Legislature(2009 - 2010)BUTROVICH 205

04/06/2009 01:30 PM Senate HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved CSHB 2(HSS) Out of Committee
Bills Previously Heard/Scheduled
Moved CSSB 139(HSS) Out of Committee
Moved CSSB 27(HSS) Out of Committee
        SB 139-INCENTIVES FOR CERTAIN MEDICAL PROVIDERS                                                                     
1:41:31 PM                                                                                                                    
CHAIR DAVIS announced consideration of SB 139.                                                                                  
SENATOR  OLSON, sponsor  of SB  139,  said this  is an  incentive                                                               
program  to  recruit  health care  practitioners  to  underserved                                                               
areas of  the state in  areas that  are hard to  fill. Forty-four                                                               
other states  already have loan  repayment programs of  some kind                                                               
and Alaska needs to do something as well.                                                                                       
He didn't think that many  people fully understood the crisis the                                                               
state  is  in already  and  what  it  is  heading for.  The  Nome                                                               
hospital had eight full-time staff  several years ago, and is now                                                               
down to  three. Because of  that everybody is scrambling  for the                                                               
temporary physicians and the  competition is getting overwhelming                                                               
- not just  from other hospitals throughout the  state of Alaska,                                                               
but  from  hospitals throughout  the  whole  United States.  This                                                               
isn't an isolated  case; there are shortages in all  parts of the                                                               
1:44:19 PM                                                                                                                    
SENATOR PASKVAN moved  to adopt CSSB 139,  labeled 26-LS0503\P as                                                               
the working  document. There  being no  objection, version  P was                                                               
before the committee.                                                                                                           
1:44:56 PM                                                                                                                    
KENDRI CEASAR,  staff to Senator  Olson, said she went  through a                                                               
lengthy description  of the  payment plan  at the  first meeting,                                                               
so, she  would explain  the changes  in the  committee substitute                                                               
(CS),  most  of  which  were  just  clarifying  changes  to  more                                                               
accurately reflect  the intent of  the program. Language  on page                                                               
1,  line   14,  says  the  Alaska   Commission  on  Postsecondary                                                               
Education shall act  as disbursing agent. The  original bill said                                                               
the commission shall  act as the fiscal agent. It  was changed to                                                               
clarify  that the  intent is  not for  the commission  to act  as                                                               
appropriating entity and  that the funds used  for loan repayment                                                               
will not be falling to the commission's budget.                                                                                 
On page  2, lines 9-10,  in reference to  eligibility, "approved"                                                               
was changed  to "verified"  to clarify  that the  commission does                                                               
not provide the  loans. Lines 12-14 in the original  bill said in                                                               
first repayment  year, and it now  says in first year  of program                                                               
participation.  Page   3,  line   28,  had  a   simple  technical                                                               
correction -  AS 14.43.435 was  changed to properly  reference AS                                                               
The  last change  was  on page  5, lines  20-22,  which says  the                                                               
commissioner  shall  prioritize  eligible   sites  based  on  the                                                               
percentage of patients treated at  the site who (1) are uninsured                                                               
(2)  have or  are  eligible for  medical  assistance or  Medicare                                                               
coverage; or  (3) have or  are eligible for other  federal health                                                               
program  benefits. The  original  bill didn't  include those  who                                                               
have or are  eligible for other federal  health program benefits,                                                               
such as those covered under VA or tribal benefits.                                                                              
The original bill  also based the prioritization of  sites on the                                                               
volume  of  these  types  of patients  treated  rather  than  the                                                               
percentage. This change  was made so as not to  give advantage to                                                               
larger urban clinics that because  of their overall large numbers                                                               
of patients  might treat a  smaller percentage of  these patients                                                               
than a smaller clinic that  treats smaller numbers of patients to                                                               
begin  with. All  these changes  were made  in consultation  with                                                               
Diane  Barrans   of  the   Alaska  Commission   on  Postsecondary                                                               
Education and  Tim Schuerch  of the  Alaska Native  Health Board.                                                               
They do  not change the overall  purpose of the bill  nor do they                                                               
address the  issues that were  brought up in the  first committee                                                               
She  said that  Senator  Dyson had  questions  regarding how  the                                                               
initial 10 practitioners in this program were chosen.                                                                           
1:50:09 PM                                                                                                                    
SENATOR  DYSON said  he also  want to  know the  definition of  a                                                               
clinical psychologist.                                                                                                          
MS. CESAR  responded that  Rod Betit,  Alaska State  Hospital and                                                               
Nursing Home Association, who played  a key role in outlining the                                                               
proposed program in  SB 139 could answer those  questions as well                                                               
as summarize the bill for the committee.                                                                                        
1:50:48 PM                                                                                                                    
DR. JAY BUTLER,  Alaska Chief Medical Officer, said  he wanted to                                                               
address  Senator Paskvan's  question  from the  last hearing.  He                                                               
said the  administration is very  conscious of the  public health                                                               
challenge in  maintaining a sufficient health  care workforce. It                                                               
also recognized the work of  the working group that developed the                                                               
plan to  address the  work force  issues, but  the administration                                                               
opposes  the  bill  at  this  time  because  funding  presents  a                                                               
He explained  that other  aspects of the  budget are  designed to                                                               
address the workforce challenges including  the UAA money for the                                                               
family  practice residency  program -  which is  one of  the most                                                               
powerful predictors for where a  physician will ultimately set up                                                               
practice. A probity  has been placed on providing  funding to the                                                               
Alaska Student Loan Corporation to  make sure loans are available                                                               
for students coming in at the undergraduate level.                                                                              
1:53:21 PM                                                                                                                    
ROD BETIT, President/CEO, Alaska  State Hospital and Nursing Home                                                               
Association  (ASHNHA),  responded  to  Senator  Dyson's  question                                                               
about how  they came  up with  the 10  occupations. He  said they                                                               
started with a  vacancy study to see how severe  the shortage was                                                               
in various parts of the state.  They also looked at the Physician                                                               
Supply Task  Force study from  2006, which he  was a part  of. At                                                               
that time they found Alaska  was about 300 physicians short. Then                                                               
they  took  that  information  back  to  the  work  group,  which                                                               
resolved it  into the 10 occupations  in the bill. Five  of those                                                               
specifically  address the  behavior health  area -  the physician                                                               
category,  which includes  psychiatrists,  nurse practitioner  as                                                               
well  as  psychologist,  the  clinical   social  worker  and  the                                                               
physician assistant.  Four of  those have  the ability  to charge                                                               
and receive payment  for the services that they  deliver in their                                                               
own right.  Particularly since  this is  focuses in  rural areas,                                                               
they  wanted to  be sure  to provide  health care  providers that                                                               
could  generate  revenue  for   those  locations.  The  physician                                                               
assistant cannot  do that  except through  a physician,  but they                                                               
can provide  services under  the supervision  of a  physician who                                                               
can then bill for those services. That  is how they got to the 10                                                               
categories, but they are open for discussion.                                                                                   
A very strong part of this  legislation is that once the advisory                                                               
committee makes recommendations, they have  to be accepted by the                                                               
department unless the commissioner puts in writing why not.                                                                     
MR. BETIT said it is very  important to move forward and at least                                                               
establish the program.  He knows the department is  in an awkward                                                               
position  now,   but  he  doesn't   think  the  two   things  the                                                               
administration  mentioned will  help  deal with  the health  care                                                               
crisis now, particularly in the rural and hard to fill areas.                                                                   
1:58:24 PM                                                                                                                    
MR.  BETIT said  that  a clinical  psychologist  has an  advanced                                                               
degree and has  to meet licensing requirements in  this state. He                                                               
isn't completely clear on the required education level.                                                                         
SENATOR DYSON  said in-state licensed clinical  counselors are as                                                               
well  equipped  to  deal  with   behavioral  issues  as  clinical                                                               
psychologists.  So  if this  bill  doesn't  include those  state-                                                               
licensed people, he has a problem with it.                                                                                      
2:00:08 PM                                                                                                                    
CHAIR DAVIS  asked if anyone  from legal was available  to answer                                                               
MS. CESAR replied no.                                                                                                           
SENATOR THOMAS asked if ASHNHA  is willing to participate in some                                                               
kind of a match for the grants or the repayment of loans.                                                                       
MR. BETIT said he hadn't put  that to his membership, but this is                                                               
not intended to help hospitals  except in the smallest areas. The                                                               
small  rural   locations  don't  have  the   ability  to  attract                                                               
providers, and  he didn't know if  they were in a  position to do                                                               
more  than  they  are  with  the  University's  expanded  nursing                                                               
2:02:14 PM                                                                                                                    
SHELLEY  HUGHES,  Director,  Government Affairs,  Alaska  Primary                                                               
Care  Association,  provided  a   chart  entitled,  "Why  a  Loan                                                               
Repayment  and Incentive  Program is  Better Than  Other Support-                                                               
for-Service  Program  Types."  She  remarked  that  a  number  of                                                               
proposals  are   "floating  around"   and  they  all   have  good                                                               
intentions in  trying to  meet the  workforce shortage,  but this                                                               
chart shows how  this particular one is better for  the state, as                                                               
far as being cost effective  and result-producing. It doesn't put                                                               
the state  at risk of  loan default  because it doesn't  hold the                                                               
loan. It  provides for  less administration  because there  is no                                                               
need to  track the person  from their time  as a student  all the                                                               
way through to their time working in the field.                                                                                 
2:05:32 PM                                                                                                                    
PAT  LUBI,  Advocacy  Director,  AARP  Alaska,  expressed  AARP's                                                               
strong  support for  SB 139.  Without it,  Alaska cannot  compete                                                               
with other states for health care providers and workers.                                                                        
2:08:04 PM                                                                                                                    
JEAN  MISCHEL,  Drafting  Attorney, Legislative  Legal  Division,                                                               
Legislative   Affairs,  regarding   a  definition   for  clinical                                                               
psychologist,  said  the  Board  of  Psychology  doesn't  license                                                               
psychologists specifically  by type, but it  does require certain                                                               
degrees before  issuing one  - and  one of those  is a  degree in                                                               
clinical  psychology.  In  her  opinion,  unless  it  is  defined                                                               
otherwise, that would be the definition that would apply here.                                                                  
MS. CESAR said the Division  of Occupational Licensing requires a                                                               
PHD level degree for a  statewide license in clinical psychology.                                                               
A Masters would qualify someone  as only a professional counselor                                                               
or a psychologist associate.                                                                                                    
SENATOR  DYSON  said  he  is disappointed  that  the  CS  doesn't                                                               
address  his  question.  He  pointed out  that  a  Masters  level                                                               
clinical psychology  student here  qualifies for a  state license                                                               
and  can bill  for payment.  To include  them, but  not including                                                               
social workers in the behavioral  sciences seems to be unwise and                                                               
SENATOR  OLSON said  he came  up with  the types  of health  care                                                               
providers with the help of the commission that Rod Betit was on.                                                                
MR. BETIT added  that they are referring to the  ad hoc workgroup                                                               
of interested parties,  and this specific question  never came up                                                               
in their discussions.  This was their best  effort initially, and                                                               
he had no problem with adding another occupation.                                                                               
2:13:44 PM                                                                                                                    
SENATOR DYSON  said he wasn't  prepared with an  amendment today,                                                               
but could  have one  by Wednesday. There  are two  other licensed                                                               
boards - one  is marriage and family counseling and  the other is                                                               
maybe behavioral counseling - who  work in alcohol rehabilitation                                                               
programs and residential programs for children.                                                                                 
CHAIR DAVIS asked  if there is a shortage in  those areas that he                                                               
could verify.                                                                                                                   
SENATOR DYSON  asked Mr. Betit  the group did their  research how                                                               
did they determine what jobs they were short in.                                                                                
MR. BETIT  replied that they  worked with the  organizations that                                                               
represent people who  work in that area regularly  - every tribal                                                               
organization,  the  Mental  Health   Trust,  primary  care  level                                                               
organizations, the State Health  Planning and Systems Development                                                               
2:16:12 PM                                                                                                                    
SENATOR DYSON said he would try to get that information.                                                                        
SENATOR OLSON  said nothing  else could  act more  immediately to                                                               
attract these health care providers  to these hard-to-find areas.                                                               
He had no  problem adding Senator Dyson's amendment  to the bill,                                                               
but it may increase the fiscal note.                                                                                            
2:19:35 PM                                                                                                                    
SENATOR  ELLIS said  he appreciated  Senator Olson  bringing this                                                               
bill  forward. Alaska  is behind  on this  issue; it  should have                                                               
tripled the  WWAMI class three  years ago,  and this is  the most                                                               
immediate thing they can do. He was very much in support of it.                                                                 
CHAIR DAVIS  said she would  support adding  a category if  it is                                                               
SENATOR  DYSON said  if the  sponsor would  agree to  support his                                                               
amendment in Finance he would agree to move the bill today.                                                                     
SENATOR OLSON said  as long as the other  committee members agree                                                               
then he will do so.                                                                                                             
2:23:21 PM                                                                                                                    
SENATOR  PASKVAN moved  to report  CS for  SB 139  from committee                                                               
with  individual  recommendations  and attached  fiscal  note(s).                                                               
There being no objection, CSSB 139(HSS) moved from committee.                                                                   

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