Legislature(2017 - 2018)CAPITOL 106
03/29/2018 03:00 PM HEALTH & SOCIAL SERVICES
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SB 108-MEDICAL CARE/LICENSING/MEDICAL BOARD 3:58:22 PM CHAIR SPOHNHOLZ announced that the next order of business would be CS FOR SPONSOR SUBSTITUTE FOR SENATE BILL NO. 108(FIN), "An Act relating to the State Medical Board; relating to the licensing of physicians, osteopaths, and podiatrists; relating to the certification of medical assistants; relating to the practice of medicine; relating to the practice of podiatry; relating to the practice of osteopathy; relating to assault of a medical professional; and providing for an effective date." 3:58:30 PM SENATOR CATHY GIESSEL, Alaska State Legislature, explained that the proposed bill included requests by the State Medical Board for changes to their statutes. She presented a PowerPoint titled "SB 108, State Medical Board," and introduced slide 2, "Purpose," which listed the two purposes of the bill: to streamline physician licensing and to address the need for both licensed and unlicensed office assistants. 3:59:58 PM SENATOR GIESSEL addressed slide 3, "Streamline MD licensing," which was addressed by the proposed bill in Sections 1, 2, 8, and 9 [and 10] for changes to the process for license approval. She declared that the reason to the delay for approval was the need for the license application to first be reviewed, and then forwarded to the State Medical Board for evaluation during its quarterly meeting. She explained that the proposed bill would authorize the executive administrator to look at the license applications, and if it was complete, and there were not any concerns, the administrator would be authorized to approve the license and issue temporary licenses, as well as grant certifications. The proposed bill also spelled out prohibitions for the board to limit the executive administrator's authority in this realm. She added that this process had already been in use by the Department of Commerce, Community & Economic Development for 20 years. She declared that it was a safe, efficient, and proven system. 4:01:49 PM SENATOR GIESSEL moved on to slide 4, "Streamline MD licensing," and reported that Sections 10 and 11 of the proposed bill added an additional second person to issue temporary licenses should the executive administrator not be available. She declared that that this would help streamline the license approvals between those quarterly board meetings. She reported that there were approximately 290 licenses in backlog, although some of these may not be complete. She noted that only about 5 percent of the applications were complete when submitted. SENATOR GIESSEL directed attention to slide 5, "Unlicensed Assistive Personnel," which was addressed in Section 3 of the proposed bill. She reported that, in the mid-1990s, physician offices began to hire unlicensed personnel for routine medical duties in order to reduce overhead costs. She pointed out that, as the state medical laws prohibited the delegation of any medical duties to an unlicensed person, the proposed bill would correct that gap in the laws and it would authorize delegation of routine medical tasks, as defined by the State Medical Board, to an unlicensed person. 4:05:15 PM SENATOR GIESSEL addressed slide 6, "2.a. Unlicensed Personnel Medical assistants," and noted that Sections 6, 12, and 14 added additional clean up language, and put "routine medical duties" under the exception to the license to practice medicine as the law currently prohibited any of these medical activities being delegated to unlicensed people. She reported that Section 12 added medical assistant to the practice of medicine, and Section 14 added medical assistants to the definition of medical professional under the Title 12 Criminal Procedure. SENATOR GIESSEL directed attention to a second category of medical assistant created in the proposed bill to again correct a problem identified by practicing physicians, slides 7 - 8, "2.b. Medical assistants - license/certification." She relayed that earlier legislation had prohibited unlicensed people from looking into the prescription drug database, as it contained sensitive information. She stated that this had now caused problems in the offices of pain or cancer doctors, as these doctors did not have staff licensed to perform this task. She relayed that the proposed bill created an entity of medical assistants who were certified through recognized training and certification programs. She added that Alaska's community colleges had training programs for certified medical assistants, which were recognized in many other states. She explained that Section 4 of the proposed bill defined the certifying process in regulation by the board, slide 9, "Medical assistant with certification Process defined." She stated that Section 5 listed specific limitations for use of the term "certified," and that Section 13 included certification in the definition of a license. She pointed out that these certified assistants would be qualified to look into the prescription drug database for a physician, as well as being assigned more complex medical duties as determined by the medical board. 4:10:04 PM SENATOR GIESSEL emphasized that the proposed bill would provide a more efficient, expeditious, and effective licensing of physicians, it would provide legal clarity for the delegation of routine medical duties to unlicensed personnel, and create more stringent licensing for a person certified or licensed by the board, slides 10 - 11, "Urgent need for SB 108." She declared that the state medical board "really needs this" and that there had not been any opposition to the proposed bill. 4:11:09 PM REPRESENTATIVE SULLIVAN-LEONARD acknowledged that other medical professionals had indicated the time element to manage all the tasks. She relayed that certified medical assistants (CMA) were very beneficial and asked if the CMAs could apply a prescription or write a prescription. SENATOR GIESSEL offered her belief that the board intended that CMAs not be allowed to do any prescribing or management of opioids other than accessing the data base. She cautioned that the term CMA was a registered trademark by one of the certifying bodies, and that neither the term or the words were used in the proposed bill. 4:13:00 PM REPRESENTATIVE KITO mused that the proposed bill was providing for licensing, registration, or certification of a medical assistant, as well as allowing medical professionals to designate routine tasks to unlicensed medical assistants. He asked if this created two classes of medical assistants, licensed and unlicensed. SENATOR GIESSEL acknowledged that there were two categories of medical assistants. One was a regular medical assistant whereas the other had sought on-going education, had taken the national certifying examination, and was qualified to pursue licensing by the State Medical Board. REPRESENTATIVE KITO expressed concern for the ability to oversee a doctor's office which could have both categories of medical assistant. SENATOR GIESSEL stated that the medical board would define the limitations on both entities, and that it would be up to the facility to monitor that the clinicians were practicing within the scope of their license. She said that these were all logistics that the medical profession would work out. 4:15:22 PM REPRESENTATIVE KITO asked about the applicability of the medical board asking to authorize a new category of medical professional when they were not in support of a similar request by the naturopath board. He expressed concern for leaving this entirely to the medical board while not knowing the requirements. SENATOR GIESSEL acknowledged that he had identified a turf situation which occurred in medicine. She shared an anecdote for the nursing profession putting in statute and regulation the authority to delegate to unlicensed assistive personnel. She said that it was "pretty routine" to trust professional boards with this. REPRESENTATIVE KITO said that, although he appreciated areas of turf, it was necessary to carefully understand what was being added. He expressed his concern for the new certification of medical assistants without fully understanding their task. He asked for a commitment from the medical profession that this would result in decreases in cost, as there would be a delegation of tasks from a licensed professional to unlicensed individuals. He expressed concern that the public would not be receiving the benefit. SENATOR GIESSEL said that these cost reductions should have been seen in the mid-1990s when medical assistants began to replace licensed professional in physician offices. REPRESENTATIVE KITO pointed out that medical costs had continued to increase since then. CHAIR SPOHNHOLZ noted that the requirement that health care providers use the prescription drug database had been added in the last few years at a time when they had not been able to bill for that. 4:19:25 PM REPRESENTATIVE TARR asked whether the role of untrained students working in medical offices was now becoming professionalized. SENATOR GIESSEL explained that the "regular" medical assistant, usually high school graduates, had been trained on the job. She reported that, as the education became more formalized over time, the State of Alaska now needed to recognize this training. REPRESENTATIVE TARR opined that, as people would be better prepared to provide information, there would be a positive benefit. She suggested that many of these had been administrative, rather than health care positions. SENATOR GIESSEL expressed her agreement and suggested that the certified medical assistant would now perform more invasive medical procedures, such as immunizations. She listed some of the safeguards as a result of medical training. REPRESENTATIVE TARR questioned whether there would be a public comment period after the State Medical Board prepared regulations. SENATOR GIESSEL expressed her agreement, noting that the regulatory process took about one year to complete, which included a period for public comment. REPRESENTATIVE EASTMAN directed attention to Section 4 of the proposed bill and asked for the reasons that immunity was offered. 4:24:20 PM SENATOR GIESSEL stated that this was standard language in health care statutes for providing immunity to people making reports of incidences. REPRESENTATIVE EASTMAN, referencing AS 08.64.111, asked whether use of the abbreviation C.M.A. was intended and whether it would run "afoul of the trademark issue" mentioned previously. SENATOR GIESSEL replied that this decision to choose the certifying body for the trademark C.M.A. was up to the State Medical Board, pointing out that these initials were not specified in the proposed bill. REPRESENTATIVE EASTMAN directed attention to Section 12 of the proposed bill and asked whether the certified medical assistants were practicing medicine. SENATOR GIESSEL explained that Section 12 indicated that a medical assistant licensed under a separate chapter of the proposed bill was exempt from practicing without a medical license. REPRESENTATIVE EASTMAN asked if the other chapter provided a comparable penalty. SENATOR GIESSEL acknowledged that there were penalties for practicing medicine without a license. She shared the State Medical Board list of other licenses and certificates. 4:27:51 PM REPRESENTATIVE KITO expressed concern regarding the definition of medical professional in Section 14. SENATOR GIESSEL directed attention to similar positions on the medical board list and acknowledged that it was a rather broad definition. REPRESENTATIVE KITO compared this to dental assistants who could be delegated tasks and asked about the consideration of someone as a medical professional "who has zero training." SENATOR GIESSEL explained that the purpose for the definition of medical professional was to authorize for the routine medical tasks, which included the medical assistant with certification. She suggested that the dental assistant should be added. 4:31:03 PM CHAIR SPOHNHOLZ opened invited testimony on SB 108. 4:31:15 PM FRED PARADY, Deputy Commissioner, Office of the Commissioner, Department of Commerce, Community & Economic Development, stated his support of the proposed bill. He stated that, in FY17, the Department of Commerce, Community & Economic Development had processed 22 percent more medical licenses and 31 percent more nursing licenses, reflecting the increased demand for health care professionals in Alaska. He reported that the department had initiated a strategic planning process which identified streamlining the application process for health care professions as its highest priority. This initiative included a comprehensive examination of the processes, which identified every step of the process to search for roadblocks and bottlenecks. He noted that 27 of these roadblocks were identified and evaluated for the cause in order to determine if this was a public safety need, whether the process was obsolete, and whether the roadblock could be simplified. He explained that there was a three-pronged approach to implementing the solutions to these roadblocks: some were in board regulation, some were improvements to the IT process, and some were changes to statute. 4:34:50 PM REPRESENTATIVE SULLIVAN-LEONARD asked if the processing for the positions in the proposed bill would be paid by the State Medical Board. MR. PARADY said that they would. 4:35:20 PM CHAIR SPOHNHOLZ opened public testimony on SB 108. 4:35:43 PM DANNY ROBINETTE, MD, Chief Medical Officer, Foundation Health Partners, stated that his organization was in support of the proposed bill to expedite the process. He reported on the struggle to bring physicians to Alaska. He lauded the safeguards in the proposed bill to ensure clean applications. 4:37:35 PM CHAIR SPOHNHOLZ closed public testimony on SB 108. 4:37:54 PM The committee took a brief at-ease. 4:38:22 PM REPRESENTATIVE TARR said that the proposed bill was an important step forward to hopefully result in more access to care and to lower costs. She stated that it would be imperative for the legislature to maintain a vigilance for the regulations upon release to the public. CHAIR SPOHNHOLZ said that she had heard concerns from physicians about the prescription drug database requirement, and that this new category would allow health care practitioners more office efficiency. She stated that the temporary licensing was an important aspect and that there were appropriate fail safes. 4:40:03 PM REPRESENTATIVE ZULKOSKY moved to report CSSSSB 108 (FIN), Version 30-LS0740\I, from committee with individual recommendations and the accompanying fiscal notes. There being no objection, CSSSSB 108 (FIN) was reported from the House Health and Social Services Standing Committee.