Legislature(2021 - 2022)BARNES 124
04/27/2022 03:15 PM House LABOR & COMMERCE
Audio | Topic |
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Start | |
SB186 | |
SB190 | |
SB193 | |
HB405|| HB406 | |
Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
+ | HB 382 | TELECONFERENCED | |
+ | SB 45 | TELECONFERENCED | |
+= | HB 405 | TELECONFERENCED | |
+= | HB 406 | TELECONFERENCED | |
+ | TELECONFERENCED | ||
+ | SB 186 | TELECONFERENCED | |
+ | SB 190 | TELECONFERENCED | |
+ | SB 193 | TELECONFERENCED | |
SB 193-EXTEND BOARD OF CHIROPRACTIC EXAMINERS 3:57:42 PM CO-CHAIR FIELDS announced that the next order of business would be CS FOR SENATE BILL NO. 193(FIN), "An Act extending the termination date of the Board of Chiropractic Examiners; requiring a report on audit compliance by the Board of Chiropractic Examiners; and providing for an effective date." 3:58:00 PM MADISON GOVIN, Staff, Senator Peter Micciche, Alaska State Legislature, presented CSSB 193(FIN) on behalf of Senator Micciche, prime sponsor. She stated that the bill would extend the sunset date for the Board of Chiropractic Examiners by five years, making the new sunset 6/30/27. She said the bill would also require that a report from the Division of Legislative Audit be submitted to the Legislative Budget and Audit Committee on the board's compliance with this year's audit. MS. GOVIN explained the changes made in CSSB 193(FIN). She spoke from the document in the committee packet titled "Senate Bill 193 Extend Board of Chiropractic Examiners, Explanation of Changes, Version I to Version G," which stated [original punctuation provided]: Page 1, Line 2 Inserts into the title "requiring a report on audit compliance by the Board of Chiropractic Examiners." Sec. 1 AS 08.03.010(c)(5) Page 1, Line 6 Extends the board extension from two years to five years. Sec. 2 Page 1, Lines 8-14 Adds a requirement for the legislative audit division to prepare and submit to the Legislative Budget and Audit Committee a report on the compliance of the Board of Chiropractic Examiners with the recommendations of the June 22, 2021 audit of the board. 3:59:23 PM CO-CHAIR FIELDS opened invited testimony. 3:59:52 PM KRIS CURTIS, CPA, CISA, Legislative Auditor, Division of Legislative Audit, provided invited testimony during the hearing on CSSB 193(FIN). She spoke from the full audit report in the committee packet titled "DEPARTMENT OF COMMERCE, COMMUNITY, AND ECONOMIC DEVELOPMENT BOARD OF CHIROPRACTIC EXAMINERS SUNSET REVIEW," dated 6/22/21. She said the audit found that the board served the public's interest by conducting its meetings in accordance with state laws, by amending certain regulations to improve the chiropractic profession, and by effectively regulating and licensing chiropractic physicians. The audit also found, she continued, that one board member did not comply with the statutory requirements for appointment and that additional resources were needed to investigate cases in a timely manner. She related that a five-year extension is recommended rather than the eight-year maximum allowed for in statute. This recommendation, she explained, is based on an issue identified during the audit that may impact the board's ability to protect the public, details of which are not included in the public audit report to preserve the confidentiality of an ongoing investigation. 4:00:42 PM CO-CHAIR FIELDS asked what the legislature has done in the past when it is found that a board member doesn't meet the statutory requirements for appointment. MS. CURTIS responded that the legislature doesn't act because usually her recommendation is to the governor's office, which typically removes the board member and appoints someone else, and which was done in this case. In further response, she said the governor's office has reported that this was done, but she cannot verify it. 4:01:15 PM REPRESENTATIVE MCCARTY asked whether this person was appointed and confirmed or was in the appointment process. MS. CURTIS replied that this person was appointed and confirmed. In further response, she confirmed that after confirmation it was found that the appointee didn't qualify. She stated that this was an issue in the prior sunset audit as well. It is usually not a risky area, she advised, so for all of Alaska's boards [the Division of Legislative Audit] doesn't necessarily send a notice to the public member to ensure that the member is qualified. But, she continued, since there was a prior recommendation related to this board, [the division] confirmed the public member. It usually has to do with whether the member has a direct financial interest in the health care industry, she explained. In this case it was found that the board member was a licensed emergency medical technician (EMT), so the member had an interest in the health care industry and therefore didn't comply with statutory requirements that prohibit this. The public member must have that consumer perspective, she added, and in this case the member didn't. 4:02:16 PM CO-CHAIR FIELDS asked whether it is fair to characterize this as an inadvertent violation. MS. CURTIS replied yes. 4:02:24 PM MS. CURTIS resumed her invited testimony. She drew attention to page 5 [Exhibit 2] of the audit and reported that as of January 2021 there were 306 licensed chiropractors. She turned to the board's schedule of revenues and expenditures on page 6 [Exhibit 3] and noted that [over the past four fiscal years] the board alternated between a deficit and a surplus. She related that according to management at the Division of Corporations, Business and Professional Licensing (DCBPL), the deficit was within a reasonable range and a fee increase was not recommended. She pointed out the board's schedule of fees on page 7 [Exhibit 4]. MS. CURTIS moved to pages 9-11 and outlined the two recommendations made by the Division of Legislative Audit. She said the first recommendation is that the governor should make board appointments in compliance with statutory requirements. The second recommendation, she related, is that the DCBPL director should allocate sufficient resources to ensure cases are investigated in a timely manner. The audit found that 11 cases had been open for over 180 days, she stated, and seven of those cases were related to the same chiropractor and had been combined into one case. For that one combined case the audit found four periods of unjustified inactivity that ranged from 55-208 days, she continued, and according to DCBPL investigative staff the inactivity was the result of competing priorities and insufficient resources. MS. CURTIS proceeded to pages 21-22 and discussed management's response to the audit. She related that the commissioner of the Department of Commerce, Community, and Economic Development (DCCED) states that the department has hired two additional investigative positions and the commissioner believes that will increase the quality and timeliness of investigations. She turned to the governor's response on page 23 and related that the governor agrees with the recommendation and states that the public member was removed. Ms. Curtis then reviewed the board chair's response on pages 25-28. She reported that the chair does not agree with the recommended extension of five years and requests an eight-year extension because he believes the board is being unfairly penalized by action of the division or the governor's office. 4:04:20 PM CO-CHAIR SPOHNHOLZ returned to the second recommendation on page 10 of the audit report. Regarding the 11 cases that were open over 180 days between July 2017 and January 2021, she asked whether each of the 11 cases was open 180 days or whether the cases were cumulatively open 180 days. MS. CURTIS responded that it was each of them. She noted that 180 days is an internal performance measure used by DCBPL. Lots of reasons can cause a case to remain open, she noted, so the Division of Legislative Audit looks at whether it is justified and there are reasons a case is open. In these cases, she said, the audit saw extended periods of inactivity, but with no justification; it was found that it is an issue with resources and competing priorities. 4:05:44 PM REPRESENTATIVE MCCARTY asked whether this is a situation of the division not being able to assist the board or the board not taking responsibility to do such things as verifying a case. MS. CURTIS answered that the board is kept outside the investigative process so it can rule on the results of the investigation in a quasi-judicial manner. Sometimes a board member might be used for expertise, but then that board member is not allowed to weigh in on the result, she noted. So, the board typically monitors the cases on an upper level and doesn't get into the details until the investigation is complete and brought to the board. REPRESENTATIVE MCCARTY inquired about whether the sunset should be effective for the board when the division is supposed to be assisting the board. He said it appears that the Board of Chiropractic Examiners is doing fine as a board and that there should be a sunset for the board and an annual sunset for the division to ensure that the division is doing its job to help the board. MS. CURTIS replied that oftentimes board chairs do bring that up and that some things are not within their control. It might be considered a penalty or a discipline from the board chair's perspective, she stated, but from her perspective and the law's perspective, this is a legislative oversight process, this is the legislature's ability to evaluate how this board is operating and that includes the division's support to this board. She explained that her recommendation for extension reflects how timely she recommends the legislature come back to review regulation of this specific occupation. She advised that while the question is termed, "Should this board be extended or not and for how long?" it could be phrased, "How much time between now and when the legislature comes back in to review?" 4:08:47 PM CO-CHAIR SPOHNHOLZ drew attention to the DCCED commissioner's response to the audit on pages 21-22. She inquired about the efforts taken by DCCED to ensure adequate staffing, whether the specific 11 cases have been resolved, and what the current timeframe is for processing complaints against a chiropractor. 4:09:29 PM SARA CHAMBERS, Director, Division of Corporations, Business and Professional Licensing (DCBPL), Department of Commerce, Community, and Economic Development (DCCED), responded that page 22 outlines the steps that were taken. One step, she specified, is that the division has added an additional senior investigator position to provide more supervisory oversight and ensure that investigators are following the division's procedures for documentation. The concern is not so much whether there is or isn't case activity, she explained, but that it hasn't been documented and so there is no way for the auditor or anyone looking at the case management systems to know whether activity has taken place on those cases. She said DCBPL agrees that that is not up to its stated standards, so adding another supervisor position has been helpful. A zero-tolerance position on the lack of documentation has been taken, she advised, and the division is actively supervising and ensuring that DCBPL investigators are acutely aware of the requirement to document within every 30-45 days even if there is no case activity and to describe what is being waited on and what is the process so that anyone can evaluate whether a case is being properly managed. Ms. Chambers stated that every case is different, so 180 days could be appropriate management for some cases and for other cases it could be more days or less days. Much of that is in the hands of the respondent, she pointed out, and whether an expert witness is needed. She related that the seven cases rolled into one have made progress and are being actively managed. 4:12:19 PM CO-CHAIR SPOHNHOLZ observed on page 22 that an additional Investigator III position has been added to the healthcare licensing team. She inquired about the number of people on the healthcare team and the number of healthcare licensing boards for which the team is responsible for providing licensing investigations and processing. MS. CHAMBERS answered that she will get back to the committee with those specific numbers, including the structure of today's healthcare team as far as numbers of staff and the boards they serve. She explained that those fluctuate with the demands of the casework where there may be increases in complaints or an increase in complexity requiring an investigator to manage a lower caseload. She explained that DCBPL can have investigators moving off and on that team; the division has partial investigators assigned to certain boards and then some boards like nursing and medical have multiple investigators due to the high volume. CO-CHAIR SPOHNHOLZ requested that the follow-up to the committee be in writing so it can be distributed to members. She said she wants to understand how the oversight is managed, particularly for chiropractors. She stated that the one chiropractor with seven complaints and the investigations not being followed up in a timely manner could be impacting many Alaskans during this amount of time. MS. CHAMBERS offered her appreciation for Co-Chair Spohnholz' comments. She stated that DCBPL is a public safety division and part of what it does is protect the rights of the licensee. So, she explained, the division has certain processes that it is required to follow and sometimes cases are very unusual and may be delayed when early action could jeopardize the case because of those due process standards. She offered her reassurance to the committee that these are of high importance to DCBPL. 4:16:04 PM The committee took an at-ease from 4:16 p.m. to 4:20 p.m. 4:20:01 PM CO-CHAIR FIELDS invited further questions from the committee on CSSB 193(FIN). 4:20:24 PM REPRESENTATIVE MCCARTY, regarding the prescription drug monitoring program (PDMP), asked about the number of investigations that occurred because of deficiencies in the division's system versus a licensee wrong. He recalled that in the past Ms. Chambers shared that licensees were investigated but it was problems in the system that created an anomaly which had to be investigated. Representative McCarty further inquired about the sunset extension of two years versus five years. MS. CHAMBERS responded that she doesn't understand the first question because the division has not had system deficiencies resulting in unwarranted investigation. She said the division does have quite a few investigations that it must investigate due to public complaints that don't result in discipline because they are found to be not jurisdictional, unwarranted, or not within the division's scope so it was more appropriate for criminal law enforcement or the consumer protection unit under the Department of Law. She offered to answer the question further if the representative wished to rephrase it. REPRESENTATIVE MCCARTY restated his question about a sunset extension of two years versus five years. MS. CHAMBERS replied that the auditor's recommendation was for a five-year extension, the Senate Labor and Commerce Standing Committee reduced the extension to two years, and then the Senate Finance Committee reversed it back to the auditor's recommendation. [CSSB 193(FIN) was held over.]