03/27/2019 03:15 PM House LABOR & COMMERCE

            HB  45-EXTEND BOARD OF DENTAL EXAMINERS                                                                         
                                                                                                                                
3:19:43 PM                                                                                                                    
                                                                                                                                
CO-CHAIR LEDOUX announced that the  first order of business would                                                               
be HOUSE BILL  NO. 45, "An Act extending the  termination date of                                                               
the Board  of Dental  Examiners; and  providing for  an effective                                                               
date."                                                                                                                          
                                                                                                                                
3:20:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  DAN ORTIZ,  Alaska  State  Legislature, as  prime                                                               
sponsor  of HB  45, introduced  the bill  and read  the following                                                               
sponsor statement [original punctuation provided]:                                                                              
                                                                                                                                
     House  Bill 45  extends  the termination  date for  the                                                                    
     Board of  Dental Examiners until  June 30th,  2027. The                                                                    
     Board of Dental Examiners  is composed of nine members:                                                                    
     six  dentists, two  dental hygienists,  and one  public                                                                    
     member.                                                                                                                    
                                                                                                                                
     Legislative Audit conducted their  review of this board                                                                    
     and  determined  that  "the audit  concludes  that  the                                                                    
     board operated in the  public's interest by effectively                                                                    
     licensing and  regulating dentists,  dental hygienists,                                                                    
     and  dental assistants.  The board  monitored licensees                                                                    
     and  worked   to  ensure  only   qualified  individuals                                                                    
     practiced in Alaska. Furthermore,  the board was active                                                                    
     in  amending regulations  to improve  the industry.  In                                                                    
     accordance  with  AS   08.03.010(c)(7),  the  board  is                                                                    
     scheduled to  terminate on June 30,  2019. We recommend                                                                    
     that  the legislature  extend  the board's  termination                                                                    
     date eight years to June 30, 2027."                                                                                        
                                                                                                                                
     The Board of Dental  Examiners serves an important role                                                                    
     in  adopting   regulations  to   carry  out   the  laws                                                                    
     governing the practice of  dentistry and dental hygiene                                                                    
     in  Alaska, and  the  continuation of  this board  will                                                                    
     ensure that  high standards of dental  care are offered                                                                    
     throughout the state.                                                                                                      
                                                                                                                                
3:22:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  FIELDS  recalled  that  when  the  Alaska  Tribal                                                               
Health System  (ATHS) implemented and expanded  the Dental Health                                                               
Aide Therapist  (DHAT) program there  was some debate  within the                                                               
dental community  about the  right way  to regulate  the program.                                                               
He  asked if  that was  something the  Board of  Dental Examiners                                                               
oversees.   He  sought to  clarify the  board's current  take the                                                               
DHAT  program  and  the  provision   of  dental  care  in  tribal                                                               
settings.                                                                                                                       
                                                                                                                                
3:23:02 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ORTIZ admitted  that he was unable  to answer that                                                               
question and deferred to David Nielson.                                                                                         
                                                                                                                                
3:24:03 PM                                                                                                                    
                                                                                                                                
DAVID NIELSON,  Chair, Board of  Dental Examiners,  Department of                                                               
Commerce, Community  & Economic Development, noted  that he can't                                                               
speak  for the  entire board  on  the DHAT  program; however,  he                                                               
opined that  the model seems  to be  working well in  its current                                                               
form.   He  addressed an  issue that  had arisen  about the  DHAT                                                               
members  not  being  licensed  by   the  state,  explaining  that                                                               
although that's  true, their education includes  supervision by a                                                               
licensed dentist.  He said that  because they are not licensed by                                                               
the state  it allows  them to  stay in  the villages  and clinics                                                               
where they  are serving  their population  the best,  adding that                                                               
the   aforementioned  tension   in  the   dental  community   has                                                               
dissipated.                                                                                                                     
                                                                                                                                
3:26:27 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  WOOL commented  that "it's  nice to  hear the  programs                                                               
working and  it's also nice  to hear him say  that the lack  of a                                                               
state license is actually helped it  work and maybe even added to                                                               
its success."  He asked if that is correct.                                                                                     
                                                                                                                                
MR. NIELSON  clarified that it  would be  best to speak  with the                                                               
tribal entities  to determine the  true impact of  their program.                                                               
Nonetheless,  he  offered his  understanding  that  if they  were                                                               
licensed,  [the DHAT  members] would  probably move  to a  higher                                                               
populated area where their work isn't needed as much.                                                                           
                                                                                                                                
3:27:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HANNAN  referred the  committee to  page 7  of the                                                               
sunset review on  the Board of Dental Examiners  [included in the                                                               
committee packet] performed by the  Division of Legislative Audit                                                               
(DLA).  The  page displayed an unaudited schedule  of the board's                                                               
revenue and expenditures from FY 14  through March 31, 2018.  She                                                               
noted that every other year they  had a deficit and asked if that                                                               
was because licensures are two years at a time.                                                                                 
                                                                                                                                
3:28:40 PM                                                                                                                    
                                                                                                                                
KRIS CURTIS, Legislative Auditor,  Division of Legislative Audit,                                                               
Answered yes.  She said  that with biannual licensing cycles it's                                                               
common to see revenues fluctuate every other year.                                                                              
                                                                                                                                
3:28:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HANNAN  said she presumed  that at the end  of the                                                               
fiscal year any excess money  that was accrued through licensures                                                               
rolls into  the general fund  and the  following year they  run a                                                               
deficit.   She  asked if  that happens  regularly with  the state                                                               
boards.                                                                                                                         
                                                                                                                                
3:29:29 PM                                                                                                                    
                                                                                                                                
MS. CURTIS  referenced a statute  that states board fees  must be                                                               
set  at a  level that  covers board  costs.   She explained  it's                                                               
reviewed every  other year rather than  on an annual basis.   She                                                               
alleged  hearing testimony  that claimed  a statute  exists which                                                               
allows boards to  carry balances forward; however,  they do track                                                               
their deficits and surpluses and either  one can last years.  She                                                               
further noted that  boards try to "tweak" those  fees every other                                                               
year to approximate the cost of the occupation.                                                                                 
                                                                                                                                
3:30:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HANNAN  directed attention  to the  audit's second                                                               
recommendation: to  implement controls to ensure  the appropriate                                                               
entities are  notified when  a licensee's  prescription authority                                                               
is suspended or  revoked.  She asked if action  had been taken to                                                               
meet that recommendation.                                                                                                       
                                                                                                                                
3:31:11 PM                                                                                                                    
                                                                                                                                
MS. CURTIS  explained that there  are two recommendations  in the                                                               
audit.  The first one is  a recommendation to the board president                                                               
to correct regulation error.  The  second one is that the DCBPL's                                                               
chief  investigator,  in  consultation  with  the  board,  should                                                               
implement  controls  to  ensure   the  appropriate  entities  are                                                               
notified when  a licensee's  prescription authority  is suspended                                                               
or revoked.   She noted that, in response,  the department stated                                                               
that they have implemented a  policy to ensure those entities are                                                               
notified.    She  further  noted  that  the  board  responded  in                                                               
agreement  to  both  recommendations  and  to  taking  corrective                                                               
action.                                                                                                                         
                                                                                                                                
MS.  CURTIS  turned  attention   to  the  schedule  of  licensing                                                               
activity on page  6 of the audit.   She noted that  as of January                                                               
2018, the board had 2,399 active licensees.                                                                                     
                                                                                                                                
3:33:26 PM                                                                                                                    
                                                                                                                                
CO-CHAIR WOOL asked  if a hygienist can  get additional licensing                                                               
for local anesthetic.                                                                                                           
                                                                                                                                
3:33:50 PM                                                                                                                    
                                                                                                                                
MS.  CURTIS  said that  is  her  understanding and  deferred  the                                                               
question to Mr. Nielson.                                                                                                        
                                                                                                                                
3:34:04 PM                                                                                                                    
                                                                                                                                
MR. NIELSON said that is correct.   He explained that a hygienist                                                               
can  have  a local  anesthetic  permit  or endorsement  on  their                                                               
license.  He added that it is a separate permitting process.                                                                    
                                                                                                                                
3:35:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HANNAN, referencing the  attached fiscal, asked if                                                               
this was  a 50 percent reduction  in the travel for  the board to                                                               
conduct its work.                                                                                                               
                                                                                                                                
3:36:04 PM                                                                                                                    
                                                                                                                                
FRED  PARADY,   Legislative  Liaison,  Department   of  Commerce,                                                               
Community  & Economic  Development, answered  no, the  50 percent                                                               
reduction has not been taken.  He  said that cut is given to them                                                               
as a  general cut across  the department, which they  can balance                                                               
at their discretion.                                                                                                            
                                                                                                                                
3:36:47 PM                                                                                                                    
                                                                                                                                
CO-CHAIR LEDOUX opened public testimony.                                                                                        
                                                                                                                                
3:37:09 PM                                                                                                                    
                                                                                                                                
MR. NIELSON stated  that the dental board serves as  a vital role                                                               
in the  regulation of dentistry  while always keeping  the health                                                               
and  welfare  of  the  Alaskan  citizens  in  mind.    Licensing,                                                               
permitting,   certification,   and   disciplinary   action   when                                                               
appropriate, is  a cornerstone of  what the public  should expect                                                               
from  the state  government if  they  are to  have confidence  in                                                               
their healthcare  providers.  He  shared that personally,  he has                                                               
enjoyed the  challenge to serve  and appreciated  the opportunity                                                               
to continue  fulfilling the board's  purpose, adding that  he was                                                               
in full support of moving HB 45.                                                                                                
                                                                                                                                
3:38:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   HANNAN  mentioned   that   the  previous   board                                                               
president,  Paul S,  wrote  a  letter in  response  to the  audit                                                               
regarding  the finding  about dentists  who  lost their  pharmacy                                                               
rights, noting  that it was  to be  discussed at the  December 7,                                                               
2018 board meeting.   She asked if Mr. Nielson  was at that board                                                               
meeting and whether that topic was addressed by the board.                                                                      
                                                                                                                                
3:38:52 PM                                                                                                                    
                                                                                                                                
MR.  NIELSON replied  that he  was  at the  December meeting  and                                                               
could not recall whether it was discussed.                                                                                      
                                                                                                                                
3:40:49 PM                                                                                                                    
                                                                                                                                
CO-CHAIR LEDOUX closed public testimony                                                                                         
                                                                                                                                
[HB 45 was held over.]