Legislature(2017 - 2018)BARNES 124

04/02/2018 03:15 PM LABOR & COMMERCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ SB 108 MEDICAL CARE/LICENSING/MEDICAL BOARD TELECONFERENCED
Heard & Held
-- Public Testimony --
+ SB 155 REAL ESTATE APPRAISAL MNGMT. COMPANIES TELECONFERENCED
Moved HCS CSSB 155(L&C) Out of Committee
-- Public Testimony --
+ HB 136 MOTOR VEHICLE DEALER FRANCHISES TELECONFERENCED
Heard & Held
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
          SB 108-MEDICAL CARE/LICENSING/MEDICAL BOARD                                                                       
                                                                                                                                
4:05:27 PM                                                                                                                    
                                                                                                                                
VICE CHAIR WOOL  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."                                                                     
                                                                                                                                
4:05:43 PM                                                                                                                    
                                                                                                                                
SENATOR  CATHY GIESSEL,  Alaska State  Legislature, presented  SB                                                               
108 as prime sponsor.   She indicated her PowerPoint presentation                                                               
would also serve a sectional analysis of the proposed bill.                                                                     
                                                                                                                                
4:06:58 PM                                                                                                                    
                                                                                                                                
SENATOR GIESSEL pointed to slide 2, "Purpose":                                                                                  
                                                                                                                                
     1. Streamline Physician Licensing                                                                                          
     2. Need for office assistants                                                                                              
          a. Unlicensed                                                                                                         
          b. Licensed                                                                                                           
                                                                                                                                
     1. Streamline MD licensing                                                                                                 
          Section 1, 2, 8, 9, 10                                                                                                
          State Medical Board to write regulations to                                                                           
          delegate to EXECUTIVE SECRETARY:                                                                                      
          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 delegate                                                                           
          authority                                                                                                             
                                                                                                                                
SENATOR   GIESSEL  explained   that  the   documentation  is                                                                    
maintained  until the  state Medical  Board  meets, but  the                                                                    
board  only  meets four  times  per  year.   She  said  this                                                                    
creates a backlog.  She said  that one the examiner looks at                                                                    
the documentation,  it would be  forwarded to  the executive                                                                    
secretary  who  would  review   the  applications  and  make                                                                    
appropriate action.                                                                                                             
                                                                                                                                
4:09:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KNOPP asked why it is not the responsibility of                                                                  
the executive secretary to prepare the documentation for the                                                                    
board.                                                                                                                          
                                                                                                                                
SENATOR GIESSEL reviewed the application process.  She stated                                                                   
the applications could be approved immediately or go to the                                                                     
board if there were issues with an application.                                                                                 
                                                                                                                                
SENATOR GIESSEL continued to slide 4, "Streamline MD Licensing":                                                                
                                                                                                                                
     Section 10, 11                                                                                                             
     1. Allows another person, designated by the board, to                                                                      
     help the Executive Secretary to issue temporary                                                                            
     license.                                                                                                                   
     2. Outlines when this could happen                                                                                         
                                                                                                                                
SENATOR GIESSEL shared that the process is used by the                                                                          
largest licensing board in the state.                                                                                           
                                                                                                                                
4:14:29 PM                                                                                                                    
                                                                                                                                
SENATOR GIESSEL moved to slide 5-6, "2.a. Unlicensed Assistive                                                                  
Personnel":                                                                                                                     
                                                                                                                                
        Unlicensed personnel trained in "routine medical                                                                        
     tasks"                                                                                                                     
                                                                                                                                
     Section 3 Regulations will                                                                                                 
     o authorize delegation to unlicensed person                                                                                
     o prohibit delegation of pain management or                                                                                
     opioid related activities                                                                                                  
     o define "routine medical tasks"                                                                                           
                                                                                                                                
     Section 6                                                                                                                  
          adds   person,   performing   delegated   "routine                                                                    
          medical duties" to exception under "License to                                                                        
          practice medicine, podiatry, or osteopathy"                                                                           
                                                                                                                                
     Section 12                                                                                                                 
          Adds "medical assistant" to list to practice                                                                          
          medicine                                                                                                              
                                                                                                                                
     Section 14                                                                                                                 
          adds "medical assistants" to definition of                                                                            
          "medical professional" under Title 12 Criminal                                                                        
          Procedure                                                                                                             
                                                                                                                                
SENATOR GIESSEL said the bill would  correct a gap in the board's                                                               
laws.                                                                                                                           
                                                                                                                                
4:17:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOSEPHSON asked  whether there would be  a need to                                                               
ensure that the unlicensed people have specific training.                                                                       
                                                                                                                                
SENATOR  GIESSEL answered  that initially  all that  was required                                                               
was  a high  school  diploma  but now  there  was some  education                                                               
available. She added  there would be a higher  level of education                                                               
required.                                                                                                                       
                                                                                                                                
REPRESENTATIVE WOOL asked for confirmation  that this first group                                                               
of medical  assistants won't  need a license  in the  future, but                                                               
the physician will be able to delegate to them.                                                                                 
                                                                                                                                
SENATOR GIESSEL answered in the affirmative.                                                                                    
                                                                                                                                
SENATOR   GIESSEL  progressed   to  slide   7-8,  "2.b.   medical                                                               
Assistants - license/certification":                                                                                            
                                                                                                                                
     Why?                                                                                                                       
          Prescription Drug Monitoring Program (PDMP)                                                                           
          ~prohibits access by any unlicensed person                                                                            
          ~envisioned clinician delegates "look up" before                                                                      
          prescribing                                                                                                           
                                                                                                                                
     Problem                                                                                                                    
          ~No licensed people in MD clinic, other than the                                                                      
          MD                                                                                                                    
          ~Frequent need to check PDMP (AS 17.30.200                                                                            
          requires license).                                                                                                    
                                                                                                                                
     Solution  recognize training and certification                                                                             
     Training programs accredited by                                                                                            
          o Commission on Accreditation of Allied Health                                                                        
          Education Programs (CAAHEP)                                                                                           
          o Accrediting Bureau of Health Education Schools                                                                      
          (ABHES)                                                                                                               
     National exams for Certification                                                                                           
     Alaska's community colleges training programs                                                                              
     Recognized in many other states/territories.                                                                               
     WA, CA, TX, FL, PA, OH, IL, MT, MS, ND, SD, WY                                                                             
                                                                                                                                
4:21:17 PM                                                                                                                    
                                                                                                                                
SENATOR GIESSEL addressed slide 9, "2.b. Medical assistant with                                                                 
certification process":                                                                                                         
                                                                                                                                
     Section 4                                                                                                                  
     Certifying process defined in regulation by Board                                                                          
     Section 5                                                                                                                  
     Limits use of term "certified"                                                                                             
     Section 13                                                                                                                 
     Certification is equivalent to a license                                                                                   
                                                                                                                                
4:22:41 PM                                                                                                                    
                                                                                                                                
VICE CHAIR  WOOL suggested the  licensure is simply to  check the                                                               
PDMP and maybe  enters the new data.  He  suggested this would be                                                               
creating  another  licensed  person   who  would  need  training,                                                               
licensure, and a background check.                                                                                              
                                                                                                                                
SENATOR  GIESSEL corrected  that the  pharmacist enters  the data                                                               
into the PDMP.  She said the other statement was correct.                                                                       
                                                                                                                                
VICE  CHAIR WOOL  suggested a  physician could  remove themselves                                                               
from  vulnerability  to revocation  of  their  license by  having                                                               
another licensed person in the office.                                                                                          
                                                                                                                                
SENATOR   GIESSEL  answered   that   each   licensed  person   is                                                               
accountable for their actions under their license.                                                                              
                                                                                                                                
4:25:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOSEPHSON  suggested  that  the  physician  would                                                               
still be held responsible [from a legal standpoint].                                                                            
                                                                                                                                
4:25:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE BIRCH  asked how many applications  are rejected a                                                               
year.                                                                                                                           
                                                                                                                                
SENATOR GIESSEL deferred  to the department and  to the executive                                                               
secretary of the state medical board.                                                                                           
                                                                                                                                
REPRESENTATIVE  BIRCH said  there  are a  lot of  confidentiality                                                               
issues in  a medical office.   He asked whether the  proposal was                                                               
to certify everyone in a medical office.                                                                                        
                                                                                                                                
SENATOR  GIESSEL answered  that the  provision would  not include                                                               
the bookkeepers.                                                                                                                
                                                                                                                                
4:28:12 PM                                                                                                                    
                                                                                                                                
SENATOR GIESSEL  briefly addressed  "Urgent need  for SB  108" on                                                               
slide 10-11.                                                                                                                    
                                                                                                                                
     Efficient, expeditious and effective licensing of MDs                                                                      
        Legal clarity for delegation of "routine medical                                                                        
     duties" to unlicensed personnel (medical assistants)                                                                       
         More legally stringent delegated activities to                                                                         
     licensed entity, a medical assistant who has achieved                                                                      
     certification                                                                                                              
                                                                                                                                
     These changes needed this session                                                                                          
                                                                                                                                
     SUPPORT:                                                                                                                   
     State Medical Board (requested)                                                                                            
     Dept of Commerce                                                                                                           
     Alaska State Hospital and Nursing Home Association                                                                         
     Alaska State Medical Association                                                                                           
     Foundation Health Partners (Fairbanks)                                                                                     
                                                                                                                                
     No opposition                                                                                                              
                                                                                                                                
                                                                                                                                
4:30:35 PM                                                                                                                    
                                                                                                                                
FRED  PARADY,   Deputy  Commissioner,  Department   of  Commerce,                                                               
Community &  Economic Development (DCCED), answered  questions in                                                               
the  hearing on  SB 108.    He said  his department  had seen  an                                                               
increase in requests for licensure.    He said the department had                                                               
an  initiative  to  streamline   the  application  process.    He                                                               
indicated   the  issues   that  slowed   the  process   had  been                                                               
identified.    He added  that  only  around  ten percent  of  the                                                               
applications were complete when they  were sent it.  He described                                                               
changes to the online process that would be implemented.                                                                        
                                                                                                                                
4:34:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  shared her  understanding  that                                                               
the  aim  was to  streamline  the  process.   She  asked  whether                                                               
licensure could be invoked when the coursework is completed.                                                                    
                                                                                                                                
MR. PARADY said he had not  heard that suggestion before but that                                                               
it seemed interesting.                                                                                                          
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD shared  that  her hesitation  to                                                               
fully support the proposal was  due to the apparent "double duty"                                                               
in the process.                                                                                                                 
                                                                                                                                
MR. PARADY answered  that he thought the school would  be quite a                                                               
logical location for the online process.                                                                                        
                                                                                                                                
4:36:26 PM                                                                                                                    
                                                                                                                                
VICE  CHAIR WOOL  asked  whether the  licensure  was a  statutory                                                               
responsibility of the state licensing board.                                                                                    
                                                                                                                                
MR.  PARADY deferred  to  the  sponsor.   He  said  he thinks  it                                                               
recognizes  the limited  board meeting  schedule  and ability  to                                                               
address problem-free applications.                                                                                              
                                                                                                                                
4:37:33 PM                                                                                                                    
                                                                                                                                
DEBORA  STOVERN,   Executive  Secretary,  State   Medical  Board,                                                               
Division  of Corporations,  Businesses, and  Profession Licensing                                                               
(DCBPL), answered questions  in the hearing on SB 108.   She said                                                               
it is important  to note that the board is  allowed to grant that                                                               
limited  authority  to  the executive  secretary  under  specific                                                               
conditions.     She  added  the  any   application  with  adverse                                                               
information would still require the  board to review for approval                                                               
of temporary  or permanent licenses.  She said it  would continue                                                               
to require specific delegation by the board on an annual basis.                                                                 
                                                                                                                                
REPRESENTATIVE BIRCH asked how many applicants are rejected.                                                                    
                                                                                                                                
MS.  STOVERN  answered that  the  board  actually denies  only  a                                                               
couple of applications per year as  an outright denial.  She said                                                               
other applications  that have adverse information  or information                                                               
of concern would be asked to come into an in-person interview.                                                                  
                                                                                                                                
REPRESENTATIVE BIRCH said it seemed like a low-risk proposal.                                                                   
                                                                                                                                
4:42:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOSEPHSON asked what is  being licensed.  He asked                                                               
if someone has done an internship  and a residency, what is being                                                               
granted with licensure.                                                                                                         
                                                                                                                                
MS.  STOVERN  answered  the board  issues  licenses  to  practice                                                               
medicine in the state.                                                                                                          
                                                                                                                                
4:43:45 PM                                                                                                                    
                                                                                                                                
JEANNIE MONK, Alaska State Hospital  and Nursing Home Association                                                               
(ASHNA), testified  in support of SB  108.  She said  ASHNA is in                                                               
support of  fixing the statutory  deficiency to  allow physicians                                                               
to delegate the tasks.                                                                                                          
                                                                                                                                
VICE  CHAIR  WOOL asked  about  the  Certified Medical  Assistant                                                               
license.                                                                                                                        
                                                                                                                                
MS.  MONK answered  there are  some concerns  about creating  new                                                               
certified personnel,  but it was  not enough to  avoid supporting                                                               
the proposed bill.                                                                                                              
                                                                                                                                
VICE CHAIR  WOOL asked whether  the medical assistant  would have                                                               
to acquire a new range of skills.                                                                                               
                                                                                                                                
MS. MONK  answered that would  be left to  the board.   She added                                                               
that  she   thinks  other  states   do  have   certified  medical                                                               
assistants.                                                                                                                     
                                                                                                                                
4:46:38 PM                                                                                                                    
                                                                                                                                
VICE CHAIR WOOL opened public testimony on SB 108.                                                                              
                                                                                                                                
4:46:52 PM                                                                                                                    
                                                                                                                                
VICE CHAIR  WOOL asked whether  Certified Medical Assistant  is a                                                               
one-off certification.                                                                                                          
                                                                                                                                
SENATOR  GIESSEL  answered  that  the  position  requirement  may                                                               
expand.  She suggested  that if a person is going  to pay for the                                                               
licensing exam and fees, they may cost more to hire.                                                                            
                                                                                                                                
VICE CHAIR WOOL held over SB 108.                                                                                               
                                                                                                                                

Document Name Date/Time Subjects
SB108 Power Point vsn I 3-29-18.pdf HL&C 4/2/2018 3:15:00 PM
SB 108
SB108 Supporting Document Flow Chart 2016.pdf HL&C 4/2/2018 3:15:00 PM
SB 108
SSSB108 Version U 1-18-18.PDF HL&C 4/2/2018 3:15:00 PM
SB 108
SB108 Supporting Document Backlog Stats DCCED 2-13-18.pdf HL&C 4/2/2018 3:15:00 PM
SB 108
CSSSSB108(FIN) Explanation of Changes 3-14-18.pdf HL&C 4/2/2018 3:15:00 PM
SB 108
CSSSSB108(FIN) Fiscal Note DCCED 3-14-18.PDF HL&C 4/2/2018 3:15:00 PM
SB 108
CSSSSB108(FIN) Sectional Analysis 3-14-18.pdf HL&C 4/2/2018 3:15:00 PM
SB 108
CSSSSB108(FIN) vsn I 3-14-18.pdf HL&C 4/2/2018 3:15:00 PM
SB 108
CSSSSB108(FIN) Sponsor Statement 3-13-18.pdf HL&C 4/2/2018 3:15:00 PM
SB 108
CSHB136 Ver. R 3.23.18.pdf HL&C 4/2/2018 3:15:00 PM
HB 136
HB136 Additional Documents-AADA Provisions and List of Alaska Businesses 3.6.17.pdf HL&C 4/2/2018 3:15:00 PM
HB 136
HB136 Additional Documents-AADA Why Franchise Laws 3.6.2017.pdf HL&C 4/2/2018 3:15:00 PM
HB 136
HB136 Additional Documents-NADA Alaska 2016 Annual Contribution 3.23.18.pdf HL&C 4/2/2018 3:15:00 PM
HB 136
CSHB136 Sectional Analysis 03.23.18.pdf HL&C 4/2/2018 3:15:00 PM
HB 136
HB136 Fiscal Note LAW-CIV 3.10.17.pdf HL&C 4/2/2018 3:15:00 PM
HB 136
SB155 Supporting Document - AMC Registry Fees - Lexology Article.pdf HL&C 4/2/2018 3:15:00 PM
SB 155
CSHB136 Sponsor Statement 3.23.18.pdf HL&C 4/2/2018 3:15:00 PM
HB 136
SB155 Supporting Documents - State AMC Bond Requirements.pdf HL&C 4/2/2018 3:15:00 PM
SB 155
SB155 Version O.PDF HL&C 4/2/2018 3:15:00 PM
SB 155
SB155 Suuporting Document - AMC Framework - Lexology Article.pdf HL&C 4/2/2018 3:15:00 PM
SB 155
SB155 Version R.pdf HL&C 4/2/2018 3:15:00 PM
SB 155
SB155 DCCED AMC Extension Request.pdf HL&C 4/2/2018 3:15:00 PM
SB 155
SB155 Explanation of Changes V.A to V.O.pdf HL&C 4/2/2018 3:15:00 PM
SB 155
SB155 Fical Note DCCED-CBPL 3.5.18.PDF HL&C 4/2/2018 3:15:00 PM
SB 155
SB155 Sectional Summary CSSB 155 (FIN).pdf HL&C 4/2/2018 3:15:00 PM
SB 155
SB155 Sponsor Statement V.O.pdf HL&C 4/2/2018 3:15:00 PM
SB 155
SB155 Support Letters 3.31.18.pdf HL&C 4/2/2018 3:15:00 PM
SB 155
SB155 Amendment R.2.pdf HL&C 4/2/2018 3:15:00 PM
SB 155
SB155 Amendment R.3.pdf HL&C 4/2/2018 3:15:00 PM
SB 155
SB155 Amendment R.1.pdf HL&C 4/2/2018 3:15:00 PM
SB 155