Legislature(2009 - 2010)BUTROVICH 205
04/06/2009 01:30 PM HEALTH & SOCIAL SERVICES
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* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
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 state. 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 14.33.430. 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 hearing. 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 challenge. 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 that. 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 program. 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 unjust. 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 people. 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 needed. 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.