed   before,   HB235  establishes   a   loan                                                                    
     forgiveness  program  for  the healthcare  professions                                                                     
     of dentistry, optometry, and pharmacy.                                                                                     
     For a  quick outline,  the  WICHE [Western  Interstate                                                                     
     Commission  for  Higher  Education]  loan  forgiveness                                                                     
     program  starts  at a  25 percent  forgiveness  on  the                                                                    
     principal    loan   amount    for   participants    who                                                                    
     maintain   their  Alaska  residency,   return   to  the                                                                    
     State,  and  practice  for at  least  five  years.   An                                                                    
     additional  25 percent  loan  forgiveness  is provided                                                                     
     to  those  who  practice  in  an underserved   area  or                                                                    
     serve  patients  who  are  covered  under  the medical                                                                     
     assistance program.                                                                                                        
     Specific  questions   were  brought  to our  attention                                                                     
     during  the last  hearing and  I would  like to take  a                                                                    
     moment  to  address  those.    First,  in  response  to                                                                    
     Rep.  Gardner's   question   regarding   other   states                                                                  
     programs,  there  is  an  addition  to your  committee                                                                   
     packet  which gives  an overview  of  programs offered                                                                     
     in  other  states.    Please  take  into  account   the                                                                    
     WICHE  program  in  Alaska  will  create  an incentive                                                                     
     for  graduated   students   to  return  to  the   state                                                                    
     through  offering   the  loan  forgiveness.    We  feel                                                                    
     adding  the incentive  for  the  student  to return  to                                                                    
     the   state  is   important   to  fill   the  need   of                                                                    
     deficiency     rates     amongst     the    healthcare                                                                     
     Connecticut   Loan   Repayment:  Up   to  $30,000   for                                                                  
     first   2    years,   an   additional    $15,000    for                                                                    
     additional  year  if  health  professionals   serve  in                                                                    
     community health centers.                                                                                                  
     Arizona:   award  amounts  for  dentists  & physicians                                                                   
     are  up to $20,000  in  first  two years,  $22,000  for                                                                    
     third and $25,000 for 4 year.                                                                                              
     Minnesota   has  a  minimum   service   obligation   of                                                                  
     three  years, up  to 4 years  of loan  forgiveness  and                                                                    
     payment  directly  to participant  in  annual lump  sum                                                                    
     of $25,000.)                                                                                                               
     Secondly,   there   was  a   question   regarding   the                                                                    
     deficiency   rates   in  the   fields   of  dentistry,                                                                   
     optometry,   and  pharmacy.     There   is  also   more                                                                    
     information   and   specific   charts   &   data   that                                                                    
     address  the  deficiency  rates  in  each field.    The                                                                    
     Alaska  Pharmacists  Association   stated,  "To get  to                                                                    
     the   national   average,    Alaska   would   need   an                                                                    
     additional 137 pharmacists."                                                                                               
     In 2001,  about  25% of Alaska  dentists  were aged  55                                                                    
     and  above.    This population   of  dentists  is  only                                                                    
     getting  larger   with  the  number  of  baby  boomers                                                                     
     coming  to retirement  age.   This  is the  same  story                                                                    
     I  have  heard   for  healthcare   fields  across   the                                                                    
     During  the  last hearing  we  heard  from  Dr.  George                                                                    
     Shaffer  from  Ketchikan  who  described  the  lack  of                                                                    
     dentists  in his  area  and unable  to  sell practices                                                                     
     due  to the  lack  of  incoming  doctors.   I  heard  a                                                                    
     similar  story  this  past  week  from  a  pharmacists                                                                     
     working    at    the   Southeast    Regional     Health                                                                    
     Consortium  (SEARHC)  here in  Juneau -  She said  they                                                                    
     were   unable   to  find   a   pharmacists   with   the                                                                    
     qualifications  so  over the  course of  6 months  they                                                                    
     went  through  a  number  of  "fill  in"  pharmacists.                                                                     
     Shelly  expressed  the  danger  to  the  patients  with                                                                    
     the  number  of  pharmacists   that  come  through  the                                                                    
     program and lack of experienced pharmacists.                                                                               
     Disparity  rates  for optometrists  cover  three  areas                                                                    
     in  the   state   at  this   time:  the   Gulf   Coast,                                                                    
     Northern   Alaska,  and  Southwest.     This  is  in  a                                                                    
     chart  distributed  by  the division  of  occupational                                                                     
     licensing.    As  stated  before,   we  are  seeing  an                                                                  
     increase  in retirees,   we need  to look  forward  and                                                                  
     address  the  decrease   in healthcare   professionals                                                                   
     before  we  see  a  further   increase  in  deficiency                                                                   
     I  believe  it  was  Rep.  Buch  who  had  a  question                                                                     
     regarding  the  classification   of underserved   areas                                                                  
     -  the  Commissioner   of  Department  of  Health   and                                                                    
     Social  Services  has  this  duty and  works  with  the                                                                    
     definitions,  and  studies  regarding  the underserved                                                                     
     areas   with  the  U.S.   Department   of  Health   and                                                                    
     Social  Services.   Alice  Rarig  from  the Department                                                                     
     of  Health  and Social  Services  is  in  the audience                                                                     
     to  address  any additional  questions   regarding  the                                                                    
     Departments  definition  and  process  for underserved                                                                     
     Also  available  in  the  audience   is Diane  Barrans                                                                     
     from  Alaska Commission  on  Postsecondary  Education,                                                                     
     Dr. David  Logan  from the  Alaska Dental  Society  and                                                                    
     Jim  Towel  is on  the  line  from  the Alaska   Dental                                                                    
     If you  would  like, let's  go ahead  and  take a  look                                                                    
     at the fiscal note.                                                                                                      
     The  program will  start  with 15  students  in FY11  -                                                                    
     5   from  each   of   the  three   fields,   pharmacy,                                                                     
     optometry,   and  dentistry.    These  costs   are  the                                                                    
     WICHE  support  fees   that  are  paid  by  the  state.                                                                    
     The  support  fee varies  depending   on the  field  of                                                                    
     study.    Fees  for  2010/2011:   Dentistry:  $22,700,                                                                     
     Optometry: $15,600, Pharmacy: $6,900.                                                                                      
     An  additional  15 students  are  added  through  FY14,                                                                    
     the  total   amount  of  students   allowable   in  the                                                                    
     program  cap at  60.  The  incremental  costs starting                                                                     
     in  FY15 is  the  average  fee increase  of  3.4%,  the                                                                    
     average  rate  determined   by  the  higher  education                                                                     
     cost adjustment.                                                                                                           
     I  also  want to  note  -  beginning  in  the  5   year                                                                    
     following  the  program   implementation,   there  will                                                                    
     be   an   income   stream   from   the   participant's                                                                     
     repayments.     In  FY15  the  first  15  participants                                                                     
     will  be  in repayment,   contributing  about  $40,000                                                                     
     in  repayment,  $116,400  in  FY16  and  so on.    This                                                                    
       would increase to approximately $420,000 annually.                                                                       
9:00:45 AM                                                                                                                    
CHAIR  SEATON  referred  to  page 2  line  20, and  paraphrased:                                                                
"In  addition  to  other  loan  forgiveness  benefits  available                                                                
to  [a] participant,   the Alaska  Commission  on  Postsecondary                                                                
Education  [shall   annually]  ...  forgive  10  percent  of  the                                                               
outstanding   principal    ...".     He   questioned   how   this                                                               
language  coincides   with  the  5 percent  stipulated   in  [sub                                                               
section] (a).                                                                                                                   
MS.    KLOSTER    explained    that    the   loan    forgiveness                                                                
participants,   as  defined   on  page   2,  lines  16-19,   will                                                               
receive   5  percent  per   year,  for   5  years,  or  a   total                                                               
forgiveness   of 25  percent.    In  addition   to meeting   that                                                               
criteria,  subsection  (b)  also  allows that  if  a participant                                                                
practices   in  an  underserved   area,  they  will  receive   an                                                               
additional   5  percent,   to  wit  10  percent,   for  5   years                                                               
totaling  a  50 percent  forgiveness   on  their principle   loan                                                               
9:03:11 AM                                                                                                                    
CHAIR  SEATON  indicated   concern  that  the  structure  of  the                                                               
bill may not convey that intent.                                                                                                
REPRESENTATIVE   MUNOZ assured  the  committee  that  the  intent                                                               
is  to  provide  a  maximum  forgiveness  of  50  percent.    She                                                               
     But  in order  to  receive  the  second  part  of  that                                                                    
     forgiveness  they  have  to meet  the requirements   of                                                                    
     the first  section,  and, if  you go to  C, on page  3,                                                                    
     the  aggregate  amount  is 50  percent;  it's outlined                                                                     
     in that language.                                                                                                          
9:04:47 AM                                                                                                                    
REPRESENTATIVE   BUCH  inquired   about   the  determination   of                                                               
what constitutes an underserved area.                                                                                           
MS. KLOSTER  indicated  that  a representative   from Department                                                                
of  Health  and Social  Services  (DHSS)  is  available  to  take                                                               
REPRESENTATIVE   BUCH  pointed  out  that only  one  optometrist                                                                
has provided support for this legislation.                                                                                      
MS.   KLOSTER   conceded   that  minimal   correspondence    from                                                               
optometrists  has  been  received,  however,  DHSS  occupational                                                                
licensing  section  has research  indicating  underserved   areas                                                               
for optometry.                                                                                                                  
9:06:43 AM                                                                                                                    
DIANE  BARRANS,  Executive  Director,   Postsecondary  Education                                                                
Commission,   Department  of  Education  and  Early  Development                                                                
(EED)  indicated   that  the  professional  fields  included   in                                                               
the bill  are industry  proposed  priorities.    She stated  that                                                               
it  poses  no  conflicts  with  the  current  structure   of  the                                                               
program,   but  it  does  create  some   special  features   that                                                               
would  be available  to  practitioners  in  the three  specified                                                                
9:08:17 AM                                                                                                                    
CHAIR  SEATON   directed  attention   to  the  CS,  page  1,  and                                                               
paraphrased    from  subsection    (b),   "Notwithstanding    the                                                               
funding    priorities    established     under   (a)    by    the                                                               
commission."       He   asked   whether    the   commission    is                                                               
comfortable with the language.                                                                                                  
MS. BARRANS responded yes.                                                                                                      
9:08:55 AM                                                                                                                    
CHAIR  SEATON  requested  her analysis  of  the bill  and how  it                                                               
will work within the system that she administers.                                                                               
9:09:06 AM                                                                                                                    
MS.  BARRANS   said   the  primary   change   is  to  provide   a                                                               
forgiveness   feature  for  these   practitioners.    Thus,   the                                                               
state  will need  to fund  that  out of the  general  fund.   The                                                               
other  loans,  for other  fields  of study,  are funded  via  the                                                               
Alaska  Student   Loan  Corporation.    The  allocation   is  for                                                               
five  students per  year, however,  there  may not  be that  many                                                               
applying.     Should   more  than   five  qualified   applicants                                                                
pursue  the available   funded seats,  the  authority  to  select                                                               
is  retained  by  the  appropriate  institution.     She opined,                                                                
that  other  than   these  minor  caveats,  the  bill   does  not                                                               
present a significant change.                                                                                                   
9:10:46 AM                                                                                                                    
CHAIR  SEATON  referred  to line  6  and read,  "...  the Alaska                                                                
Commission    on   Postsecondary    Education    shall   provide                                                                
adequate  funding  ...".    Thus,  the commission   will provide                                                                
loans   for  at   least   five   applicants   in  each   of   the                                                               
categories.    He  inquired  whether  this  poses  any conflicts                                                                
with the commission.                                                                                                            
9:11:29 AM                                                                                                                    
MS.  BARRANS   said  if  funds  are   not  appropriated   by  the                                                               
legislature,   then  the  loans  will  not  be  made  with  these                                                               
terms and conditions.                                                                                                           
CHAIR  SEATON  surmised  that  the  legislature   would  have  to                                                               
appropriate separate funds for the forgiveness loans.                                                                           
9:12:27 AM                                                                                                                    
MS.   BARRANS   explained   that   the   forgiveness   contracts                                                                
entitle  the  recipients   to  certain  benefits.     Because  of                                                               
that,  the  loans  require  up-front  funding  from  the general                                                                
fund.       The   commission    will   establish    a   separate                                                                
appropriation   stream   for  funding,  and   incoming  payments                                                                
will  be  returned  to  the  general  funds.    It  is  the  same                                                               
process  as  occurs  with   WWAMI  [Washington, Wyoming,  Alaska,                                                               
Montana, and Idaho Medical Education Program].                                                                                  
9:13:47 AM                                                                                                                    
REPRESENTATIVE  GARDNER  asked  if the  forgiveness  facet  isn't                                                               
funded,  will  there be  an effect  on  a qualified  applicant's                                                                
loan  options;   could  student   still  receive  a  loan,   that                                                               
otherwise    would    have   been    available,    absent    this                                                               
MS.  BARRANS  deferred  to the  assistant  attorney  general  for                                                               
that  answer.   However, she  predicted  that, if  this language                                                                
is  put  into  statute   and  funds  are  not  appropriated,   it                                                               
could prove to be problematic.                                                                                                  
REPRESENTATIVE   GARDNER  underscored   that  it  could  have  an                                                               
adverse impact on students entering the field.                                                                                  
MS. BARRANS offered to consult with DOL.                                                                                        
9:15:06 AM                                                                                                                    
REPRESENTATIVE  BUCH  asked  how this  differs from  the way  the                                                               
forgiveness  policies   have worked  in  the  past,  and whether                                                                
there  are  other  programs  structured  similarly,   other  than                                                               
MS.  BARRANS  said  that  the  way  in  which  Alaska  currently                                                                
participates   in the  Professional   Student  Exchange  Program                                                                
(PSEP)  is  a variation  from  the  original  structure.    Until                                                               
1992,  all of  the  Alaskans  who participated   did  so with  no                                                               
service  or  loan  obligation  relative   to the  support   fees.                                                               
Around  1998,  the  legislature   stipulated  that  the  student                                                                
loan  corporation  could  fund loans  to  individuals  who  chose                                                               
to   borrow    the   support   fee    on   their   own   behalf.                                                                
Approximately     half   of    the    other   western    states,                                                                
participating  in  the exchange,  have  some service  obligation                                                                
related   to  their   resident's   participating   in  the   PSEP                                                               
program.    Typically  it  is  a one  to  one  obligation:    one                                                               
year  of support  for  one  year of  obligation  for  up to  four                                                               
years.    The  proposed  bill  offers  two  differences:    1)  a                                                               
partial  discharge  of  the  financial  obligation;  and  2)  the                                                               
time   period  required   to  serve   to  receive   the  maximum                                                                
9:17:25 AM                                                                                                                    
REPRESENTATIVE  BUCH  asked  how this  legislation  differs  from                                                               
the  original   forgiveness   loans  offered   in  Alaska.     He                                                               
recalled  a  program that  forgave  50  percent  of a  loan if  a                                                               
student returned as a resident for five years.                                                                                  
MS.   BARRANS  concurred    that  the   original   general   fund                                                               
forgiveness  loan  allowed for  a 50  percent discharge  if  they                                                               
completed their degree and returned for five years.                                                                             
REPRESENTATIVE    BUCH   remembered   that   it  was   dismissed                                                                
because  of  the feeble  requirements,   and  the high  level  of                                                               
MS. BARRANS  clarified  that  it was  eliminated  when the  state                                                               
chose  to discontinue  the  program in  1986.  A  combination  of                                                               
factors  caused  this  decision  including:    low  oil revenues                                                                
versus   the  cost   of   the  program,   minimal   underwriting                                                                
standards,  no credit  checks,  and default  rates  in excess  of                                                               
30  percent.   It proved  to  be a  costly  program,  and only  a                                                               
relatively   small  number  of  residents   benefited   from  the                                                               
9:21:05 AM                                                                                                                    
REPRESENTATIVE   BUCH asked  whether  the  proposed  forgiveness                                                                
format and venue is an appropriate way to proceed.                                                                              
MS.  BARRANS refrained   from offering  a  value judgment.    The                                                               
structure   is  aimed   at  those   who  are   targeting   highly                                                               
professional   areas,   with  the   possibilities   of  monetary                                                                
9:22:51 AM                                                                                                                    
CHAIR  SEATON  recalled  previous  legislation  that  proposed  a                                                               
more general forgiveness program.                                                                                               
MS.  BARRANS stated  that  HB 58  was a  loan repayment  program                                                                
without  a  built-in  entitlement.     She  said  that  she  will                                                               
provide  further  information  to  the committee   regarding  any                                                               
cumulative impact of these two pieces of legislation.                                                                           
9:24:48 AM                                                                                                                    
REPRESENTATIVE    GARDNER   pointed   out   that   this  program                                                                
targets   students   who   are   entering   highly   competitive                                                                
fields.     She  asked   if  the   implication   is  that   these                                                               
student's  will  be  less  apt to  default,  and  have  a  higher                                                               
probability rate of finishing school.                                                                                           
MS.  BARRANS  these  are students  who  will  have  completed  an                                                               
undergraduate  program,  and  demonstrated  academic  success  to                                                               
a  level  of  being  admitted   to a  professional   institution                                                                
and, as such, are considered a good risk.                                                                                       
REPRESENTATIVE   GARDNER  surmised   that  the  concern   is  not                                                               
that  these   candidates  could   be  successful  and   pay  back                                                               
their  loans  without  assistance,   but  rather  to  mold  their                                                               
behavior   in  such  a  way  that   they  return  to  Alaska   to                                                               
MS.  BARRANS  reported  that  the  WICHE  participants,   in  the                                                               
PSEP,  from  states   that  have  a  forgiveness  component,   or                                                               
service  obligation,  have  a  return  rate double  that  of  the                                                               
states which do not.                                                                                                            
9:27:05 AM                                                                                                                    
CHAIR  SEATON  opined  that  the  problem  may not  be  the  loan                                                               
forgiveness  aspect,  but  that many  of  the openings  are  held                                                               
for  residents  of the  other WWAMI  states.   He  asked if  this                                                               
program   will   provide  a   benefit   of  gaining   slots   for                                                               
Alaskans to enter professional schools.                                                                                         
9:27:42 AM                                                                                                                    
MS.  BARRANS  replied  yes,  and  said  that  the schools   which                                                               
participate  in the  PSEP are  reserving  a number  of slots  for                                                               
WICHE  state  residents.   Thus,  each  institution  prioritizes                                                                
state  admits  first,  then  WICHE admits,  and  anyone  else  is                                                               
considered  a  non-resident.    If there  is  an over  demand  by                                                               
state  admits, the  only means  for entering  an  institution  is                                                               
by  being  a  WICHE/PSEP   participant  from  a  sending   state.                                                               
She  pointed  out  that  this  is an  important  access  program                                                                
for Alaskans.                                                                                                                   
9:29:58 AM                                                                                                                    
ALICE  RARIG,  Planner  IV,  Department   of  Health  and  Social                                                               
Services (DHSS), availed herself for questions.                                                                                 
9:30:21 AM                                                                                                                    
REPRESENTATIVE  BUCH  referred  to  page 2,  lines  26-28,  which                                                               
discusses  underserved areas,  and asked  about the  standard for                                                               
this provision.                                                                                                                 
9:31:00 AM                                                                                                                    
MS.  RARIG indicated  that two  processes exist  to address  this                                                               
language, allowing identification  of an area as  either having a                                                               
health  professional  shortage  or being  medically  underserved.                                                               
The bill  suggests that the  commissioner would  apply discretion                                                               
to determine  which designation  might apply.   The  most readily                                                               
available  designations  are  primary care,  health  professional                                                               
shortage  areas, and  dental health  professional shortage  areas                                                               
for the purposes  of this bill.  She indicated  that there are no                                                               
shortage  area specifications  for  optometrists or  pharmacists.                                                               
She said:                                                                                                                       
     We've suggested to  the ... proposers of  the bill that                                                                    
     the  primary care  health  professional shortage  area,                                                                    
     based on  primary care physician  shortages would  be a                                                                    
     good   proxy   for   shortages   of   pharmacists   and                                                                    
MS. RARIG  said that  the occupation  licensing data  indicates a                                                               
distribution  of  pharmacy  and  optometry parallel  to  that  of                                                               
physicians, so this could be a satisfactory approach.                                                                           
9:32:48 AM                                                                                                                    
REPRESENTATIVE BUCH  queried whether  the commissioner  by policy                                                               
administers  to  this oversight,  and  whether  there is  written                                                               
statute,  regulation,  or policy  that  will  accompany the  bill                                                               
through the finance committee.                                                                                                  
MS. RARIG  responded that there  is not a regulation  specific to                                                               
this  proposal, but  agreements do  exist between  the state  and                                                               
federal governments  that allow  the department to  undertake the                                                               
activity of submitting requests  for designations.  Currently the                                                               
designations  are  used  primarily  for  processing  of  National                                                               
Health  Service  Corps  (NHSC)   placements  and  loan  repayment                                                               
requests.   She said that  this is  a long standing  program that                                                               
can  be accessed  on  the internet  via  the Health  Professional                                                               
Shortage Areas (HPSA) website.                                                                                                  
9:35:07 AM                                                                                                                    
CHAIR  SEATON  asked whether  bill  language  could designate  an                                                               
underserved area  for primary care physicians,  and eliminate the                                                               
need  for the  department  to individually  process and  identify                                                               
underserved areas for the three named professions.                                                                              
MS.  RARIG pointed  out  that there  is no  fiscal  note for  the                                                               
department, suggesting  that the existing designations  of health                                                               
professional shortage areas would be used.                                                                                      
9:36:08 AM                                                                                                                    
CHAIR  SEATON  expressed concern  and  suggested  that a  sponsor                                                               
amendment could rectify this oversight.                                                                                         
9:36:48 AM                                                                                                                    
REPRESENTATIVE P.  WILSON established her understanding  that the                                                               
medical assistance  program was  reviewed, and it  was discovered                                                               
that  pharmacists and  optometrists were  found lacking  equal to                                                               
the  underserved  areas  for  physicians.   She  agreed  that  an                                                               
amendment might be necessary.                                                                                                   
MS. RARIG said that the  licensing data was examined to establish                                                               
the   availability   and   distribution   of   optometrists   and                                                               
pharmacists,  and   how  it  correlates   to  physicians.     The                                                               
information gleaned  did not ascertain that  the listed, licensed                                                               
doctor is in practice, but that  they have an Alaska residence in                                                               
a particular area  of the state.  She used  this informal process                                                               
to establish a rationale for pharmacist and optometrist needs.                                                                  
9:38:30 AM                                                                                                                    
REPRESENTATIVE GARDNER recalled the  prior statement that this is                                                               
industry led  legislation, which  is not  uncommon.   However, in                                                               
this case  the industry  will not  benefit from  the legislation,                                                               
but the effects will be evident to all Alaskans.                                                                                
9:39:34 AM                                                                                                                    
CHAIR SEATON opined that this may  be why letters of support have                                                               
been spare.   He directed  attention to [subparagraph]  (B), line                                                               
29,  and  expressed  concern  that some  facilities  may  not  be                                                               
identified for  benefit, such as  the Anchorage  Native Hospital,                                                               
or the Pioneer's  Home.  He asked whether this  language works to                                                               
identify underserved areas adequately.                                                                                          
MS. RARIG acknowledged  that the implications in  the urban areas                                                               
where  a person  may be  employed by  an organization  with gross                                                               
billings exceeding  five percent for Medicaid/Medicare,  could be                                                               
questionable.  However, the benefit  is evident for areas such as                                                               
Ketchikan,  which  do  not  meet   the  federal  criteria  for  a                                                               
definition  of shortage  in the  area  of dental  health.   Under                                                               
subparagraph   (B)  a   dentist  practicing   in  Ketchikan   and                                                               
participating in the Medicaid program would be eligible.                                                                        
9:43:04 AM                                                                                                                    
CHAIR  SEATON read  from  page  2, lines  29-30:    "... who  are                                                               
covered under  the medical assistance program  in the state,...",                                                               
and asked whether that would  include the Native Health Programs,                                                               
Medicare, and  Medicaid.   He pondered  whether most  dentists in                                                               
the state  could attribute  five percent of  their billings  to a                                                               
medical assistance program.                                                                                                     
MS.  RARIG suggested  that the  definition of  medical assistance                                                               
program should be  clarified.  She reported that  about one third                                                               
of Alaska's  dentists participate in  the Medicaid program,  to a                                                               
level  of claims  exceeding  $10,000 per  year.   The  department                                                               
would rely  on an applicant  disclosing their gross  and Medicaid                                                               
9:45:32 AM                                                                                                                    
CHAIR SEATON opened public testimony.                                                                                           
9:45:58 AM                                                                                                                    
DR. DAVID LOGAN,  DDS, Alaska Dental Society,  stated support for                                                               
HB 235, disclosing that he is  a benefactor of the Alaska Student                                                               
Loan and WICHE  programs.  These programs are  the primary reason                                                               
that he  was able to attend  a professional school and  return to                                                               
practice in Alaska.  He  indicated how students graduating dental                                                               
school  are faced  with an  overwhelming debt.   Five  percent of                                                               
Medicaid billings for a dental  practice, represent a significant                                                               
amount  of billings.    Medicaid is  approximately  a 50  percent                                                               
reimbursement  of  fees, which  translates  to  10 percent  of  a                                                               
practice; not an  insignificant amount.  The goal  of the society                                                               
is  to  encourage  more  participation   to  alleviate  needs  of                                                               
patients and burdens on practitioners.                                                                                          
9:48:43 AM                                                                                                                    
REPRESENTATIVE MUNOZ asked if the  medical assistance language is                                                               
too  broad  and  should  stipulate  Medicare  or  other  specific                                                               
DR. LOGAN regarding dentistry, Medicare  does not cover services,                                                               
only Medicaid reimburses dentistry.                                                                                             
9:49:27 AM                                                                                                                    
REPRESENTATIVE MUNOZ solicited comment  from the chair on whether                                                               
a definition should be included in subparagraph (B).                                                                            
CHAIR SEATON  opined that  subparagraph (B)  is unclear  and will                                                               
need revising as the bill goes forward.                                                                                         
9:50:03 AM                                                                                                                    
CHAIR SEATON  asked whether tracking  the Medicaid  percentage of                                                               
the gross  billings, in  a typical  dentistry office,  would pose                                                               
any problem in order to qualify for this type of program.                                                                       
DR. LOGAN responded that it would not.                                                                                          
CHAIR SEATON  inquired whether  it would present  a problem  in a                                                               
shared office situation.                                                                                                        
DR.  LOGAN  indicated  that  it  would be  unusual  to  not  have                                                               
separate billings,  even when dentists  share an office.   Modern                                                               
dental management systems  are computerized to allow  for ease of                                                               
CHAIR SEATON  suggested that  the pharmacists  may be  faced with                                                               
more of a challenge given  the nature of their office structures,                                                               
often   within   large   corporate   facilities   where   several                                                               
pharmacists may be employed and work  in shifts.  It is important                                                               
for  the  administrators  of the  program  to  clearly  delineate                                                               
expectations and the verification process.                                                                                      
9:53:36 AM                                                                                                                    
NANCY DAVIS, Executive  Director, Alaska Pharmacists Association,                                                               
stated  that  she  will  provide  information  to  the  committee                                                               
regarding the Medicaid questions.   She posed two questions.  The                                                               
first one  referred to  the previous statement  that half  of the                                                               
participating  WICHE states  provide forgiveness  with a  service                                                               
attachment.   She  asked if  this  applies to  the support  fees.                                                               
Also, she  asked if there is  a guarantee for instate  tuition at                                                               
the WICHE school of pharmacy.                                                                                                   
9:55:50 AM                                                                                                                    
MS. BARRANS explained that when  a student accepts admission as a                                                               
certified  student, they  agree,  if they  are  supported by  the                                                               
state,  to  enter into  a  service  obligation, which  they  must                                                               
discharge,  or they  will have  a financial  repayment obligation                                                               
relative to the  support fee that was paid on  their behalf.  The                                                               
support fee  is a  negotiated fee  set by  the WICHE  program, in                                                               
cooperation with  the deans of  participating schools.   Pharmacy                                                               
is a  unique situation,  in that  the support  fee has  been kept                                                               
low, at $6,900 per year.  For  some schools it does not cover the                                                               
differential  of what  they would  otherwise charge  the student,                                                               
and those  schools have  the option  of recovering  directly from                                                               
the student that  differential.  She provided an  example using a                                                               
resident  rate of  tuition,  plus a  support fee.    If the  non-                                                               
resident  rate of  tuition left  a gap,  the difference  could be                                                               
recovered from the  student.  The WICHE staff  indicates that the                                                               
schools have  refrained from collecting the  additional cost from                                                               
students, however, that is not  likely to continue in perpetuity.                                                               
What the  WICHE staff would like  to do is raise  the support fee                                                               
for pharmacy  to a  level that  will ensure  that schools  do not                                                               
have a financial deficit in relation to WICHE students.                                                                         
9:58:12 AM                                                                                                                    
MS.  DAVIS surmised  that the  support fee  does provide  instate                                                               
tuition to the student.                                                                                                         
MS.  BARRANS  said not  in  every  case,  as  it depends  on  the                                                               
negotiated terms with individual institutes.                                                                                    
9:59:11 AM                                                                                                                    
CHAIR SEATON  stated that  the bill  will be held.   [HB  235 was                                                               
held over.]                                                                                                                     
9:59:31 AM                                                                                                                    

Document Name Date/Time Subjects
HB 206 material.pdf HEDC 3/27/2009 8:00:00 AM
HEDC 4/3/2009 8:00:00 AM
HEDC 2/1/2010 8:00:00 AM
CS HB 206 (EDC) April 22 workdraft.pdf HEDC 8/25/2009 9:00:00 AM
HEDC 2/1/2010 8:00:00 AM
HB 206 Sponsor statement.doc HEDC 8/25/2009 9:00:00 AM
HEDC 2/1/2010 8:00:00 AM
HB 206
Post Secondary courses for High School Students - HB 206
HB 206 Student Count Briefing.doc HEDC 8/25/2009 9:00:00 AM
HEDC 2/1/2010 8:00:00 AM
Dual student count/count averaging - HB 206
HB 206
Briefing paper for high schoolers taking postsecondary courses HB206.doc HEDC 8/25/2009 9:00:00 AM
HEDC 2/1/2010 8:00:00 AM
HEDC 2/5/2010 8:00:00 AM
HB 206
Post Secondary courses for High School Students - HB 206
HB206_CountChart.xlsx HEDC 1/20/2010 8:00:00 AM
HEDC 2/1/2010 8:00:00 AM
HB 206
HB235 version R.pdf HEDC 1/22/2010 8:00:00 AM
HEDC 2/1/2010 8:00:00 AM
HB 235
HB235 Sponsor Statement.pdf HEDC 1/22/2010 8:00:00 AM
HEDC 2/1/2010 8:00:00 AM
HB 235
Ltr House Ed Comm RE HB235 WICHE.pdf HEDC 1/22/2010 8:00:00 AM
HEDC 2/1/2010 8:00:00 AM
HB 235
WICHE Tuition -pharmacy school.xls HEDC 2/1/2010 8:00:00 AM
HB 235
WICHE- Pharmacy Workforce.pdf HEDC 2/1/2010 8:00:00 AM
HB 235
HB235- statistics.doc HEDC 2/1/2010 8:00:00 AM
HB 235
HB 317 materials.pdf HEDC 2/1/2010 8:00:00 AM
HEDC 2/5/2010 8:00:00 AM
HB 317
HB235CS-EED-ACPE-01-29-10.pdf HEDC 2/1/2010 8:00:00 AM
HB 235
HB317_EED_ACYA_1-27-10.pdf HEDC 2/1/2010 8:00:00 AM
HEDC 2/5/2010 8:00:00 AM
HB317_EED_ESS_1-27-10.pdf HEDC 2/1/2010 8:00:00 AM
HEDC 2/5/2010 8:00:00 AM
Scan001 (5).pdf HEDC 2/1/2010 8:00:00 AM
HB 235
Scan001 (6).pdf HEDC 2/1/2010 8:00:00 AM
HB 235