Legislature(2017 - 2018)SENATE FINANCE 532

02/27/2018 09:00 AM FINANCE

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

Document Name Date/Time Subjects
SB 105 - Legislative Research - Medicaid Expansion & Behavorial Health Grants.pdf SFIN 2/27/2018 9:00:00 AM
SB 105
SB 105 - Summary of Changes, ver D to ver J.pdf SFIN 2/27/2018 9:00:00 AM
SB 105
SB 105 Sponsor Statement.pdf SFIN 2/27/2018 9:00:00 AM
SB 105
SB108 Letter of Support - Foundation Health Partners 2-7-18.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SB108 Letter of Support Cmmsr Navarre 2-2-16.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SB108 Letter of Support ASMB 2-9-18.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SB108 Power Point Presentation 2-12-18.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SSSB108 Sectional Analysis 2-13-18.cg.jmc.2.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SSSB 108 Sponsor Statment 1-22-18.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SB165 Sponsor Statement.pdf SFIN 2/27/2018 9:00:00 AM
SB 165
SB 165 CMS Letter Approving Alaska's State Innovation Waiver.pdf SFIN 2/27/2018 9:00:00 AM
SB 165
SB 165 ACHI Fund.pdf SFIN 2/27/2018 9:00:00 AM
SB 165
SB165 Sectional Analysis.pdf SFIN 2/27/2018 9:00:00 AM
SB 165
SB 105 - HSS FY18 Behavorial Health Treatment Recovery Grant Reductions.pdf SFIN 2/27/2018 9:00:00 AM
SB 105
SB 105 - Sectional Analysis.pdf SFIN 2/27/2018 9:00:00 AM
SB 105
SB 105 AAMFT Testimony 02232018 Finance.pdf SFIN 2/27/2018 9:00:00 AM
SB 105
SB 108 letter to Senator Giessel.pdf SFIN 2/27/2018 9:00:00 AM
SB 108
SB108 SS Letter of Support ASMA 2-27-18.pdf SFIN 2/27/2018 9:00:00 AM
SB 108