Legislature(2017 - 2018)CAPITOL 106
03/18/2017 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB159 | |
| SB91 | |
| HB103 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 159 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | SB 91 | TELECONFERENCED | |
| += | HB 103 | TELECONFERENCED | |
HB 103-OPTOMETRY & OPTOMETRISTS
3:49:32 PM
CHAIR SPOHNHOLZ announced that the final order of business would
be HOUSE BILL NO. 103, "An Act relating to the practice of
optometry."
[In front of the committee was the proposed committee substitute
for HB 103, Version D.]
3:49:57 PM
BERNICE NISBETT, Staff, Representative Ivy Spohnholz, Alaska
State Legislature, paraphrased from the sponsor statement
[Included in members' packets] which read:
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 [Included in
members' packets], which read:
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)
3:52:17 PM
CHAIR SPOHNHOLZ opened public testimony.
3:52:44 PM
JILL GEERING MATHESON, OD, reported that she was a practicing
doctor of optometry and that she had testified numerous times
before legislative committees in support of changes to the
optometry statute over the last 25 years. She explained that
those statutes had allowed doctors of optometry to safely
practice to the level of their training and education. She
asked for support to proposed HB 103, explaining that the state
boards and commissions were appointed and confirmed by the
Alaska State Legislature to represent the people of Alaska in
these areas of expertise. She explained that the state chose to
set up separate boards for each medical profession because each
profession was unique and the oversight needed to be handled by
the members of that profession. She noted that the approved
statutes were very broad for the medical board, the dentistry
board, and the Board of Advanced Practice Nurses, and that these
boards could autonomously manage their respective professions
within the law in an honest, safe and responsible manner. She
pointed out that the optometry statute, however, was too
complicated and restrictive. Proposed HB 103 would allow the
State Board of Examiners in Optometry to have the same autonomy
as the other boards. She assured the committee that, as a past
president of the state optometry board, the board acted with the
same level of professionalism and safety as the aforementioned
boards. She reiterated that the proposed bill was not about eye
surgery, even though doctors of optometry had performed minor
eye surgery for many years. They were trained in depth for
these procedures, which were routine within the scope of
practice. She declared that she would no more perform an eye
surgery that she was not trained for than any other profession.
She offered her belief that all professions, including
optometry, must evolve and there was no way to predict what
tools and options a doctor of optometry would need in 20 years
to protect or cure the vision of a patient. She stated that the
proposed bill allowed the profession to evolve and make the
necessary changes. HB 103 allowed doctors of optometry in
Alaska to operate with the same autonomy, respect, efficiency,
and oversight as the other professional health care
practitioners were granted.
REPRESENTATIVE SULLIVAN-LEONARD asked about the minor surgeries
performed by optometrists.
DR. MATHESON explained that the most common surgery was for
removal of a foreign body, and that these had been approved and
authorized for almost 25 years.
REPRESENTATIVE TARR offered her belief that practitioners should
be authorized to practice to their full scope and be regulated
by peer professionals. She stated her support for the proposed
bill. She said that regulations would be drafted, which would
be followed by a public comment period when professionals could
speak out, and if there was anything questionable, the process
would reveal any problems.
DR. MATHESON expressed her agreement that any complaint brought
to the board would be investigated, and there could be a vote to
see if there should be a sanction on an optometrist. She said
that the legal process would also be started. She stated that
there had not been any sanctions against optometrists during her
8 years on the board.
REPRESENTATIVE TARR asked if the regulations were available for
public comment.
DR. MATHESON expressed her agreement, and explained that after
the regulations were set, they went to Department of Law to
ensure they met the law, went out for public comment, and were
again voted on by the board.
REPRESENTATIVE EASTMAN stated that the investigation process
could be very costly, even if they did not result in sanctions.
He asked if there was any hesitation due to the potential of an
increase to liability cost.
DR. MATHESON replied that she was not aware of any opposition
from optometrists for that reason, and she explained that this
could lead to an increase in licensing fees at a later time.
She offered her belief that optometrists and the board were all
"a pretty conservative bunch."
CHAIR SPOHNHOLZ pointed out that Dr. Matheson was a practicing
optometrist and not necessarily an expert on the operations of
the board.
REPRESENTATIVE EASTMAN asked why the optometry board was not
currently treated like the other boards.
DR. MATHESON offered her belief that this had just been a matter
of time, and, as other parts of the statute had been cleaned up,
this was now the final stage.
4:04:01 PM
HARRIET MILKS, Assistant Attorney General, Commercial and Fair
Business Section, Civil Division (Juneau), Department of Law,
said that she represented professional licensing boards.
REPRESENTATIVE TARR asked about the process.
MS. MILKS, in response, said that the board typically drafted
the proposed regulation, and it often took time to determine the
language which represented the inclination of the board. Then,
the proposed regulation went out for public comment. It could
go out more than once for public comment and for more than 30
days. She noted that, based on public comment, the board could
revisit the regulation, and if there were substantial changes,
it would again go out for public comment. She acknowledged that
the transparency of this process could sometimes frustrate the
public for the amount of time necessary to adopt a regulation.
She added that the board did discuss the scope of practice. She
said that typically the health care related boards met at least
two or three times each year, and that the public was always
advised.
4:08:09 PM
RACHEL REINHARDT, MD, American Academy of Ophthalmology,
reported that she was a board-certified ophthalmologist. She
stated her opposition to proposed HB 103. She said that the
primary goal of any legislation involving medical care was for
patient safety. She stated that HB 103 removed the existing
surgery restrictions, and would redefine the field. She asked
that it be clearly specified in the law that surgery was outside
the scope of practice for optometry. She said that without
specific language to restrict surgery, Alaska would be the first
state to adopt such broad unprecedented legislation. She
suggested that the definition of surgery be added to the
proposed bill, and that surgery be expressly prohibited. She
noted that the Board of Optometry could still govern its own
profession, even though surgery was prohibited. She offered an
example of the lack of restrictions under the Oklahoma law. She
said that a major study released in July 2016 had data which
concluded that optometrists doing laser surgery in Oklahoma were
causing patient harm and increasing health care costs. She
stated that the proposed bill would result in unprecedented
sweeping change in the practice of optometry, with profound
implications for patient safety. She said that, at the very
least the proposed bill needed a definition of surgery to ensure
public safety. She made the distinction that optometry school
was not a medical education or a surgical education, as the
students received approximately one tenth of the clinical hours.
She concluded by stating that prescription narcotic death was
the leading cause of unintended death in the country, and that
HB 103 would allow optometrists to prescribe these narcotics.
She declared that this was not the time to expand who could
prescribe these medications.
REPRESENTATIVE TARR said that there was a challenge from a
shortage of providers in every area of health care in Alaska.
She suggested that the proposed bill offered an opportunity for
trained professionals to meet this need for health care. She
relayed that the optometrists wanted to continue with the things
they had already done for the past decade.
DR. REINHARDT relayed that there were 26 ophthalmologists in the
State of Alaska and that the State of Washington had a similar
ratio of ophthalmologists to the population. She acknowledged
that the Alaska population was spread over remote areas, though
she stated that the State of Washington had patients in remote
areas, as well. She said that it was important to note that
ophthalmologists had a responsibility for patient safety. She
suggested that there was a nationwide trend of optometrists
introducing vague bills with the intention of expanding the
scope to include surgery.
REPRESENTATIVE JOHNSTON asked about the committee substitute
which had removed the reference to surgery.
DR. REINHARDT explained that the committee substitute did not
change Sections 5 and 6, which offered new definitions for
optometry, which inserted language for treatment or performance
of preventive procedures. She stated that the inclusion of
treatment opened the door for any treatment modality to treat
any and all eye diseases, and it included surgery. She deemed
that the crux of the issue was that the new definition of
optometry could be interpreted to include all surgeries.
4:17:41 PM
VICTORIA BLOWER, OD, Optometrist, shared that she had been in
optometric practice in Anchorage for 32 years. She stated her
support for HB 103. She reported that technology and best
practices had advanced to allow for superior medical care, which
included eye care. She pointed out that the statute governing
the optometry board was more than 40 years old and did not allow
for reaction to the rapidly changing environment without
repeatedly going to the Alaska State Legislature for action.
She noted that the protocols had been extended to protect the
public. She shared her respect for the Board of Optometry. She
said it was unfair and a waste of resources to prevent
optometrists from providing care at the highest level of their
education and training, as this did include knowledge about the
entire body. She pointed out that, as so much of Alaska was
rural, most of the eye care was administered by the more than
150 optometrists serving in 80 communities. She directed
attention to a letter of support from the CEO of the
Southcentral Foundation. She expressed her objection to the
argument that optometrists could not be trusted to have sound
judgement about their skills and training, thereby not acting in
the public's best interest. She offered examples about other
medical professions working within their education and training.
She stated that HB 103 would modernize the statute and allow
detailed legislation to be determined by the optometry board, as
was the current standard in all other prescribing professions in
Alaska. It would also streamline the legislative governing
process and bring the best practices to the residents of the
state in a cost-effective manner.
4:21:43 PM
KARL ROSEN, MD, Ophthalmologist, voiced his strong opposition to
the proposed bill. He reported that he had been in practice for
23 years in Anchorage. He shared his educational background.
He declared that the proposed bill was the most expansive scope
of practice bill in the country. He said that the bill
dismissed the rigorous training of an ophthalmologist. He
offered his belief that the optometry board, a group of non-
surgeons, was going to decide which potential surgical
privileges would be allowed. He suggested to correct the
proposed bill by providing an amendment with a definition of
surgery. He declared that the optometry board already had the
ability to regulate its profession. He shared an article which
refuted the statement that more optometrists doing procedures
would cut costs, and he directed attention to a study which
determined that more than twice the number of eyes were re-
treated after laser surgery by optometrists versus
ophthalmologists. He stated that health policy makers should be
cautious about approving laser privileges for optometrists. He
pointed out that optometrists did not take hospital calls and
did not have hospital privileges, and if a complication
occurred, there would be the need to transfer patients to a
hospital. He declared "you can't get good doing a couple of
procedures a year." He said that insurance carriers would not
accept CPT codes by optometrists. He declared that, should all
privileges be made similar, then there needed to be an equally
strong legislative effort to ensure that all aspects of school,
training, and continued competency were also similar, or it
would become a two-tiered system for patients. He declared that
the proposed bill would make it difficult to recruit new
ophthalmologists to Alaska.
REPRESENTATIVE KITO asked how much of his educational study and
experience provided for vision and eye, or was most of it just
medical.
DR. ROSEN explained his education and background, which included
three years of ophthalmology residency of more than 110 hours
each week. He stated that it was not a job, it was a lifestyle,
a culture. He shared that studying at a major medical center
included interaction with the other colleges and allowed for
better communication with the other areas of medicine.
REPRESENTATIVE TARR said that she shared the concern for
surgeries by properly trained individuals. She mused that, if
the Board of Optometry wanted to propose regulations allowing
performance of Lasik surgery, those regulations would be opened
for a public comment period. She offered her belief that those
with views similar to Dr. Rosen would speak out in opposition.
She said that she did not see the circumstance to which he was
worried actually happening, as it would not make its way through
the public process.
DR. ROSEN replied that this was an ideological question and he
asked if optometry was being redefined. He said that there had
been a change in the past 10 years, and that optometry wanted to
be something else. He stated that there had been a process for
standardization in the American Medical System since 1910.
REPRESENTATIVE TARR reiterated that she could not see a
circumstance where this would happen.
DR. ROSEN said most providers followed their oath, although he
was there to protect the public from the outliers. He reminded
that there was method in place for licensing.
4:33:23 PM
ALFRED DERAMUS, MD, Ophthalmologist, stated his gentle
opposition to the proposed bill. He said that this was the
latest legislation on which he had been testifying since 1982.
He said that the ophthalmologist purview for the definition of
surgery was different than the definition of surgery by
optometry. His problem was that the proposed legislation left
an opening for interpretation that treatment for all eye disease
could include surgery. He declared that "we should be very,
very careful about this bill." He emphasized that
ophthalmologists were concerned that optometrists would perform
ophthalmic surgeries and be protected by the definition.
REPRESENTATIVE JOHNSTON asked what type of surgery would be
performed by optometrists.
DR. DERAMUS replied that the definition was open ended, and he
offered an example for the removal of a superficial foreign body
versus a deeply imbedded foreign body in the cornea.
CHAIR SPOHNHOLZ referenced the earlier testimony regarding the
regulatory process for changing regulations around the practice
of optometry and asked if he was concerned that there would not
be the opportunity to testify and for those concerns to be put
on the record.
DR. DERAMUS expressed his agreement that he would be allowed to
testify, and, in response to Chair Spohnholz, that he was aware
that the meetings of the Board of Optometry were all public. He
replied that he had only testified on one occasion regarding
various optometric bills, and that he had found that, regarding
the experience, he had been able to present his point of view
and have it weighed by the board. In further response to Chair
Spohnholz, he said that he had always been treated respectfully
by the board.
REPRESENTATIVE TARR reiterated that she could not see the
circumstance whereby optometrists were given the authority to
perform procedures that offered concern to ophthalmologist. She
stated that there were "bad actors that are in the provider
community whether it be for dental care or physical therapy or
other areas."
DR. DERAMUS said that the reality of life goes far beyond the
written or spoken word. He said that the pain of experience
from a surprise was "where you really find out where you stand."
He offered an example for a seemingly minor accident.
CHAIR SPOHNHOLZ asked if he was suggesting that an optometrist
might try to treat this incident in an emergency room.
DR. DERAMUS replied that he did not believe that an optometrist
would be in the operating room because they did not have
admitting privileges.
4:45:43 PM
DAVID ZUMBRO, MD, Ophthalmologist, shared his background as a
retina surgeon. He offered his belief that the proposed bill
"radically redefines optometry" as optometry did not have any
procedural background in its training or practice. He stated
that the proposed bill removed the prohibition against lasers in
surgery. He declared that there was a difference between
optometry and ophthalmology. He offered an example of some co-
workers who were optometrists and had gone back to school for
ophthalmology. He stated that they were not given any credit by
the medical school for their doctor of optometry degree. He
offered his belief that the regulations had changed in 2008 when
prescriptive authority advanced the scope of the optometry
practice. The proposed bill was too vague and open ended, as it
removed the specific prohibition against lasers in surgery and
allowed non-physicians to regulate the practice of surgery. He
declared that the focus of any health care issue should be
patient safety.
CHAIR SPOHNHOLZ asked where the legislation changed the scope of
practice.
DR. ZUMBRO explained that the removal of the prohibition against
lasers in surgery and the allowance for the treatment of eye
conditions were worrisome, as it would allow optometrists to
expand the scope of practice.
CHAIR SPOHNHOLZ stated that the proposed bill did not remove any
limitations, but only added language for the opportunity to use
pharmaceutical agents for the treatment of eye disease and
develop uniform standards for the practice of optometry. She
said that it rescinded the limitations on the amount of
education, as the continuing education requirements had already
been expanded.
DR. ZUMBRO suggested that an amendment defining eye surgery
would offer clarity for all the parties.
4:50:30 PM
PAUL BARNEY, OD, Chair, Board of Optometry, reassured the
committee that the board did not have the authority to write
regulations for anything that optometrists did not have the
education to do, and that the purpose of the board was to
protect the public. In response to Representative Tarr, he said
that he supported the bill.
4:52:17 PM
ELIZABETH MORGAN, MD, Ophthalmologist, said that she had
practiced in Anchorage for almost 14 years, and that she worked
closely with optometrists, especially in working with glaucoma
patients. She lauded the relationship and stated that the
proposed bill created a divisive force between the two
practices. She said that ophthalmologists took eye care of
individuals very seriously and they were adamant if there was
something that threatened the patient's best interest. She
offered her belief that the problem with the bill was that the
language was "a bit open ended." She suggested that the two
groups of providers arrive at a common definition for treatment
that was in the best interest of the patient.
REPRESENTATIVE JOHNSTON asked for that definition for treatment.
DR. MORGAN offered her belief that both sides needed to agree on
the definition of surgery.
4:56:01 PM
DAVID KARPIK, OD, stated that he was an optometrist and his
group provided the majority of eye care on the Kenai Peninsula.
He reported that he was also the medical director [indisc], and
that these practices offered similar comprehensive eye care
services and worked in conjunction with other primary care
providers. He declared that this model was cost effective and
in the patient's best interest. He stated that optometrists
practiced in small communities throughout Alaska and had a long
history of compassionate conservative care. He referenced a
recent study which reported that Alaska was last in access to
health care, and that this was an opportunity to help change
that alarming statistic. He said that all health care providers
practiced to the extent of their ever-evolving training. He
declared that optometrists have had full prescribing privileges
for 10 years. He pointed out that optometrists had been safely
performing procedures for decades, noting that they had training
on the entire body. He said that some schools duplicate medical
and dental courses for the first few years of the program.
4:59:26 PM
ERIC COULTER, MD, Ophthalmologist, referenced a letter that he
had sent to the committee, and shared that he had good
relationships with optometrists. He stated that privileges were
delineated through hospitals and surgery centers and were
outlined by law. He expressed his concern that the optometric
community would not let the public know the differences in
medical training. He declared that the proposed bill needed a
definition of surgery.
5:02:17 PM
ERIK CHRISTIANSON, OD, Optometrist, said that he was the only
full-time eye care provider in the community. He suggested that
the proposed bill was modernizing language to allow the
profession to move forward and regulate similar to other health
care providers. He said that the goal was to work as
effectively as possible, and that there were a variety of little
procedures that could be done often enough to be good. He
expressed his concern for the rural communities to get qualified
health care providers, and, unless there was the ability to
practice to the level of training, it would be difficult to
attract them.
5:04:28 PM
CHAIR SPOHNHOLZ closed public testimony.
5:04:51 PM
CHAIR SPOHNHOLZ stated that the proposed bill was introduced to
modernize the way optometry was managed in Alaska, as it was the
only health profession in the state where it was necessary to
visit in statute every time a small change was made to education
or scope of practice. She pointed out that things changed more
rapidly than the legislature could move. She offered her belief
that there were enough tools in the regulatory process to allow
for robust public participation and opportunities for concerns
to be expressed and to ensure that the Board of Optometry would
not "go rogue." She added that the proposed bill would get the
legislature out of the business of micromanaging optometrists.
She shared a personal story of an eye surgery performed by a
local optometrist. She offered her belief that it was best to
not define "surgery" in statute as it was a complex and broad
term. She shared that it was very difficult to arrive at a
definition of "surgery" which met all the criteria. She
suggested that it was best to let the regulatory process work.
She said that best management practices were to delegate
authority to the lowest possible level, and allow those
professionals the opportunity to perform their work. She lauded
the "robust regulatory process as it related to the way that
board regulations were adopted."
REPRESENTATIVE JOHNSTON asked how the board for chiropractors
regulated in Alaska.
MS. MILKS, in response, explained that the Board of Chiropractic
Examiners was managed with the same legal advice from the
Department of Law as the other boards. She stated that an
Assistant Attorney General was assigned to advise in both board
procedure and procedure for constructing and adopting
regulations, and that sometimes the Assistant Attorney General
would attend the board meetings.
REPRESENTATIVE JOHNSTON asked if there was a similar process for
change which required bringing proposed changes to the Alaska
State Legislature.
MS. MILKS replied that all the boards were under the
Administrative Procedure Act (APA). She explained that the APA
set out the procedures for adopting regulations and having
hearings, and that all the boards were under the APA and
followed the same rules with respect to adoption of regulations.
REPRESENTATIVE EASTMAN shared that the board of chiropractors
were very proud of their process, as they had pursued some
unique approaches to their profession. He expressed his hope
that the Board of Optometry would review this example. He asked
whether an expanded scope for optometrists would result in fewer
ophthalmologists.
CHAIR SPOHNHOLZ emphasized that she did not, as the sponsor of
the proposed bill, introduce the bill because of the unique
nature of the state. She said that this was a response to a
comparison of the State of Alaska to the State of Washington by
an earlier testifier. She declared that the intent of the
proposed bill was not to expand the scope of the Board of
Optometry, but instead to delegate discussions regarding the
practice of optometry to the Board of Optometry, rather than
having it done in statute on an annual basis.
REPRESENTATIVE TARR said that she would have concerns if the
regulations allowed for optometrists to perform eye surgery.
She offered her understanding that this was beyond the scope of
practice, and she could not see a circumstance in which this
would be the result. She declared that there were many barriers
to expansion of specialties. She opined that with the limited
number of providers it was necessary to take the opportunity to
allow practice to the full scope of training. She added that
the health care fields were always evolving, and she stated her
support of HB 103.
5:15:41 PM
REPRESENTATIVE TARR moved to report CSHB 103, Version 30-
LS0459\D, Bruce, 2/21/17, out of committee with individual
recommendations and the accompanying fiscal notes. There being
no objection, CSHB 103 (HSS) was moved from the House Health and
Social Services Standing Committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB0159 ver A 3.6.17.pdf |
HHSS 3/18/2017 3:00:00 PM HHSS 3/25/2017 3:00:00 PM HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 159 |
| HB159 Sponsor Statement 3.6.17.pdf |
HHSS 3/18/2017 3:00:00 PM HHSS 3/25/2017 3:00:00 PM HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 159 |
| HB 159 Sectional Analysis ver A 3.6.17.pdf |
HHSS 3/18/2017 3:00:00 PM HHSS 3/25/2017 3:00:00 PM HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 159 |
| HB159 Fiscal Note DHSS-PHAS 3.6.17.pdf |
HHSS 3/18/2017 3:00:00 PM HHSS 3/25/2017 3:00:00 PM HHSS 3/30/2017 3:00:00 PM HHSS 4/4/2017 3:00:00 PM HHSS 4/11/2017 3:00:00 PM |
HB 159 |
| SB 91 ver A.pdf |
HHSS 3/18/2017 3:00:00 PM |
SB 91 |
| SB091 Sponsor Statement 3.16.17.pdf |
HHSS 3/18/2017 3:00:00 PM |
SB 91 |
| SB091 ver J 3.16.17.pdf |
HHSS 3/18/2017 3:00:00 PM |
SB 91 |
| SB091 Sectional Analysis ver J 3.16.17.pdf |
HHSS 3/18/2017 3:00:00 PM |
SB 91 |
| SB091 Additional Documents-Explanation of Changes, ver J 3.17.17.pdf |
HHSS 3/18/2017 3:00:00 PM |
SB 91 |
| SB091 Fiscal Note DHSS-PHAS ver J 3.16.17.pdf |
HHSS 3/18/2017 3:00:00 PM |
SB 91 |
| SB 36 Opposition Letter Coulter MD vs. SB36 HB103.pdf |
HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM SFIN 3/14/2017 9:00:00 AM |
HB 103 SB 36 |
| HB 103 Draft Proposed Blank CS ver D 3.13.2017.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Explanation of Changes (CS) 2.22.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Letters of Support 2.22.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Fiscal Note DCCED--DCBPL 3.13.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Sectional Analysis (CS) 2.22.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Sponsor Statement 2.22.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Supporting Document Ohio State Optometry Curriculum 2.22.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Supporting Document Medical Liability Premiums Fact Sheet 2.22.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Supporting Document Regulation Flow Chart 3-10-17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Supporting Document-Board of the Examiners in Optometry.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Supporting Document-Optometrists Practicing in AK 2.22.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Supporting Documents Optometry Education Flyer 2.22.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB103 Career Guide Optometry 2.22.17.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB103 Letters of Opposition-Support.pdf |
HHSS 3/14/2017 3:00:00 PM HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |
| HB 103 Opposing Document--Letters 3.15.17.pdf |
HHSS 3/16/2017 3:00:00 PM HHSS 3/18/2017 3:00:00 PM |
HB 103 |