Legislature(2017 - 2018)SENATE FINANCE 532
02/27/2018 09:00 AM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB108 | |
| SB105 | |
| SB165 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 105 | TELECONFERENCED | |
| + | SB 108 | TELECONFERENCED | |
| + | SB 165 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE BILL NO. 108
"An Act relating to the State Medical Board; relating
to the licensing of physicians, osteopaths, and
podiatrists; and providing for an effective date."
9:03:32 AM
SENATOR CATHY GIESSEL, SPONSOR, discussed the presentation,
"SB 108 State Medical Board" (copy on file).
9:03:51 AM
Senator Giessel highlighted Slide 2, "Purpose":
1. Streamline Physician Licensing
2. Need for office assistants
9:04:26 AM
Senator Giessel discussed Slide 3, "Streamline MD
licensing":
Section 1, 2, 8, 9, 10
State Medical Board to write regulations to
delegate to EXECUTIVE ADMINISTRATOR:
1. review applications and grant license if
requirements are met
2. review applications and issue temporary
license if requirements are met
3. grant certification if requirements are met
4. spells out prohibitions to this delegated
authority
9:06:28 AM
Senator Giessel discussed Slide 4, "Streamline MD
licensing":
Section 10, 11
1. Allows another person, designated by the
board, to help the Executive Administrator to
issue temporary license.
2. Outlines when this could happen
Senator Giessel stated that this change was urgently needed
and widely supported.
9:08:20 AM
Senator Giessel highlighted Slide 5, "Medical Assistants -
Unlicensed Assistive Personnel":
Medical Assistants
trained in "routine medical tasks"
Section 3
authorizes delegation to unlicensed person
prohibits delegation of pain management or opioid
related activities
Senator Giessel offered a brief history of the role of
medical assistance in practice.
9:10:31 AM
Senator Giessel addressed Slide 6, "Medical Assistants -
Unlicensed Assistive Personnel":
Section 6
adds unlicensed assistive personnel, performing
delegated routine medical duties to exception
under "License to practice medicine, podiatry, or
osteopathy"
Section 13
adds "medical assistants" to definition of
"medical professional" under Title 12 Criminal
Procedure
Senator Giessel stated that only licensed medical
professionals could access the state's pharmaceutical
database.
9:12:18 AM
Senator Giessel looked at Slide 7, "Certified Medical
Assistants - NEW entity":
Why?
Prescription Drug Monitoring Program (PDMP)
prohibits access by any unlicensed person
envisioned clinician delegate "look up" before
prescribing
Problem
No licensed people in MD clinic, other than the
MD
Frequent need to check on PDMP
Solution
Alaska's Community Colleges training programs for
CMA
National exams for Certification
Done in most other states. Washington State is one
example
9:14:17 AM
Senator Giessel discussed Slide 8, "CMA (Certified Medical
Assistant) Process defined":
Section 4
Certification - process will be defined in
regulation
Section 5
Title "CMA" and limits its use
Section 12
Penalty for practicing without license as CMA
Senator Giessel addressed Slide 9, "Urgent need for SB
108":
Efficient, expeditious and effective licensing of MDs
Legal clarity for delegation of "routine medical
duties" to unlicensed assistive personnel (medical
assistants)
More legally stringent delegated activities to
licensed entity, Certified Medical Assistant
9:14:29 AM
Senator Giessel discussed Slide 10, "Urgent need for SB
108":
These changes needed this session
Support
State Medical Board (requested)
Department of Commerce
No opposition
9:15:10 AM
Senator Stevens asked how long the temporary license would
last and whether it removed the responsibility to precure a
permanent license.
Senator Giessel replied that the temporary license was
time-limited. She deferred to Ms. Stovern.
9:15:50 AM
Co-Chair MacKinnon wondered whether medical assistants were
licensed in other states.
Senator Giessel replied that other states recognized
certified medical assistants, which was why the national
exams were available.
9:16:13 AM
Senator von Imhof looked at the fiscal note, which
reflected that professional licensing programs were funded
by receipt supported services to fund the two new full-time
positions that the bill would create, which meant that the
expense would be paid by the health professionals that were
involved with the board.
Senator Giessel replied in the affirmative.
9:16:51 AM
Co-Chair MacKinnon wondered whether the structure of the
bill was understood by the entire committee.
9:16:55 AM
Senator Olson asked how the bill would affect heath
corporations in rural Alaska.
Senator Giessel responded that she had not heard from
specific native corporations or native health
organizations. She imagined that if Anchorage was
experiencing issues then rural areas must be as well.
9:18:06 AM
Senator Olson wondered about continuing medical education
(CME) requirements for medical assistants.
Senator Giessel deferred to Ms. Stovern.
9:18:31 AM
Senator Olson asked whether other professionals working
under the per view of the medical board would be affected
by the bill.
Senator Giessel replied that physician's assistants were
affected, because they delegated to unlicensed assisted
personnel and needed to access the PDMP.
9:19:23 AM
Co-Chair Hoffman wondered whether the legislation would
increase the number of certified medical assistants in the
state.
Senator Giessel replied that it was hard to predict whether
the numbers would grow but that it was a growing field of
work.
9:20:32 AM
Senator von Imhof read from the sponsor statement:
The bill provides for physician delegation of
specific, routine activities to unlicensed personnel
working in physician offices.
Senator von Imhof assumed that the "specific, routine
activities" would be within the parameters of their
training and would be spelled out in regulation.
Senator Giessel replied in the affirmative.
9:21:33 AM
Senator Micciche spoke to concerns that had been voiced by
the American Association of Medical Assistants (AAMA) about
confusion surrounding certified medical assistants.
Senator Giessel said that she had been in communication
with the association and had clarified with them the
importance of the bill. She stated that the association
could bring other concerns to the Board of Medicine.
9:22:13 AM
Co-Chair MacKinnon noted that there was a letter in the
packet from the AAMA that offered suggestions on what
initials to give certified medical assistants (copy on
file).
Senator Giessel stated that she was aware of the letter and
had instructed the AAMA to communicate with the Board of
Medicine. She asserted that she was carrying the
legislation on behalf of the board and would not change any
aspects of the bill unless the board agreed.
9:22:50 AM
Co-Chair MacKinnon wondered how many other states
recognized certified medical assistants through licensure
programs. She asked whether the final licensure of a doctor
coming into the state had to be approved by the board, and
after that happened, would a list of physicians officially
approved to practice in the stat be approved by the board.
Senator Giessel deferred the question to Ms. Stovern.
9:24:20 AM
Co-Chair MacKinnon understood that a "clean" application
would not go before the board, but a questionable
application would go before the board for further scrutiny.
Senator Giessel shared that it would be up to the board how
they wanted to review applications approved by the
executive administrator. She said that the issue was not
discussed in the bill.
9:25:02 AM
FRED PARADY, DEPUTY COMMISSIONER, DEPARTMENT OF COMMERCE,
COMMUNITY, AND ECONOMIC DEVELOPMENT, spoke in support of
the legislation. He shared that the workload of the medical
board had dramatically increased due to telemedicine. He
stated that in 2015, the backlog reached 6 months in
application processing time due to the volume of
applications received. He relayed that in FY17, the
division processed 22 percent more medical licenses and 31
percent more nursing licenses than in FY16. He related that
to date in FY18, more licenses had been received than the
entirety of the previous fiscal year. He shared that the
department had worked to streamline the application process
for health care professions. He said that a comprehensive
examination of the application process had been done to
identify areas of friction, or "rubs." He relayed that 27
rubs had been identified, which had been evaluated
individually to determine whether the issue served a public
safety purpose, met a public safety need, or whether the
process was outdated or obsolete. He explained that a
three-pronged approach had been initiated to implementing
solutions to streamlining the licensure process. The areas
of friction were split in three areas: small changes
through board regulations, improvements in technology, and
changes to statute that would allow the department to more
effectively administer programs. He concluded that
legislative support of the bill was the final step in
ensuring Alaska's health care facilities were able to stay
open, while remining fully staffed and able to serve the
public in a timely fashion.
9:32:10 AM
DEBORA STOVERN, EXECUTIVE DIRECTOR, ALASKA STATE MEDICAL
BOARD, ANCHORAGE (via teleconference), stated that under
current statute only the board was authorized to grant
licenses, the board also had the authority to delegate to
her the authority to approve applications for temporary
permits, curtesy licenses, and resident permits. She said
that because the board only met four times per year,
temporary permits allowed applicants with complete files to
practice until the next board meeting, when files would be
considered by the board for approval of a permanent
license. She said that a temporary permit was time-limited
to 6 months and could not be extended. She related that as
part of the licensing streamlining project that Mr. Parady
spoke to, the board had taken actions to improve
application processing, including; in office efficiencies,
changes to application requirements, the inclusion of
participation in programs offered by the Federation of
State Medical Boards, the adoption of regulation for an
expedited temporary permit. She anticipated that once the
legislation passed, the board would continue to delegate
the approval authority to the executive secretary as well
as the licensing supervisor, for the issuance of the
expedited temporary permits. She said that once an
expedited file was complete, it would be referred to the
executive secretary for approval of the permeant license.
Any application with derogatory or adverse information,
discrepancies, or questions and concerns would require a
board review for approval of temporary or permanent
license, as appropriate. She related that under the
legislation much of the temporary licensure would be at the
discretion of the board. She spoke to the CME question
posed by Senator Olson. She said the licensing program
required that assistants maintain their national
certification, which meant they had to complete continuing
medical education. She anticipated that the board would
require something similar with certified medical
assistants.
9:37:11 AM
Senator Stevens wanted a guarantee that no one would be
given a temporary license that did not have the necessary
medical background.
Ms. Stovern responded that temporary permits were issued on
a checklist that had been developed by the board and
delineated all of the requirements for licensure. She said
that the process ensured that all requirements were met,
and all credentials were in place before temporary permits
were issued. The board would be tasked with further
developing that checklist for the enhanced process.
9:38:33 AM
Senator Stevens wanted assurances that the public would be
safe.
Senator Olson commented that he understood Senator
Stevens's concerns but that he had witnessed a lack of
service in rural areas of the state due to the lack of
streamlining in the permitting process.
9:40:16 AM
Co-Chair MacKinnon felt it was important to note that
Senator Olson was a doctor.
Senator Olson said he was first licensed as a medical
doctor in 1984 and had practiced in rural Alaska throughout
his career. He added that he had been on the medical board
from 1995, until he was elected to office.
9:41:50 AM
Senator Micciche asked whether the bill would speed up the
permitting process without reducing the credential
requirements.
Ms. Stovern replied yes. She said that the board considered
that the credentials had been reviewed for the issuance of
a temporary permit and took that into consideration when
granting a permanent license.
9:43:58 AM
Senator Micciche reiterated concern that requirements would
be reduced at the risk of public safety.
9:44:31 AM
Co-Chair MacKinnon understood that Senator Micciche was
requesting assurances that there would be no changes in
requirements for permanent licensure in the state.
Ms. Stovern replied that the requirements would not be
changed.
9:44:47 AM
Senator Stevens requested further information on the
backlog of 290 applications.
Ms. Stovern said that there was not currently a huge
backlog. She related that there had been an influx in
application due to increased telemedicine. She felt that
once streamlining efficiencies were implemented the
application processing time would be significantly reduced.
She relayed that there were some delays in the process that
were outside of the boards control. She stated that once an
application was received by her office it took
approximately one to three weeks to issue a temporary
license. She said that current backlogs were related to
missing documents and credentials in files.
9:47:53 AM
Senator Stevens felt that a 6-month extension would take
care of the current backlog.
Ms. Stovern responded in the affirmative.
9:48:42 AM
DOCTOR DANNY ROBINETTE, CHIEF MEDICAL OFFICER, FOUNDATION
HEALTH PARTNERS, FAIRBANKS (via teleconference), understood
the concern about credentials. He encouraged keeping the
diligent process intact and not changing the standards. He
stressed the importance of a streamlined process for
granting privileges to candidates. He related that he had
lost candidates to other states because the licensing
process had taken too long. He expressed strong support for
the legislation.
9:50:49 AM
Senator Stevens wondered how the bill would help with
efficiency of licensure.
Dr. Robinette thought that granting authority to the
director would save waiting for the next board meeting for
a clean candidate.
9:51:48 AM
Senator Stevens surmised that if an individual had been
given a 6-month extension, but at the end of the 6 months
the file was not complete, he would be denied the
opportunity to continue to work in the state.
Dr. Robinette agreed.
9:52:23 AM
Vice-Chair Bishop asked how much it cost to vet applicants.
Dr. Robinette answered that, including the cost of hiring
temporary staff to manage the workload, the cost was
several hundreds of thousands of dollars. The cost of
recruiting an individual physician was between $30,000 and
$50,000.
9:53:41 AM
Vice-Chair Bishop remarked that the hospital would spend
time vetting the individual, as would the board.
Dr. Robinette agreed, and believed that both vetting
opportunities should exist, he thought that anything that
could be done to streamline the vetting would be helpful.
9:54:33 AM
9:54:55 AM
Co-Chair MacKinnon CLOSED public testimony.
9:55:02 AM
AT EASE
9:55:19 AM
RECONVENED
9:55:22 AM
Co-Chair MacKinnon directed attention to the fiscal note.
9:55:39 AM
Vice-Chair Bishop discussed the fiscal note from the
Department of Commerce, Community and Economic Development
(DCCED). He read from the analysis:
One full-time Records and Licensing Supervisor is
needed to implement this program. Currently, one
existing Records and Licensing Supervisor is spread
among numerous programs; only part of that position's
time is dedicated to medical programs. As a result of
the addition of the certified medical assistant
license type, the workload related to medical programs
supports a dedicated Records and Licensing Supervisor.
If the bill passes the following expenses will be
incurred:
Personal Services: $177.8 (2 full-time positions)
Travel: $1.5 (1 training session per year)
Services: $10.0 (annual legal review)
$5.0 (annual investigations)
$4.5 (regulations project in the first year)
$30.0 (annual core services & allocated
costs)
Supplies: $20.0 (set up for new employees in the first
year)
$2.5 (postage in the first year) $1.0
(office supplies)
Professional licensing programs within the Division of
Corporations, Business and Professional Licensing are
funded by Receipt Supported Services, fund source 1156
Rcpt Svcs (DGF). Licensing fees for each occupation
are set per AS 08.01.065 so the total amount of
revenue collected approximately equals the
occupation's actual regulatory costs.
9:57:42 AM
Co-Chair MacKinnon asked whether Ms. Stovern had comments
pertaining to the AAMA and their concerns with CMAs in
Alaska.
Ms. Stovern replied that the board had not considered the
concerns.
9:58:54 AM
Co-Chair MacKinnon spoke again to the letter from Donald A.
Balasa, Ms. Davis, MBA, CEO and Legal Counsel for the AAMA.
She asked Senator Giessel to speak to her credentials.
Senator Giessel shared that she had been a registered nurse
in Alaska since 1974, and Advanced Nurse Practitioner since
2000. She relayed that she had served on the Board of
Nursing from 2002 to 2010, five of those years she served
as chair of the board. She said that the issue raised by
the AAMA was trivial, as opposed to the legislation, which
would address a critically urgent matter.
10:01:07 AM
Senator Olson asked whether Senator Giessel had received
letters of support of opposition from physician groups.
Senator Giessel said that she had not received letters from
the Alaska State Medical Association or the Association of
Physicians and Surgeons. She reminded the committee that
the Board of Medicine had written the bill.
Co-Chair MacKinnon announced that amendments were due by
5pm the following day.
SB 108 was HEARD and HELD in committee for further
consideration.