03/14/2017 03:00 PM House HEALTH & SOCIAL SERVICES

                HB 103-OPTOMETRY & OPTOMETRISTS                                                                             
                                                                                                                                
3:23:22 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that the  first order of business would                                                               
be  HOUSE BILL  NO.  103, "An  Act relating  to  the practice  of                                                               
optometry."                                                                                                                     
                                                                                                                                
3:23:37 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ,  as the  sponsor of  the proposed  bill, offered                                                               
some  insights  for the  purpose  and  intent  of  HB 103.    She                                                               
explained that the bill gave  authority to the Board of Optometry                                                               
to regulate the practice of  optometry and assured that the Board                                                               
would have  the opportunity to update  its educational standards,                                                               
continuing education  standards, and  scope of practice  based on                                                               
the best practices  and available evidence.   She emphasized that                                                               
the  proposed  bill  would  not  allow  optometrists  to  provide                                                               
services  outside   their  scope  of  practice,   which  included                                                               
performance of surgeries.  The  proposed bill would allow for the                                                               
Board of  Optometry to utilize  the regulatory process  to manage                                                               
themselves,  similar  to  doctors,  nurses, and  midwives.    She                                                               
declared that  a robust process existed  which ensured thoughtful                                                               
consideration  and  opportunity  for  public  testimony  for  any                                                               
proposed  changes.     She  declared  her  desire   to  "get  the                                                               
legislature  out of  the business  of managing  optometry in  the                                                               
State of Alaska."                                                                                                               
                                                                                                                                
3:25:48 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EDGMON  moved  to adopt  the  proposed  committee                                                               
substitute (CS) for HB 103,  labeled 30-LS0459\D, Bruce, 2/21/17,                                                               
as the working document.                                                                                                        
                                                                                                                                
CHAIR SPOHNHOLZ objected for discussion.                                                                                        
                                                                                                                                
3:26:23 PM                                                                                                                    
                                                                                                                                
BERNICE  NISBETT,  Staff,  Representative Ivy  Spohnholz,  Alaska                                                               
State  Legislature,   paraphrased  from  the   sponsor  statement                                                               
[included in  members' packets], which read  as follows [original                                                               
punctuation provided]:                                                                                                          
                                                                                                                                
     HB  103 modernizes  and  updates  the Alaska  Optometry                                                                    
     Statute,  as  many parts  are  over  50 years  old.  It                                                                    
     allows the  optometry board  the authority  to regulate                                                                    
     its  practice  the  same as  other  prescribing  health                                                                    
     professions  such as  dentistry, medicine  and nursing.                                                                    
     This bill  also allows the  board to continue  to adopt                                                                    
     regulations, updated to current  practice and moves the                                                                    
     continuing  education   (CE)  requirements   back  into                                                                    
     regulations. Continuing education  is still required by                                                                    
     current  statute, but  the hours  and subjects  will be                                                                    
     determined  by the  board  as  with other  professions.                                                                    
     This change allows the board  flexibility to control CE                                                                    
     requirements and  is recommended  by the  Department of                                                                    
     Commerce,  Community  and   Economic  Development.  The                                                                    
     current  regulations require  more  CE  hours than  the                                                                    
     statute subsection deleted by  this bill. HB 103 allows                                                                    
     the  optometry  board   to  determine  prescribed  drug                                                                    
     schedules,  including  standards   and  limitations  on                                                                    
     practice  determined by  the  board.  The bill  ensures                                                                    
     that no  licensee may perform any  procedure beyond the                                                                    
     scope  of  the   licensee's  education,  training,  and                                                                    
     experience  as established  by the  board. This  allows                                                                    
     for future new and  improved diagnostic and therapeutic                                                                    
     procedures  as  determined  by  the  board,  while  not                                                                    
     having  to  return to  the  legislature  for every  new                                                                    
     technological advance, which is  currently the case and                                                                    
     unnecessarily burdensome.  The optometry  definition in                                                                    
     this bill is updated  to reflect current and modern-day                                                                    
     practice.                                                                                                                  
                                                                                                                                
MS. NISBETT paraphrased from the Sectional Analysis of the bill                                                                 
[included in members' packets], which read as follows [original                                                                 
punctuation provided]:                                                                                                          
                                                                                                                                
     Section   1  AS.08.72.050   (4)(6)  updates   very  old                                                                    
     statutes to indicate that  regulations shall be adopted                                                                    
     to  govern   the  current   prescription  and   use  of                                                                    
     pharmaceutical  agents; and  develop uniform  standards                                                                    
     for the practice of optometry.                                                                                             
                                                                                                                                
     Section 2  AS.08.72.060 (c)(4) the board  shall publish                                                                    
     advisory opinions regarding  standards for the practice                                                                    
     of optometry.                                                                                                              
                                                                                                                                
     Section   3  AS   08.72.181(d)  moves   the  continuing                                                                    
     education  (CE) requirements  back into  regulation, as                                                                    
     desired by  the Department  of Commerce,  Community and                                                                    
     Economic  Development.  Continuing education  is  still                                                                    
     required  by   current  statute,  but  the   hours  and                                                                    
     subjects will be determined by the board.                                                                                  
                                                                                                                                
     Section  4   AS  08.72.272(a)  clarifies   the  current                                                                    
     statute for the board  to regulate pharmaceutical agent                                                                    
     prescription  including  standards and  limitations  on                                                                    
     practice determined by the board.                                                                                          
                                                                                                                                
     Section 5  AS 08.72.278  Limitation on practice  adds a                                                                    
     new   section  that   sets  limitations   on  services,                                                                    
     ensuring  that   the  board   may  not   authorize  any                                                                    
     procedure beyond the scope  of the licensee's education                                                                    
     and experience.                                                                                                            
                                                                                                                                
     Section  6   AS  08.72.300(3)  updates   the  optometry                                                                    
     definition to reflect current practice.                                                                                    
                                                                                                                                
     Section  7  Effective  date  for  Section  2.  This  is                                                                    
     because (3) of  Section 2 was added to  statute in 2016                                                                    
     via Senate  Bill 74, the  Medicaid Reform bill,  and it                                                                    
     had the effective date of  July 2017, so (4) is written                                                                    
     to  comply with  that  date as  well. (per  Legislative                                                                    
     Drafting)                                                                                                                  
                                                                                                                                
REPRESENTATIVE EASTMAN  asked what the biggest  problem was which                                                               
the proposed bill would address.                                                                                                
                                                                                                                                
CHAIR  SPOHNHOLZ   said  that  the   discussion  was   still  for                                                               
distinguishing  the   proposed  committee  substitute   from  the                                                               
original bill.                                                                                                                  
                                                                                                                                
MS. NISBETT,  in response to Representative  Eastman, offered her                                                               
belief that the  biggest issue was for  definitions of ophthalmic                                                               
surgery and non-invasive procedures, which had been removed.                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  removed her objection.   There being  no further                                                               
objection,  the proposed  committee substitute  (CS) for  HB 103,                                                               
labeled 30-LS0459\D,  Bruce, 2/21/17, was adopted  as the working                                                               
document.                                                                                                                       
                                                                                                                                
3:31:16 PM                                                                                                                    
                                                                                                                                
PAUL BARNEY,  OD, Chair,  Alaska Board  of Optometry,  shared his                                                               
background,  including   his  past   presidency  of   the  Alaska                                                               
Optometric Association,  and stated his support  for the proposed                                                               
bill as  it would allow  the Board  of Optometry to  regulate the                                                               
details of the  practice of optometry, similar  to the regulation                                                               
of  advanced practice nurses,  dentists, and medical doctors.  He                                                               
stated that this  would not set new precedence in  health care as                                                               
other health  care providers were  regulated in this same  way in                                                               
the state.   The proposed  bill would give optometrists  a better                                                               
opportunity  to practice  at the  highest level  of education  by                                                               
allowing   the   Board   of  Optometry   to   write   regulations                                                               
commensurate with educational advances.   He pointed out that the                                                               
current optometry  statute was  written more  than 40  years ago,                                                               
and it required  that optometry pursue a  statute change whenever                                                               
there were advances  in education and technology.   He noted that                                                               
statute changes  were costly and  time consuming.  He  added that                                                               
the  board  could  not   promulgate  regulations,  practices,  or                                                               
procedures that  were beyond the  education of  optometrists, and                                                               
that the board was overseen by  the Department of Law, similar to                                                               
other   health  care   boards,  which   would  ensure   that  the                                                               
regulations were  within the scope  of optometric education.   He                                                               
stated that  the medical  legal system  and the  insurance system                                                               
also ensured  safeguards, as any  health care  provider providing                                                               
care outside  their education was subject  to disciplinary action                                                               
by the board as well as  serious medical legal ramifications.  He                                                               
noted  that, as  insurance providers  did not  pay providers  for                                                               
care outside the scope of  education, there was not any incentive                                                               
for  any  health care  provider  to  provide care  outside  their                                                               
education.   He added that  there were serious consequences.   He                                                               
assured that the primary concern of  the board was for the safety                                                               
of the public.   He declared that  optometrists were conservative                                                               
and cautious  practitioners, which would not  change with passage                                                               
of the  proposed bill.   He stated  that the proposed  bill would                                                               
put the regulatory  details for the practice of  optometry in the                                                               
Board of  Optometry, as they  could incorporate  new technologies                                                               
and  advances in  eye  care  as they  occur.    He reported  that                                                               
optometry  provided about  70  percent  of the  eye  care in  the                                                               
United States,  and often in  rural areas, optometrists  were the                                                               
only eye care providers in the community.                                                                                       
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  referred to page 2,  line 15, of                                                               
the   committee  substitute   regarding  the   deletion  of   the                                                               
continuing  education  concerning  the  injection  of  nontopical                                                               
therapeutic  pharmaceutical agents  and asked  for Dr.  Barney to                                                               
expand on this.                                                                                                                 
                                                                                                                                
DR.  BARNEY  explained  that optometrists  did  minor  procedures                                                               
which could require injectable anesthetics  or steroids.  He said                                                               
that the proposed bill would clean  up the statutes and allow the                                                               
Board of Optometry to decide the educational requirements.                                                                      
                                                                                                                                
3:37:47 PM                                                                                                                    
                                                                                                                                
JEFF   GONNASON,  OD,   Legislative   Chair,  Alaska   Optometric                                                               
Association, offered  some of his  background.  He  reported that                                                               
the optometry doctorate  degree was brought to the  same level of                                                               
education as medicine  and dentistry more than 45 years  ago.  He                                                               
detailed that  this included four years  of undergraduate school,                                                               
followed by  a four year graduate  professional doctoral program,                                                               
and then  one to  two years of  residency or  advanced education,                                                               
which exactly  followed the  model for dental  school.   He added                                                               
that 66  percent of  optometry students were  women.   He pointed                                                               
out  that advanced  practice  nursing,  dentistry, medicine,  and                                                               
optometry  were  all  independent,   with  their  own  regulatory                                                               
boards,  and were  all currently  authorized to  prescribe drugs,                                                               
including  controlled  narcotics,  in  Alaska.   He  stated  that                                                               
optometrists  were  defined  as  physicians by  the  Centers  for                                                               
Medicare  and  Medicaid  Services  and  were  held  to  the  same                                                               
standard of  care as other  medical professions in  the treatment                                                               
of  Medicare  and  Medicaid  patients.    He  reported  that  the                                                               
optometry malpractice insurance fee was  low, about $485 per year                                                               
for  $4  million  of  coverage.     He  relayed  that  about  150                                                               
optometrists practiced in Alaska,  providing the vast majority of                                                               
eye  care  in  the  state,   and  serving  more  than  80  remote                                                               
locations.  He  declared that optometrists were  the primary care                                                               
physicians  for eye  care in  Alaska.   He  said that  antiquated                                                               
state  statutes  were  a  barrier  to  attracting  the  best  new                                                               
doctors.   He  declared that  proposed HB  103 did  not authorize                                                               
optometrists  to  do anything,  it  only  updated the  antiquated                                                               
statutes  and gave  the  State Board  of  Optometry authority  to                                                               
regulate  the  profession with  the  sworn  duty to  protect  the                                                               
public.   He said that licensing  included professional judgement                                                               
for when  to refer  patients for specialty  care.   He emphasized                                                               
that   the  proposed   bill  did   not  compare   optometry  with                                                               
ophthalmology.  He  offered a comparison of a  family doctor with                                                               
a  neurosurgeon.    He  reiterated   that  the  board  would  not                                                               
authorize any optometrist  to perform a treatment  for which they                                                               
were not qualified.  He declared  that risk of harm to the public                                                               
had  never  been  an  issue.   He  declared  that  the  Board  of                                                               
Optometry  deserved  the  same  level of  respect  as  the  other                                                               
professions.  He stated his support for proposed HB 103.                                                                        
                                                                                                                                
REPRESENTATIVE JOHNSTON asked about  the low cost for malpractice                                                               
insurance.                                                                                                                      
                                                                                                                                
DR.  GONNASON replied  that optometrists  were very  conservative                                                               
and were sued less often.  He  relayed that this was based on the                                                               
actuarial tables, although the rates  were a bit higher in states                                                               
with more lawyers.                                                                                                              
                                                                                                                                
3:44:31 PM                                                                                                                    
                                                                                                                                
HARRIET MILKS,  Assistant Attorney  General, Commercial  and Fair                                                               
Business  Section, Civil  Division (Juneau),  Department of  Law,                                                               
directed attention  to page 4  of the  administrative regulations                                                               
drafting manual  [Included in members'  packets] and  spoke about                                                               
the  flow chart  which detailed  the  steps taken  by boards  for                                                               
proposals to  adopt regulations governing  each profession.   She                                                               
noted that  the Department of  Law (DOL) was always  available to                                                               
advise and  assist with  the process,  but DOL  did not  tell the                                                               
boards  how to  regulate  their professions  or  get involved  in                                                               
policy  issues.    The  department   ensured  that  the  proposed                                                               
regulations   were  constitutional,   and  consistent   with  the                                                               
administrative  procedure  act.    She called  attention  to  the                                                               
transparency  of the  process  to the  public,  as every  Alaskan                                                               
could  see  what  the  licensing  boards  proposed  to  adopt  as                                                               
regulations.   She reported  that DOL  ensured that  the proposed                                                               
regulations  went   out  for  public  comment   and  that  public                                                               
questions could  be submitted.   Once the regulation was  put out                                                               
for  public notice  and the  public comments  were received,  the                                                               
board would  meet in  a noticed public  meeting, and  discuss the                                                               
public  comments.   If the  regulations were  adopted, they  were                                                               
sent  to DOL  for  review to  ensure  constitutionality, and  not                                                               
beyond the  scope of the authority  of the board.   She explained                                                               
that  advisory  opinions  were   observations  about  the  way  a                                                               
practice might happen  in a licensed program  consistent with the                                                               
regulations.  These advisory opinions  were not law, and were not                                                               
brought  to DOL  for vetting.   She  reminded the  committee that                                                               
things  changed,  such  as new  treatment  modalities  and  daily                                                               
issues  that could  not be  anticipated.   She  said that  boards                                                               
could also ask the DOL to look at advisory opinions.                                                                            
                                                                                                                                
3:50:33 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ said that HB 103 would be held over.