This joint meeting of the House and Senate Health and Social Services Committees will now come to order.
It is 3.32 PM, Thursday, February 12th, 2026 in Davis 106.
Members present are Senators Myers, Clayman, Giesell, Dunbar,
and Representatives, Refrage, Meers, Gray, Prox, and
myself and Representative Feels has also just joined us.
Let the record reflect that we have a quorum to conduct business.
Please take this time to silence your cell phones for the duration of the meeting.
Staffing the committee today, we've Andrew Gionati as Health and Social Services Recording Secretary and Zach Lawhorn, our LIO moderator.
Katie Giorgio is my committee aide and if you need anything during the meetings, please don't hesitate to get her attention.
Today, We have presentation about the Alaska Rural Health Transformation Program.
And we wanted to take this opportunity to really talk about the
possibilities that can be done with funding from RHTP.
Today, we have Monique Martin
from the Alaska Native Tribal Health Consortium,
Nancy Mirriman with the Alaskan Primary Care Association,
and Jared Kosen with
the ALASCA Hospital and Healthcare Association
to talk about the RHDP.
These organizations were part of the application
and development of RHP,
and we are looking forward to hearing of their work
with RHDP
and how this will impact Alaska.
So to our presenters, please come to the presenter's table,
put yourself on the record, and begin your presentation.
Thank you so much to chairs Dembar and Mina for scheduling this meeting to help share information on the Rural Health Transformation Program.
For the record, my name is Monique Martin.
I serve as the Vice President of Intergovernmental Affairs for the Alaska Native Tribal Health Consortium.
Thank for your record.
My name's Jared Kosen.
I am President and CEO of the Alaskan Hospital and Healthcare Association and appreciate the opportunity to be here.
And thank you for the record.
My name is Nancy Merriman and I am the CEO
of the Alaska Primary Care Association.
For the Record, this is Monique Martin.
I'm gonna kick us off with a little bit
of sort of level setting about
the Rural Health Transformation Program.
If we could go back one slide for a minute please.
As Chair Mina mentioned, our organizations serve as part of the Advisory Council to the Department of Health and Commissioner Hedberg and her team to help provide informed, structured and practical input.
So that the Rural Health Transformation Program, the efforts the projects are implemented effectively and sustainably a big component of
is released is sustainability in the future. And as we have watched various hearings before
legislative committees, we are acutely tuned into conversations that legislators have raised,
really wanting to understand implications of the Rural Health Transformation Program,
RHTP, and understanding clearly how we build a program that doesn't leave future legislators
and trying to fill that bag.
So that is something we spend a lot of time talking about
as part of the advisory council,
but also when we talk to various groups that we represent,
and really anyone who will listen,
is really thinking about how do we build these programs
sustainably for the future.
I think one of things, when I previously worked
at the Department of then Health and Social Services,
behavioral health waiver.
and my colleague formerly at the state that I now work with at ANTHC largely led that effort.
And through that process, we heard Medicaid is an incredibly important tool for expanding
access to behavioral health services for Alaskans. However,
we've heard time and time again, there's places that Medicaid just doesn't build the gap.
How do we build that facility? How to we train the workforce?
How we get workforce into our rural communities?
This might be that opportunity to kind of help build that gap and look at additional opportunities we have in the future.
We'll talk a little bit about the program context, a bit of how we're really going to evaluate this opportunity.
from a perspective of provider organizations
and really what we're helping
to people understand about this opportunity.
And really, we have a lot of questions as do you
about what this program really is, what it's meant to do
and how can we really maximize this
opportunity while caring for some of the requirements
that CMS, the Centers for Medicare and Medicaid Services,
has outlined.
program level setting for folks watching at home is the RHTP program was authorized through
the budget reconciliation process known as HR1, one big beautiful bill, whatever you
might want to call it.
I like to provide a little bit of context because some of us know it is different things.
So that level settings really important with this opportunity because there are a lot of
This program allocates $50 billion to rural health transformation over the next five years.
And we've seen in this program some definitions regarding the distribution of money,
which actually helps level set.
states competing against one another.
Oftentimes we see grants distributed based on population size
and we don't often fare well in our state
when we compete like that,
but half of the money was distributed equally among states.
Alaska was awarded $272 million in year one.
This is the second highest allocation of any state.
There was some media coverage about Alaska's award amount.
attention and continues to get a lot of attention. And this really equates to
Texas was the state with the largest appropriation for the Rural Health
Transformation Program equites to about $9 for every Texas resident. In our state
that's just shy of $370 per resident in our State. So we have a incredibly high
Alaska rural.
So this is an incredible opportunity for this.
And I think one of the things we've spent a lot of time talking
about and really asking for clarity from CMS is there's calling
out in the notice of funding opportunity
that monies could be clawed back if a state fails
to meet their deliverables.
And, I always direct people think about the milestones
that I believe begin on page 40 in this state's application
The EMS might grade the Department of Health and Alaskan organizations that ultimately apply for and receive an award.
How are we achieving the vision that's outlined in the application for the Rural Health Transformation Program?
Senator Keasel?
Thank you Madam Chair.
A question Ms. Martin.
The questions that I'm getting from people first of all is, what is rural?
Are we going to make sure this actually gets to the far reaches of our state?
Thank you.
Through the Chair, Senator Giesel, for purposes of
Like, let's go to the technical part of the Rural Health Transformation Program.
The entire state of Alaska qualifies as rural.
But as part the state's application, they had to define rural and they list several
measures in the Department of Health's Application of how we're defining rural, and really they
say everywhere except for the municipality of Anchorage is considered rural however,
care in our state, a small population over a large geography, services provided in Anchorage
will be and service providers, organizations, social service agencies that are in anchorage.
are eligible. So the entirety of our state is eligible to apply for rural health transformation
program dollars. And to your point about, you know, how do we make sure these dollars
get to the rural, the most rural communities, from the tribal health perspective, and really
from my partners here at the table today, we've talked about that a lot. Because these opportunities
to expand services to Alaskans.
And if we are not very thoughtful
in the process that we develop
and the hurdles people have to go over
in terms of reporting, developing applications,
we will drive further health disparities
for Alascans living in rural communities.
It is a big part of our conversation regularly
with the Department of Health.
And I think we've really seen that acknowledged
pathways to funding that the Department of Health is outlined, where some groups have
said some of our smallest community health centers, smallest social service agencies
We just don't apply for grants like this.
We are simply too small.
So we don' even know where to start.
And so that administrative readiness component
is really acknowledging some of the smallest organizations
in our most rural communities.
How do we help them get ready to move
towards that planning phase?
So I think we've really seen the Department of Health
set up a very thoughtful process
to help Alaskan organizations see themselves
in a pathway to funding.
Representative Fields.
Thank you through the chair.
At the same time, there are these new grants.
Providers are also navigating sort of an intentional maze of red tape designed to cut off care,
talk about some of the barriers that you all are going to navigate in terms of work requirements,
verifying that people are in fact Alaska Natives or other categories that are supposed to be exempt from the new
Medicaid restrictions and how challenging is it going to be
to navigate all those before you try to hopefully also grab some new money.
Thank you.
For the record, my name is Jared Kosen.
Through the chair, Representative Fields, I think we just have a few more slides.
We're going to talk about the challenge of the timing of this issue before us,
and I think it would be a good way to kind of dovetail and some other questions you have,
so I'd ask, and deferentially, of course, if we could just cover those slides and then get back.
Thank you. Please continue.
Thank you, Madam Chair.
For the record, this is Monique Martin again.
On this slide, we outline the six initiatives.
These are really the big buckets that the state has outlined
in the Rural Health Transformation Program application
in terms of where they're seeing projects.
And I'm being clear to share with folks,
just because you don't see your particular program
or service line identified in that application,
arching themes that are in these initiatives
and show how your project might tie
to some of the initiatives.
Because we know things that maybe work in the YK,
Delta region might be different
than what they need in The Bristol Bay Area
or in that interior.
So we really want folks to not be able to hem it in
by what the see in those initiatives
really find a place for what
outcomes for Alaskans in their communities? I should say, I shamelessly
use some of the Department of Health slides from their January convening at the Hilton.
And I really encourage Alaskans who are interested more to go to the Alaska Department
of health website.
They have right at top of their page a link to The Rural Health Transformation Program
and it is a wealth of knowledge.
So I'll try and call some these out.
I included a links at bottom for those watching at home.
link and see some of these presentations, but these are directly slides that the Department
of Health presented to help really.
Make sure Alaskans were aware of this opportunity. They had some space limitations
Because we are moving fast and furious to get information out there
So challenging to find a place big enough to hold the convening
But on this slide
I think you see the really the three big goals that the Department of Health has outlined as part of their
Application and then where do each of those six initiatives on the previous slide fit in to the states program?
You know, we've talked to a lot of people who say, well, I'm not a health care provider,
so I probably don't qualify for these monies, and that's simply not the case.
And this is another slide.
The Department of Health talks about this a
lot in terms of who might be eligible.
And even if you don t see yourself listed in the color chart on the left side of the screen.
you are still eligible, right? The Department of Health is going to list information about
what are requirements, but if you're a social service agency providing child care in a rural
community, you qualify. So Commissioner Hedberg has talked a lot about child
care as an important part of supporting our workforce to make sure that the lack of child
preclude them from work opportunities in their regions?
I have a quick question.
I'm curious as you've all been very involved
in this stakeholder engagement process,
what are some examples of entities and organizations
that don't traditionally interact
with the Department of Health or these types of grants
that should be engaged in the RHTP?
Thank you, Madam chair. I think some of the groups I
think about are a lot of social service agencies that are
maybe
helping people with expanding or upskill opportunities,
where they think about workforce being very different
than the healthcare delivery system, schools,
community centers that maybe have the opportunity
with a little extra assistance, planning, et cetera,
that could keep their doors open longer,
maybe dedicate some time for seniors to come in
in the morning or afternoon
when they typically have quieter hours.
And how do we take advantage of facilities
in existence in our rural communities like schools or other facilities where we could say hey let's open this up for seniors.
Let's opened this for whoever might be really lacking in access to in the long winter months.
Some of that physical activity that would help the department has talked about how we really want to focus on.
more access to preventative care, less acute care access, how do we make sure that Alaskans get
connected to those preventatives services, things like getting out and be able to walk more,
go swimming, whatever it might be. I think there's a great opportunity for folks that
train people in CPR or first aid that maybe just don't typically see themselves in a state grant
Through the chair I would also add for me that comes to mind
childcare, even though of course childcare intersects with the department.
But not in this way.
We are going for transformation in a way in which can support the larger healthcare system.
And EMS, again, same thing, obviously EMS interacts with Department of Health.
But there's some really innovative models for delivering care at a lower level setting that could be explored.
So those are two other organizations that I think comes to mind.
Thank you.
And you have a question from Senator Klayman.
You've talked about health care a couple of times and early on you talked
about sustainability and so in a very very rough economic sense if we said
we're gonna put three million dollars a year for the next five years towards
child care I am a hundred percent sure there would be childcare providers across
the state that would have been more than happy to take some of that money and we
could figure out a way to get it to them and then five
years from now suddenly the three the $3 million year is gone how do we how
Specifically in child care, how do we align this effort of the transformation and make that sustainable?
Through the Chair, Senator Clayman, one of things that we've talked about specific to childcare in that is helping people get the right training that they might need or
even building out facilities while there is a strict limitation on
buying or building new facilities, renovations are allowable to an extent.
The Department of Health is pushing hard on their partners at the Centers for Medicare
and Medicaid Services for what's the line, right?
Like how far do renovations, how can they go?
But we know that's one of the biggest things, are there opportunities to look at existing
existing service lines by maybe adding on to a facility.
So I think the extent of which renovations will be allowed is a little bit of an unknown
through guidance from CMS and we are always looking for that.
But I thing there's the opportunity to really look at facilities maybe in our
communities that we could repurpose, revamp, maybe make some of the improvements to protect child safety.
Thank you, please proceed
For the record, this is Jared Kosen. I'm gonna start my part of the presentation if you will and as Monique just did a really nice job
Giving context on kind of how we got here. The next thing we're going to talk about is really evaluating the opportunity
And not so much from a department standpoint not
so, much, from
a government standpoint but really from the an outside provider perspective as we can offer it
And when I say evaluating the opportunity, really,
the first thing that comes to mind to us are the challenges.
And I think it's important to be realistic.
I mean, Senator Clinton just asked a really good question
about child care.
And you can try and answer that 10 different ways.
But the point is,
that's a good question. And I don't think we know. I mean, I think that kind of plays into this idea of
we have this massive opportunity in front of us in terms of dollars, but it's full of challenges
that we all have to be realistic about. So for looking at that, what we would want to highlight
for this first year and a lot of people will call this
five years of funding and we like to look at it more of
as cycles or tranches of
funding because well yes you're going to get funding each year for over a period
of five
years
there's a two-year spend window for recipients of those funds
and so we have to looking at kind of a little bigger and more
And so the framework, the way this is supposed to work
is we understand it from CMS is money comes,
the award is determined,
states have one year to obligate those funds,
and then whoever gets the funds essentially has two years
to exhaust them, to expend them in full.
And, so, I'm gonna rewind back to where we are today,
but I am gonna spend one minute just kinda looking forward
to give an idea of how chaotic this can get
from a timeline standpoint.
So if we want to look at a typical tranche timeline and how they intersect,
let's just pretend we wake up tomorrow and it's going to be October 1st of this year.
That means federal fiscal year 2027 begins. Here is what we would expect.
If we woke up and say it was October first, we wouldn't know the state at that point all
awards have been issued, right? That one year spending obligation by the
state will have passed. They better have gotten all the money out.
We also would know at that point that we've hit a deadline that if you have
received funds, you've won your left to spend it. At that very same day, at
that same time, we would also be tuning in to obviously the internet because
there would be an announcement coming from CMS on how much we're going to get
for the next tranche of money. And on that, very
same, day we'd expect the Department of Health would
their awards process for actually awarding out Tronch 2 of funds.
So all of this stuff intersects, there's a lot of money coming in,
there is a lotta money that has to be allocated, and it all
happens in a pretty short window. And so if we look forward, I guess the big
takeaway for us, we have all been from a provider standpoint cognizant of
this well before the award came in. So now we're back to today.
the funds that we were talking about today,
the first 272 million, we heard about that December 31st.
We all know that, right?
A lot of people don't know, and I know you do,
this is more for the record and for public,
the clock on spending this money started on October 1st,
and so that means as of this hearing today
The $272 million that Tronch won, the state has to obligate all those funds within the next seven and a half months.
That means stated differently.
We have seven-and-a-half months to stand up our grant system to formally solicit
everybody in the State for proposals.
Seven and half of months, to receive that solicitation, develop a thorough application, and submit it.
Within that seven-and-a-half months scoring of that application award decisions and then distribution
All of That just in the seven and a half window in my opinion. That's a lot. that's A lot of work to accomplish
the
Concerning Part of, that just to be totally candid is the spend window
Also Started on October 1st so that means
Even with all this stuff that has to happen in the next seven and a half months from today
We have 19 months as providers if we do or do not you know get funding for this
You're gonna have nineteen months for them today to spend that money
None of us have that. Money yet to spent in fact. We are building the system as we speak and
So for me and and us I would say the takeaway here is
You, as the legislature, know well, there's so much that still has to happen.
So many questions that Nancy Merriman will go into that we just don't know about.
And we have time pressure on top of that.
And the time-pressure doesn't mean we need to rush and panic and do all this just to
get the money out and spend it.
it's hard to spend a lot of money even on individual projects in 19 months for
providers and so that's a very very real concern. It's hardest spend it
smartly. We can waste $270 million dollars. You believe it through the
chair very good point but also even getting that money out the door to
actually physically expend it on projects when you can't use it
on construction to the fullest extent. Right. If we have a feeling it might even
Physically spend those dollars in that small window, but point taken for sure and we have a question from senator Myers
Thank you madam chair. So
With this timeline, you know one thing that pops up to my mind is
You know rural most of the time means small small organization small staffs
And we're talking about you, know, I know that department health is still putting together a lot of
the requirements and what the applications seem to look like and stuff,
what are your organizations able to do for some of the smaller providers in helping them craft some
of those applications so that they have plans ready and eligible for this money?
Through the chair, Senator, thanks for that question and certainly you guys chime in as well.
In answering your question, I do want to be very clear for the record.
None of this is the Department of Health's fault, and I think we all know that this, is CMS's, fault
Designing this in the way in which it was designed was very poorly done because of the amount of time they did it and
What the expectations are?
Regardless of how you feel about all that it it, was a poor approach to doing this with that said
It's a big opportunity and we need to
sees it and so I could speak for my organization and I know there's other
organizations out there doing things like this but we recognize what you just
said as we realize well wait a minute we have a couple small hospitals in
particular who don't have grant writers on staff they know how to administer
programs they have the ability to do administer programs but they don' t have
people to actually write grants
And so that was a wake up call for us.
It was something we didn't even consider.
Someone brought this up about two and a half weeks ago to us
and we said, wait, that's not good.
And, so we immediately went to our internal resources
and made a call out to out facilities
and are going to pair our smaller facilities
that need that help with grant writers
for the first round of funding
so they have a fair, equitable shot.
But we're also lucky to be in that position.
everyone else is in the same position.
But I'll open it up to my colleagues here.
Through the Chair, Senator Meyers,
for the Restored Nancy Maryman,
Alaska Primary Care Association,
there are certainly small health centers
in our most frontier and rural locations
across the state that are challenged
with the thought of applying for this money,
which has so many.
and compliance factors to it.
I think the
It's been really good and heartening to see that the department has created a planning
and a readiness pathway for these organizations.
So if they have a good idea for something that they want to do in their community but
really need to build their administrative muscle to get there, there is a pathway
Madam Chair, if I may, for the record, this is Monique Martin, through the chair, Senator Beyers, when the things were.
doing at ANTHG is one, talking about the rural health
transformation program.
So folks are really aware.
And that oftentimes means people have a lot more questions
than we have answers.
But I think one of the things that we've
spent a lotta time doing is especially in year one
specifically because of that time frame
that Jared just outlined is, I
think some folks have heard transformation
and think, oh, it's gotta be something brand new
that I haven't thought of yet.
That's simply not the case. If organizations have a strategic plan that they've already
gone through a planning process with their boards of directors or leadership teams or
community members, look to those existing things they already have. What are things
One of the things we're thinking about is equipment and thinking
about that in terms of financial sustainability might look different in a state like ours.
That, and I don't have a great example of this, but I will work on one,
is if folks are limited to services in Anchorage,
are there services that we could provide closer to home and hub communities
us, the same amount of money, but we're taking off that travel component, right?
That oftentimes is the barrier between Alaskans getting healthcare.
We just spent a lot of time yesterday back in Anchorage talking about Alascans and just
rates. It is really challenging to get people, to want to
get a colorectal cancer screening. And then also, by the
way, hop on a plane, come into Anchorage or your
neighborhood hub community.
and do the prep, do all the things,
and is there opportunities for us
to make sure the providers are going
to the hub communities more?
We already do that, but is that an opportunity
with equipment that we could,
that makes sense in terms of numbers,
of screenings provided, mammograms, you name it.
Are there things that could be doing closer to home
that help us reduce the cost of transportation,
which as that rises,
more and more spent on transportation,
and it's really squeezing healthcare.
So there's that opportunity where we can look at
maybe equipment is an opportunity for us.
Representative Prox?
Yes, thank you through the chair.
I guess, are you developing some sort of a plan?
Probably on a chalkboard rather than chiseled in stone,
but are kind of, cause it does.
seem difficult to get an organized plan statewide that big with these constraints.
But are you working on a publishing a plan or something like that?
Through the chair, thank you Representative Prox.
Our organizations, the answer I guess short answers is no.
I don't think in the way you're envisioning it.
We have helped advise the department when they've asked us questions,
you know, with our respective organizations.
I know we all overlap in health care,
so we're constantly talking about ideas.
We all probably would do it differently depending
on which one of us you would talk to.
So I think what we are looking to is to see what the Department is thinking
and really looking at the solicitation process.
I mean, when that gets opened up,
we see a lot of projects out there and that.
The people that can do the projects I think are going to be the ones that will be driving the ideas that could lead to meaningful transformation.
And so, no, I don't think we're all putting it on a chalkboard.
I thing we have ideas on what the chalk board would look like, but our organizations together are not creating the plan for with the department.
And I we are more advising them along the way, if that makes sense.
Five six seven years ago you were thinking about you. I wonder if we could do this
Do you have that list?
Through the chair
So within our organizations and we're obviously different for the record is Jared Kosen from the Hospital and Health Care Association
I mean, I know my members which are all Velasquez hospitals nursing homes and with behavioral health providers and a growing number of other
provider types, all of them have their strategic plans,
all have them what they want to do and could do.
And I think the question is,
what aligns with the vision behind this sum of money?
What is practical?
What can you actually spend in 24 months or 19 months
or whatever it is which is not that easy?
Yep.
Um, so yes, I think those ideas all exist out there.
I Think it's going to be coalescing and making it fit within this process.
That's gonna be the big challenge, but the ideas are there, thank you.
Madam Chair, if I may, through the chair,
Representative Prox at ANTHC.
We've gone through that strategic planning document
that was developed by the ANCHC Board of Directors
as a starting point.
I should say our, excuse me, our operational team,
looking at this as an opportunity, right?
And also, though, we realize that
This is intended to be transformational, so we released a survey at ANTHC sent to every single employee at the organization and said
What are one of those things or some of
those thing that you think we could
implement as an organization that maybe
we've just never been able to do or even
had the time to think about that could
really move the dial for health care
outcomes. And we had an incredible
response to those and really great ideas.
One of those was lactation specialists.
We have lactations specialists to help new moms,
but we don't have 24-7 coverage for those.
And babies are born at all times of day and night,
maybe just not conveniently Monday through Friday
between 8 and 5 p.m.
So we're looking to expand those services even more.
Maybe help New Moms, we have a pretty robust
patient housing system.
Oftentimes new moms are discharged from the hospital, but they're not quite ready to go home yet.
So can we go and meet them at the patient lodging facilities that we operate to ensure they are getting the supports they need.
Really an acknowledgement of the state's healthy beginnings initiative and this application.
So those are some of, one of ideas that came through from our survey of employees.
And there's some really great ideas to help.
Alaskans that need services, right?
Like as a provider, we're seeing things like equipment
and all these exciting, shiny things.
And there's a lot of things that are just really more nuanced
and maybe people based that would really move the dial
on health care outcomes.
Thank you.
Please continue.
Great for the record I'm Nancy Maryman Alaska primary care Association. So good afternoon chair Dunbar and chairman and members of your committees
I am the CEO of the Alaska Primary Care Association where my team and I work to support the
Alaska's 29 federally qualified health center organizations and they operate over 200 clinic
sites across Alaska and collectively they provide comprehensive primary care services
to one in six Alaskans.
Commissioner Hedberg asked APCA to serve on the advisory council along with ANTHC and
And we've really appreciated the opportunity to engage and support the initial planning and
to provide input to the department as they build the framework for Alaska's Rural Health Transformation Program proposal to CMS.
As noted by my colleagues, Ms. Martin and Mr. Kosen,
the segment of our testimony that I am going to present is intended to help underscore
the many important questions that still remain at this stage.
Even as state leaders and stakeholders continue to explore opportunities for collaboration
and while prospective applicants prepare their letters of interest.
I'm going to highlight questions in a few categories.
The first one is construction.
We know many organizations in Alaska wish to secure resources to support new construction
projects and building expansions.
And we have learned from the department and CMS grant guidance that new Construction costs
But questions remain about what exactly is permissible related to renovation, expansion and other similar projects.
Applicants are going to need answers to questions about whether specific costs are eligible and to whom to direct those questions.
There's a level of uncertainty about who has the authority to approve or deny projects?
and what that approval process will look like and how long it will take.
Once answers to construction related questions are obtained,
then how will these be shared and other prospective applicants
learn about those experiences and additional lessons learned
in the first budget period funding cycle?
So next, I'm just going to highlight a few questions about the understandable restriction on supplanting existing federal funds
With recognition of that restriction will the state of Alaska be required to secure CMS approval
For specific waivers to support innovative payment and care delivery models that are articulated in the states
Rural health transformation program proposed
plans, and what other approvals are needed in order to move forward with innovative
voluntary, value-based care, or value based payment projects,
and then how are authorized payers defined?
There's also some questions about broadband and connectivity.
Throughout Alaska, of course, we continue to work on strengthening broadband infrastructure,
something critical for healthcare transformation,
and we've been challenged with resolving broadband
infrastructure in affordable and sustainable ways.
How will we deliver on implementing new promising technology
and transformation in the short timeline of this program?
when we struggle to meet basic telecommunication
infrastructure and equipment needs in our rural regions.
You also might be wondering about multi-year projects.
We know many of the folks that we're talking to
are wondering of those.
And many folks are thinking about transformative projects that are going
to be multi year and multi budget period.
plan and apply for funding for those multi-period projects.
So how will those long-term plans be considered
and how the awards be determined
beyond the initial two-year time span?
Will preference be given to those projects?
How can they plan for long term projects
if they don't have some certainty in future funding?
But on the other side, if there are multi period projects,
that are considered would they edge out new innovative projects
that just get proposed in budget period three, for example.
The state of Alaska has said that indirect costs are not permissible
for rural health transformation project grantees.
Organizations are wondering how they'll cover the real costs
of managing and implementing those projects.
Are indirect and administrative cost limitations
tracked on a per-project basis?
Or is that indirect costs are disallowed altogether
in totality?
How will organizations learn more about those restrictions
so that their project plans are well-informed?
And ultimately, they can determine
whether a project is feasible or not.
So you can see that things are moving fast.
and this is a massive program, the department is in routine regular frequent conversation
with CMS and we know that they are like even as we speak, getting more information and
more answers.
And not only is CMS like really trying to figure out the answers, sometimes they're
Despite the numerous questions that remain the two hundred seventy two million dollar investment in the Alaska health care system each year for the next
Five years is vital for our state and worth the effort to invest in it
So I'll yield the mic at this point
Thank you
Thank You madam chair
So, this question doesn't directly tie to this slide, but I was wondering about your
role as the advisory council, your three entities, and I believe it's the Fourth Medical Association,
there's a fourth entity, isn't there, or is it just the three of you?
Trust.
The trust.
Thank you.
The mental health trust is the fourth density.
So I know that you have been very involved the last several months and early on.
role going forward, and you mentioned, you know, selecting these projects, approving these
projects. The way it seems to be structured now is that the basically the commissioner
has kind of an up-down decision and $200 million or more sort of vested in this one person without
legislative input, by the way, as the law currently stands. Is that your understanding? And
Regardless, what do you see as your own role going forward or how's and maybe more importantly, how is doh? See your role? Going forward
Through the chair senator Dunbar, I think this is sort of
Like a lot of things around the Rural Health Transformation Program kind of ever evolving.
And as we've talked with Commissioner Heberg, I think there will be a very robust evaluation of applications.
It's not just going to be the commissioner with her highlighter saying yay or nay on applications and they were really working with the Alaska Community Foundation to develop a very thoughtful data driven process that is as.
is as supportive for applicants as it need be.
And so I think that while the commissioner is sort of listed as the.
Final say on this. I think there will be a very robust process for folks to be able to look at and say
Was this developed in a vacuum or was it really developed based on data on the best projects rose to the top?
And I Think the Department of Health is probably better suited to maybe get into some of the mechanics with the Alaska Community Foundation
Who will, be serving as the subgrant administrator sort of as
the recipient of the letters of interest that were talked about.
Tuesday at a webinar and then really helping applicants
through that process.
So I think there's a pretty robust process in mind
by the Department of Health.
And as far as our role, I
think Commissioner Hedberg has said it best,
where we might be more of a directional support
versus decision-making.
So you won't see us voting yay, or nay or ranking projects
or anything like that.
We are really to be a voice for,
especially in future years.
We've outlined the department outlined a vision
for the Rural Health Transformation Program
and their application.
And as we see year one awards,
where do we maybe need to
be little bit more targeted in years two or three?
Did we seen lots of equipment
and now let's get to workforce or technology
really seeing what rose to the top in year One
Meeting the goals and initiatives, but also doable in year one and then maybe we would provide some insight on hey
We need a little bit more focus on workforce
We needed to see more focused in child care or education or certification
So it would really be more of that
I think the highest level and I thank the commissioner said at best is directional versus decision-making
First, if either of you have somebody to add to that, and then I've got a follow-up.
I'll hold for your follow up, good.
Good.
I will just, you know, this is a large enough sum of money that it's not just the people
on this panel that are concerned about it, so I spoke with a number of my colleagues,
Department of Transportation in some years, where there is this supposed rubric of how things are
scored, and then right at the last minute it goes into the governor's office or somewhere like that,
and all of a sudden there's new projects on there that weren't even scored or were scored quite
differently, now they've been awarded this. And so...
I guess my question to you or it's not even a question because ultimately a
Department of Health is, you know, what can you do to promote a transparency in
the rubric or the criteria how these are selected and then sort of hold the line
that if if a project actually does meet the Criteria it is actually the one that
that is awarded versus again at sort towards the end of the process. There is
a re-sorting in an opaque fashion.
Any comments on that mr. Chair I'll start and you use the word that I would have answered before with transparency and I think
That's the most important thing
You know our role as as Monique so well put everything's been evolving. I mean honestly our involvement really
Came out of the fact that we've just been looking ahead
When it was talked about
that this money would be coming,
all of us collectively just started talking about
what's it gonna take to actually do this?
And can the department do that?
Will they have the resources?
Because we wanna make sure things are done
as least disruptive as possible for the healthcare system.
And going back to Representative Fields,
I certainly haven't forgotten your question from earlier,
but we're already looking ahead to, you know,
what is coming down the pike with Medicaid.
In preparing for this presentation today, we spent most of our day actually talking about Medicaid
and eligibility and what that's all going to mean in the coming months with this very large
challenge in front of us today. So I guess this is all to say that I think our hope and we have
gone back and forth on this as a group is really the legislature needs to be involved to ensure
And I think the Department of Health would agree to that.
I look at each of you, Vice Chair Giesle, you know,
with your health care experience and everyone else.
You guys have a wealth of experience among yourselves
and you guys will ask questions that we want to ask
and questions
that are even above what we would ask.
And, I believe we all have to be transparent
through this process.
And so that's my hope and I would also balance it with,
don't forget about time.
delay too much, and I'm not saying willful delay, we're just going to put providers,
not even the three of us, but actual providers.
They're going be limited to actually putting this money to use.
So how do you balance that?
And I think it all comes back to transparency in not having situations like you just
described happen.
Thank you, Madam Chair.
I saw representative Ruffridge and then Gray and
then Senator Cleman.
And then Mears.
Thank you, Chirmina. Thanks for being here today. This is a really amazing
opportunity and I have to first thank the Department of Health for the work
that thereby know their night and day. It feels like on this work. I'd like to
maybe steer just a little off the RHTP for just
a second and utilize your three's expertise in the healthcare space.
you each come from a very different perspective and I think as advisory council members probably
have given this advice maybe in the meetings that you're in uh what specifically kind of from
each of you do you think in your sort of perspective spaces are the biggest needs that RHTP could
Like on a grand scale, I know big needs, but I don't think the RHTP money can be used for that
because of all of the limitations. Do you just have some general thoughts on if it were
up to you today and you could kind of say, each of you get a cool, you know, 90 million to spend
Through the chair, Nancy Merriman for the record, the 29 federally qualified health centers
across the state have a myriad of ideas about things that they'd like to see to improve
their own clinics and their communities.
And so the ideas range from standing up a geriatric clinic or a wound care clinic within
to helping the school establish a school-based clinic
or help the community stand up additional supports
and programming for the communities' youth.
So I think that those programs are smaller
maybe than a brand new building,
but they can in totality be transformational
for a community.
Representative Ruffridge I'm you know reminded of even conversations we had earlier today of just kind of bold ideas that
Would be worth considering but you don't for me. There's two things that come to mind right away. The first is
Even though I represent hospitals and nursing homes and these larger providers
We're big believers in community based services
with the idea that it's far less far more affordable to have people getting access in the community far
more efficient. There's so many positive aspects to that. So, you know, in an ideal world, I would
like to see service line development specifically for behavioral health and other services. My problem
is it doesn't seem like it really will do that.
And this goes back to kind of the question
from Representative Klayman.
If I had an opportunity to design this for a day
at the federal level, I would have said,
for Alaska at least,
I wouldn't have absolutely allowed all construction.
And the reason I'd have done that is because to me,
if you can front load upfront costs to whether it's building, bringing providers on,
bringing equipment, and all of that stuff is one time expenses. If you could pay for that with
this funds, then what's left is you're left with basically an operation that you
can turn on. And once you turn it on you start seeing patients and you get revenue,
so it self-sustaining. So to me the fact that this money can't fully potentially be used for
one time upfront costs, kind of disadvantages,
some of the things that I would like to see strategically
happen, just to be candid.
And that leads me to kind my final answer.
And I've expressed this, and we've express this
with the department, transparently.
I will run an open solicitation process.
I want to say what the ideas are out there in the field
and then respond to those ideas and build around them
on what I think is good, rather than lay out.
The idea is I want to see happen if that makes sense
Madam chair if I make is that the the dream the Dream Big One is
Something that's really exciting
Through the chair representative reference. I'm gonna steal an idea from Dan Nelson at Tanana Chiefs conference
Tanna not Chiefs Conference provides care in a region that would be in the top five biggest states in
the country if it were a state and
It was sort of funny
During the convening in January, there was talk about drones to deliver medications, right?
like controlled substances, right?
Like we'll talk about in that type of thing.
And there were some out of state vendors
that sort of chuckled at like,
oh, delivery medications via drone, that's so silly.
And I'm like actually, I couldn't help myself,
told them that there are at least two tribal health
organizations that would like to stand up drone delivery
because the only way they get medications
to those communities is
via river. So during freeze up and breakup, they don't get deliveries to those communities.
So they see drones as a possibility to make sure that patients don t go without medications
when they need it. I think that there s also
When I think of opportunities, less exciting than drones dropping off packages at front doors is we have an electronic health record.
We have a shared Surner domain in the tribal health system that a big number of the Tribal health organizations and tribes utilize, not everyone.
But we know it could be better, and that a better electronic health record in EHR would mean better health outcomes when a patient is maybe getting care at a tribal and a non-tribal facility.
or we're on divert and they're going to a non-tribal facility.
We know we can help improve patient outcomes
if that system were better.
So less slick and exciting than drones,
but those are some of the exciting opportunities
and it can be as simple also as changing beds
in facilities where maybe that's just a lower priority
because they still work or using installing lifts
bariatric patients so that we have less injuries for our health care working
team. So there's a lot of different opportunities that folks I get excited
about when we talk about really what these opportunities look like and things
that I tell folks when they say well this might sound silly but this would this
work I'm like I think it sounds great you should apply for the state and let
them tell you no.
Thank you just a brief follow-up if I may thank you, and maybe just this secondary question to that
Well, I appreciate you bringing up dr. Nelson and the work that he does go pharmacy team
and I think that there is a
Lot to offer in all of your answers
I wanted to think through sort of the role that some of
the legislative pieces are going to come into this,
particularly with what I would consider that mid-level
practitioner field.
And I think all of us are gonna struggle through,
you know, what does that look like for Alaska,
and where does it go, and a number of our health committees
have dealt with some the compacts and licensure
types issues.
Do you have any comments on how you know you would foresee mid-level practitioners?
Specifically in Alaska health care, so I'm thinking physicians assistants pharmacists nurse practitioners
You know the whole gamut of those people that kind of fill in
The gaps that that might be across the state so
How do you think we should move forward as a legislative body with some of the needs that the Rural Health Care Transformation Project asked for us to do?
Madam Chair, if I may, Representative Refrage, I feel like that's a question best asked of that department.
And I will say, just to be really direct.
is there are some things the advisory council were asked about there to provide that direction
versus decision making. I don't, speaking as an advisory Council member
and as the body collectively, we did not take up some of the policy decisions that are
directly in the lane for the legislature to move forward, perhaps in terms of bills for
the governor to introduce. We did not weigh in nor did we make recommendations on some of those
policy provisions. Now, I will say each organization that serves on the advisory council may or may not
support or might not have a position on sum of the compact licensures, but I think in
not decisions or direction that the advisory council suggested the Department of Health
implement.
Thank you.
All right.
We have a running queue.
I have Representative Gray and then Senator Clayman, Representative Meers, and Representative
Fields.
Thank You.
Through the chair, I think I am kind of coming off of Senator Dunbar's line of questioning
where the money should go because I don't think it's very much money.
Our state has enormous needs.
And when I look at the initiatives, healthy beginnings,
healthy communities, I looked at who can receive this and I see schools on the list
and know what our deferred maintenance list is for our schools,
I'm actually grateful that new construction is kept off the table.
I believe that the expansion at ANTHC for the emergency room is $251 million
is the cost, something like that.
Madam Chair, if I may, through the chair,
Representative Gray, it's about $450 million.
Thank you.
So to expand, to add some beds,
and to create a new emergency bay,
is about 450 million dollars.
So you could see how if we,
well, throughout 20 of those projects,
I mean, is not gonna cover.
So, but when I think about the renovation fund,
and I thing about
You know, if I wanted to transform the health of rural school kids, maybe fixing the roof
so they're not leaking, may be making it so the toilets flush, and maybe getting rid of the mold
would transform their health. And I think we could eat up this money very fast through that
sort of interpretation of where the money should go. That's just thinking about the Department of
OCS can use a lot of this money
for technological advances.
DOC can
use autonomous money to expand telehealth options
in the prisons.
I mean, I'm just thinking of all these ways
where this is money will disappear.
And so again, it's sort of like as the advisory committee,
how do you guys make sure that
we don't use all of the money for
what I think are very important issues,
but actually won't go in the direction
of the transformation that you guys are looking for.
Through the chair, I mean,
Representative, that's a really good point.
We all have,
I feel like what it really comes down to for this,
and this is where I
think the legislature is really critical,
is what is the definition of transformation?
Because some people, it might be really shiny,
big, splashy things.
I could tell you for me and my constituency, it's the basics.
In fact, and I've on record for years,
if you really want to drive down healthcare costs,
going and addressing social determinants of health,
socio-economic factors,
that's really where you need to go, preventative health.
When you start looking at that lens, you're right,
it is not very much money.
So, I think that gets to that kind of central question of what is transformation, what does
it mean in this project, in the program, and to be totally honest with you, if you do that
right now, you're going to get really frustrated because you are going run up into all those
questions that we went over that are unresolved.
What should this be reserved for we all have different opinions and how do you settle on that?
So I know I didn't answer your your question directly, but I guess I'm trying to say is your questions very valid
And I I wish I had a better answer for you
Through the chair
Representative Gray and Nancy Merriman for the record
I think you make a great point and have
good questions. I think some of those questions were contemplated as the notice of funding
opportunity was designed and certain limitations were put in place for categories of spend.
So they're limited by percentage or by hard dollar amounts so that not everything could go into
To your point the entire amount could be taken up with with one building
All right, and we now have senator Klayman, I can met I'm sure I actually have three questions, but I'll get try to get them quickly
first
Mental health fres is not here. Was that just scheduling and plane to plane reservations or have they been participating?
Through the chair, Senator Klayman, the Alaska Mental Health Trust Authority was added a little bit later in the process,
really with a focus on behavioral health, developmental disabilities, seniors living with dementia, Alzheimer's, right?
addition to the team to cover some of those areas.
I believe, I don't want to steal the department's thunder,
and I'm trying to be very conscientious
and deferential to Commissioner Hedberg.
There's another member that was added
to really kind of round out the Team.
And I think they were added very recently,
and a little bit, this was already in the works
for us to participate.
So there's not a fifth member just there. They were the fourth member
Madam chair
Through the chair senator Klayman
There is a 5th member
You know what?
The chair I'll just answer it really directly yeah, that's the whole point is this is really truly been evolving
I mean we started at the very beginning
ourselves talking to each other and then that kind of coalesced in this advisory council.
But yeah, to answer your question directly, mental health trust I know was
I believe has joined at this point,
and I think the Alaska Municipal League was added.
And no, they were not purposely excluded.
I know we had just been working on this
and were invited to be before the committee.
So I I it's a coincidence, but I guess I'll be the one
to steal thunder if thunder has been stolen.
But yes, those are the five people
that have started to participate in this advisory capacity.
Right, and then next question, which I
think is Martin, you're the.
That's one to answer this because I believe you at ANTHC have been very involved in lots
of outcomes and metrics and in terms of what ANTHC is doing and I've heard now a couple
of presentations in the Senate has committee and seen met with some folks but the one thing
I really haven't heard anything about is outcomes in metrics for this project.
Have I just been missing it or do we not have them yet and if we don't have one can we expect
to see some?
Through the chair, Senator Klayman, at ANTHC, we have a very robust tribal epidemiology center.
So I think we will start hearing about some of the, the Department of Health has included in some
of their presentation high level outcomes, which are.
90% of seniors will have access to usual and accessible primary care.
So they have some of those measures that we will broadly measure transformation in Alaska
collectively.
But I think we'll see that in some applications that are submitted by organizations in Alaskia
and what we would propose doing as part of our application and thereby what outcomes
Alaska Native people have
It's amazing how much I talk about colons in my job as a policy person.
But Alaska Native people have a very high prevalence of colorectal cancer.
So we're looking at opportunities.
We have fellow at the Alaska native medical center who's studying up on things like what
if we were to expand the use of Cologard to really address the backlog of Alaskans living
in rural communities for cancer screenings.
We really anticipate applicants would really delve into with this investment.
This is what we would propose we can achieve with those dollars.
So I think we will start to see some really specific measures as part of applications
that come to fruition.
So a comment on that and then my last question.
It sounds like ANTHD has a lot more knowledge about outcomes and metrics than the department has and I would be troubled if we're waiting for applications.
It seems like you could help the Department figure out some outcomes in metrics to help what the applications show rather than wait for the application to show them because it seems that's one of the things we as the legislature might like to hear about.
I really appreciate the notion that the legislature needs to get more involved.
But one of the more telling aspects of
the questions we've had, including for the commissioner,
at one our hearings was, well, can't we be the ones that appropriate these?
Can't, we'd be in the one that do these things.
So, because we the Legislature would like to be involved,
and at least how I heard the answer was no, you really can be
involved this is a grant deal, and we're managing the grant,
and you can really have nothing to do with it.
And so I like the idea that the legislature can be involved.
But what I heard from the department is not really you can't.
And, so, you're here saying you need to be
involved and my question for you, and it may take a little
longer than you could answer today, but if we can
be in involved, how can we be
involved in being involved effectively?
Because the last thing I want to
be involve in is being
involved getting in the way of success.
But I'm also very concerned that if
we cannot be
involved it doesn't feel like there's much of a
through the chair, Senator, before I answer your question,
I do want to acknowledge the state has a great epidemiology
team, too.
Dr. McLaughlin, they're going back to COVID.
So I don't want everyone to overlook them.
You know, for the record, these are all individual opinions,
right?
That's a concept of an advisory body.
So we all kind of freely speak for ourselves.
And I say this in complete deference to the legislature.
But if I had the privilege of being in your position,
it would be ludicrous for you guys not to be involved.
It's too much money and too
much at stake to not have involvement,
especially with the power of the purse.
But I also understand the concept of a federal grant
and all of that.
So to answer your question really directly,
if if could.
Set the rules on where I would want to see you involved or I think the biggest impact could be achieved
It's not on the individual appropriations and funding decisions to me. It is on
the
Oversight and accountability it's hearings
It it is analyzing the decisions that are made and putting those on a public record and holding people accountable
That make those decisions so that if those kind of opaque moments happen or there's change up
People know why and people are held accountable.
So I think that gets the legislature away from the potential
of inadvertently delaying things that could then affect the funds
actually being used, but puts you in a position of power
that you really should be doing.
Hopefully that answers your question.
Madam chair, if I may add to that I agree 100% with Jared's points on that and I think there's
unique opportunities where we sort of acknowledge
Things are really busy in Juneau for you, but there are other ways that the Department of Health has involved the legislature.
If I may, I believe Senator Geessol served as an ex officio member to SB 74,
the Medicaid Reform Bill from 2016, and
made sure that legislature had a seat at the table.
And I think that is something we could certainly,
I would be happy to take back to the department as looking at unique ways that we can ensure the legislatures involved in that conversation.
And as a reminder, we are directional, not decision makers.
But I think that is something I've certainly heard loud and clear last week when I was in Juneau and today in this forum.
And I thing it's something that can certainly take to that department of health.
I know you are all raising that concern, but I thank we have a unique position and opportunity.
with the state to drive that home.
Thank you.
I don't currently know if there's ex officio room
on the ever-growing advisory committee.
We could put the HES chairs on
the advisory community in an ex-officio member.
They'd have to do it voluntarily then.
Right next we have a representative mirrors
and then representative Fields.
Thank You through the chair.
So I'll take the opportunity to say one of our opportunities.
One of the things that we can do is tell you
what's important to us.
So I hear Ms. Martin about the fact that Medicare does,
and Medicaid doesn't take care of all the
things we have now.
We're expecting those gaps to grow.
Preventative health care, a lot of back for the buck.
And I would like to see the scale heavily weighed
upstream changes. If the only thing we did with this money was reduced ACEs scores,
that would be amazing. Certainly not the
only that we can do, but that durable upstream is where I would like to see a lot of focus.
Thank you.
All right, Representative Fields.
Thanks through the chair. Yell's organizations bring a
don't necessarily bring as the perspective of frontline workers, so what I've heard from
nurses is concerned about growing numbers of patients and nurses and very dangerous
conditions in hospitals. Not all hospitals have a union,
so we don t necessarily hear that from nurses at non-union hospitals,
so I guess I would ask, what is your plan to solicit input from frontline
workers in your organization so that we understand the challenges they see in
Without asking them to review the 82 page application that department health put in
Just I just understanding the daily challenges they face might might help all of us
better understand where to direct RHTP money because you know a rank and file nurse out in YKHC
I don't I Don't hear from them
Or generally at an MC even so that I think that perspective would be valuable and right now that voice just is not on the advisory council
Through the chair, Representative Fields, I guess being the one from you obviously have Alaska Native Medical Center with you and I have the privilege of working with the hospitals.
I absolutely, man, understand concerns about conditions in different places and different circumstances and everything should be considered and there's a lot of facts I think that needs to be concerned.
say high level things and just leave it there. But yes,
everything's a work in progress.
But I would say that that's something I will take back to my
membership is the importance of engaging staff at all levels.
Miss Martin talked about this earlier and we talked
about the strain COVID. If you were to ask me, who's the most
important person in the hospital? To me it's some people who
clean the Hospital rooms. Because if if they're understaffed
or if they are unable to do their job, everything stops.
And that's a custodial level job to some people.
So I will take that back.
I know employee forums, large organizations,
small organizations.
Everyone doesn't differ only,
but I think that is good feedback and I appreciate it.
Thank you.
Madam Chair, if I could add to that,
through the chair, Representative Fields,
I would say the
Probably most every worker at ANTHC is not shy about sharing their ideas for improvement and that's why we opened up the survey to get feedback from workers.
frontline workers, very recently, Natasha Singh,
president and CEO at ANTHC and Al Montoya, our COO,
rounded with the EVS, the housekeeping team
that take care of our patient housing locations.
And that rounding wasn't standing around talking
to workers.
They put their rubber gloves on and cleaned rooms.
And talk to the workers about, you know,
some of the things you hear.
Right away, the worker said, man, we hear a lot from patients that these beds,
that the patients are staying in, are horrible.
And they went back to the office and ordered new beds for all the patient lodging.
So we purposely, right, because not every frontline worker has a
lot of time at a computer either.
So really important to our COO, Mr. Montoya is,
single day and he makes sure that he provides some of those overnight hours so people working
on Sunday at 11 p.m. have that opportunity to connect with leaders and share their opportunities
for improvement and we take those very seriously. It is not something you just don't often get
that type of feedback from workers who are not sitting in front of a computer every day. So we
leadership team is that rounding to ensure that everybody who's busy with
patient care busy in the cafeteria busy cleaning rooms has that connection
face-to-face leadership with with face leadership face to face
Madam Chair, if I may add Nancy Merriman for the record.
Recently, I sat at a table at community health center
with some very impressive employees and staff
who brought their own ideas about standing up
a new line of business at this community
health Center.
Very exciting, but super smart people,
and to your point, Representative Fields,
We wouldn't know, but that leader of that community health center happens to be one of those that
regularly is in authentic
conversations with their staff and really wants to capitalize on the
Intelligence and the aspiration of the people who really do have the hearts
For their patients in their communities
Thank you. I have Representative Gray and then Senator Giesel.
Thank You through the chair to Ms. Mary-Ann.
I just wanted to highlight when you pointed out the
federally qualified health clinics ideas of the geriatric clinic, the wound care
clinic and the school-based clinic. I love those ideas.
I hope that they go forward and I just wanted to draw a
attention to it as being really good ideas, I want to thank all three of you
for being here and i wanted wish Monique Martin a happy birthday.
Madam Chair, if I may, through the Chair of Representative Gray, thank you so much.
It is my birthday today, and I am lucky enough to be in Juneau testifying on a beautiful day.
So, Thank you, so, much, a committee hearing is your birthday present, Senator Giesel.
Thank you, Madam Chair.
So I wanted to comment, Nancy Merriman,
when you were talking about the folks on the ground.
It made me think of the community health workers
at my Gerdwood Clinic.
And they certainly are providing vital services.
It's part of The Rural Health Transformation Project
to recognize those as clinicians for reimbursement,
which will allow that program to flourish.
The other thing I wanted to add, and perhaps Senator Klayman had forgotten this because I know that it had been announced,
but the presiding officers of both bodies of the legislature.
Speaker Edgman and Senator Stevens did approach the commissioner about the importance of having legislators on the advisory council.
And suggested them as non voting members.
Both of the bodies, both the presiding officers did appoint someone with advice from the two chairs of
the body of health committees.
So Representative Mina will represent the House as a non-voting member.
recommended to represent the Senate as a non voting member.
So there will be representation on the advisory council from the legislature.
We've grown from three to four to five to six.
Seven to seven.
Yes.
Six, seven, they're funny.
Do we have anywhere comments?
from the committee or any other questions for our wonderful presenters today?
Oh, Senator Myers, all in the way in corner.
Thank you, Madam Chair.
For Mr. Martin, I've been burning to ask this question for half an hour now.
Those two gentlemen you spoke to when you talked to them about how it would actually
be useful to deliver medication by drones, what was their response?
I think our outside vendors have a lot of opportunity
to really learn from rural Alaskans.
And I said that to them, my feedback to
them was that's great that you came to Anchorage
now get out and see rural Alaska.
So I'm hopeful that they will take that advice.
I also offered up that I
think any of our organizations here presenting before you today.
Would gladly help them find some community health centers, tribal health clinics, water and sanitation facilities, whatever it might be to see in rural Alaska.
I also suggest that they come back not in the summer months so they could get a real feel for Alaska, so hopefully Senator Myers, they'll take us up on that offer.
Representative Prox, and we're close to our end time at five o'clock, we have a few more minutes left.
Representative prox.
I'll do this here. Thank you. This has been a fun exercise and
We talked about how do we think about what is transformative and that's hard to put your
Mind around and I was thinking
Many years ago. I worked in the baby with my parents and we got a machine that rolled hamburger buns
And that was transformative for the hamburger bun production.
Not necessarily the entire bakery, but there's little things that are transformative,
and then there are bigger things
that our transformative.
We talk the drone delivery.
It can be for medications. They're actually pretty close.
They've got the drones.
The university has got drones figured out.
mechanically, operationally. It's just permission to get it done. But that could
transform freight services where you could fly fresh vegetables and daily to a...
I don't know, that might be transformative. There's all kinds of words. And, but it
sometimes things are transformative things
are disruptive. And don't be afraid to think about that.
Think about them all. At this point I would say to me it seems like just a big
brainstorming session right now. Don't take anything off the table.
It would be important to evaluate things
objectively and figure out where we want to go
and I think we can get it done. The Department of Health, I thought, did a remarkable job
gearing up to the COVID response. They can be done, and so good luck with it. Thank you.
With those closing remarks, I really want to thank our presenters and thank also the Senate Health and Social Services Committee for joining us here in Davis 106, and to really get a better understanding of what we can do with these rural health dollars that are coming to the state.
And I would have the committee singing a happy birthday, but we did not publicly notice that.
The next meeting of the House Health and Social Services Committee will be next Tuesday, February 17th at 3.15 p.m.
The time is 4.58 p,m
and this joint hearing of The House and Senate Health & Social services committee is now adjourned.